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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by SS Ohdee on May 9, 2012, at 18:16:32
Who here waited through a long period between when they first began their AD and when they felt they were in remission/good enough?
- You know, those who took over a month before they felt anything, and perhaps longer until they felt truly themselves.Please specify if you say you felt "better" whether or not 'better' means an improvement, or 'better' means remission. And if you could: what's your thoughts regarding long lagtimes for ADs?
I'm currently a month in on my current dose of effexor, and I'm still having my moments and doubts. I just want to calm myself, by reminding myself that there are people out there in which the 6-8 week recommendation was actually worth it, even with very little mood lift for quite some time.
I am new to this place, but I have definitely encountered it before. I'm 20, in university, and have been struggling with a depressive episode in varying intensities for the past year, plus various episodes throughout high school.
So please! Share with me the times that endurance gave you success. No horror stories/effexor hate/warnings/negativity.
Posted by Phillipa on May 9, 2012, at 19:03:01
In reply to Did patience pay off for your AD to work?, posted by SS Ohdee on May 9, 2012, at 18:16:32
So much older than you but the first ad I took was paxil l0mg with a benzo. Was RN and working and took 3 months leave. I think it took about 2-3 months felt normal. Continued the benzo though low dose. Phillipa
Posted by SS Ohdee on May 9, 2012, at 19:43:32
In reply to Re: Did patience pay off for your AD to work? » SS Ohdee, posted by Phillipa on May 9, 2012, at 19:03:01
I took Lexapro when I was 15, but I didn't seem to have a concept then of how horribly depressed I really was and had no desire to be social. I didn't take anything for any other episode until last year. I've been doing the "Merry-go-Round" since.
My psych told me that I really just need to choose something and stick with it, as I haven't stuck with any adjunct med for over two months. But in my defense, when one feels suicidal, isn't that the time to consider something different?
Posted by bleauberry on May 10, 2012, at 5:13:07
In reply to Did patience pay off for your AD to work?, posted by SS Ohdee on May 9, 2012, at 18:16:32
This is just my opinion, but I think the longer a med takes to work, the more off target it is. The more on target a med is, the faster it works.
My first med was paxil. It took probably 8 weeks to feel any benefit from that, and then it was a full 3 months before I could say it was definitely working. It was also about that time I first encountered the emotional numbness thing.....depression was gone but I had become numb....the only thing on my depression score that did not improve and actually got worse was the topic of "interest in hobbies and activities".
Anyway, yeah, meds can take a long time to get brain chemistry to adjust. In Savella trials some of the people didn't see their best benefits until 6 months or 9 months, at which time major benefits showed up. Had they not been in clinical trials those patients probably never would have gone that long and never would have reached the benefits.
Watching people post on Nardil over the years, most of the people who did well on that med had a fairly long lag time.
But of course long trials also fail a lot. So you kind of have to make personal judgements and decisions along the way.
I think remission is rather rare with any med, my best guess is maybe 10%-15% of patients? But I think it is important to put things in perspective.....we're dealing with a chronic illness of unknown origin and unknown future.....ANY improvement in quality of life should be welcomed and appreciated. The best we can do in a whole lot of chronic illnesses is help the patient's quality of life improve.
Remission should always be the goal, in my opinion. But along the way, any improvement should be praised, welcomed, and thanked with open arms.
Posted by Phillipa on May 10, 2012, at 19:32:40
In reply to Re: Did patience pay off for your AD to work?, posted by bleauberry on May 10, 2012, at 5:13:07
Paxil l0mg first ad took about 2-3 months to adjust to. Returned to work. Stopped it after two years was fine til thyroid decided to do it's thing. Phillipa
Posted by papillon2 on May 11, 2012, at 6:18:31
In reply to Re: Did patience pay off for your AD to work?, posted by bleauberry on May 10, 2012, at 5:13:07
The usual advice is that it can take up to 8 weeks to notice an improvement, but often one does get an inkling about whether a med is going to work after 2-3 weeks. Psychiatrists admit to this. There are always exceptions. I don't think I responded to Remeron, for example, until I hit 45-60mg; but then I ended up scrapping it anyway for lack of efficacy in the face of intolerable side effects. So who knows?
