Psycho-Babble Medication Thread 1002510

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Re: Other options besides AAP for depression?

Posted by jono_in_adelaide on November 14, 2011, at 17:10:05

In reply to Re: Other options besides AAP for depression?, posted by jono_in_adelaide on November 14, 2011, at 16:47:17

Oh, final option would be Effexor XR 150mg in the morning, and Remeron 30-45mg at bedtime

All are very good combos, that hit depression through multiple effects on different neurotransmitters, and are all well worth trying.

 

Re: Other options besides AAP for depression? Doll Face

Posted by herpills on November 14, 2011, at 17:12:59

In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19

> I've just started (actually 6 months ago) adding AAPs to Effexor to fight my depression symptoms. So far I've been on Abilify, Geodon, Latuda, and now back on Abilify. Limited if any help from any of them.
>
> I see my doc Friday and I'm wondering what other options I might discuss with him. Last I saw him he sounded optimistic about lots of AAPs I hadn't tried yet, but I'm starting to feel that class of drug is not the answer.
>
> Thanks for any input you might have.
>
> Sharon

You might think about trying Lamictal? I got a boost in mood with as little as 100mg. It doesn't have as many side effects as the AAPs... herpills

 

Re: Other options besides AAP for depression?

Posted by psychobot5000 on November 14, 2011, at 17:56:12

In reply to Re: Other options besides AAP for depression?, posted by jono_in_adelaide on November 14, 2011, at 17:10:05

> Oh, final option would be Effexor XR 150mg in the morning, and Remeron 30-45mg at bedtime
>
> All are very good combos, that hit depression through multiple effects on different neurotransmitters, and are all well worth trying.

I agree with both the options suggested by jono--those are good combinations. However, I do not agree with the use of Lamictal in unipolar depression. I have not been active in reading the research the last few years, but the last time I checked, the evidence was very much against any such use. It offers the possibility of quick improvement in first weeks, followed by a gradual return to baseline mood, and possibly below, and with the addition of any side-effects you may end up with (it's a relatively low-side-effect med for an anticonvulsant, but that's not saying all that much).

A quick check of the internet confirms that there have been no changes in the state of the research since I last checked, not for unipolar depression. Stay away. Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).

Here's a useful blog on the subject. Take note that the positive study (on bipolar, not unipolar) at the end occurred in a study that was deliberately done on a short time-scale.
http://knowledgeisnecessity.blogspot.com/2011/01/lamictal-strange-tale-of-med-with-no.html

 

Re: Other options besides AAP for depression? psychobot5000

Posted by ed_uk2010 on November 15, 2011, at 7:32:36

In reply to Re: Other options besides AAP for depression?, posted by psychobot5000 on November 14, 2011, at 17:56:12

>Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).

That's the thing about Lamictal, I'm never quite sure what it's supposed to be good for.

 

Re: Other options besides AAP for depression?

Posted by SLS on November 15, 2011, at 8:14:54

In reply to Re: Other options besides AAP for depression? psychobot5000, posted by ed_uk2010 on November 15, 2011, at 7:32:36

> >Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).
>
> That's the thing about Lamictal, I'm never quite sure what it's supposed to be good for.

Lamotrigine might be more of a potentiator of psychotropic drugs than it is a monotherapeutic agent. There is no question in my mind that it can produce robust antidepressant effects. Unfortunately, these improvements last only briefly; with the drug sometimes yielding a partial response thereafter.


- Scott

 

Re: Other options besides AAP for depression?

Posted by creepy on November 15, 2011, at 8:31:37

In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19

The AAPs all do some serotonin receptor antagonism. Not much different than trazodone / nefazodone I think.
If thats not doing it, you might want to try TCA's next.

