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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 Velthir on January 20, 2012, at 9:02:54
Hi all,
Currently starting to run out of med ideas due to the fact that anything that touches serotonin seems to cause me weird issues after a while.
Quick history:
Current diagnoses: Dysthymia/atypical depression/treatment resistant recurrent depressionMeds:
Citalopram (Celexa) - Emotional numbness, no real help with depression. After being on 30mg for about a month it turned me completely nocturnal. Couldn't sleep during the night at all, even having been awake for >24 hours and not having consumed caffeine. Could sleep fine during the day though. Got some irritibility. GP raised me to 40mg to see if it would help, then started getting horrible headaches, nausea, dizziness until I dropped dose.Duloxetine (Cymbalta) - 60mg did nothing for a month aside from make me tired, then helped incredibly well for two weeks (pretty much complete remission). It then pooped out and made me nocturnal. Tried Zopiclone up to 15mg for night-time insomnia, didn't work. Also tried raising med up to 90mg, got dizzines/nausea/headaches/diarreah/disorientation.
Tried a bunch of other meds: Lofepramine (tachycardia), Valdoxan/Agomelatine (allergic), Reboxetine (seemed to work fairly well and pretty quickly, but bad insomnia, even when combined with Remeron), Remeron alone (way too sedating, only helped depression for a few days at each dose increase), Nortriptyline (great for sleep, not too sedating, worked okay for a while then pooped out), Zoloft (wasn't on it long enough to tell, psychiatrist took me off it since he didn't lik the Nortriptyline + Zoloft combo), Abilify (Worked well, caused bad insomnia)
Moclobemide - 300mg helped a bit, gave me some insomnia/urination issues which I'm taking 50mg Promethazine nightly for. Went up to 450mg, felt fairly good. Promethazine was helping for sleep. After a month or so at 450mg, I've been shoved nocturnal again. Tired/sleepy all day, start to wake up as the day goes on. By the evening, I'm very awake. Even when I do manage to get to sleep through a combination of meds and extreme tiredness I don't sleep well, wake up often, feel sleepy during the day. Also been fairly irritable since it started, but I'm not sure if this is just due to not sleeping or something else.
Interestingly right now I seem to feel better during the day the less I sleep/try to sleep at night. On the nights I manage to get some sleep I tend to feel sleepy/depressed/etc. On the nights I don't really sleep, I tend to feel good for no reason during the next day and feel like I have more energy even though I'm physically exhausted.
Could really use some ideas on potential meds I could try next, or ideally if anyone else has reacted strangely to serotonin meds and found something that works. Wellbutrin would probably be the obvious choice, but that isn't approved for depression in England and my psych doesn't want to prescribe it off-license.
Not sure on Imipramine due to my reaction to Lofepramine/the fact that it hits serotonin a reasonable amount (and my psych isn't fond of tricyclics)
Lamictal would be interesting, but is a second line med here for bipolar, not normally an option for depression.
Thanks
Posted by creepy on January 20, 2012, at 15:31:12
In reply to Weirdness with serotonin meds, out of ideas, posted by Velthir on January 20, 2012, at 9:02:54
desipramine was a good NRI drug for me. Might be worth a try.
wellbutrin pooped out on me pretty quickly. Ive done several trials all ended the same.
You might give something like nefazadone a shot if you can get it there. If you responded to abilify thats a good sign that serotonin receptor antagonism might help your depression. The dopamine antagonism can cause akathisia, wonder if you had that? It has a reputation for being pretty activating.
I tried hydroxyzine and prazosin for sleep. Did okay on them. Key is their short half-lives so youre not groggy in the AM.
MAOIs seem to be notorious for sleep issues.Ive done a couple sleep 'resets' where I stay up all night and go to sleep at 9 or 10pm. Then I get on a schedule of waking at 6am or so. That is, until I stay up too late again. =(
Posted by polarbear206 on January 20, 2012, at 21:38:46
In reply to Weirdness with serotonin meds, out of ideas, posted by Velthir on January 20, 2012, at 9:02:54
> Hi all,
>
> Currently starting to run out of med ideas due to the fact that anything that touches serotonin seems to cause me weird issues after a while.
