Posted by King Vultan on May 9, 2004, at 10:23:35
In reply to Friend with long-term depression, posted by nephron on May 9, 2004, at 9:35:26
> I have a friend with depression- almost constantly since he was a child (6 or so). It's always there at least at a low level, but gets much worse from time to time.
>
> He's taken sertraline/ citalopram and others from the SSRIs- none had any appreciable effect.
>
> He tried Effexor but had projectile vomiting :(
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> He was taking moclobemide at 2x the recommended max. dose, which had no effect on the depression but was awful to get off.
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> Was taking Seroquel for sleeping and nightmares which seemed to be working pretty well but they took him off it because of the cost. He tried temazepam for sleep which made him groggy but didn't help with sleep.
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> He's currently taking lithium and sodium valproate. They don't seem to be having much of an effect but it's hard to tell.
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> He hasn't tried the tricyclics or MAOIs.
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> His psych seems unwilling to try new things- I was hoping some people here might have some suggestions to look into?
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> Sorry if this post doesn't make sense.
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> Thanks,
>
> Sarah
>
The tricyclics work on a different neurotransmitter (norepinephrine) than do the SSRIs, have a rather different side effect profile, and are relatively cheap because they have been around for decades and are available as generics. There is a school of thought that people who have chronic, long term depression might do well to try an antidepressant that works on norepinephrine.A couple of tricyclics that I've tried are nortriptyline, which is somewhat sedating, and desipramine, which is more activating. These two drugs have the fewest side effects in the tricyclic class, but both can still cause constipation and dry mouth. I found the side effects somewhat annoying at times but still relatively manageable.
Beyond the tricyclics are the MAOIs, one of which (Nardil) I'm currently taking, but my opinion is that it's more conservative to try a tricyclic first. Your friend might also want to consider Wellbutrin, which works on yet another neurotransmitter (dopamine).
Todd
poster:King Vultan
thread:345044
URL: http://www.dr-bob.org/babble/20040505/msgs/345055.html