Posted by ed_uk2010 on January 23, 2015, at 5:04:40
In reply to Re: What is stronger Amitriptyline or Cymbalta?, posted by fido on January 22, 2015, at 21:06:19
Hi Fido,
>I have always had anxiety and ocd, since childhood.
>LexaproHow long did you try Lexapro for? SSRIs are useful for OCD but usually start to work very gradually. The onset of action in OCD is often very delayed. A therapeutic trial of an SSRI in OCD is 12 weeks at the maximum dose. If one SSRI is not effective, a different SSRI (or SNRI) can be tried. SSRIs work considerably more slowly for chronic OCD than they do for depression. If you have both, the depressive symptoms should therefore improve first.
SNRIs such as Cymbalta are no more effective than SSRIs for OCD but can, for certain people, give additional relief from depressive symptoms. Overall, the effectiveness of Cymbalta for depression is similar to SSRIs - but some people respond better to one than the other. You'll have to give it longer to decide whether it works better for you.
>I dont know if prozac would work when 20mg lexapro did nothing.
It's possible, but I think you should give Cymbalta a proper trial first. If depression is your main problem and Cymabalta alone isn't working, you could look at taking an 'augmenting' medication. A low dose of Abilify is a common choice.
>Since Ritalin doesn't work I wanted to try amphetamines.
I think you need to treat your depression before you even look at the possibility of ADD. You can't diagnose ADD based on the presence of attentional problems during a depressive episode. Most people have substantial attentional impairment during depressive illness. And remember, amphetamines are rarely effective antidepressants. They may be mood elevating in the short term but this is no good for someone like yourself with long term depression. It's pointless having a short term boost when it's likely to be followed by a crash.
I hope Cymbalta works out for you. Its serotonergic properties can help anxiety and OCD as well as depression. Its noradrenergic effect could improve attentional impairment as well as depression. I think you should ask your doctor about augmenting it if there's no relief after a couple more weeks.
>Obviously you can get serotonin syndrome from SSRI + amphetamines.
It's possible but very uncommon. Still, amphetamine is not a first-line strategy for augmenting antidepressants. Neither is Provigil. Provigil is not an antidepressant and it is not likely to help your depression. It doesn't help OCD or anxiety either.
Common strategies for resistant depression include adding an augmenting med to an antidepressant. Common choices include:
Abilify - 5mg initially, then 10mg to continue.
Seroquel - could be a good choice if insomnia is a problem. You might find it too sedating. Abilify could be a better choice perhaps.
Lithium - low dose. You don't have to be bipolar to use lithium augmentation. Some people respond remarkably well, others don't. You don't have to take it for months to find out either, you should know whether it suits you in a few weeks at most. Some people notice an improvement within days of a small dose.
poster:ed_uk2010
thread:1075382
URL: http://www.dr-bob.org/babble/20150102/msgs/1075407.html