![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by shadowmon on December 21, 2008, at 5:40:25
Just wondering if anyone out there can help me.
Just got back on paxil after a horrid try to switch to effexor. At the max dose 60 mg, want to talk to dr about adjunctive meds, because I don't want to get off the paxil because it seems the only thing that has some positive effect, and am totally not willing to change meds at this time.
What do they normally pair up with paxil?
Am definitely not willing to try wellbutrin, it's too stimulating, and currently take trazodone for sleep. Have tried remeron and risperdal, but can't remember if it helped the residual depression that I am feeling or if it helped me sleep.
Posted by SLS on December 21, 2008, at 6:41:33
In reply to adjunctive meds to pair with paxil?, posted by shadowmon on December 21, 2008, at 5:40:25
> Just wondering if anyone out there can help me.
>
> Just got back on paxil after a horrid try to switch to effexor. At the max dose 60 mg, want to talk to dr about adjunctive meds, because I don't want to get off the paxil because it seems the only thing that has some positive effect, and am totally not willing to change meds at this time.
>
> What do they normally pair up with paxil?
>
> Am definitely not willing to try wellbutrin, it's too stimulating,Have you already tried it?
"They" don't normally pair up anything with Paxil. It is still a psychopharmacological jungle out there. There is often very little consensus as to what to do when trying to augment antidepressants. You might want to perform a search on the Internet for relevant material written by Stephen Stahl, MD, PhD. He is considered one of the masters of polypharmacy in psychiatric medicine. He currently likes adding Geodon to some treatment regimes. He also likes to combine SRIs with TCAs; desipramine and nortriptyline being the drugs of choice.
I think these might be worth looking into as adjuncts to Paxil:Remeron
lithium
nortriptyline
desipramine
Provigil
Abilify
Geodon
LamictalI am not as enthusiastic as some are to add stimulants, but they can help.
Posted by Phillipa on December 21, 2008, at 12:35:17
In reply to Re: adjunctive meds to pair with paxil? » shadowmon, posted by SLS on December 21, 2008, at 6:41:33
Scott low benzos worked for me with paxil??? Why not benzos? Thanks Phillipa
Posted by Phillipa on December 21, 2008, at 12:45:40
In reply to Re: adjunctive meds to pair with paxil? » SLS, posted by Phillipa on December 21, 2008, at 12:35:17
Goggled his name and at the bottom of biography he's affiliated with so many drug companies. Couldn't find the site on adjuncts to paxil and other ad's Phillipa
Posted by desolationrower on December 21, 2008, at 13:53:20
In reply to Re: adjunctive meds to pair with paxil? » shadowmon, posted by SLS on December 21, 2008, at 6:41:33
> > Just wondering if anyone out there can help me.
> >
> > Just got back on paxil after a horrid try to switch to effexor. At the max dose 60 mg, want to talk to dr about adjunctive meds, because I don't want to get off the paxil because it seems the only thing that has some positive effect, and am totally not willing to change meds at this time.
> >
> > What do they normally pair up with paxil?
> >
> > Am definitely not willing to try wellbutrin, it's too stimulating,
>
> Have you already tried it?
>
> "They" don't normally pair up anything with Paxil. It is still a psychopharmacological jungle out there. There is often very little consensus as to what to do when trying to augment antidepressants. You might want to perform a search on the Internet for relevant material written by Stephen Stahl, MD, PhD. He is considered one of the masters of polypharmacy in psychiatric medicine. He currently likes adding Geodon to some treatment regimes. He also likes to combine SRIs with TCAs; desipramine and nortriptyline being the drugs of choice.
>
>
> I think these might be worth looking into as adjuncts to Paxil:
>
> Remeron
> lithium
> nortriptyline
> desipramine
> Provigil
> Abilify
> Geodon
> Lamictal
>
> I am not as enthusiastic as some are to add stimulants, but they can help.
>
>If bupropion and venlafaxine both seems overstimulating, i'd probably not add a tca, its likely to have a similar effect.
It depends on what problems you are facing, but if its a basic depression type symptoms, lithium would probably be a good first choice.
-d/r
Posted by SLS on December 21, 2008, at 14:31:42
In reply to Re: adjunctive meds to pair with paxil?, posted by desolationrower on December 21, 2008, at 13:53:20
Hi.
> If bupropion and venlafaxine both seems overstimulating, i'd probably not add a tca, its likely to have a similar effect.
What makes you say this?
- Scott
Posted by SLS on December 21, 2008, at 14:41:16
In reply to Re: adjunctive meds to pair with paxil? » SLS, posted by Phillipa on December 21, 2008, at 12:35:17
> Scott low benzos worked for me with paxil??? Why not benzos? Thanks Phillipa
Usually, the term "augmenter" is used to describe how one agent works to enhance the actions of another.
I know it seems like a fine line, but the term "adjunct" would better describe the role I think BZDs generally serve when combined with antidepressants. It helps relieve the overall symptomology without actually making the antidepressant work better.
I would say that Klonopin and Xanax can indeed act as true augmenters of antidepressants because of the serotonin and norepinephrine properties these drugs possess respectively.
- Scott
Posted by desolationrower on December 21, 2008, at 15:55:33
In reply to Re: adjunctive meds to pair with paxil? » desolationrower, posted by SLS on December 21, 2008, at 14:31:42
> Hi.
>
> > If bupropion and venlafaxine both seems overstimulating, i'd probably not add a tca, its likely to have a similar effect.
>
> What makes you say this?
>
>
> - ScottDo you think they wouldn't? It seems not to be an ideal choice. Even when they are sedating, they can still cause tachycardia anticholinergically.
