![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 45. This is the beginning of the thread.
Posted by jenny80 on May 2, 2007, at 19:19:53
So far none of the antidepressants have made the slightest difference to my chronic dysthymia.
I have read a lot that antidepressants sometimes have no more success rate than with placebo.
I am beginning to think that these medications have no effect what so ever on depression.
May be i feel this way because i have never felt any response to them?
Never the less I am trying to decide which would be best for me.
I have tried most of the SSRI's and could not tolerate the MAOIs. Do you think I may benefit from a more noradrenergic antidepressant or may be RIMA or tricyclic. What would you recommend for me ?
j x
Posted by Phillipa on May 2, 2007, at 21:50:36
In reply to Do antidepressants work ?, posted by jenny80 on May 2, 2007, at 19:19:53
I wish I had the answer same problem here. They need testing to see what a particular person would respond to. Maybe theraphy is the answer for less severe cases? I just don't know. Love Phillipa
Posted by football on May 3, 2007, at 2:24:02
In reply to Do antidepressants work ?, posted by jenny80 on May 2, 2007, at 19:19:53
I asked the same question until I tried Nardil. YES, ANTIDEPRESSANTS DO INDEED WORK!
:)
Posted by Bonnie_CA on May 3, 2007, at 2:46:52
In reply to Do antidepressants work ?, posted by jenny80 on May 2, 2007, at 19:19:53
I think for those for whom they don't work... they either don't really need them or they're just barking up the wrong tree (maybe an antipsychotic or anticonvulsant would work better in some cases). For those who find relief in antidepressants, we can assure you, it's not a placebo effect. If it were, then the first drugs I tried would have worked! I do find it interesting how some people are not affected by antidepressants at all, or not until they take a high dose. I have a friend on 60mg of prozac a day. I thought that was really high, but she says that's the dose where she begins to feel any effects at all. I also seem to be rather sensitive to these drugs, and I never seem to need as much as some doctors think I do.
To summarize... yes, for most people.
-Bonnie
Posted by AdamCanada on May 3, 2007, at 3:21:10
In reply to Do antidepressants work ?, posted by jenny80 on May 2, 2007, at 19:19:53
i dont know what would have happened to me if it wasn't for the paxil.
dont listen to that anti-medication propaganda. clinical depression and just ''i'm sad because so and soo'' depression and two completely different things... meds are for one kind, and talk therapy for another. People need to understand this but there si a great deal of ignorance in the world.
paxil made me livable and i would not even be able to post this right now if it wasn't for paxil. all meds effect people different ways and no mental illness is the same in everyone.
Posted by linkadge on May 3, 2007, at 6:26:08
In reply to Do antidepressants work ?, posted by jenny80 on May 2, 2007, at 19:19:53
>sometimes have no more success rate than with >placebo.
Lets clarify. In *more than half* of all published clinical trials, antidepressants fail to perform better than placebo.
Linkadge
Posted by Racer on May 3, 2007, at 12:01:47
In reply to Do antidepressants work ?, posted by jenny80 on May 2, 2007, at 19:19:53
> I am beginning to think that these medications have no effect what so ever on depression.
> May be i feel this way because i have never felt any response to them?My guess is that you're feeling this way because you're depressed, and depression comes with that sort of negative thinking by its very nature. It's hard to believe, when you feel that bad, that ANYTHING will EVER make any difference.
Anti-depressants do affect depression. I think a big part of the problem is that there is no way to say, "ah, this sort of depression is caused by [x], so we can treat it with [a]." It's all a matter of trial and error, and that can be particularly hard with antidepressants.
The first problem is that the benefits aren't apparent for weeks, or even months. During that time, there are a lot of adverse effects, which can lead to early discontinuation of a trial. Bottom line -- a lot of people don't respond to antidepressants because they give up too soon, before the medications have a chance to work. Many of the start up effects go away in a few weeks, or a couple of months. What you experience when you first start a medication is not what you'll experience farther down the line.
It's hard, though, when you're depressed, and feeling pretty punk from the side effects, and not yet getting any benefit from the drugs. It's easier to say they won't work, and stop them. I know this, because I've done it. But if you can stick it out, it's often possible to feel pretty normal again -- just a question of riding that Medication-Go-Round a little longer.
> Never the less I am trying to decide which would be best for me.
> I have tried most of the SSRI's and could not tolerate the MAOIs. Do you think I may benefit from a more noradrenergic antidepressant or may be RIMA or tricyclic. What would you recommend for me ?
