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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by gilmourr on May 15, 2012, at 16:01:16
My symptoms are
- anxiety+panic(include gagging/nausea/heaving)
- major depression
- insomniaMedicines tried
- Paxil (didnt work)
- Prozac (didnt work)
- Cipralex (worked on depression+insomnia SE)
- Zoloft (worked on depression + diahrea SE)
- Nardil (worked on depression + too many SE)
- Cymbalta (worked on anxiety + suicidal thoughts)
- Effexor (didnt work)
- Parnate (been on 10 days, so far nothing)I need a really good mix of drugs to get something to work. I'm thinking something very high in NE + sert since cymbalta worked, agomelatine for insomnia, Stelazine for my gagging/panic)
But what drug is very to cymbalta? Or is there a better set of drugs anyone can think of? I've only used ativan and clonazepam (ativan hardly works)
TY for any help
Posted by gadchik on May 15, 2012, at 17:05:46
In reply to What will work for my panic disorder + MDD??, posted by gilmourr on May 15, 2012, at 16:01:16
Hello,I was diagnosed with gad,panic disorder,and major depression. I took remeron,zoloft,and klonopin.That's the combo it took to get me well.Plus I had cognitive behavioral therapy. I wish you the best! Oh,and exercise,good food helped.
Posted by GoddamnElectric on May 15, 2012, at 17:07:15
In reply to What will work for my panic disorder + MDD??, posted by gilmourr on May 15, 2012, at 16:01:16
Mirtazapine sounds like a good option for you. It is useful for those with anxiety, depression, insomnia + indications for anti-nausea/vomiting and arguably works faster than SSRI/SNRI medications for the most part.
You may find Mirtazapine in combination with an Norepinephrine reuptake inhibitor useful to you. I suggest you augment with an NRI medication after a trial of Mirtazapine at a starting dose of 30mg for a few weeks. (For quite a while you may feel like a zombie, but this will pass... this is more unlikely if starting at 30mg instead of the standard 15mg dose)
In terms of which NRI type medication to try is hard to say... perhaps reboxetine? As always, this is best to be figured out while you talk to your doctor.
Hopefully my suggestions will be a good starting point.
This is also based on personal experience on my behalf. All the best!
Posted by gilmourr on May 15, 2012, at 19:08:23
In reply to Re: What will work for my panic disorder + MDD??, posted by GoddamnElectric on May 15, 2012, at 17:07:15
Actually forgot to mention that I've tried mirtazapine. I was on 15 mg for about 6-7 weeks, it helped my mood but I was sleeping 16 hours a day, even taking it at 9 pm. Was always tired during the day. Did nothing for anxiety/panic. And it gave me a huge acne break out. Mirtazapine was meh, probably somewhere in the middle if I had to rate it.
Posted by GoddamnElectric on May 15, 2012, at 21:22:50
In reply to Re: What will work for my panic disorder + MDD??, posted by gilmourr on May 15, 2012, at 19:08:23
> Actually forgot to mention that I've tried mirtazapine. I was on 15 mg for about 6-7 weeks, it helped my mood but I was sleeping 16 hours a day, even taking it at 9 pm. Was always tired during the day. Did nothing for anxiety/panic. And it gave me a huge acne break out. Mirtazapine was meh, probably somewhere in the middle if I had to rate it.
>
>15mg is quite sedating. It can take more than 2 months for the overall drowsiness to ease, which is why 30mgs or more would probably work better for you. Mirt tends to be less sedating the more you increase the dose. The sedating effects of the medication alone should have kept some anxiety/panic away.
While you may have suffered an acne outbreak with Mirtazapine, it is infrequently reported. I would suggest persisting with it for up to 6 months, and titrating to a higher dose (45-60mg) and see how things go.
If you don't think this is acceptable, then try an NRI/norepinephrine type medication... perhaps you need to jump onto another neurotransmitter.
All the best.