 

Re: Other options besides AAP for depression? SLS

Posted by psychobot5000 on November 15, 2011, at 10:39:21

In reply to Re: Other options besides AAP for depression?, posted by SLS on November 15, 2011, at 8:14:54

> > >Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).
> >
> > That's the thing about Lamictal, I'm never quite sure what it's supposed to be good for.
>
> Lamotrigine might be more of a potentiator of psychotropic drugs than it is a monotherapeutic agent. There is no question in my mind that it can produce robust antidepressant effects. Unfortunately, these improvements last only briefly; with the drug sometimes yielding a partial response thereafter.
>
>
> - Scott

I agree, of course, about the rapid improvements the drug can offer, and also that they disappear. However, I think any partial response is an illusion--based largely on the fact that, when the drug is withdrawn, you temporarily do worse (until your body readjusts to the new baseline). This is based, in part, on anecdotal watching of people on message boards over the years ("It doesn't seem to help, but then I get worse if I stop, so I guess I'll keep taking it."), part on a relatively recent trial against that prozac-zyprexa combination, the only decent numbers the drug has gotten, uh...ever, in a study designed to be extra short, so that Lamictal would still be titrating and thus wouldn't work as well as the other drug...missing the point that Lamictal ONLY works when it's still being titrated upward. And of course there's my own experience. There's a danger, of course, in extrapolating too much from one experience, and I usually try to avoid that, constantly qualifying, (i.e. "as with other drugs, mileage varies, so you'll just have to try it and see if it's helpful for you.")...but, consider this:

I get a response to EVERY antidepressant and augmentor I've ever taken. MAOis, every one I've ever taken (high dose selegiline, tranylcipromine (sp?) phenelzine), tricyclics, SSRIs, all the modern atypical antidepressants, as well as atypical antipsychotics, and even stimulants in a way (though their effect is different)...the list goes on for days. Also vagal nerve stimulation and cranial electrotherapy stimulation, St John's Wort (a little). They all make my depression recede (though stimulants only in proportion to your blood-levels of the drug at any given time). If you can name it and call it an antidepressant, it works for me. Here, in contrast, is the list of every antidepressant drug EVER that offered me no net benefit:
Lamictal.

I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work. I very much doubt it works as an augmentor (for what it's worth, I've tried that, too). It does, however, offer many a transient (though very substantial!) benefit during upward titration, juxtaposed against a corresponding transient lowering of mood when the drug is discontinued or titrated downward. I think that's the entire story. Obviously, I don't know enough to be certain about that (no one does), but it all fits together pretty neatly and matches all the available evidence.

 

Re: Other options besides AAP for depression?

Posted by SLS on November 15, 2011, at 15:09:59

In reply to Re: Other options besides AAP for depression? SLS, posted by psychobot5000 on November 15, 2011, at 10:39:21

> I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.


My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.


- Scott

 

Re: Other options besides AAP for depression? SLS

Posted by psychobot5000 on November 15, 2011, at 16:03:12

In reply to Re: Other options besides AAP for depression?, posted by SLS on November 15, 2011, at 15:09:59

> > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
>
>
> My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
>
>
> - Scott

You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?

 

Re: Other options besides AAP for depression? psychobot5000

Posted by SLS on November 15, 2011, at 18:32:42

In reply to Re: Other options besides AAP for depression? SLS, posted by psychobot5000 on November 15, 2011, at 16:03:12

> > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.

> > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.

> You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?


No.

I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.


- Scott

 

Re: Other options besides AAP for depression? Doll Face

Posted by Phidippus on November 15, 2011, at 20:34:37

In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19

Lots of options. You can try augmenting with a different class of AD, such as Wellbutrin, an NDRI or perhaps a TCA, like Clomipramine (the risk of seratonin syndrome is exaggerated).

You can try stimulants, like Methylphenidate, Dextroamphetamine or Nuvigil.

You can try Tramadol, a pain drug which has been found useful in the treatment of depression. It is an opiate, so there is some risk of dependence. Tramdol is also an SNRI and NMDA antagonist.

You can try regular opiates, but they are tricky.

The last I can think of is Memantine, an NMDA antagonist. Originally created as an Alzheimer's treatment, it has been studied for the treatment of depression, anxiety, OCD, etc.

