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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by jammerlich on August 8, 2007, at 15:18:29
I am very leery of taking antidepressants and have been for quite some time. But, I've been feeling especially awful lately and think it may be time to bite the bullet. I've seen a pdoc recently and his suggestions are:
Celexa
Effexor XR
Zoloft
ProzacMy top three concerns are:
withdrawal
weight gain
sweatingI'm pretty sure I DO NOT want the Effexor because of it's similarity to Cymbalta, about which I've heard several horrific withdrawal stories.
Which of these might be a good place to start and what are important things I should know about them? Anything else come to mind that might be a better option?
Posted by Racer on August 8, 2007, at 15:54:09
In reply to Considering meds and need advice, posted by jammerlich on August 8, 2007, at 15:18:29
> I've seen a pdoc recently and his suggestions are:
>
> Celexa
> Effexor XR
> Zoloft
> Prozac
>
> My top three concerns are:
>
> withdrawal
> weight gain
> sweating
>
> I'm pretty sure I DO NOT want the Effexor because of it's similarity to Cymbalta, about which I've heard several horrific withdrawal stories.
>
> Which of these might be a good place to start and what are important things I should know about them? Anything else come to mind that might be a better option?
>Hm... See, as you probably already know, it's hard to predict what might be best. Here are a few random comments:
Out of the three SSRIs on that list -- Celexa, Prozac, and Zoloft -- Celexa is likely to be the most calming, with Zoloft and Prozac more activating. Zoloft, for me, had the fewest side effects, but that's not true of everyone.
Effexor does have the most chance of {ahem} "discontinuation syndrome." In fact, much worse, in my experience, than Cymbalta. Cymbalta also seems like a much more effective drug to me, with far fewer side effects. If you were going to try either of them, I'd say try Cymbalta -- which, frankly, would likely be my first suggestion these days, anyway. The withdrawal is an issue, but there are things you can do to improve matters.
Your pdoc only mentioned serotinergic medications, so you're not going to get too much variation between them, really. ALL serotinergic medications can cause weight gain in susceptible individuals. That's the bad news. The better news is that there are things that can be done to mitigate that, including adding other medications to counter some of it.
What symptoms specifically are you trying to address? I've had pretty good luck with Wellbutrin XL and a low dose of SSRI, which might also be an option for you. On the other hand, Wellbutrin is associated with anxiety for a lot of people.
Good luck.
Posted by jammerlich on August 8, 2007, at 16:13:37
In reply to Re: Considering meds and need advice » jammerlich, posted by Racer on August 8, 2007, at 15:54:09
I guess the symptoms I want to address are feeling sad nearly all the time, crying (sometimes for a reason I can name and, other times, not), and a serious lack of motivation to do anything other than sit in bed with my laptop. Oh, and concentration....a 30 minute sitcom seems to be more than I can manage.
I did try Wellbutrin SR about a year ago and it was NOT a good experience; I only lasted 3 days. I'm not sure I'd call it anxiety, but I felt agitated, irritable, and on the verge of telling everyone EXACTLY what I thought of them. (The one thing I regret is that I did not follow through with my inclination to tell my mother to shut the f*ck up!) However, the prescription was filled with Budeprion, and I've read about lots of people having problems with that; but, not with the brand name or bupropion. I'd definitely be willing to try it again.
Can you explain the reasoning behind using both Wellbutrin XL and a low dose of SSRI? Does the SSRI tame some of the activating features of the Wellbutrin??
Thanks, Racer. I really appreciate your input.
Posted by King of Nothing on August 8, 2007, at 16:15:26
In reply to Considering meds and need advice, posted by jammerlich on August 8, 2007, at 15:18:29
> I am very leery of taking antidepressants and have been for quite some time. But, I've been feeling especially awful lately and think it may be time to bite the bullet. I've seen a pdoc recently and his suggestions are:
>
> Celexa
> Effexor XR
> Zoloft
> Prozac
>
> My top three concerns are:
>
> withdrawal
> weight gain
> sweating
>
> I'm pretty sure I DO NOT want the Effexor because of it's similarity to Cymbalta, about which I've heard several horrific withdrawal stories.
>
> Which of these might be a good place to start and what are important things I should know about them? Anything else come to mind that might be a better option?
>It really just depends on the individual person...it's really a gamble like situation. My wife does great on Effexor, it did nothing for me. Zoloft worked great for me for many years, prozac made me anxious. Different meds effect different people in different ways...that's the bottom line!!
My Pdoc let's me choose my own meds...my guess(usually) is as good as his with basic anti-depressants. You really have to try one to see how it works for YOU. Good Luck to you.
Posted by Phillipa on August 8, 2007, at 18:41:04
In reply to Re: Considering meds and need advice » jammerlich, posted by King of Nothing on August 8, 2007, at 16:15:26
Agree with above for me it's luvox. Zoloft was bad either. Good luck. Love Phillipa and it's so individual.
