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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Meltingpot on March 25, 2009, at 14:00:00
Hi,
Anybody ever suddenly had a response to an Antidepressant after 4 weeks. IF so, on which drug and at what dosage.
I've been on this Anafranil now for almost a month and I don't feel as though it is helping me that much but the private psychiatrist I saw said I should give it at least 6 to 8 weeks before knowing for sure.
I know that this is the general rule but I've never had a response to an antidepressant after 3 weeks so I'm feeling very optimistic.
The Zyprexa is helping with the anxiety but so far I'm feeling apathetic, weepy, worried and morbid. It's spring here in the uk and yet it feels like winter to me, everything seems bleak.
Denise
Posted by Phillipa on March 25, 2009, at 14:16:05
In reply to Anyone ever had a response to AD after 4 weeks?, posted by Meltingpot on March 25, 2009, at 14:00:00
Hi Denise sorry so far no relief. I know a lot do have responses after four weeks. Do you feel nothing good at all? Shoot I'd say try two more weeks. Not that I take my own advise. Love Phillipa
Posted by myco on March 25, 2009, at 19:17:38
In reply to Anyone ever had a response to AD after 4 weeks?, posted by Meltingpot on March 25, 2009, at 14:00:00
It took me exactly 4 weeks on Nardil (a MAOI) to experience my first good response. This response, still at a low dose, went away - lost efficacy, after a couple weeks causing me to up the dose...in the end it took a total of 8 weeks (2 months) to get a stable constant good response to nardil. A long time I know...so anyone out there thinking about bailing on a med...make sure you do allow proper+++ time before you move on (if you can). It just may be worth it.
myco
> Hi,
>
> Anybody ever suddenly had a response to an Antidepressant after 4 weeks. IF so, on which drug and at what dosage.
>
> I've been on this Anafranil now for almost a month and I don't feel as though it is helping me that much but the private psychiatrist I saw said I should give it at least 6 to 8 weeks before knowing for sure.
>
> I know that this is the general rule but I've never had a response to an antidepressant after 3 weeks so I'm feeling very optimistic.
>
> The Zyprexa is helping with the anxiety but so far I'm feeling apathetic, weepy, worried and morbid. It's spring here in the uk and yet it feels like winter to me, everything seems bleak.
>
>
> Denise
Posted by myco on March 25, 2009, at 19:20:16
In reply to Re: Anyone ever had a response to AD after 4 weeks? » Meltingpot, posted by myco on March 25, 2009, at 19:17:38
Ah, sorry forgot dosage. 45mg - 2 weeks; 60mg 5 weeks (2 weeks into 60mg first response noted); 75mg 2 weeks (I remain here with good sustained response)
> It took me exactly 4 weeks on Nardil (a MAOI) to experience my first good response. This response, still at a low dose, went away - lost efficacy, after a couple weeks causing me to up the dose...in the end it took a total of 8 weeks (2 months) to get a stable constant good response to nardil. A long time I know...so anyone out there thinking about bailing on a med...make sure you do allow proper+++ time before you move on (if you can). It just may be worth it.
>
> myco
>
>
>
> > Hi,
> >
> > Anybody ever suddenly had a response to an Antidepressant after 4 weeks. IF so, on which drug and at what dosage.
> >
> > I've been on this Anafranil now for almost a month and I don't feel as though it is helping me that much but the private psychiatrist I saw said I should give it at least 6 to 8 weeks before knowing for sure.
> >
> > I know that this is the general rule but I've never had a response to an antidepressant after 3 weeks so I'm feeling very optimistic.
> >
> > The Zyprexa is helping with the anxiety but so far I'm feeling apathetic, weepy, worried and morbid. It's spring here in the uk and yet it feels like winter to me, everything seems bleak.
> >
> >
> > Denise
>
>
Posted by yxibow on March 25, 2009, at 19:27:20
In reply to Anyone ever had a response to AD after 4 weeks?, posted by Meltingpot on March 25, 2009, at 14:00:00
> Hi,
>
> Anybody ever suddenly had a response to an Antidepressant after 4 weeks. IF so, on which drug and at what dosage.