Eric

 

Re: Other options besides AAP for depression? SLS

Posted by Bob on November 15, 2011, at 20:42:40

In reply to Re: Other options besides AAP for depression? psychobot5000, posted by SLS on November 15, 2011, at 18:32:42

> > > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
>
> > > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
>
> > You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
>
>
> No.
>
> I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.
>
>
> - Scott


Scott, do you still have Abilify on board?

Bob

 

Re: Other options besides AAP for depression? SLS

Posted by psychobot5000 on November 15, 2011, at 20:54:12

In reply to Re: Other options besides AAP for depression? psychobot5000, posted by SLS on November 15, 2011, at 18:32:42

> > > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
>
> > > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
>
> > You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
>
>
> No.
>
> I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.
>
>
> - Scott

I suppose there's no reason there couldn't be a niche where the med is useful. Best of luck in maintaining a regimen that works for you.
-PB

 

Re: Other options besides AAP for depression? Bob

Posted by SLS on November 15, 2011, at 20:55:48

In reply to Re: Other options besides AAP for depression? SLS, posted by Bob on November 15, 2011, at 20:42:40

Hi Bob.

> Scott, do you still have Abilify on board?

Yes. I'm still at 10 mg.

Currently:

Pristiq 100 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg


- Scott

 

Re: Other options besides AAP for depression?

Posted by SLS on November 15, 2011, at 20:56:47

In reply to Re: Other options besides AAP for depression? SLS, posted by psychobot5000 on November 15, 2011, at 20:54:12

> > > > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
> >
> > > > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
> >
> > > You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
> >
> >
> > No.
> >
> > I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.
> >
> >
> > - Scott
>
> I suppose there's no reason there couldn't be a niche where the med is useful. Best of luck in maintaining a regimen that works for you.

I gotta find one that works first.

:-(


- Scott

 

Re: Other options besides AAP for depression?

Posted by Zyprexa on November 16, 2011, at 6:26:01

In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19

Usualy they use SSRIs for depression. Thats about all they do, even though sometimes they think it can help with anxiety but they don't for me. I would suggest Celexa for depression, it worked realy well when I started taking it. I brought me out of sad wanting to cry all the time. I'm not sure but the brand celexa might work better. Currently I take zoloft. Not sure if I need an AD anymore.

 

Re: Other options besides AAP for depression? SLS

Posted by Phillipa on November 16, 2011, at 18:26:58

In reply to Re: Other options besides AAP for depression?, posted by SLS on November 15, 2011, at 20:56:47

Scott any improvement from pristiq? Phillipa

 

Re: Other options besides AAP for depression? gadchik

Posted by sleepygirl2 on November 16, 2011, at 21:14:56

In reply to Re: Other options besides AAP for depression? Phillipa, posted by gadchik on November 14, 2011, at 10:13:32

Hey,
If you don't mind, can you describe some of the psychotic symptoms that went with your depression? It would be helpful to me.
Thanks,
sleepy

 

Re: Other options besides AAP for depression? sleepygirl2

Posted by gadchik on November 17, 2011, at 9:32:57

In reply to Re: Other options besides AAP for depression? gadchik, posted by sleepygirl2 on November 16, 2011, at 21:14:56

The psychotic symptoms came after I stopped sleeping & eating.I thought I had an x in my tongue and i would look at it in the mirror,and think I was marked by the devil,also thought the mirror moved everytime i looked in it. I thought my stomach was disconnected from my intestines and kept going to the er wanting xrays.I was sure that if i ate or took any pills i would die.I got obsessed w/owls.Thought if I looked one in the eye,whether real or in a picture,I would die.I had loud music blaring in my head all night long,and felt as if bugs were crawling up & down my legs.I really felt doomed and often thought of walking into the dead of night,laying down in the woods and dying by freezing to death.I was pretty bad off.I would hear some evil voice saying bad things to me.I was afraid of water too,I thought I would die if I took a bath.Didnt wash my hair for 4 months,now I think,yuk.I almost got put into the psych ward.I came back from all that,cant believe it and I am so grateful to feel good again.