> j xHere's your list from your other post:
>Citalopram 3 months at i think 20 mg od.
>Venlafaxine 225 mg 2 years
>mirtazapine 15 mg 4 weeks
>Fluoextine 20 mg 4 weeks
>escitalopram 10 mg 6 weeks with lamotrigine 100 mg
>nardil 15 mg tds and parnate 10 mg tds both only 2 weeksI see three SSRIs, to for less than the period I'd expect to see any improvement, and one at the minimum dose. Personally, before trying any of the TCAs, I'd try another SSRI trial, and probably add an augmenting agent. I'm biased in favor of either Zoloft or Prozac myself, but you also have the option of trying Paxil (which I don't recommend), or more extensive trials of Celexa or Lexapro. A lot of people get great results from Lexapro, and it seems to be the SSRI of choice for a lot of pdocs. Again, though, I like Prozac and Zoloft myself -- because I've had the best results from them.
You didn't mention what sorts of problems you've had with medicatiosn in the past, other than not responding. Sometimes specific side effect profiles can help a lot in trying to figure out what might be a good drug to try next.
I know you said that Effexor didn't help, but I can't believe you stayed on it for two years with NO response of ANY kind. What did it do?
Also, what does your depression look like? Are you one who wakens early? Or hypersomnolent? Leaden paralysis? Or staring at the walls? Anhedonia? Can you react when something positive happens? That sort of symptomology also helps with figuring out medications to try.
I think in one of your earlier posts you mentioned bulimic behavior? Is that completely gone? If so, and if it's been long enough, and you're willing to take a bit of a risk, Wellbutrin XL is often a very good augmenting agent with SSRIs. It's also a pretty friendly drug, in terms of side effects, although it is activating, so may increase anxiety. It can also cause headaches.
I can think of a bunch of options, but before I try to list them, it would really help to know more about your symptoms, and what effects -- beneficial or adverse -- you've had from the drugs you've tried. Some of what I'm thinking about would be great if you have symptom group A, but a fiasco for symptom group B, you know?
Good luck.
Posted by Racer on May 3, 2007, at 13:21:36
In reply to Re: Do antidepressants work ?, posted by linkadge on May 3, 2007, at 6:26:08
A lot of people on this board will tell you that antidepressants have helped them a great deal. Others will tell you that psychotropic medications allow them to function. And still others, myself included, say that psychotropic medications are tools, like any other -- no screwdriver will work, if it's not used correctly and for the purpose intended. (Except that a screwdriver can fill in for a hoof pick in a pinch...)
It's true that many studies show some less than stellar results. When you take all the research together, though, it shows that most people who experience major depressive disorder can be helped by antidepressant medications. Does that mean that any AD will do? Of course not -- but the research sure looks to indicate that trying a variety of drugs is more likely than not to provide relief from depressive symptoms. It may not be the first, second, or even third drug that's tried -- but in the end, there's a very strong likelihood that everyone with depression can benefit from some medication or combination.
I'm very sorry that you haven't found what you're looking for with medications, Linkadge. I hope that you find relief somewhere, whether it's through medication, therapy, meditation, or some other mechanism. It must be very difficult for you to feel this way, and for so long.
Good luck.
Posted by linkadge on May 3, 2007, at 14:12:40
In reply to That may be true, but... » linkadge, posted by Racer on May 3, 2007, at 13:21:36
>A lot of people on this board will tell you that >antidepressants have helped them a great deal. >Others will tell you that psychotropic >medications allow them to function.
And if you ask many of those who were assigned placebos in studies, I'm sure they will also say they were helped a great deal. (to play the devils advocate)
>It's true that many studies show some less than >stellar results. When you take all the research >together, though, it shows that most people who >experience major depressive disorder can be >helped by antidepressant medications.I don't think they shows this at all. I personally think the bottom line is that people can improve ragardless. It is nice to want to attibute that to something solid and concrete such as a medication, that way, ones recovery feels controlled. Nobody likes to enter clinical depression and exit it as the stars see fit. I think that, infact, medications are like crosswalk buttons: something to occupy your time untill things go your way.
>Does that mean that any AD will do? Of course >not -- but the research sure looks to indicate >that trying a variety of drugs is more likely >than not to provide relief from depressive >symptoms.
I don't think the data shows this at all. I believe the data show that the chances of recovery on the second and third antidepressants are dramatically decreased. Look at STARD. By the third antidepressant, only like 18% had usefull effect. I think this indicates perfectly that by the third, fourth etc drug, the placebo responders have been essentially weeded out.
