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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by kayla on February 22, 2000, at 11:40:44
I have been suffering from social anxiety for the past 6 years, and the last 2 years I have succumbed to a horrible depression that only keeps getting worse. I have tried many different meds, and I am at a loss as to what to try next. I have taken most of the ssri's, wellbutrin, effexor, sm. dose of pamelor, desipramine(made the anxiety sooooo much worse), and I finally responded to Parnate. Didn't last long though. Tried augmenting with cytomel,no good. When I stopped taking the Parnate, that's when my depression really became horrible. I really need something to give me some pep, and I have a tendency to sleep too much. I would love to hear from some you folks if you have any suggestions as to what I should try next. I know that it is all trial and error, but my pdoc and I are at loose ends. he is thinking along the lines of serzone, but I am afraid that is not going to give me the boost i so desperately need. Any advice would be appreciated more than you know.
Posted by Carolyn on February 22, 2000, at 14:19:07
In reply to help!!!!!!!, posted by kayla on February 22, 2000, at 11:40:44
I wish it was easy. Has your doctor suggested Naltrexone, which several folks on this site seem to have had good luck with? Maybe you want to try ECT. I personally had a good experience with it...others have not. Sadly, everyone is different. My thoughts are with you...
Carolyn
Posted by Cindy W on February 22, 2000, at 21:53:09
In reply to help!!!!!!!, posted by kayla on February 22, 2000, at 11:40:44
> I have been suffering from social anxiety for the past 6 years, and the last 2 years I have succumbed to a horrible depression that only keeps getting worse. I have tried many different meds, and I am at a loss as to what to try next. I have taken most of the ssri's, wellbutrin, effexor, sm. dose of pamelor, desipramine(made the anxiety sooooo much worse), and I finally responded to Parnate. Didn't last long though. Tried augmenting with cytomel,no good. When I stopped taking the Parnate, that's when my depression really became horrible. I really need something to give me some pep, and I have a tendency to sleep too much. I would love to hear from some you folks if you have any suggestions as to what I should try next. I know that it is all trial and error, but my pdoc and I are at loose ends. he is thinking along the lines of serzone, but I am afraid that is not going to give me the boost i so desperately need. Any advice would be appreciated more than you know.
Kayla, I tried Serzone and found it was really useful for reducing social anxiety and depression.--Cindy W
Posted by jd on February 23, 2000, at 2:53:42
In reply to help!!!!!!!, posted by kayla on February 22, 2000, at 11:40:44
Kayla,
As some other people on this board have remarked recently, running out of antidepressants to try doesn't mean you're running out of medication options. In fact, all it may mean is that your depression and social anxiety (if they indeed have a chemical basis) would best be treated by an entirely different kind of medicine.
While a partial response to Parnate might lead you and your doctor to consider a trial of Nardil (the other well-known MAOI, a very different drug often better for social anxiety than Parnate), there are all kinds of other things you don't mention having tried or considered. The main category is probably mood stabilizers, which can often help in otherwise refractory depression. Lithium, valproate, and gabapentin are three popular mood stabilizers (the latter two actually anti-convulsants) that are often very effective, either alone or added atop an antidepressant. Gabapentin is perhaps especially worth consideration since it's been showing some effectiveness recently in social phobia and anxiety disorders, as well as with mood problems. But there are lots of other things to consider as well--what is the best thing to try first depends largely on the details of your particular situation. If your current pdoc isn't up-to-date on these treatment options (and a lot of them frankly aren't--the field has changed extremely quickly), you may want to consider getting a referral to a doctor who specializes in refractory mood & anxiety disorders. There are a lot of possibilities still out there! (Of course, there's also "talk therapy" too, but no one likes to be reminded of this if the problem feels largely chemical!) :-)
best to you,
jd
> I have been suffering from social anxiety for the past 6 years, and the last 2 years I have succumbed to a horrible depression that only keeps getting worse. I have tried many different meds, and I am at a loss as to what to try next. I have taken most of the ssri's, wellbutrin, effexor, sm. dose of pamelor, desipramine(made the anxiety sooooo much worse), and I finally responded to Parnate. Didn't last long though. Tried augmenting with cytomel,no good. When I stopped taking the Parnate, that's when my depression really became horrible. I really need something to give me some pep, and I have a tendency to sleep too much. I would love to hear from some you folks if you have any suggestions as to what I should try next. I know that it is all trial and error, but my pdoc and I are at loose ends. he is thinking along the lines of serzone, but I am afraid that is not going to give me the boost i so desperately need. Any advice would be appreciated more than you know.
Posted by JohnL on February 23, 2000, at 5:48:46
In reply to help!!!!!!!, posted by kayla on February 22, 2000, at 11:40:44
Have you tried the psychostimulants? Antipsychotics? Benzos? Mood stabilizers? In cases like yours a combination that often works very well is a blend of: low dose favorite SSRI so far OR low dose benzo, with a favorite stimulant (experiment short trials) and a tiny dose antipsychotic. All of these will target other chemical imbalances that have so far been missed, and that can cause your symptoms. Any one or all of these drug classes can target your symptoms. Clearly the antidepressants are missing the mark. And even more clearly enhancing NE function for you is especially bad. Your medication responses so far indicate the underlying problem is elsewhere, and will likely be targeted by a benzo, stimulant, antipsychotic, but likely a blend of all three in small doses each.
It's also possible that a chemical instability or electrical instability exists, which would respond to one of several mood stabilizers.
I don't think Serzone is a good idea. It has some NE action, and your past trials of NE drugs made you much worse. Besides which, it's just another variation of things you've already tried. At this point I think it has become crucial and urgent to explore other classes of drugs. The antidepressants are not targeting whatever the underlying problem is.
But whether you start with benzos, stimulants, antipsychotics, or mood stabilizers seems like a flip of the coin to me. The best way to get a clearer picture of what's going on is to convince your doc to give you short trials (1 to 2 weeks) of each. Be a guinea pig for a while (as long as you're stable enough to endure). The purpose is to further narrow the search. Some drugs will give you an adverse response. Abandon them quickly, and try to make sense of the clues they give you. Other drugs will be neutral. Move on. You will accidentally stumble onto something that helps a lot. Then you'll know where to concentrate the search. In the end you can go back and combine low doses of the more favorable trials for a blend that will take into account all the chemical imbalances/instabilities you discovered during trials. It just doesn't make sense to me to continue more antidepressants at this point. I think better results will be found elsewhere.
The hesitancy to explore outside the antidepressant class when they aren't working is, I believe, a major cause of treatment failure and continued patient suffering.
This is the end of the thread.
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