Posted by bleauberry on May 16, 2012, at 5:09:57
In reply to What will work for my panic disorder + MDD??, posted by gilmourr on May 15, 2012, at 16:01:16
Savella. And if you combine it with the antidepressant you have found most agreeable thus far, then you'll have more control to customize the ratio of NE and 5ht.
Cymbalta norepinephrine to serotonin ratio is 1:9.
Effexor is 1:30.
Savella is 3:2.I would be tempted to think along the same lines as you are, that NE is a player in this case. If that turns out to be true, then the above ratios would suggest why effexor didn't work, cymbalta did a little bit, and why savella might have some potential for you.
Another approach is to combine a TCA with SSRI.
During the first few days of savella sleep was horrible for me. But after that I had some really good sleep. And it was the only med that did anything for me after failing ECT.
Posted by SLS on May 16, 2012, at 6:16:44
In reply to Re: What will work for my panic disorder + MDD??, posted by bleauberry on May 16, 2012, at 5:09:57
> Savella. And if you combine it with the antidepressant you have found most agreeable thus far, then you'll have more control to customize the ratio of NE and 5ht.
>
> Cymbalta norepinephrine to serotonin ratio is 1:9.
> Effexor is 1:30.
> Savella is 3:2.
Haven't we already been through this? The occupancy ratio of Effexor for the SERT:NET at 300 mg is closer to 1:1. It has been measured as being 1.4:1. Again, binding affinity is not the only property to be considered when assessing its pharmacodynamics.Our personal theories don't always match clinical observations.
I am not impressed with Savella as an antidepressant. I just don't see it working for people who try it. I'm sure some people respond to it, but I think Effexor has a better chance of working.
- Scott
Posted by gilmourr on May 16, 2012, at 22:30:38
In reply to Re: What will work for my panic disorder + MDD?? » bleauberry, posted by SLS on May 16, 2012, at 6:16:44
I would've liked to go on effexor longer, but I tried it for 10-11 days, and my BP was already up to 160/110 on 150 mg, and I was having tremendous chest pain. Like burning chest pain, and pretty harsh prolonged pain for hours at times.
Do you think I should've just stuck with it? Because I didn't want my BP to go into stage 3 hypertension and my chest hurt too much
Posted by gilmourr on May 16, 2012, at 22:37:06
In reply to Re: What will work for my panic disorder + MDD??, posted by gilmourr on May 16, 2012, at 22:30:38
And these weightings of 3:2 and 1:9, aren't they kind of meaningless since for example lets say effexor might be 1:30, but its serotonin power could be 100 times greater than cymbalta's.
So even if its 1:30, it could still have a higher concentration of NE reuptake, its just that relative to its SERT reuptake its not as much
Posted by SLS on May 17, 2012, at 6:32:23
In reply to Re: What will work for my panic disorder + MDD??, posted by gilmourr on May 16, 2012, at 22:30:38
> I would've liked to go on effexor longer, but I tried it for 10-11 days, and my BP was already up to 160/110 on 150 mg, and I was having tremendous chest pain. Like burning chest pain, and pretty harsh prolonged pain for hours at times.
>
> Do you think I should've just stuck with it? Because I didn't want my BP to go into stage 3 hypertension and my chest hurt too muchIf it were me, I don't think I would have continued taking Effexor. If you are looking to try a SNRI-type drug, I would consider going with Cymbalta (duloxetine) first before trying Savella (milnacipran). Perhaps the most efficacious SNRI out there is Anafranil (clomipramine), a tricyclic antidepressant. However, it comes with a side effect burden that is predominantly anticholinergic in nature. With its additional NE effects, this would include an elevated heart rate. There would actually be a slight decrease in blood pressure (due to NE alpha-1a receptor blockade). Orthostatic hypotension can occur. One thing about tricyclics is that they are often effective for panic disorder. Imipramine has been studied most for this indication. However, the few investigations of clomipramine have suggested that it is more effective than impramine.
Nardil, a monoamine oxidase inhibitor (MAOI) is also good for panic disorder.
Good luck.