-d/r
Posted by SLS on December 21, 2008, at 16:17:06
In reply to Re: adjunctive meds to pair with paxil?, posted by desolationrower on December 21, 2008, at 15:55:33
> > > If bupropion and venlafaxine both seems overstimulating, i'd probably not add a tca, its likely to have a similar effect.
> > What makes you say this?
> Do you think they wouldn't? It seems not to be an ideal choice. Even when they are sedating, they can still cause tachycardia anticholinergically.
I understand your concerns.As "paradoxical" as it might sound, desipramine can effectively treat anxiety. This is not a function of any sedative effects that some people may experience early in treatment. If the anxiety is secondary to, and a symptom of, the depression itself, any drug that hits the right target for the depression will improve both the depression and the anxiety simultaneously. Personally, I find nortriptyline to be more calming than desipramine. However, I have responded to desipramine robustly in the past, and my anxiety resolved along with the depression. As an aside, it is interesting that Effexor can treat generalized anxiety disorder (GAD) so well.
Desipramine can certainly produce a "wired" feeling for some people. Very often, though, this disappears.
No guarantees. Trial and error.
Believe it or not, anticholinergic drugs can have antidepressant effects, as pro-cholinergic drugs can have depressogenic effects.
- Scott
Posted by bleauberry on December 21, 2008, at 17:09:43
In reply to adjunctive meds to pair with paxil?, posted by shadowmon on December 21, 2008, at 5:40:25
These are the meds SLS suggested:
Remeron
lithium
nortriptyline
desipramine
Provigil
Abilify
Geodon
LamictalI agree with those, but would add three more to the list:
Ritalin
Adderal
ZyprexaIt would help to define what you mean by "residual" symptoms. If lack of pleasure or flatness, then Provigil or Ritalin might be first choices. If it is sleep problems, then Zyprexa. Actually, Zyprexa all around for just about anything, as long as you don't mind gaining a few pounds. Nortriptyline could also help all around.
But honestly, there is no way to predict. I just think that of all the meds out there to choose from, the ones listed are the best choices to look at. And actually, depending on the symptoms you are trying to target, it may be that three two add-on meds may be needed. One, for example, for sleep and overall; the other for daytime motivation and energy.
Posted by Phillipa on December 21, 2008, at 19:46:01
In reply to Re: adjunctive meds to pair with paxil? » Phillipa, posted by SLS on December 21, 2008, at 14:41:16
Scott so you're saying so I really get it that klonopin has serotonin xanax norepeneprine? What about valium? Love Jan
Posted by SLS on December 22, 2008, at 6:55:18
In reply to Re: adjunctive meds to pair with paxil? » SLS, posted by Phillipa on December 21, 2008, at 19:46:01
> Scott so you're saying so I really get it that klonopin has serotonin xanax norepeneprine? What about valium? Love Jan
None that I know of.
- Scott
Posted by SLS on December 22, 2008, at 7:29:15
In reply to Re: adjunctive meds to pair with paxil? » Phillipa, posted by SLS on December 21, 2008, at 14:41:16
> I would say that Klonopin and Xanax can indeed act as true augmenters of antidepressants because of the serotonin and norepinephrine properties these drugs possess respectively.
Just to add: Klonopin probably acts more often as an augmenter to antimanic agents. Before Depakote came to market, my doctor had to treat me for treatment-induced mania. Lithium barely helped. Adding Klonopin made all the difference and helped stabilize me. Perhaps there is a synergism between the serotonergic actions of both drugs. Regardless, Klonopin was chosen specifically by doctors at that time to help treat mania.
- Scott
Posted by Glydin 3.9 on December 22, 2008, at 8:14:06
In reply to Re: adjunctive meds to pair with paxil?, posted by SLS on December 22, 2008, at 6:55:18
> > Scott so you're saying so I really get it that klonopin has serotonin xanax norepeneprine? What about valium? Love Jan
>
> None that I know of.
>
>
> - Scott~~~ Thanks for that clarification.
So far as I know, benzos, as well as other head meds, don't actually contain neurotransmittors?
Posted by Phillipa on December 22, 2008, at 19:51:23
In reply to Re: adjunctive meds to pair with paxil?, posted by SLS on December 22, 2008, at 7:29:15
Any idea why klonpin caused me to feel suicidal and wasn't? Phillipa
Posted by SLS on December 23, 2008, at 6:17:16
In reply to Re: adjunctive meds to pair with paxil? » SLS, posted by Phillipa on December 22, 2008, at 19:51:23
> Any idea why klonpin caused me to feel suicidal and wasn't? Phillipa
Klonopin increases the severity of my depression when I take it. My guess is that its poorly understood serotoninergic properties result in a reduction of dopaminergic flow in mesolimbic cortex.
- Scott
Posted by desolationrower on December 23, 2008, at 10:49:16
In reply to Re: adjunctive meds to pair with paxil?, posted by SLS on December 23, 2008, at 6:17:16
Hm. I'd like to think of a reason that is parsimonious with its reputed better effects in social anxiety. Haven't had a chance to find the fulltext of that 5ht study scott pointed out (thx btw)
-d/r
Posted by Phillipa on December 23, 2008, at 19:44:45
In reply to Re: adjunctive meds to pair with paxil?, posted by SLS on December 23, 2008, at 6:17:16
Scott so I need dopamine? Love Phillipa
Posted by SLS on December 24, 2008, at 6:47:09
In reply to Re: adjunctive meds to pair with paxil? » SLS, posted by Phillipa on December 23, 2008, at 19:44:45
> Scott so I need dopamine? Love Phillipa
I try to resist explaining illness and treatment in terms of "levels" of neurotransmitter. However, that Klonopin made you feel worse is a clue as to what are your biological abnormalities. Maybe you can list what drugs you have tried, and how you reacted to them.
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.