>
> I've been on this Anafranil now for almost a month and I don't feel as though it is helping me that much but the private psychiatrist I saw said I should give it at least 6 to 8 weeks before knowing for sure.
>
> I know that this is the general rule but I've never had a response to an antidepressant after 3 weeks so I'm feeling very optimistic.
>
> The Zyprexa is helping with the anxiety but so far I'm feeling apathetic, weepy, worried and morbid. It's spring here in the uk and yet it feels like winter to me, everything seems bleak.
>
>
> DeniseI would say that there are some responses to SRI/SSRIs after a month, but the general rule for a trial of an SSRI is 12 weeks for full results.
There are other psychological factors which could be making things feel bleak, those I can't say, only a psychologist could tell you.
But if it isn't producing some results after a month and you haven't been through the gamut of SSRIs and you are feeling more than apathy but serious symptoms such as suicidal thoughts, it could be a time to try something else such as Celexa or the like if you haven't already.
Also, while Anafranil can be a potent antidepressant, it also has side effects just like other TCAs, which does include sedation.
-- best wishes
- Jay
Posted by Meltingpot on March 26, 2009, at 12:18:07
In reply to Re: Anyone ever had a response to AD after 4 weeks? » Meltingpot, posted by Phillipa on March 25, 2009, at 14:16:05
Thanks Phillipa :-)
Posted by Meltingpot on March 26, 2009, at 12:19:40
In reply to Re: Anyone ever had a response to AD after 4 weeks? » myco, posted by myco on March 25, 2009, at 19:20:16
.
Posted by Meltingpot on March 26, 2009, at 12:27:31
In reply to Re: Anyone ever had a response to AD after 4 weeks? » Meltingpot, posted by yxibow on March 25, 2009, at 19:27:20
Hi Jay,
Over the last 7 years I've been through the many types of antidepressants.
In 2001 to 2003 - I tried Effexor, Remeron, Seroxat, Prozac, Prothiaden, Lamictal, Lithium, Zooloft, Celexa, tegretol, Nardil and Zyprexa now and again.
2003 I responded to Seroxat at 40mg but response only lasted for two years before it seemed to lose affect in 2005. I also tried rTMS. Since then I've tried adding Buspar, T3 hormone, lamictal and Mirtazapine to the Seroxat with no joy.
Just over a year ago I was put on lexapro which did seem to help a little but even that stopped working last November and since then I've been having a lot of terrible anxiety and suicidal thoughts. The zyprexa does help with the anxiety but I'm still feeling depressed. i.e. lack of joy or looking forward to anything.
As far as I am aware there aren't any circumstantial reasons for my being depressed (I tried therapy), I have no major stresses in my life.
Thanks for getting back to me.
Denise
Posted by SLS on March 26, 2009, at 15:26:51
In reply to Anyone ever had a response to AD after 4 weeks?, posted by Meltingpot on March 25, 2009, at 14:00:00
> Hi,
>
> Anybody ever suddenly had a response to an Antidepressant after 4 weeks. IF so, on which drug and at what dosage.
>
> I've been on this Anafranil now for almost a month and I don't feel as though it is helping me that much but the private psychiatrist I saw said I should give it at least 6 to 8 weeks before knowing for sure.Good rule of thumb.
For as many drugs as you have tried and failed, it seems to me that you have no better investment of your time but to give these drugs every chance of working. Remember, you have to be at your unique therapeutic dosage for 3-4 weeks before you can expect results. You have to consider that it may take weeks to reach that dosage.
Did you experience a brief "blip" improvement during the first week?
