Posted by Sad Panda on May 2, 2004, at 14:14:36
In reply to Depression systematic treatment, posted by nephron on May 2, 2004, at 7:15:57
> My pdoc says that there's an evidence-based systematic method of treating depression pharmalogically (to complement therapy stuff)...
>
> SSRIs- so Paxil or Cipralex or what have you- try 2 or 3- if these don't work move to
>
> SNRIs- for example Effexor, then
>
> Tricyclics: for example impiramine, then
>
> Selective reversible MAOIs- e.g. moclobemide.
>
> If none of these work well enough, pick the one which worked best with the least side effects, and add a mood stabiliser like lithium.
>
> Any feedback on this?
>
> Thanks, Sarah
>
>Hi Sarah,
> SSRIs- so Paxil or Cipralex or what have you- try 2 or 3- if these don't work move
>Paxil is the last of the SSRI's to try due to it having the worst side effects & being difficult to withdrawl from. Zoloft is a good first try because it's the safest & has the best track record of the SSRI's, Lexapro seems like it's worth a go too as it seems to be gathering postive users. Prozac is worth a go because it's easy to give up.
> SNRIs- for example Effexor, then
>Effexor dragged me out of a deep hole, so I am fond of it.
> Tricyclics: for example impiramine, then
>Not Imipramine. Clomipramine & Amitriptyline are the two TCA's with the best record, side effects probably aren't much worse than SSRI's, just different. Nortriptyline & Desipramine have their uses too, they can add energy to an SSRI that is working & they are usefull to some ADD people like Strattera is.
> Selective reversible MAOIs- e.g. moclobemide.
>I agree with Scott 110%. Moclobemide is pretty useless for the majority of people, but maybe the thing for someone who has tried everything else.
Similar are Wellbutrin, Remeron & Trazodone, they are pretty weak for most people, but can be a great add on to SSRI's or Effexor as something that counters side effects, i.e. Wellbutrin can rid people of SSRI induced apathy or increase libido. I take Remeron with Effexor & have found it gives great sleep as well as rids me of nausea and anorgasmia problems caused by Effexor.
The irreversible MAOI's Nardil & Parnate are possibly the best AD's that feature the least side effects, but you have to watch what you eat & what drugs you take with them. Sadly these two seem to be the last resort, even though they could be possibly first choice. Given a choice, I would cut to the chase & go directly to Parnate for my symptoms knowing what I know now.
Cheers,
Panda.
poster:Sad Panda
thread:342407
URL: http://www.dr-bob.org/babble/20040429/msgs/342497.html