- Scott
Posted by gilmourr on May 17, 2012, at 9:52:11
In reply to Re: What will work for my panic disorder + MDD?? » gilmourr, posted by SLS on May 17, 2012, at 6:32:23
Thanks. I actually tried cymbalta, which helped my anxiety + panic (only one out of 8 meds to do that so far). But a week later it gave me crazy suicidal thoughts 24/7. I put up with it for a week, but it was making me crazy.
Tried Nardil, made me too sedated, hypotension, urinary issues, constipation, and didn't work on anxiety + panic.
I agree that I should probably try clomipramine, as I've read great things about anafranil. I know my pdoc mention imipramine.
Posted by SLS on May 17, 2012, at 12:49:04
In reply to Re: What will work for my panic disorder + MDD??, posted by gilmourr on May 17, 2012, at 9:52:11
> Thanks. I actually tried cymbalta, which helped my anxiety + panic (only one out of 8 meds to do that so far). But a week later it gave me crazy suicidal thoughts 24/7.
Darn. It happens. Can you describe in what ways your thoughts were changed by Cymbalta? Perhaps Bleauberry's suggestion of using Savella should be considered.
Have you tried Paxil yet? It is probably the best SSRI for panic disorder. It might be interesting to combine it with desipramine or nortriptyline. Perhaps imipramine can be considered as well. Paxil can be mixed with a TCA, as long as the dosage of TCA is reduced by 50% in order to compensate for the effect of Paxil to increase TCA blood levels (cytochrome CPY450 2D6 inhibition).
> Tried Nardil, made me too sedated, hypotension, urinary issues, constipation, and didn't work on anxiety + panic.
How long did you take it for, and what was the dosage?
> I agree that I should probably try clomipramine, as I've read great things about anafranil. I know my pdoc mention imipramine.
I hope others here offer more feedback.
Good luck.
- Scott
Posted by gilmourr on May 17, 2012, at 16:15:16
In reply to Re: What will work for my panic disorder + MDD?? » gilmourr, posted by SLS on May 17, 2012, at 12:49:04
On Cymbalta during the 3rd week I had nonstop suicidal thoughts and major depression. Would go to school to study and just zone out and come home, maybe reading 1 page after 3 hours. Whenever I looked at fences with spikes I'd think about forcing my neck on them and stabbing my jugular on them. Thought about drowning myself, hanging myself with just about any cord, wire, curtain, bedsheet I'd look at. Essentially, anything I looked at got me to think of a way to kill myself with it. When I went off it, my mind just doesn't go there, even being majorly depressed.
Tried paxil 30 mg for 7-8 weeks. Had sex issues, and it didn't help the depression or anxiety. Maybe I need more. But the SE's were not bad at all, just the sexual issues.Was on Nardil for 10 weeks. 60 mg for 6 weeks, and 75 for the remaining 4. Helped depression, not panic/anxiety.
Thanks for your help so far
Posted by gilmourr on May 17, 2012, at 16:45:33
In reply to Re: What will work for my panic disorder + MDD??, posted by gilmourr on May 17, 2012, at 16:15:16
What do you think about using,
Clomipramine and possibly an NRI?
or
Clomipramine + trifluoperazine (apparently really good for severe anxiety + gagging)
Posted by Phillipa on May 18, 2012, at 10:06:11
In reply to Re: What will work for my panic disorder + MDD??, posted by gilmourr on May 17, 2012, at 16:45:33
Didn't read the whole thread did anyone suggest xanaxa as it works for panic disorder like no other med? Even low doses work for years. Know many who use this alone. Phillipa
Posted by gilmourr on May 18, 2012, at 17:46:20
In reply to Re: What will work for my panic disorder + MDD?? » gilmourr, posted by Phillipa on May 18, 2012, at 10:06:11
Is it possible that all my symptoms are caused by food intolerances?
2 weeks ago I got a blood test for food intolerances. Apparently I have extreme intolerance with all dairy, all gluten, breads, beer, alcohol, eggs, and I have all this stuff like every day..
Maybe that's why I developed this just in the last 14 months?
This is the end of the thread.
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