- Scott
Posted by desolationrower on March 27, 2009, at 3:14:48
In reply to Re: Anyone ever had a response to AD after 4 weeks? » Meltingpot, posted by SLS on March 26, 2009, at 15:26:51
I think, if you are the sort who don't have a lot of daily ups and downs to complicate things, 2-3 weeks at sufficient dose (so either getting serious side effects that aren't typically transiet with said medication, or up to high end of dosage range) is enough to know if a med will work for you. this isn't necessarily the full effect, but if it isn't doing anything, its not going to, or it will end up doing a tiny amount. I don't think response just pops into being after 5 weeks. It probably helps to have a partner or parent or older child or close friend give their feedback on if med is making improvement. I think most of 'delayed response' is just people who can't tell very well what mood is from events, and waht mood from drug (which, for most situations in life, is a very worthless skill, so its not really something to think you can do if you can't)
-d/r
Posted by Meltingpot on March 30, 2009, at 8:17:43
In reply to Re: Anyone ever had a response to AD after 4 weeks? » Meltingpot, posted by SLS on March 26, 2009, at 15:26:51
Hi Scott,
I'm not sure about there being a blip improvement the first week. I think any med gives some improvement (the first week) when compared to no meds. On no meds, I feel totally empty, flat, weak, anxious etc.
I know I had a lot of anxiety during the day and then the usual slight improvement in mood in the evening.
I'm now at week five on 100mg. I can tell I'm still not right because when I'm ok I actually take a bit of care about what I'm going to wear in the morning but the lower I am putting something nice on is too much hassle. I don't have any motivation at all and am feeling anxious and guilty about the fact that I have no motivation. The only good thing is I'm sleeping and I have more energy than when unmedicated.
I'm still having sucidal thoughts still (although I try to push them out of my mind and tell myself it's not an option, it kind of feels like the most rationale thing to do). It's just that I've spent 8 years fighting this thing (whatever it is), I had two good years on Seroxat 40mg between 2003 and 2005 and since then I feel like I'm just getting worst and becomming more resistent. I don't think there is a drug I haven't tried which makes me feel more hopeless. I was thinking ECT but then I've been told ECT doesn't work for my kind of depression and then I also see Bleuberry's comment about people relapsing from it after a month. Just seems so hopeless right now.I do have the Zyprexa which does still help a bit but it only works for me if I take 10mg every five days. Is this ok to do? I'm so scared that I might unintentionally do something to stop even that drug from helping as this drug is priceless to me. If I take 10mg every day then I feel too spaced out all the time and lower doses taken regularly don't seem to help that much right now.
I've tried Nardil about three times in the past (only for a month) and although it seemed to help the anxiety, again I still didn't feel like it was doing that much for depression. I still didn't feel like I was enjoying life on it. When the Seroxat worked I actually felt like I was enjoying life again, I started going out socialising and even started having piano lessons and went on holiday. Then it went and pooped out.
Would Parnate or Ensam help me if Nardil didn't? I was even thinking about perhaps trying the combination you are on but I know you suffer from Bipolar and I don't.
I intend giving this clomipramine a good eight weeks but I just have this feeling I'll go back after the eight weeks is up (in about four weeks time) and she will just increase the dose as you can go up to 250mg. Therefore, I feel as though I should start doing it myself before I go to see her.
Denise
Posted by SLS on March 30, 2009, at 8:40:44
In reply to To Scott, posted by Meltingpot on March 30, 2009, at 8:17:43
You certainly deserve more out of life than what you are currently given. Whenever I read your posts, I become frustrated that I can't do something more constructive to help you.
Yes, I do feel you are wasting too much time at lower dosages. As my own personal rule of thumb, you should give each dosage increase 3 weeks to begin working. I don't think it makes much sense to go past that.
As for suicide - whatever mental gymnastics you employ to prevent it earns a gold medal.
Nardil: 75-90mg for at least 5 weeks if tolerated.
Parnate: Yes, there are people whom respond to Parnate whom do not respond to Nardil, and vice-versa. 60-80 for 3-4 weeks if tolerated.
Adding a tricyclic to an MAOI: I seem to be the only one posting who is currently taking such a combination.