>
> Quick history:
> Current diagnoses: Dysthymia/atypical depression/treatment resistant recurrent depression
>
> Meds:
> Citalopram (Celexa) - Emotional numbness, no real help with depression. After being on 30mg for about a month it turned me completely nocturnal. Couldn't sleep during the night at all, even having been awake for >24 hours and not having consumed caffeine. Could sleep fine during u day though. Got some irritibility. GP raised me to 40mg to see if it would help, then started getting horrible headaches, nausea, dizziness until I dropped dose.
>
> Duloxetine (Cymbalta) - 60mg did nothing for a month aside from make me tired, then helped incredibly well for two weeks (pretty much complete remission). It then pooped out and made me nocturnal. Tried Zopiclone up to 15mg for night-time insomnia, didn't work. Also tried raising med up to 90mg, got dizzines/nausea/headaches/diarreah/disorientation.
>
> Tried a bunch of other meds: Lofepramine (tachycardia), Valdoxan/Agomelatine (allergic), Reboxetine (seemed to work fairly well and pretty quickly, but bad insomnia, even when combined with Remeron), Remeron alone (way too sedating, only helped depression for a few days at each dose increase), Nortriptyline (great for sleep, not too sedating, worked okay for a while then pooped out), Zoloft (wasn't on it long enough to tell, psychiatrist took me off it since he didn't lik the Nortriptyline + Zoloft combo), Abilify (Worked well, caused bad insomnia)
>
> Moclobemide - 300mg helped a bit, gave me some insomnia/urination issues which I'm taking 50mg Promethazine nightly for. Went up to 450mg, felt fairly good. Promethazine was helping for sleep. After a month or so at 450mg, I've been shoved nocturnal again. Tired/sleepy all day, start to wake up as the day goes on. By the evening, I'm very awake. Even when I do manage to get to sleep through a combination of meds and extreme tiredness I don't sleep well, wake up often, feel sleepy during the day. Also been fairly irritable since it started, but I'm not sure if this is just due to not sleeping or something else.
>
> Interestingly right now I seem to feel better during the day the less I sleep/try to sleep at night. On the nights I manage to get some sleep I tend to feel sleepy/depressed/etc. On the nights I don't really sleep, I tend to feel good for no reason during the next day and feel like I have more energy even though I'm physically exhausted.
>
> Could really use some ideas on potential meds I could try next, or ideally if anyone else has reacted strangely to serotonin meds and found something that works. Wellbutrin would probably be the obvious choice, but that isn't approved for depression in England and my psych doesn't want to prescribe it off-license.
>
> Not sure on Imipramine due to my reaction to Lofepramine/the fact that it hits serotonin a reasonable amount (and my psych isn't fond of tricyclics)
>
> Lamictal would be interesting, but is a second line med here for bipolar, not normally an option for depression.
>
> Thanks
You need a mood stabalizer to augment your AD. Lamictal would be a good choice. Been in the same scenerio as you. Go to psycheducation.org for more info on affective disorders.
Posted by papillon on January 21, 2012, at 9:17:48
In reply to Re: Weirdness with serotonin meds, out of ideas, posted by polarbear206 on January 20, 2012, at 21:38:46
Ever had a sleep study?
Undiagnosed sleep disorders can contribute to depression, and since your sleep is clearly an issue, perhaps this is worth investigating.
Posted by phidippus on January 22, 2012, at 22:32:38
In reply to Weirdness with serotonin meds, out of ideas, posted by Velthir on January 20, 2012, at 9:02:54
>Citalopram, Duloxetine, Lofepramine, Reboxetine, >Valdoxan, Remeron, Nortriptyline, Zoloft
You seem to get a lot of insomnia when you take antidepressants. Tell me, do you find that you can't stop thinking and maybe feel a little pressured and anxious?