>It may not be the first, second, or even third >drug that's tried -- but in the end, there's a >very strong likelihood that everyone with >depression can benefit from some medication or >combination.
I think thats a very unprovable statement. We've known for a long time that (in the majority of cases) depression gets better on its own without
intervention usually in less than 2 years. So if somebody is trying drugs for 2 years, there is a good likelyhood that their depression will just get better.I believe the most objective views show that antidepressants do little more than nothing.
>I'm very sorry that you haven't found what >you're looking for with medications, Linkadge. I >hope that you find relief somewhere, whether >it's through medication, therapy, meditation, or >some other mechanism. It must be very difficult >for you to feel this way, and for so long.Actually on a daily basis I'm better off meds than I am on meds. I am still looking for help with the insomnia though.
Linkadge
Posted by Ines on May 3, 2007, at 14:52:47
In reply to Do antidepressants work ?, posted by jenny80 on May 2, 2007, at 19:19:53
First- Jenny, you say you have dysthymia. Is that your formal diagnosis? Dysthymia is almost always more difficult to treat than major depression, partcularly if you have dysthymia + episodes of major depression. And it also takes longer to treat. Maybe it'll help to be aware of that- you may need more experimenting than other people but you'll get there. I think I've said before (as has Racer above) that it looks like you've tried a lot of things, but in a lot of cases not had an adequate trial- i.e. not for long enough at an adequate dose. I know it's difficult to stick to something that makes you feel worse to begin with, but the problem with doing that is you may end up feeling that nothing works and giving up. You really have to give the medication a chance to kick in, othersise you're setting yourself up for failure. Why not make a commitment to try whatever's precribed to you for at least 3 months? Then find a good pdoc with a good reputation, maybe send him a letter in advance of the appointment with all your symptoms, age of onset, sleep and eating patterns, all of those details, and a list of all the meds you've tried, with length of trial and details of your reactions to them. And then put yourself in his hands and do what he says for as long as he says. You could finally find relief- imagine how that would feel. Best of luck, keep us updates.
Re: antidepressant efficacy. I think it's really unfair to suggest that antidpressants do nothing at all. They clearly do for a lot of people. When it comes to difficult cases, it's finding the right medication, or combination of medications, for each individual person that will be difficult. I think a lot of that (but not all) has to do with finding the right, experienced, pdoc and getting the right diagnosis. Clearly different types of depression respond better to different treatments, but a lot of GPs will still deny that and say it doesn't matter which AD you give someone, they're just as likely to repond well to it. That's just silly as far as I'm concerned.
Then we come to the placebo effect, an the issue of whether people will get better overtime regardless. I think that's true for episodic depression that has clear external causes (like a bereavement, excessive stress at work etc). In those cases people will likely get out of it on their own, but they may be pushed along by an AD. But if you're talking about chronic recurrent depression, dysthymia, atypical depression... I don;t believe that's true at all. People will struggle and fight and get a bit better only to get worse again. I think it is unfair to suggest to those people (and I include myself here) that they will get better on their own. They need long term medication, and therapy to get to know their patterns better and prevent relapse. Then there are the cases where depression is recurrent/ chronical but clearly cause by some horrible external event like childhood trauma. There we will probably still need medication, but therapy will play a major role and may be the difference between sucess and failure.
I have quite a strong opinion on this because I undermined myself by not getting adequate treatmtent for years, trying to get out of it on my own, and only managing to keep my head floating above the water but never really getting better. By letting it go on for so long I've made it much worse to treat because the patterns of behaviour associated with the depression become so ingrained and hard to get out of.
Re the placebo effect, I do believe it is very real, but not sufficient in chronic cases. I do believe that if someone reallly wants to get better, and really wants a medication to work, they'll help themselves along. On the other hand, if someone goes on meds reluctantly, or thinking at the outset that they won't work, they'll hinder the process. Everything to do with the mind is just so complex and influenced by so many factors. That's what makes it so difficult for the doctors trying to treat it.
Posted by linkadge on May 3, 2007, at 16:15:46
In reply to Re: Do antidepressants work ?, posted by Ines on May 3, 2007, at 14:52:47
Ok I guess its not fair to say that antidepressants don't work.
Antidepressants do work, and so do placebos.