You might want to come off of clomipramine for at least a week before beginning an MAOI. Supposedly, it is safer to add an MAOI to an ongoing treatment of a tricyclic than the other way around. Better still is to begin both drugs simultaneously and increase the dosages gradually. I would choose either desipramine or nortriptyline as the adjunct medication. For you, probably nortriptyline with its 5-HT2a receptor antagonism would be the better first choice. This is a property that Zyprexa and nortriptyline have in common.
ECT: There is almost never a long-term remission. Maintenance treatments are usually necessary. One treatment per month seems to be common.
I wish I could do more.
- Scott
Posted by Meltingpot on March 30, 2009, at 12:59:25
In reply to Re: To Scott, posted by SLS on March 30, 2009, at 8:40:44
Hi Scott,
Thanks for responding and the kind words. Re the Nortryptaline antagonising 5HT2A receptors, I've tried Mirtazapine in the past and didn't respond to it so wouldn't this rule out Nortryptaline?
If ECT worked I'd be prepared to do it once a month without a shadow of a doubt.
Zyprexa has always been a life saver for me, why do you think it helps so many people with suicidal thoughts? I dread to think what I'd do if it ever stopped helping me but I'd love to know what it does that helps.
With your history of depression, what kept you going??? Also, what does each drug that you are on give you in isolation? i.e. What would the MAOI do for you on it's own?
Do you have any theories on why medication poops out. I'd love to know why the Seroxat stopped working after two years. Do you have a back up plan should the combination of drugs you are on stop working (God Forbid)?
One other thing. A while back I brought up the subject of Deep Brain Stimulation for depression and I remember you saying that you had heard that there had been complications with Deep Brain Stimulation, can you elaborate?
Denise
Posted by SLS on April 3, 2009, at 9:18:45
In reply to Re: To Scott, posted by Meltingpot on March 30, 2009, at 12:59:25
> Thanks for responding and the kind words. Re the Nortryptaline antagonising 5HT2A receptors, I've tried Mirtazapine in the past and didn't respond to it so wouldn't this rule out Nortryptaline?
They are two radically different drugs in the way they potentiate NE neurotransmission.
> If ECT worked I'd be prepared to do it once a month without a shadow of a doubt.
Yes. I would probably do it too.
> Zyprexa has always been a life saver for me, why do you think it helps so many people with suicidal thoughts?
It is sometimes overlooked that Zyprexa also binds to 5-HT2c receptors, which might increase DA and NE activity in the prefrontal cortex. Perhaps its antagonizing D4 receptors is also helpful.
> I dread to think what I'd do if it ever stopped helping me but I'd love to know what it does that helps.
I guess it would give clues as to how else to attack the depression.
> With your history of depression, what kept you going???
Death was illogical.
> Also, what does each drug that you are on give you in isolation?
- Parnate: Partial antidepressant response beginning on day 13 and ending by day 17.
- TCA: Complete remission antidepressant response beginning on day 13 and ending by the end of the third week.
- Lamictal: Typical early partial improvement at low dosages which disappears quickly. Stable partial improvement at 200mg.
- Abilify: A slight increase in mental energy and motivation.
> Do you have any theories on why medication poops out.
I really don't. Perhaps there is a disturbance in the system that allows for a change in second messenger cacades / gene function that serves to reduce the number of membrane-bound G-protein coupled 5-HT postsynaptic receptors. Over-downregulation.
> I'd love to know why the Seroxat stopped working after two years. Do you have a back up plan should the combination of drugs you are on stop working (God Forbid)?
No, not if it were to completely stop working. Add Topamax. Add Namenda.
I will be interested to see how people respond to agomelatine. Vilazodone might be an interesting drug for you if it ever becomes available. It is a 5-HT reuptake inhibitor and 5-HT1a partial agonist. It would be something like adding buspirone to paroxetine, only without the DA antagonism.> One other thing. A while back I brought up the subject of Deep Brain Stimulation for depression and I remember you saying that you had heard that there had been complications with Deep Brain Stimulation, can you elaborate?
