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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Bonnie on May 11, 2000, at 22:18:32
you probably have seen me in other messages..so to make a long story short, i am a 15 year old female that has been depressed for about a year. I have been on prozac, wellbutrin, celexa, and effexor. None of these have worked, so i stopped taking meds 2 weeks ago cold turkey (mmmmm, sounds good!)I am going to the pdoc on monday, should i get on a new a/d? and is yes, what kind? Thanks
Posted by bob on May 12, 2000, at 0:57:26
In reply to HELP, should i start a new medicine?any advice?, posted by Bonnie on May 11, 2000, at 22:18:32
Hi Bonnie!
Is this pdoc new, or is this the person who's been prescribing your meds so far?
If your pdoc's new, she might still want to try an SSRI or one of the somewhat-new wondermeds. How *did* the prozac and celexa work for you? If they helped at all, maybe giving zoloft or paxil a shot would be a good idea. Even though they're all in the same class, they are different enough so that where one may not work, another will.
If you're like me, on the other hand, SSRIs were a complete bust. It took my pdoc and I two years to finally give up on them. I switched to a tricyclic antidepressant (TCA) after that. I've had much better results with TCAs than SSRIs ... which apparently is not all that uncommon -- SSRI non-responders responding well to TCAs and vice versa. I took nortriptyline for a long time, over a year, and it worked much better for me than zoloft, the SSRI that worked the least worst for me. I've just switched to desipramine for a couple of esoteric reasons -- just trying a tweak to see if I can get more out of this than the nortrip -- but both have the most favorable side effect profiles of the TCAs and are two of this class that people tend to respond to well.
If you can, keep a diary of how you are feeling when you start your new med(s). As you try more and more different meds and they all have different effects, it can get really difficult to come up with any sense of HOW you are doing. My therapist also suggests (and I really should do it) keeping tape-recorded diary entries, since the tone of your voice can reflect as much or more of your emotional state and frame of mind than writing things out can do.
good luck with your doc!
bob
Posted by JohnL on May 12, 2000, at 4:02:57
In reply to HELP, should i start a new medicine?any advice?, posted by Bonnie on May 11, 2000, at 22:18:32
> you probably have seen me in other messages..so to make a long story short, i am a 15 year old female that has been depressed for about a year. I have been on prozac, wellbutrin, celexa, and effexor. None of these have worked, so i stopped taking meds 2 weeks ago cold turkey (mmmmm, sounds good!)I am going to the pdoc on monday, should i get on a new a/d? and is yes, what kind? Thanks
Bonnie
It is just an opinion, but I do think you should keep trying. Since you haven't responded to several serotonin drugs, I'm not sure staying in that class is a good idea. I think the time has come to explore other chemistries. Two choices off the top of my head that stand out are Desipramine or Nortriptyline. With either, expect side effects of dry mouth and mild constipation.I would also consider adding Zyprexa 2.5 to 5mg. It is showing a lot of promise for a wide range of symptoms, especially in patients who have not responded well to more common antidepressants. Though Zyprexa is classified as an antipsychotic, it has powerful antidepressant and mood stabilizing effects as well. You don't need to be a schizophrenic to respond nicely to it. And at the low doses that will probably work, it is very safe. Take at dinner time so its sedation will improve sleep without carrying over into the next day. You will have to tighten up on eating, because weight gain is common.
And another thing to consider as an add-on is a stimulant. They can be fast antidepressants...usually 24 to 72 hours. If one like Ritalin gives any problem, then immediately switch to another like Adderall. Those are probably the two most common.
At this point I just get a little skeptical of the antidepressant class, based on the multiple failures so far. That's why I would suggest observing the clues that some other chemistry is probably at fault. Zyprexa or stimulants would target those other chemistries that your previous drugs didn't...with or without Desipramine or Nortriptyline. Unfortunately there isn't any easy answer, and the choices can be overwhelming. But I would whittle the list for consideration down to these, either as monotherapy or in any combination: Desipramine, Nortriptyline, Zyprexa, Ritalin, Adderall. I wouldn't at all be surprised to see your physcian object to some of these. And that's too bad, because I think one or two of these might really do the trick for you with tolerable side effects and good safety.
JohnL
Posted by ChrisK on May 12, 2000, at 6:58:59
In reply to HELP, should i start a new medicine?any advice?, posted by Bonnie on May 11, 2000, at 22:18:32
I agree a lot with John L in his post with one caveat. I have had success using Zyprexa and Adderall in combination with an AD. It took a while to find an AD that gave me SOME improvement. If any of your previous meds helped a little then you may want to augment that with a stimulant or AP.
I never reacted to SSRI's and ended up with Nortriptyline as my main AD. It helped me stabilize some but I still had a lot of suicidal thoughts. That's when we added the Zyprexa and it did wonders for having terrible thoughts. It can take just a small dose to make the difference.
That combination relieved much of my depression but left me without much emotion. That's when I added the Adderall (stimulant). It has helped to get some of my emotions back.
Admitedly it's a long and tough process but it can be done. I have most of my life back because of going through this process. Some pdocs are against a system of augmenting Ad's. They think that there will be a reaction to a single med but sometimes it does take a combination to find what's right for you.
Another suggestion: when you go to your doctors appointment print out some of your posts and some of the responses you have gotten. Show your doc where these ideas came from. Almost everyone here is a patient for a reason and can articulate how specific things worked for them. There may be personal experiences here that your doc may not have run in to.
Hope this helps and good luck,
Chris
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