I took Effexor for 7 years. I and others have experienced a definite increase in anti-depressent effect from each dose increase. However, I can't recall what the early days were like. It may be that I first had to reach a particular doseage.
Patience and persistence does pay off - in bucketloads! I had 2 proper trials of SSRIs fail before we found a medication that worked (yep, this was Effexor XR, AD no. 3). I have taken something like 14 different psych meds over 11 years, often more than one at once. 'Worked', for me, entails a significant decrease in symptoms and significant increase in functioning. I don't think I have ever reached full remission, but I do believe it is possible. There are others here who have been on even more psych meds, who have been fighting far longer than me, and who are winning the war. It is worth it.
Maybe Effexor will eventually kick in, maybe it won't. The important thing is to keep fighting. It is highly likely that you will find relief from your depression. This may involve medication, other treatments or a combination thereof. Hang in there!
Posted by SLS on May 16, 2012, at 21:04:01
In reply to Re: Did patience pay off for your AD to work?, posted by papillon2 on May 11, 2012, at 6:18:31
Yes.
I agree with the sentiments represented in the previous post.
- Scott
> The usual advice is that it can take up to 8 weeks to notice an improvement, but often one does get an inkling about whether a med is going to work after 2-3 weeks. Psychiatrists admit to this. There are always exceptions. I don't think I responded to Remeron, for example, until I hit 45-60mg; but then I ended up scrapping it anyway for lack of efficacy in the face of intolerable side effects. So who knows?
>
> I took Effexor for 7 years. I and others have experienced a definite increase in anti-depressent effect from each dose increase. However, I can't recall what the early days were like. It may be that I first had to reach a particular doseage.
>
> Patience and persistence does pay off - in bucketloads! I had 2 proper trials of SSRIs fail before we found a medication that worked (yep, this was Effexor XR, AD no. 3). I have taken something like 14 different psych meds over 11 years, often more than one at once. 'Worked', for me, entails a significant decrease in symptoms and significant increase in functioning. I don't think I have ever reached full remission, but I do believe it is possible. There are others here who have been on even more psych meds, who have been fighting far longer than me, and who are winning the war. It is worth it.
>
> Maybe Effexor will eventually kick in, maybe it won't. The important thing is to keep fighting. It is highly likely that you will find relief from your depression. This may involve medication, other treatments or a combination thereof. Hang in there!
Posted by SLS on May 16, 2012, at 21:34:59
In reply to Re: Did patience pay off for your AD to work?, posted by SS Ohdee on May 9, 2012, at 19:43:32
> I took Lexapro when I was 15, but I didn't seem to have a concept then of how horribly depressed I really was and had no desire to be social. I didn't take anything for any other episode until last year. I've been doing the "Merry-go-Round" since.
>
> My psych told me that I really just need to choose something and stick with it, as I haven't stuck with any adjunct med for over two months. But in my defense, when one feels suicidal, isn't that the time to consider something different?Two months is a long time to struggle with suicidal thoughts. While you are trialing different antidepressants, perhaps it makes sense to use Zyprexa, Seroquel, or Abilify to mitagate these thoughts.
Ideally, one would experience some improvement by the end of week three, regardless of how slight it may be. Sometimes, a doctor will notice a small improvement that has not been perceived by the patient. This can be a dangerous time in treatment. Someone who has suffered from a severe anergic depression will often experience an increase in mental energy before a positive effect on mood emerges. During this period of time, the increased energy allows one to think about suicide more actively, create a plan, and act on it. A patient should be instructed that this is possibility, and that weekly visits are necessary.
Some people report having to wait 6 weeks before anything positive happens. I like to give any one dosage adjustment three weeks to produce results. Consider, though, that it might take two or three weeks to reach the target dosage and allow for the drug to reach a [pharmacokinetic] equilibrium.
Patience?
Supposedly, most people who are going to respond well to an antidepressant will begin to do so by the end of week 4.
No one that I know of has a crystal ball. How does one know in advance if they are in the minority of people who respond well to an antidepressant, but only after eight weeks have passed?
These are very difficult decisions. Hopefully, your doctor can make his judgments based upon prior clinical experience in a way that neither of us can.
- Scott
This is the end of the thread.
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