Linkadge
Posted by kaleidoscope on May 3, 2007, at 16:27:19
In reply to Short answer: yes, they do » jenny80, posted by Racer on May 3, 2007, at 12:01:47
In many clinical trials, antidepressants are marginally but statistically more effective than placebo in reducing patient's 'scores' on depression rating scales.
Ed
Posted by jenny80 on May 3, 2007, at 16:34:28
In reply to Re: Do antidepressants work ?, posted by linkadge on May 3, 2007, at 16:15:46
Thanks for you posts.
I have suffered from dysthymia with episodes of major depression that last weeks to months at a time. When i am dysthymic i manage to function, go to work occasionally watch a film at the cinema or go for a meal. I always tend to feel that I'm not really enjoying myself. I always feel tired and tend to want to sleep a lot.
At the moment i guess i'm in a major depressive eipsode. Here i feel hopeless, cry a lot, don't have much of an appetite. I also feel i can't actually speak to any of my family. Its as if i don't have the energy to open my mouth. I feel emotionally numb. Sleep has always tended to be normal to oversleeping. I have never really had insomnia. I can't concentrate either and just want to lie in bed. I don't even have the energy to feed my self. My sister helps by making me an evening meal otherwise i would lie in bed.
I went through a few years where i was suffering from body dysmorphic disorder too.
The anorexia and bulimia are completely over too. They were a for of the body dysmorphic problem.
I just don't think the SSRIs do anything for me. The venlafaxine did nothing. I took it while i was having CBT at university. I still stayed in most of the time, did not have friends and at times became suicidal again. I tool the dose of 150 mg once a day which i believe only exerts serotinergic effect at this dose. Its difficult to say if venlafaxine did anything. I certainly remember crying most days and lying in bed while taking it.
what do you think about moclobemde or a more noradrenergic type ?
Posted by Shortstop on May 3, 2007, at 16:43:08
In reply to Re: Do antidepressants work ?, posted by linkadge on May 3, 2007, at 16:15:46
Linkadge, wondering: Are antidepressants the only class of drug whose clinical efficacy you chalk up entirely to psychosomatic dynamics? Or are there other categories you believe are 100% placebos as well?
Right now I'm a bit of an Emsam skeptic, but only because I've been on the 6 mg patch for nearly five weeks and don't note any benefits or side effects at all. But I'm not prepared to say that I think all ADs are "sugar pills" ...
> Ok I guess its not fair to say that antidepressants don't work.
>
> Antidepressants do work, and so do placebos.
>
> Linkadge
Posted by jenny80 on May 3, 2007, at 16:58:34
In reply to Re: Do antidepressants work ? )) Linkadge, posted by Shortstop on May 3, 2007, at 16:43:08
Just took a depression rating scale the HAMD; I am currently scoring high enough for severe major depression. That a suprise! I guess thats where i am at the moment. This usually lasts for a few months and sometimes goes back to dysthymia/mild depression.
It sucks.
Posted by Ines on May 3, 2007, at 16:59:30
In reply to Re: Do antidepressants work ?, posted by linkadge on May 3, 2007, at 16:15:46
> Ok I guess its not fair to say that antidepressants don't work.
>
> Antidepressants do work, and so do placebos.
>
> LinkadgeI agree that is true for some cases. And the thing is, if AD's sometimes make people better due to a placebo effect, that's fine too no? Same outcome :-)
I must say though, if placebo effect was all there was, I'd be cured right now, last trial of ADs I was so convinced it would work- but no...
Posted by Quintal on May 3, 2007, at 17:02:03
In reply to Do antidepressants work ?, posted by jenny80 on May 2, 2007, at 19:19:53
>Do you think I may benefit from a more noradrenergic antidepressant or may be RIMA or tricyclic. What would you recommend for me ?
I'd recommend something dopaminergic. Bupropion (Wellbutrin/Zyban in the UK) would be the best place to start if you're looking for something to boost dopamine that's also noradrenergic. I remember you tried sulpiride? Did that have any effect? How about *low-dose* amisulpride which boosts dopaminergic transmission? From personal experience and reading many others here I'd say noradrenergic drugs increase drive and motivation but that comes at the price of increased anxiety and irritability. I've never had the impression they're very good for dysthymia though.
