Posted by JohnL on June 2, 2000, at 4:21:47
In reply to Same side effect to everything I try - agitation, posted by Barker on June 1, 2000, at 17:44:05
> Hi - I very suddenly started experiencing depression along with other menopausal symptoms 3 year ago. It has since varied from mild to quite intense. Problem has been that everything I try has the same side effect within days to a couple of weeks - agitation, sometimes intense, often accompanied by a feeling of being extremely hot/feverish (quite different from hot flashes) and frequently with baseless mental/emotional anxiety. Estrogen does this - more intense in direct relationship to the dosage. St. John's Wort resulted in agitation, Zoloft in severe agitation and heat sensation (of course I was also taking St John's Wort and Estrogen when I tried it - with my then Doctor's knowledge). Phenylalanine also caused a similar reaction. I am fearful of trying new things. I have even weaned off estrogen with the result that the anxiety has decreased markedly -- however the depression has become more intense as I weaned off and is now essentially constant. Not to mention that other menopausal symptoms have returned, including night sweats. What does one do when antidepressant substances result in intolerable agitation? Is this common? It seems to point out to me that the cause of my depression is not related to a lack of serotonin, and that antidepressant substances, even estrogen (which I have read does potentiate the effect of anti-depressants) are over-increasing serotonin action in my brain?
>
> Barker
Wow, that is frustrating. I sure feel for you. I know the despair you're feeling. But try to hang in there. You seem strong-willed. There is a way.Though it's probably too obvious to even mention, I think in your case it is very important to have a physician who is especially good. Not just any garden variety physican who throws SSRIs at depression patients. Do you have a real good doctor? If not, would you consider asking around for one?
Even though you've had bad experiences with meds so far, there is a bright side. That is, our reactions to different meds provide powerful clues as to what is going on. We need to know what chemistry we're dealing with, and our reactions--good, neutral, or bad--provide clues. It's kind of like detective work. I think you are already doing a great job of analyzing the clues, because you have come to question a serotonin link. That could very well be true with you.
Depression can be caused by low serotonin, low norepinephrine, low dopamine....BUT it can also be caused by excess norepinephrine function or excess dopamine function. That is even more valid when there is an anxiety/agitation component to the depression, as in your case.
You might want to ask your doc for a trial of Zyprexa, an antipsychotic. I prefer to call it a dopamine reducer. Based on the clues given so far, that would make sense to me.
Another avenue to consider would be a trial of a benzo like Xanax. Sometimes GABA malfunction is the cause of depression, and also has the anxiety/agitation component. Xanax has proven to be successful in selected patients in controlled studies as monotherapy for treating depression.
An outside possibility would be that you would respond well to a beta-blocker (antihypertensive med), or as I prefer to call them, norepinephrine reducers. But this would be farther down my priority list. Benzos and APS would be at the top of the list. I wouldn't even consider other antidepressants at this time. We can always return to them later if needed. But for now, we need more clues from other med classes to get a clearer picture. And hopefully the search will end soon as you stumble onto the right med. It's my guess, based on what you've said so far, that your best chance of finding the right med is by looking at the benzo or AP classes of meds.
But I would be negligent by not mentioning Lithium, Neurontin, or Lamictal. It could be there's a chemical/electrical instability going on here. Of the three, Neurontin in my mind would have the best chance with you, in light of the agitation component.
There are certainly plenty of choices. I get the gut instinct your answer won't be found in the antidepressant class. If you are knowledgable enough and confident enough, TELL your doctor what you want to try and why (AP, benzo, whatever). Don't ask or suggest, but rather tell him/her directly this is what you want to do. Unless the physcian is mired in his/her own ego, I have found they are usually open to complying with the patient's desires, especially if the patient has apparently put some research into the decision. You've certainly come to the right place to get started on that.
Anyway, I know there's a lot here to think about, but I hope some of it will be immediately helpful to you.
JohnL
poster:JohnL
thread:35580
URL: http://www.dr-bob.org/babble/20000526/msgs/35627.html