I really don't recall having said that. I would wait for scientists to better locate the area(s) in the brain unique to each individual that produces the optimal focus of stimulation (which actually serves to interfere with neurotransmission).
- Scott
Posted by Meltingpot on April 4, 2009, at 13:35:07
In reply to Re: To Scott » Meltingpot, posted by SLS on April 3, 2009, at 9:18:45
Hi Scott,
Sorry I won't drag this out for too long. Thanks for your responses. It's good that you actually responded to both the MAOI and the tryciclic even just for a short while, so the two together produce a complete remission then?? What do you class as a partial response?
I'm confused about how antagonising 5HT2A receptors would potentiate NE Transmission bout would like to understand can you explain??
Also, I've already tried adding Buspar to Seroxat and it didn't work, in what way would you think Agomelatine might be more effective? I don't understand what you mean about the DA Antagonisim???
Why is death illogical. I mean I understand in the sense that the aim is to feel better and killing myself is not going to achieve this :-) but to me sometimes it seems the most logical thing to do. I'm not enjoying anything, not looking forward to anything, can't get motivated and feel constantly anxious and I don't even know why.
When I first came to this board (when my depression and anxiety came back to greet me like a long lost enemy) in 2001 IF was feeling suicidal then for two years. What kept me going for the first two years was a) the fact that I had a good job that I wanted to hang on to, b) this board and the people on it and the fact that there was so many drugs I hadn't yet tried and c) I had Zyprexa for when the anxiety became too bad.
Now I'm 8 years down the road, I no longer have the good job to hang on to and to distract me, The SSRIs seemed to have completely pooped out on me as for the first time in a long time I'm feeling suicidal on them which worries me greatly, the Zyprexa is only helping with the anxiety and not really the suicidal thoughts anymore and I have tried most of the different drugs out there to no avail.
I know that you have had a long struggle with this illness so can you give me some advise on how I can actively fight this thing and not give up. I am feeling a lot less hopeful than I did 8 years ago. I'm desperate for somebody to tell me that there is still hope (might sound melodramatic) and that there are still things I can try.
I've been feeling sucidial every day for months and I don't know why. I was trying to figure out what actually changed since last November when the lexapro ceased to work anymore and what has changed is I have less motivation. I feel very apathetic about everything almost as if I'm preparing to die. It's horrible and I'm scared.
Denise
Posted by desolationrower on April 4, 2009, at 23:08:53
In reply to Re: To Scott, posted by Meltingpot on April 4, 2009, at 13:35:07
:( that sounds quite rough. what job did you have before?
if you are having growing suicidal thoughts, i'd recommend starting on lithium, as it (and zyprexa) is one of the most effective drugs for that.
I'm sure there are more drugs/combinations you haven't tried. was there a thread with more of your history?, i'll try to give some ideas if you want. the biggest challenge might be just getting hold of the drugs, as my understand is british psychiatrists are quite stingy.
-d/r
Posted by Meltingpot on April 5, 2009, at 7:21:44
In reply to Re: To Scott » Meltingpot, posted by desolationrower on April 4, 2009, at 23:08:53
Hi,
I used to be an implementation Manager at IBM in ebusiness hosting, my depression started about 2 years before I was made redundant though. I have had a lot of other jobs since then.
I'm really worried that my depression might have become more resistant.
Back in my twenties antidepressants worked really well for me, it didn't matter which AD they just seemed to work very well and very quickly.
Then when I hit 35, I started having major problems with depression and anxiety and suicidal thoughts again.
Between 2001 and 2003 I tried Seroxat, Zooloft, Mirtazapine, lithium, lamictal, tegretol, Nardil effexor, prozac and prothiaden and I think there might have been others in there.