 

Re: Other options besides AAP for depression? gadchik

Posted by ed_uk2010 on November 17, 2011, at 11:46:22

In reply to Re: Other options besides AAP for depression? sleepygirl2, posted by gadchik on November 17, 2011, at 9:32:57

> The psychotic symptoms came after I stopped sleeping & eating.I thought I had an x in my tongue and i would look at it in the mirror,and think I was marked by the devil,also thought the mirror moved everytime i looked in it. I thought my stomach was disconnected from my intestines and kept going to the er wanting xrays.I was sure that if i ate or took any pills i would die.I got obsessed w/owls.Thought if I looked one in the eye,whether real or in a picture,I would die.I had loud music blaring in my head all night long,and felt as if bugs were crawling up & down my legs.I really felt doomed and often thought of walking into the dead of night,laying down in the woods and dying by freezing to death.I was pretty bad off.I would hear some evil voice saying bad things to me.I was afraid of water too,I thought I would die if I took a bath.Didnt wash my hair for 4 months,now I think,yuk.I almost got put into the psych ward.I came back from all that,cant believe it and I am so grateful to feel good again.

Gadchik, thanks for posting your experience. What brought you out of this awful psychotic depression?

 

Re: Other options besides AAP for depression? gadchik

Posted by sleepygirl2 on November 17, 2011, at 12:11:37

In reply to Re: Other options besides AAP for depression? sleepygirl2, posted by gadchik on November 17, 2011, at 9:32:57

Thanks for sharing that. Were you on any meds at the time?

 

Re: Other options besides AAP for depression? ed_uk2010

Posted by gadchik on November 17, 2011, at 12:13:45

In reply to Re: Other options besides AAP for depression? gadchik, posted by ed_uk2010 on November 17, 2011, at 11:46:22

It was a slow process.I felt like a half crushed insect,left to suffer.My husband kept telling me that when spring came,I would heal.I held onto his statement.It was after a pdoc was summoned to er room,and she told my husband i would die w/o treatment,and he was crying for me to take meds,they gave me an ativan injection.I slept,hadnt slept in a month.I went home,started to sleep,took crumbs of ativan,saw that i wouldnt die,so i tasted a strawberry.I relished the flavor,noticed the deep color.I prayed for sanity.I dreamed in brilliant colors,beautiful sunny days,green grass.In my dream I would run up to people and tell them i was well.I decided to start walking again,outside in the sun.Spring was arriving,and i came alive,ate very healthy,started to see a pdoc and therapist.I took the zoloft,remeron,and klonopin.Very gradually,my mind came back to me.At the beginning,when I knew I was headed for a breakdown,I had a dream.It was a hummingbird w/its wings glued to a white plate,and its eyes were the saddest ive seen.this was this last dream i had for months.After that dream,I seemed to give in to the downward spiral,and just let myself fall.Never again.

 

Re: Other options besides AAP for depression? gadchik

Posted by ed_uk2010 on November 17, 2011, at 12:31:09

In reply to Re: Other options besides AAP for depression? ed_uk2010, posted by gadchik on November 17, 2011, at 12:13:45

Gadchik, do you think that not being able to sleep was what brought on the psychotic symptoms?


 

Re: Other options besides AAP for depression? ed_uk2010

Posted by gadchik on November 17, 2011, at 12:59:58

In reply to Re: Other options besides AAP for depression? gadchik, posted by ed_uk2010 on November 17, 2011, at 12:31:09

It was no sleep to the extreme,and no food.I think combined w/extreme anxiety,all that contributed to me losing it.When they torture people by keeping them from sleeping,the person will get psychotic.I was my torturer,my brain was.

 

Re: Other options besides AAP for depression? gadchik

Posted by ed_uk2010 on November 17, 2011, at 14:17:43

In reply to Re: Other options besides AAP for depression? ed_uk2010, posted by gadchik on November 17, 2011, at 12:59:58

> It was no sleep to the extreme,and no food.I think combined w/extreme anxiety,all that contributed to me losing it.When they torture people by keeping them from sleeping,the person will get psychotic.I was my torturer,my brain was.

I see, so you didn't need an antipsychotic to get better, you needed to sleep?


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