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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Morhoun on June 27, 2006, at 17:25:01
I'm a newbie looking for input on what to try. Severe deperession starting 3 months ago. I am extemely sensative to meds and am having a really hard time finding something to work. Tried Nefazodone for 3 weeks but couldn't take it...the anxiety/panic attacks lasted most of the day. I switched to Cymbalta, supposedly the latest and greatest, but it was the same thing with more severe side effects. I gave it 6 weeks but again, no relief from depression and the anxiety attacks are unbearable. Xanax helps on occasion but it knocks me out, even at .5 mgs, I can't function. The last time I tried it it didn't even help.
I'm hoping there are some folks out there who are as sensative to meds as I am and can make some recomendations. Right now I'm taking a bunch of Amino Acids and L-tryptophan and it's working better than the AD's but its far from a solution (although I've only given it a week and a half). I think I need to keep searching for an AD but I'm terrified of how bad the anxiety gets.
At this point I don't even care about sexual side effects, sleepyness, weight gain...I just need to feel better and not have the horrible anxiety. I'm considering Norpramin/Disepramine because I've heard the TCAs are good for anxiety but a few threads on this site have said the opposite. Do the MAOIs have the anxiety problems too? Are the Anti-Psychotics good for anxiety? How about the Stimulamts (I wouldn't think so)? Remeron and anxiety? I just don't seem to do very well with the benzos. Are NRIs better or worse for Anxiety than SSRIs or SNRIs?
Any input would be much appreciated.
Posted by blueberry on June 27, 2006, at 19:30:22
In reply to Extremely Sensative to Meds and looking for Input, posted by Morhoun on June 27, 2006, at 17:25:01
I'm extremely sensitive to meds too.
Lexapro is probably the ssri most likely to work on anxiety, in my opinion. Paxil also, except that lexapro tends to have fewer side effects in the sexual department. Lexapro does increase anxiety to start with though, making it tough to get started. The antianxiety effect is pretty good in about 80% of people who try it, but it takes 1 to 4 weeks to kick in...and in the meantime anxiety is worse. I found that even just 2.5mg or 5mg were plenty. By cutting the pills into chunks, you can start real small and work up.
For short-term use to get started on an ssri for anxiety, maybe a different benzo. I found klonopin has good calming with less sedation than xanax, and it lasts longer. Another option might be to use small doses of the antipsychotic seroquel...maybe 12.5mg whenever needed. And once the ssri has kicked in, get off the antipsychotic. It's just my own opinion from using antipsychotics for years, I do not think they are safe for longterm use.
Anyway...lexapro as the big guns, but klonopin or valium or ativan or seroquel for short-term getting started.
Posted by bassman on June 27, 2006, at 20:00:02
In reply to Re: Extremely Sensative to Meds and looking for Input, posted by blueberry on June 27, 2006, at 19:30:22
Me, too. Start at a very low-VERY LOW dose (like 2.5 mg Paxil, e.g.). Sounds like you need a benzo for awhile, anyway. I agree with everything blueberry said, but I'd try Ativan before Klonopin if you're having trouble with depression. Remember not to take the suppliments if you go on an AD.
Posted by Phillipa on June 27, 2006, at 22:08:18
In reply to Re: Extremely Sensative to Meds and looking for Input, posted by bassman on June 27, 2006, at 20:00:02
Why no supplements? Maybe that's why my meds don't work I take a bunch of supplements. But I agree start with baby doses and work up. I like valium long acting. Once a day dosing at night. Love Phillipa
Posted by bassman on June 28, 2006, at 5:56:32
In reply to Extremely Sensative to Meds and looking for Input, posted by Morhoun on June 27, 2006, at 17:25:01
It is the "Amino Acids and L-tryptophan" that I was concerned about with the addition of an AD.