Curious you got irritable on Celexa.
Are you sure you're not bipolar? The insomnia and irritability can be manifestations of hypomania.
Its also very curious Abilify worked well for you, a drug often prescribed for bipolar disorder. The pattern of insomia would fit too, because Abilify can be activating at certain doses.
The reason antidepressants may be pooping out on you is because they may be making you cycle, pushing you from a good affect to a poor affect over a course of time.
Maybe you should try Lamictal.
Eric
Posted by Velthir on January 23, 2012, at 7:03:54
In reply to Re: Weirdness with serotonin meds, out of ideas » Velthir, posted by phidippus on January 22, 2012, at 22:32:38
I don't normally feel anxious/pressured or find that I can't stop thinking. It's more just that anything serotonergic tends to just flip my sleep cycle such that I'm awake at night and sleepy during the day.
Reboxetine I just sort of felt wired most of the time, pretty stimulating med. I get the feeling it might have gradually improved over time, wasn't on it long enough to tell. Didn't get the daytime sleepiness that I get on serotonergic meds.
Neither of the two psychiatrists I've had have suspected bipolar, but that may change after the last month I've had. I've definitely had some weird cycling of some kind going on. Most of the month I've been depressed, feeling sleepy during the day/awake at night and not sleeping well. Then I had three days where I basically didn't sleep at all and felt great (weirdly energetic/wired feeling despite being physically exhausted). Then back to depressed/nocturnal, then for the past couple of days I've slept okay at night and felt okay during the day.
Think I'm going to push for Lamictal when I see my psych on the 30th. Suspect I'll have to settle for Lithium if I want a mood stabiliser though.
Alternatively, as I only went up to 5mg of Abilify, it might be worth trying it at 15/20mg since I know it's supposed to be better for controlling bipolar/more sedating at those doses.
> >Citalopram, Duloxetine, Lofepramine, Reboxetine, >Valdoxan, Remeron, Nortriptyline, Zoloft
>
> You seem to get a lot of insomnia when you take antidepressants. Tell me, do you find that you can't stop thinking and maybe feel a little pressured and anxious?
>
> Curious you got irritable on Celexa.
>
> Are you sure you're not bipolar? The insomnia and irritability can be manifestations of hypomania.
>
> Its also very curious Abilify worked well for you, a drug often prescribed for bipolar disorder. The pattern of insomia would fit too, because Abilify can be activating at certain doses.
>
> The reason antidepressants may be pooping out on you is because they may be making you cycle, pushing you from a good affect to a poor affect over a course of time.
>
> Maybe you should try Lamictal.
>
> Eric
Posted by papillon on January 23, 2012, at 7:36:42
In reply to Weirdness with serotonin meds, out of ideas, posted by Velthir on January 20, 2012, at 9:02:54
Apologies if I am being Captain Obvious, but have you ever experimented with taking your meds at a different times of the day? e.g. morning instead of night time.
Posted by Velthir on January 23, 2012, at 7:58:16
In reply to Re: Weirdness with serotonin meds, out of ideas, posted by papillon on January 23, 2012, at 7:36:42
> Apologies if I am being Captain Obvious, but have you ever experimented with taking your meds at a different times of the day? e.g. morning instead of night time.
No problem :P Yeah, first thing I try/tried when I get/had the sleep issues. Never made any difference on Citalopram/Cymbalta. Doesn't seem to make any difference at all with Moclobemide either.
Posted by phidippus on January 23, 2012, at 13:34:41
In reply to Re: Weirdness with serotonin meds, out of ideas, posted by Velthir on January 23, 2012, at 7:03:54
Erratic sleep cycles are an earmark of bipolar disorder. Getting into a normal sleep phase improves symptoms greatly. Lithium is great for getting sleep aligned.
I would go up to 10 mg on the Abilify and see how you feel at that range. 15 or 20 mg might be too heavy.
Eric
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