Then in 2003 the Psychiatrist put me on 40mg of Seroxat and I started to feel better again :-) . Then in 2005 the Seroxat seemed to stop being so effective, in that I seemed to stop enjoying things as much but even then I didn't feel as bad as I had back in 2001.
The psychiatrist tried adding buspar, lithium, T3 to the Seroxat to no avail, even so I was still not suicidal during this time.
Then I did a switch from Seroxat to lexapro and the lexapro seemed to start helping a bit, in that I felt stronger and more motivated (still had problems with anxiety though but bearable).
Last year, I felt the lexapro stopped working, in that anxiety and lack of motivation came back, I tried switching back to Seroxat but still no joy. Since November of last year I've been having a lot of suicidal ideations. I hate being this way.
Zyprexa seems to help with the anxiety still but I'm still feeling very apathetic. Nothing has worked as well as Seroxat did back in 2003, I actually started to feel like I was actually living a life again, you know having relationships, going out socialising, going on holiday etc and then 2005 all that went away.
Just need some encouragement right now as I'm starting to feel very despondent. I'm feeling very negative and need some hope that things will get better.
I'd try ECT but I feel negative about even that working.
Thanks....Denise
Posted by Phillipa on April 5, 2009, at 18:49:11
In reply to To d/r, posted by Meltingpot on April 5, 2009, at 7:21:44
Denise I'm so sorry. Yes that's a lot of meds. Love Phillipa
Posted by desolationrower on April 5, 2009, at 23:06:31
In reply to Re: To d/r » Meltingpot, posted by Phillipa on April 5, 2009, at 18:49:11
sounds like you've never tried a TCA. I would do that right away, although also think about lithium too since you're struggling with feelings of suicide. tcas (preferably desipramine, nortryptaline, protryptaline; they've much less side effects) are quite good for the apathy end of depression. you've responded well in the past i'm sure you'll be able to get out of this spell too.
-d/r
Posted by Meltingpot on April 6, 2009, at 10:21:31
In reply to Re: To d/r, posted by desolationrower on April 5, 2009, at 23:06:31
d/r,
Thanks I hope I can. I am currently trying out a tricyclic clomipramine and so far I don't think it's helping much.
I'm really hoping the psychiatrist might have some idea on what I should do when I go to see her next.
Denise
Posted by Meltingpot on April 7, 2009, at 7:11:59
In reply to Re: To Scott » Meltingpot, posted by SLS on April 3, 2009, at 9:18:45
Scott,
Sorry I just saw your message on the "Social" board, I don't participate on there at the moment because I'm feeling anti-social to say the least :-)
Sorry to hear about your grandmother and I'm sorry to see that you are not feeling good yourself. For some reason I had it in my mind that you were in full remission on the combination you are on, hence my asking you all of the questions. In fact I'm sure a previous post of yours said that you were in remission so I'm confused now.
Anyway, thanks for all of your suggestions.
Denise
Posted by SLS on April 7, 2009, at 13:13:47
In reply to Re: To Scott, posted by Meltingpot on April 7, 2009, at 7:11:59
I had plateaued on my previous treatment, which included Nardil and nortriptyline. Eventually, I lost some of my initial improvement. At some point, I decided to swap Parnate for Nardil. Parnate allowed me to feel brighter and become more functional, but I was looking for a greater improvement in cognitive function and memory. Instead of waiting to see how far this combination would take me, I chose to swap desipramine for nortriptyline in an effort to accomplish this. I responded very nicely early in the trial, but gradually lost this improvement and later began to deteriorate. Parnate and desipramine were old friends. Together, they produced a full remission in 1987. It is hard to forget such things. It is hard not to want such things returned once they have been stolen. I would like to feel 100%, but I will settle for less if it means functionality and stability.
I first need to see how my current treatment will take me. I can then judge how aggressively to treat the residual depression, should there be any.
I remain hopeful of achieving a full remission again, but I am prepared to use all of what God gives me to work with to build a happy life in the meantime.
- Scott
This is the end of the thread.
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