Posted by DharmaBum on August 8, 2007, at 19:56:35
In reply to Considering meds and need advice, posted by jammerlich on August 8, 2007, at 15:18:29
Plannig on a horrid withdrawal is a good way to eliminate options that might help your present condition. Virtually ALL AD's have associated withdrawal symptoms for SOME people if taken long enough.
Perhaps plan instead on a slow, well-managed taper off that may be less uncomfortable than you expect. That's not to say it will be a cakewalk; everyone is different.
I've cut back on Effexor recently from 225 to 125. It was not bad at all, nice and slow, over a few weeks. I do understand dropping the last 125 is probably more uncomfortable. I'm holding at this point, as I can feel the outermost clouds of melancholia rolling in. Yet, I have more energy and motivation, and more "feeling" in general, than I had as a zombie at 225. So, I may need to switch things around..add something... dunno, I see the pdoc this month. Whatever change is made, if it's a new drug, I will cross the withdrawal bridge when I get there. In the meanwhile, I'm more worried about side effects I can live with.
I guess, like so many things, it's risk vs. reward.
Best of luck.
Posted by d0pamine on August 9, 2007, at 4:45:56
In reply to Considering meds and need advice, posted by jammerlich on August 8, 2007, at 15:18:29
> I am very leery of taking antidepressants and have been for quite some time. But, I've been feeling especially awful lately and think it may be time to bite the bullet. I've seen a pdoc recently and his suggestions are:
>
> Celexa
> Effexor XR
> Zoloft
> Prozac
>
> My top three concerns are:
>
> withdrawal
> weight gain
> sweatingArrrrggghhh seeing all those serotonin elevating substances in one place is killing me. take them from my sight and bring me another box of EMSAM. (the only AD worthy of my approval)
Posted by Racer on August 9, 2007, at 13:14:51
In reply to Re: Considering meds and need advice » Racer, posted by jammerlich on August 8, 2007, at 16:13:37
>
>
> I did try Wellbutrin SR about a year ago and it was NOT a good experience; I only lasted 3 days. However, the prescription was filled with Budeprion, and I've read about lots of people having problems with that; but, not with the brand name or bupropion.What dose did you start at? If the starting dose was too high, that could also be a problem. In fact, I'm very pleased to be taking 450mg of the XL, because the 150mgs are not available in generic, so I don't have to deal with that issue. It probably is worth trying again, considering it's about the only antidepressant I know of which doesn't cause weight gain for most people.
> Can you explain the reasoning behind using both Wellbutrin XL and a low dose of SSRI? Does the SSRI tame some of the activating features of the Wellbutrin??
>The reasoning is simpler than that: Wellbutrin works on dopamine and norepinephrine, which can benefit motivation and depression; the SSRI works on sertonin, which can be beneficial for depression and anxiety. You're basically hitting all the bases if you take some of each. Also, though, Wellbutrin isn't a particularly robust antidepressant for a lot of people, so helping it along is a good idea. But yes, the SSRI should help reduce some of the activation Wellbutrin can cause.
Other options might be Wellbutrin with a low dose of Seroquel, or an SSRI with a low dose of Abilify, or maybe a combination which includes Lamictal. If I were walking into your doctor's office, though, I think I'd ask to try Wellbutrin XL, with the understanding that we'd add in an SSRI once we saw whether it was tolerable.
The one piece of advice I'd call most critical, though, is that -- horrible as it is at times -- it's far better to start one medication at a time, and stick it out for at least six weeks. Obviously, there are some situations in which you can't: I got a rash all over my face from one generic fluoxetine, and I had the rage reaction to Remeron which was terrifying. Those sorts of things pretty well require stopping. But at this point, I think I would be able to stick out just general weirdness for a couple of weeks...
Good luck to you! I really hope things improve for you very soon, you've had an awful lot on your plate lately, and it's got to be rough for you.
Posted by yznhymer on August 9, 2007, at 17:01:19
In reply to Considering meds and need advice, posted by jammerlich on August 8, 2007, at 15:18:29
Hey there...
Regarding your reservations about the meds involved, I would make just a couple of observations.
Withdrawal: you're aware of the possible unpleasantness. That's the main thing. So many of us have fallen into nasty withdrawal periods just because we weren't warned about their possibility by our doctors. With the knowledge you have, you should be able to wean yourself off almost any of the meds in question with little if any difficulty. More important is finding something that gives you a good response anyway, so focus on that and try to put worry about the other aside.
Weight Gain: Again, forewarned is forearmed. The weight gain can sneak up on you awfully fast too. I didn't find it an issue with Wellbutrin but it was one with SSRI's and definitely with Nardil. Still, with the right diet and regular exercise you can dodge that bullet - and you'll be a healthier more fit individual as a result. Not only that, the exercise will most likely provide antidepressant benefits of its own.
Sweating: I don't think there is any way to predict if any of these meds will cause that problem for you. The only med that did that to me was Cymbalta. Still, if you get a robust antidepressant response, could you manage some excess sweating?
Best of luck to you,
Y
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