Posted by Morhoun on June 28, 2006, at 9:31:39
In reply to Re: Extremely Sensative to Meds and looking for Input, posted by bassman on June 28, 2006, at 5:56:32
Thank you all, I knew not to keep taking L-Tryptophan with an AD but the Aminos too? Has anyone tried Remeron? I hear it's fast acting and not too bad for Anxiety but that it often poops out too. Anyone tried the TCAs?
Posted by bassman on June 28, 2006, at 14:40:26
In reply to Re: Extremely Sensative to Meds and looking for Input, posted by Morhoun on June 28, 2006, at 9:31:39
If you haven't, you might try Remedyfind.com and crazymeds.org for first-hand info on Remeron and TCA's. You're right, it was the tryptophan I was most concerned about-but I would stop taking the AA's too, esp. if you take a TCA, but I'm sure a lot of people would disagree with me. Both TCA's and AA's have been know to cause arrhythmias...I just wouldn't want to be the one to find out the effects were synergistic for no apparent therapeutic gain. Whatever you do, best of luck.
Posted by Karen44 on June 28, 2006, at 23:16:48
In reply to Re: Extremely Sensative to Meds and looking for Input, posted by bassman on June 28, 2006, at 14:40:26
I have been extremely sensitive to almost every single antidepressant I have been prescribed and have had either adverse reactions or allergic reactions such as rash. The only antidepressant that worked with me in the past was the MAOI Parnate, and so this is what I have gone to again. However, not as effective as it once was. I was prescribed Remeron for the anxiety and difficulty falling asleep, and at 1/2 the lowest dose, it knocked me out through the next day even though I took it before going to bed. Same with Seroquel and Ambilify. I could not function the next day, even with very small doses. I am not psychotic, and so this is a factor I suppose. Most recently I was tried on Risperidone, and I had a very bad reaction identified as a Serotonin Syndrom Reaction. Right now I am going off the Parnate and am a little depressed as I go off of it slowly. My psychiatrist has said he would like me to consider Lamictal, one thing I have not tried, and I am very reluctant given my horrible reaction to all of the new antidepressants. This becomes an almost trial and error approach I guess to find one that works, and so I would say hang in there from one who has been there and is still there. I did get some help from the Parnate, but it does not help anxiety.
Karen
Posted by bassman on June 29, 2006, at 6:01:28
In reply to Re: Extremely Sensative to Meds and looking for Input, posted by Karen44 on June 28, 2006, at 23:16:48
I hear you. Here's my theory :>) no matter what drug it is, if I don't take any, I don't have a reaction to it-so, if I take a tiny, tiny amount, probably I'll be O.K. As a med-sensitive person, too, what I had to learn was [1] not to listen to the doc that tells me to start at 50-100% therapeutic dose and [2] stop calling myself a weenie and just take a very small amount...with SSRI's, I've started as low as 1 mg. This also gives me time to assure myself that the stuff isn't going to have an unwanted side effect, like killing me. :>} Then I really slowly creep up with the med (it took me a YEAR to get to a therapeutic dose of Paxil, but I then was rewarded with the three best years of my life).
Start off low, go slow. I like that. :>}
Posted by notfred on June 29, 2006, at 16:49:04
In reply to Re: Extremely Sensative to Meds and looking for Input, posted by Morhoun on June 28, 2006, at 9:31:39
> Thank you all, I knew not to keep taking L-Tryptophan with an AD but the Aminos too? Has anyone tried Remeron? I hear it's fast acting and not too bad for Anxiety but that it often poops out too. Anyone tried the TCAs?
L-Tryptophan is an amino acid. There is a rate limiting step in its conversion so it should be OK to take with AD's. L-Tryptophan is abundent in most foods.
