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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 phidippus on October 15, 2017, at 8:26:16
So I was on Lithium, Invega and Vyvanse and I was having depression-restlesness, poor concentration, feelings of hopelessness. Then I started getting anxious about everything. I stopped the Vyvanse and the anxiety did not abate. It seems like I traded depression for anxiety. Is my mood unstable? I have started Effexor-how long until it treats the anxiety?
Eric
Posted by SLS on October 15, 2017, at 11:57:00
In reply to Depression switch to anxiety. Starting Effexor., posted by phidippus on October 15, 2017, at 8:26:16
> So I was on Lithium, Invega and Vyvanse and I was having depression-restlesness, poor concentration, feelings of hopelessness. Then I started getting anxious about everything. I stopped the Vyvanse and the anxiety did not abate. It seems like I traded depression for anxiety. Is my mood unstable? I have started Effexor-how long until it treats the anxiety?
>
> EricOut of curiosity, have you tried taking nortriptyline or any other TCA? Your symptoms now sound much like that of melancholic depression with its attendant anxiety.
I found Effexor 300mg/day + nortriptyline 75 mg/day to be an interesting combination. It was partially helpful for my bipolar depression. Unfortunately, we never went higher on the nortriptyline. It turns out that I need 100 mg/day for maximum effect. I have no compunction to returning to the two drugs at higher dosages if my current regime doesn't demonstrate a trajectory towards remission during the next two months. I am not worried about a switch into mania because Abilify seems to be an effective prophylactic against it. I should think that the Invega would provide you with coverage against mania.
Oh... To answer your original question, I don't know.
- Scott
Posted by phidippus on October 15, 2017, at 15:53:00
In reply to Re: Depression switch to anxiety. Starting Effexor. » phidippus, posted by SLS on October 15, 2017, at 11:57:00
>Out of curiosity, have you tried taking nortriptyline or any other TCA?
The only TCA I have been on is clomipramine. It was a superior antidepressant and anti-obsessional, but it came with a price. Anorgasmia. I couldn't c*m to save my life. I would jerk myself raw taking clomipramine. My psychiatrist was very sympathetic and switched me to Zoloft.
Eric
Posted by Christ_empowered on October 16, 2017, at 13:36:08
In reply to Re: Depression switch to anxiety. Starting Effexor., posted by phidippus on October 15, 2017, at 15:53:00
hi. w/ the invega on board, I'd guess that you'd get a faster response, and you might be able to get more mileage out of lower doses. again, that's just a guess.
Posted by SLS on October 16, 2017, at 16:09:41
In reply to Re: Depression switch to anxiety. Starting Effexor., posted by phidippus on October 15, 2017, at 15:53:00
> >Out of curiosity, have you tried taking nortriptyline or any other TCA?
>
> The only TCA I have been on is clomipramine. It was a superior antidepressant and anti-obsessional, but it came with a price. Anorgasmia. I couldn't c*m to save my life. I would jerk myself raw taking clomipramine. My psychiatrist was very sympathetic and switched me to Zoloft.
>
> EricUnderstood.
Again, I would suggest that you consider adding a full therapeutic dosage of nortriptyline to Effexor 300 mg/day, especially with the symptoms you describe. You could even add Wellbutrin to Effexor. The latter strategy is used more often, but I would not abandon SRIs until you try adding nortriptyline.
How does Abilify affect you?
A friend of mine who is diagnosed with having MDD did pretty well on Abilify, Lamictal, and Wellbutrin. She didn't like the weight-gain from Abilify, so she later found remission using a combination of ketamine (intranasal) and Lamictal.
What are your reasons for taking Invega? Would you be willing to add a low dosage of Abilify to it?
Anxiety -> Depression
Depression -> AnxietyIt's a nasty loop.
- Scott
Posted by phidippus on October 16, 2017, at 16:45:58
In reply to Re: Depression switch to anxiety. Starting Effexor. » phidippus, posted by SLS on October 16, 2017, at 16:09:41
Tell me about nortryptaline.
Abilify and I have a strange relationship. It got me out of a bad psychotic episode in 2008 and was onboard for awhile. It seems to do its job, but lately when I try to take it I feel weird, maybe a little over stimulated. It definitely is not as tranparent as the Invega.
I take Invega primarily to reduce OCD symptoms. It also keeps me from becoming hypomanic.
Eric
Posted by SLS on October 20, 2017, at 21:51:42
In reply to Re: Depression switch to anxiety. Starting Effexor., posted by phidippus on October 16, 2017, at 16:45:58
Hi, Eric.
Sorry I didn't get to this post sooner.
> Tell me about nortryptaline.
1. Selective (not specific like desipramine) NE reuptake inhibitor.
2. 5-HT2a antagonist.
3. Narrow therapeutic dosage window. If you feel wonderful at 75 mg/day, you might return to feeling horrible at 100 mg/day. For me 100 mg/day is ideal. At 150 mg/day, the benefits I obtained at 100 mg/day disappeared. The reference range for effective NOR blood levels is 50 to 150 ng/mL. However, this is to be used as a guideline to help steer clinical decisions.
4. Milder with regard to side effects than most other TCA, including desipramine.
5. I find NOR to be more pleasant and a better mood-brighter than DMI.
6. Somnolence might appear early, but can disappear quickly.Scientists do not understand the totality of what nortriptyline does and how it is different from any other antidepressant drug. Clinicians must rely on empirical observations seen in clinical trials and in private practice. Why should DMI work better than NOR for some people and vice-versa? All I can say is that Effexor worked better for me when NOR was added. I guess one could make the argument that this is easily explained by the complementarity of Effexor's SRI to nortriptyline's NRI. I don't know.
> Abilify and I have a strange relationship. It got me out of a bad psychotic episode in 2008 and was onboard for awhile. It seems to do its job, but lately when I try to take it I feel weird, maybe a little over stimulated. It definitely is not as tranparent as the Invega.
Sometimes, I allow a drug to make me feel weird at first and see where it goes. These are enormously powerful drugs in the brain, and one should expect to feel somehow different when first starting one. You might find that you feel even more weird the second time around.
> I take Invega primarily to reduce OCD symptoms.Do you think that Abilify would reverse this improvement, even if Invega remained on board?
> It also keeps me from becoming hypomanic.
I think that Abilify has done this for me in that I have not had a manic reaction to medication since beginning it 15 years ago.
Does Wellbutrin make things worse for you?
- Scott
Posted by phidippus on October 21, 2017, at 9:37:08
In reply to Re: Depression switch to anxiety. Starting Effexor. » phidippus, posted by SLS on October 20, 2017, at 21:51:42
> I take Invega primarily to reduce OCD symptoms.>>Do you think that Abilify would reverse this >>improvement, even if Invega remained on board?
No, I don't think it would.
>Does Wellbutrin make things worse for you?
It tends to increase my anxiety.
Eric
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