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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 Still Struggling on July 21, 2018, at 16:39:48
Many years ago when trying different combinations of drugs, I was on Lexapro & Asendin for short time. Felt good, but had some side effects and was scared of TD. Have always wondered why the combination helped and if another drug or combination would work similarly. Have been on a number of SSRIs & SNRIs and numerous natural supplements, but no other TCAs. Am no longer in area of the doctor who prescribed this combination, so asking dr not an easy option. Was a regular reader of this forum years ago and have come back now because I need to discuss my options with new doctor.
Posted by Christ_empowered on July 21, 2018, at 18:21:28
In reply to Why escitalopram + amoxapine worked?,safer choice?, posted by Still Struggling on July 21, 2018, at 16:39:48
hi. never taken amoxapine, but a former shrink recommended it. it apparently can be used at higher doses for people with my set off issues (read: severe, agitated depression), and at lower doses in less severe cases. but...
i would not take another antidepressant with a tca, just based on personal experience. when you say 'depression,' what sort of problems are you having?
maybe...amoxapine+buspar, amoxapine+a stimulant (based on my uppers+tca experiences, I'd vote for Ritalin before an amphetamine), amoxapine+gabapentin, lyrica, or a benzodiazepine...
the TD risk -is- real w/ amoxapine, but it may not be any higher than the 'atypicals.' true story. i read a small study that compared high dose amoxapine to risperidone, in schizophrenia, and the amoxapine seemed better tolerated w/ more pronounced effects on mood and anxiety, plus its cheap and the prolactin elevation wasn't as pronounced.
i guess the other option would be to work with an ssri and add stuff, thus avoiding TD. maybe...lexapro+wellbutrin? an ssri+remeron? an ssri+a mild stimulant? I don't know you, so I"m just throwing things out there for you.
hope this helps a bit. good luck.
Posted by Still Struggling on July 21, 2018, at 18:41:34
In reply to Re: Why escitalopram + amoxapine worked?,safer choice?, posted by Christ_empowered on July 21, 2018, at 18:21:28
As far as my depression: lack of motivation, have to force myself to do anything. Tend toward social anxiety at the best of times, when depression worsens become pretty much agoraphobic. Tend to see everything as hopeless. Know in the past I need to work at everything together w/ or w/o medications: prayer, exercise, positive experiences, helping others (hard when I don't want to be around people), reframing thoughts, etc. Due to various reasons (moving & losing doctor, other health issues) have not been taking anything lately. Have had bad experiences with wellbutrin, remeron, pristiq, paxil, etc. Was on lexapro the longest, most meds just seem to quit working after a while. My thoughts when I meet with my new doctor: consider prozac, cymbalta or a tca, but want to be well-prepared for the discussion. (I also have kidney disease - don't think severe enough to be a big problem, but definitely want to take it into consideration.)
Posted by Christ_empowered on July 21, 2018, at 21:35:39
In reply to Why escitalopram + amoxapine worked?,safer choice? » Christ_empowered, posted by Still Struggling on July 21, 2018, at 18:41:34
:-(
I understand trying prayer. I do believe God heals, but...sometimes psych drugs are necessary.
i take antioxidants w/ my 'atypical,' and i don't have td or eps. is that an option for you? vitamin e, vitamin c, b-100, niacinamide...its Orthomolecular.
here's a free site on Orthomolecular:
www.doctoryourself.com
Posted by Still Struggling on July 21, 2018, at 21:47:12
In reply to Re: Why escitalopram + amoxapine worked?,safer choice?, posted by Christ_empowered on July 21, 2018, at 21:35:39
I have taken different combinations of B-vitamins and magnesium, as well as NADH, sam-e and some other natural products such as rhodiola. Also tried L-Methylfolate for a time. Still take the B-vitamins and magnesium.
Posted by Christ_empowered on July 22, 2018, at 11:27:50
In reply to Why escitalopram + amoxapine worked?,safer choice? » Christ_empowered, posted by Still Struggling on July 21, 2018, at 21:47:12
hi. the -big- appeal of Orthomolecular (a lot like what you're also taking, with high doses of basic antioxidants added) is the prevention of EPS, TD, and even akathisia. Of course...I'm pretty much stuck on a moderate dose of Abilify for the long haul. If one has the option, it would probably be prudent to avoid the neuroleptics.
not all depression is treated with antidepressants. Provigil and Nuvigil are sometimes part of the solution...if one's insurance is ok with it, of course. I'm considering asking my shrink about Mirapex. Some studies show a positive effect in both Bipolar and Unipolar forms of depression.
even today, I've seen a lot of 21st century goof ball combos, lol. Klonopin+Adderall or an 'atypical' plus some sort of stimulant both seem to be fairly common, with private practice docs, anyway. That's an old school way of dealing with things, but...for -some- people, it works well, even over the long haul.
I dunno. The data on antidepressants isn't so promising, honestly. It gets worse in Bipolar, for whatever reason(s). I'm not saying that to be a Bummer Bob, just...you're definitely not the only one who isn't getting better with antidepressants.
Posted by rjlockhart37 on July 22, 2018, at 14:28:18
In reply to Why escitalopram + amoxapine worked?,safer choice?, posted by Still Struggling on July 21, 2018, at 16:39:48
amoxapine researched, yes it has antidepressant and neuroleptic properties, just as you said it can induce tardive dyskinesia, i don't have a full answer why maybe this combination worked well, maybe the dosage you where on when these 2 were combined were not considered 'negative' or serotonin like syndromes, i've noticed you can take a small amount of another SSRI with one, but it has to be very small, but still there's risks associated with it.
i found some info on amoxapine, and escitalopram.... this is a comparative chart of it's effects and interactions, and yes it is known to have tardive dyskinesia inducing properties due to dopamine antagonist properties
https://www.drugbank.ca/drugs/DB00543
https://www.drugbank.ca/drugs/DB01175that isn't wikipedia form, it describes more in depth on how these two can interact, and their mechanisms of action
Posted by rjlockhart37 on July 22, 2018, at 14:31:51
In reply to Re: Why escitalopram + amoxapine worked?,safer choice?, posted by rjlockhart37 on July 22, 2018, at 14:28:18
you could use Effexor and SSRI, or Remeron, which known as california rocket fuel, its used in severe depression
Posted by Still Struggling on July 22, 2018, at 16:51:19
In reply to Re: Why escitalopram + amoxapine worked?,safer choice?, posted by rjlockhart37 on July 22, 2018, at 14:31:51
> you could use Effexor and SSRI, or Remeron, which known as california rocket fuel, its used in severe depression
Doubt that I could use Effexor as I could not take Pristiq. Remeron was a no-go also, I slept all the time and it raised my blood pressure. I do appreciate the link with drug info - I had not seen that one before and will be definitely be reading more on that site.
This is the end of the thread.
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