Tricyclics are excellent antidepressants - I was compiling a chart of all the meds I've taken recently and when it came to dothiepin (a popular TCA in the UK) I had to give it a 10/10 for effectiveness - I stopped it after two months because I was well again. Dothiepin was the only antidepressant that got a 10/10 for effectiveness in the whole chart. Clomipramine is generally considered to be the most powerful TCA, having a strong serotonin reuptake properties alongside the typical TCA profile, but the side effects are harsh. Lofepramine is the other TCA I'd recommend because it generally better tolerated than other TCAs due to milder side effects while still retaining the TCA efficiency. A friend of mine achieved a full remission on lofepramine in a short space of time and came off it after six months. She's still doing well as far as I know. If you have problems tolerating drugs I'd recommend lofepramine first if you decide on a TCA.
Then there's opiates. These are the only class of drug I'd say will certainly attack dysthymia, and by that I don't mean getting high. A dysthymic person would probably be able to feel some relief from doses as low as 16mg codeine (personal experience), while a person using it for recreational purposes will usually take 120-400mg.
Anyway, if you're curious about whether they'll work for you, you can buy a pack of painkillers OTC and see for yourself. There's some evidence lamotrigine can prevent tolerance to opiates, so low doses can be effective for long periods of time.Q
Posted by linkadge on May 3, 2007, at 17:46:59
In reply to Re: Do antidepressants work ? )) Linkadge, posted by Shortstop on May 3, 2007, at 16:43:08
No I never said AD's were 100% placebo. I would just tend to think that depression is probably one of the most sensitive illnesses to placebo.
As such, many antidperessants could very well could be undetected placebos.
I think a lot of their effect is hyped.
I also don't know (for example) if more than half of all blood pressure medication clinical trials failed to distinguish from placebo, or more than half of all asthma medication clinical trials failed to outperform placebo.
Linkadge
Posted by linkadge on May 3, 2007, at 17:48:00
In reply to Re: Do antidepressants work ? )) Linkadge, posted by jenny80 on May 3, 2007, at 16:58:34
I agree with you. I am by no means trying to close doors to treamtnet options. I just personally think they are (mostly) placebo.
But don't take my words as 100% fact.
Linkadge
Posted by linkadge on May 3, 2007, at 17:51:14
In reply to Re: Do antidepressants work ? » linkadge, posted by Ines on May 3, 2007, at 16:59:30
>I agree that is true for some cases.
I don't think it is just *some* cases. The truth is that in more than half of all clincialy trials, antidepressants failed to outperform placebo.
>And the thing is, if AD's sometimes make people >better due to a placebo effect, that's fine too >no? Same outcome :-)
True enough.
>I must say though, if placebo effect was all >there was, I'd be cured right now, last trial of >ADs I was so convinced it would work- but no...
Susceptability to placebo effect varies from person to person. (I don't mean to portray this as any kind of character flaw)
Linkadge
Posted by Ines on May 3, 2007, at 18:33:52
In reply to Re: Do antidepressants work ?, posted by linkadge on May 3, 2007, at 17:51:14
Hey Linkadge,
Don't get me wrong, I agree with you in a way. I just think that the placebo effect will be strong in cases where the depression would solve itself anyway, but not so strong in many other cases. In a lot of clinical trials- though not all- all these cases get bunched together, so it confounds the results in my view. A good clinical trial would match individuals in placebo and treatment groups according to subtype of depression, age of onset, recurrency of depression, whether the depression was precipitated by a specific event or not...all these factors. I understand it's impossible to carry out a large clinical trial with all these matches, but without that it's difficult to be clear about the results in my view. Of course the absolutely ideal clinical trial would be within subject, the same person gets placebo and then treatment or vice versa. There you eliminate most of the variability.
Posted by Racer on May 3, 2007, at 19:30:48
In reply to Re: Short answer: yes, they do, posted by kaleidoscope on May 3, 2007, at 16:27:19
Posted by Declan on May 3, 2007, at 22:32:45
In reply to Re: Do antidepressants work ? )) Linkadge » jenny80, posted by linkadge on May 3, 2007, at 17:48:00
Would it be possible to see if the placebo effect is stronger in those who are lonely and in need of attention and care (as are many depressed people)?
Is the placebo effect stronger in the elderly?
