Posted by King Vultan on April 5, 2004, at 20:20:04
In reply to SSRI dosing + alternatives for atypical depression, posted by Cairo on April 5, 2004, at 13:06:40
> I have tried various SSRIs for depression with Fibromyalgia, but have not done very well on them. Effexor XR, Celexa and Lexapro all cause extreme drowsiness, numbness, muscle aches and pain, and weight gain on even tiny doses, and when the dose is increased because the atypical type symptoms are not helped, I start to get attacks of nervousness, sweating and chest pain. I'm now on Prozac 30mg, titrating very slowly from 5mg over 2.5 months, but the drowsiness is extreme and the muscle tightness and atypical symptoms have not abated. My mood has increased slightly, though it's never been that bad before; I mostly become lethargic, and unable to handle any little stressor in the afternoons, like crashing. My mornings are not too bad, but muscle tightness is constant, 24/7. I've been on Unithroid which brings my TSH level down, but it hasn't done anything for the other symptoms. It looks as if I have autonomic feedback dysfunction as all my lab tests for thyroid, adrenals, hypothalamus are normal, but my symptoms look like organ hyporesponsiveness.
>
> Is it worthwhile to continue increasing the dose of Prozac, or is a trial of an MAOI inhibitor warranted? I'm afraid of fatigue increasing or the panic attacks getting worse on them. Would Gepirone be a good option, and when do you think it will be approved? How far out are we looking at the CRH inhibitors and potentiators?
>
> Thanks!
>
> Cairo
You might want to consider an activating tricyclic antidepressant. I really think tricyclics are better for chronic pain and fibromyalgia than are SSRIs, but I understand that MAOIs have some utility for chronic pain also. The problem with an MAOI is that there is some likelihood of also encountering drowsiness, plus there is all the associated MAOI baggage. Don't get me wrong, as I take an MAOI, but I just think it makes more sense to try a tricyclic first, particularly in your case because you have reacted so poorly to SSRIs. The two I would suggest are desipramine and (Vivactil) protriptyline, neither of which have much effect on serotonin and are selective for norepinephrine instead. The Vivactil is more stimulating but is more expensive and has more side effects. If you are hellbent on trying an MAOI, I would suggest Parnate rather than Nardil because it is both more activating and less serotonergic.Todd
poster:King Vultan
thread:332902
URL: http://www.dr-bob.org/babble/20040402/msgs/333091.html