Posted by Phillipa on June 29, 2006, at 20:20:17
In reply to Re: Extremely Sensative to Meds and looking for Input » bassman, posted by Phillipa on June 27, 2006, at 22:08:18
I just was taken off of lamictal. It's a mood stabalizer and is know to help boost an antidessant. I would think with parnate being so strong that lamictal would do nothing. I may be wrong which I am quite frequently. Why lamictal? Love Phillipa
Posted by pulse on July 1, 2006, at 9:33:13
In reply to Re: Extremely Sensative to Meds and looking for In, posted by notfred on June 29, 2006, at 16:49:04
no, l-tryptophan is warned against with ads, especially the ssris, (no coinkidink that l-tryp was banned, then, magically prozac came to be)
i would hope that by now all have been told by there docs never to mix st. johns wort with any prescrpition ad.
tcas: since all 3 neurotrans. - s, n, d - are effected (even with despramine being mostly n) - i would still avoid l-tryp.
tyrosine and taurine were given to me in detox by the head there - he was/is a friend, but also an addictionologist, formerly an internist. i noticed no untoward effects, but, of course, this was for at most an 18 day period, and you are kept so busy, you're unlikely to notice much of anything, imo. afterward, i discontinued both.
taurine in pill form, now only 10 yrs. later, has wholly unacceptable GI side-effects for me .
for Morhoun: as always, YMMV on the last 2 - taurine and tyrosine, but since you are wanting more - as in a prescription ad - i can't see the point due to the possible risks of continuing ANY aminos.
pulse
Posted by bassman on July 1, 2006, at 9:40:21
In reply to Re: Extremely Sensative to Meds and looking for In, posted by pulse on July 1, 2006, at 9:33:13
Pulse-great post.
Posted by pulse on July 1, 2006, at 10:50:43
In reply to Re: Extremely Sensative to Meds and looking for In, posted by bassman on July 1, 2006, at 9:40:21
bassman, a big TY!
Posted by notfred on July 3, 2006, at 0:34:04
In reply to Re: Extremely Sensative to Meds and looking for In, posted by pulse on July 1, 2006, at 9:33:13
> no, l-tryptophan is warned against with ads, especially the ssris,
Tryptophan, found as a component of dietary protein, is particularly plentiful in chocolate, oats, bananas, dried dates, milk, yogurt, cottage cheese, meat, fish, turkey, chicken, sesame, chickpeas, and peanuts.
So everyone is taking l-tryptophan with their AD's. I would question the need to take l-tryptophan as a supp at all, unless you are malnurished. It is abundant in most foods.
(no coinkidink that l-tryp was banned, then, magically prozac came to be)
>It was really a bad batch that caused EMS.
In 1989, a large outbreak of a new, disabling, and in some cases deadly autoimmune illness called eosinophilia-myalgia syndrome (EMS) was traced to L-tryptophan. The bacterial culture used to synthesize tryptophan by a major Japanese manufacturer, Showa Denko KK, had recently been genetically engineered to increase tryptophan production; with the higher tryptophan concentration in the culture medium, the purification process had also been streamlined to reduce costs, and a purification step that used charcoal absorption to remove impurities had been omitted. This allowed another bacterial metabolite through the purification, resulting in the presence of an end-product contaminant responsible for the toxic effects. The FDA was unable to establish with certainty that this was the sole cause of the outbreak. Tryptophan was banned from sale in the US, and other countries followed suit.
Posted by Morhoun on July 5, 2006, at 17:51:58
In reply to Re: Extremely Sensative to Meds and looking for In, posted by bassman on July 1, 2006, at 9:40:21
Again, thank you all.
From what I've read, taking L-tryptophan (different from just dietary tryptophan?) as a supppliment with an SSRI runs the rist of serotonin syndrome...to much serotonin which can be fatal. However, there are studies that show L-Try suppliments in small amounts (500-1000mg) can acutally enhance or quicken the effects of SSRIs but one must be very careful.
I'm just not sure what to do at this point. The Aminos and L-Tryp are helping...the anxiety attacks aren't as bad, the depression isn't quite as intense and it helps me sleep...it's been 3 weeks and I'm hoping that maybe it gets better over time but the depression is still pretty heavy and I'm just not sure it's enough. The thought of trying another AD scares the hell out of me. I'll try and stick it out for a while yet.
This is the end of the thread.
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