Posted by polarbear206 on May 3, 2007, at 22:43:28
In reply to Re: Do antidepressants work ?, posted by Ines on May 3, 2007, at 14:52:47
> First- Jenny, you say you have dysthymia. Is that your formal diagnosis? Dysthymia is almost always more difficult to treat than major depression, partcularly if you have dysthymia + episodes of major depression. And it also takes longer to treat. Maybe it'll help to be aware of that- you may need more experimenting than other people but you'll get there. I think I've said before (as has Racer above) that it looks like you've tried a lot of things, but in a lot of cases not had an adequate trial- i.e. not for long enough at an adequate dose. I know it's difficult to stick to something that makes you feel worse to begin with, but the problem with doing that is you may end up feeling that nothing works and giving up. You really have to give the medication a chance to kick in, othersise you're setting yourself up for failure. Why not make a commitment to try whatever's precribed to you for at least 3 months? Then find a good pdoc with a good reputation, maybe send him a letter in advance of the appointment with all your symptoms, age of onset, sleep and eating patterns, all of those details, and a list of all the meds you've tried, with length of trial and details of your reactions to them. And then put yourself in his hands and do what he says for as long as he says. You could finally find relief- imagine how that would feel. Best of luck, keep us updates.
>
> Re: antidepressant efficacy. I think it's really unfair to suggest that antidpressants do nothing at all. They clearly do for a lot of people. When it comes to difficult cases, it's finding the right medication, or combination of medications, for each individual person that will be difficult. I think a lot of that (but not all) has to do with finding the right, experienced, pdoc and getting the right diagnosis. Clearly different types of depression respond better to different treatments, but a lot of GPs will still deny that and say it doesn't matter which AD you give someone, they're just as likely to repond well to it. That's just silly as far as I'm concerned.
>
> Then we come to the placebo effect, an the issue of whether people will get better overtime regardless. I think that's true for episodic depression that has clear external causes (like a bereavement, excessive stress at work etc). In those cases people will likely get out of it on their own, but they may be pushed along by an AD. But if you're talking about chronic recurrent depression, dysthymia, atypical depression... I don;t believe that's true at all. People will struggle and fight and get a bit better only to get worse again. I think it is unfair to suggest to those people (and I include myself here) that they will get better on their own. They need long term medication, and therapy to get to know their patterns better and prevent relapse. Then there are the cases where depression is recurrent/ chronical but clearly cause by some horrible external event like childhood trauma. There we will probably still need medication, but therapy will play a major role and may be the difference between sucess and failure.
>
> I have quite a strong opinion on this because I undermined myself by not getting adequate treatmtent for years, trying to get out of it on my own, and only managing to keep my head floating above the water but never really getting better. By letting it go on for so long I've made it much worse to treat because the patterns of behaviour associated with the depression become so ingrained and hard to get out of.
>
> Re the placebo effect, I do believe it is very real, but not sufficient in chronic cases. I do believe that if someone reallly wants to get better, and really wants a medication to work, they'll help themselves along. On the other hand, if someone goes on meds reluctantly, or thinking at the outset that they won't work, they'll hinder the process. Everything to do with the mind is just so complex and influenced by so many factors. That's what makes it so difficult for the doctors trying to treat it.
>Well put Inez.
Thanks,
Polarbear
Posted by polarbear206 on May 3, 2007, at 23:45:38
In reply to Re: Do antidepressants work ?, posted by jenny80 on May 3, 2007, at 16:34:28
> Thanks for you posts.
> I have suffered from dysthymia with episodes of major depression that last weeks to months at a time. When i am dysthymic i manage to function, go to work occasionally watch a film at the cinema or go for a meal. I always tend to feel that I'm not really enjoying myself. I always feel tired and tend to want to sleep a lot.
> At the moment i guess i'm in a major depressive eipsode. Here i feel hopeless, cry a lot, don't have much of an appetite. I also feel i can't actually speak to any of my family. Its as if i don't have the energy to open my mouth. I feel emotionally numb. Sleep has always tended to be normal to oversleeping. I have never really had insomnia. I can't concentrate either and just want to lie in bed. I don't even have the energy to feed my self. My sister helps by making me an evening meal otherwise i would lie in bed.
> I went through a few years where i was suffering from body dysmorphic disorder too.
> The anorexia and bulimia are completely over too. They were a for of the body dysmorphic problem.
> I just don't think the SSRIs do anything for me. The venlafaxine did nothing. I took it while i was having CBT at university. I still stayed in most of the time, did not have friends and at times became suicidal again. I tool the dose of 150 mg once a day which i believe only exerts serotinergic effect at this dose. Its difficult to say if venlafaxine did anything. I certainly remember crying most days and lying in bed while taking it.
> what do you think about moclobemde or a more noradrenergic type ?
My symptoms of atypical depression are associated with my soft bipolar,abated with Lamicatal and effexor.http://www.psycom.net/depression.central.lieber.html
http://www.psycom.net/depression.central.atypical.htmlPolarbear
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