Shown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by ben on March 5, 2001, at 11:54:21
Hi babblers
My depression started in the autumn of 1999 after a mononucleosis. First I tried Trimipramine (Surmontil) up to 150 mg and it worked well for my sleep but not for my melancholic mood. I went off it because i felt too much sleepy during the daytime. Then I tried Citalopram (Celexa) which worked a little while (4 weeks). I increased the dose up to 40 mg but nothing happend. My doc added Effexor to the Celexa (up to 150 mg) and it worked good on my mood but I experienced awful headaches. Then I decreased the Celexa and after 2 weeks I pooped out. Then i changed the doc who found the Celexa/Effexor combo very strange. He suggested me to come off the Effexor and increasing the Celexa to 100 or more mg a day (he had some good responders on higher doses of Celexa)
I tried this option but i felt loss of drive and sleepy during daytime (small doses made me nervous and gave me drive). Then my doc added a small amount of lithium to 100 mg Celexa. I experienced nausea, nervousness and anxiety, so we stoped
this trial after 2 weeks. The next step was adding Remeron. I took 7.5 mg to 60 mg of Celexa and after 2 days my mood improved, but I felt very sedated and my head was all the time drugged.
After a week I couldnt tolerate this side effects and
we stoped the Remeron. 2 weeks ago I started to add 1 tablet of Deanxit (Flupentixol 0.5 mg + Melitracene 10 mg) to 60mg Celexa and after 3 days I remarked an improvement. My doc told me to increase the Deanxit to 2 tablets but I didnt feel a difference. Today (after 10 better days) I felt more depressed again, it comes over me like a dark cloud who brings storm and blizzard. What should i do next?
1) increasing the Deanxit (flupentixol+melitracene)?2) adding Risperdal or Amisulpride (Solian)?
3) adding a noradrenergic agent such as nortryptiline or dibenzepine ?
4) changing to a RIMA/MAOI like moclobemide ?
5) changing the ssri (I think serotonine alone is not the way to treat such a depression ?!)
There are many options but I dont know which could be the best to my depression type: melancholic mood, loss of self esteem and interests (anhedonia).
I hate being an object of trial, all these med changes make me sick. Is it possible to feel depressed because nof the meds ? It is said that they change your vision of living ?!Any ideas or suggestions ?
Many thanks
ben
Posted by AndyJ on March 8, 2001, at 1:16:11
In reply to Whats my next med option ??? Help please !!!, posted by ben on March 5, 2001, at 11:54:21
I am not sure what to tell you, since I know the success of treatment varies from person to person. Don't despair though, you haven't exhausted the list of possible drugs or combinations by any means. You have barely dabbled in the ssri class which is what is helping many many people today, myself included. (I take prozac, buspar, and depakote). You may want to ask your doctor about depakote. It has a lot fewer side affects than lithium and can actually prevent headaches.
I know how it is. I have just started to get out from under a cloud that has dogged me for about a year now because I think (and hope) I have finally found a cocktail of meds that works for me. It took a lot of experimentation though. Always remember you are strong for going through this, and although people won't see it, you are brave for facing this demon.
Best of Luck.
Jason
Posted by allisonm on March 8, 2001, at 10:43:47
In reply to Whats my next med option ??? Help please !!!, posted by ben on March 5, 2001, at 11:54:21
I'm no expert on this, but if you have only tried Celexa, you might want to go back and try one or more of the other SSRIs like Prozac, Zoloft, Paxil...
Have you tried a trial of Remeron or the Effexor XR alone? Both have worked well for some people. Remeron will cause sedation at first, but this usually lifts. Another possibility would be to try adding Remeron to the Effexor; it's known to be a powerful combination.
Have you tried Wellbutrin alone and/or augmentation with Wellbutrin?
I have read algorithms for depression that go in the above order. If those tacks fail, then they go toward MAOIs or the tricyclics.
I have not been able to tolerate SSRIs or Effexor, but have found Remeron and Wellbutrin somewhat helpful. I also tried Wellbutrin with Celexa. The Celexa helped mood, but there was too much fatigue, tremor, insomnia and no drive. I also am taking Neurontin, which has helped as a mood stabilizer; I've felt no side effects.
I expect to add Serzone next and may try Risperdal or Zyprexa.
Good luck.
Posted by JohnL on March 8, 2001, at 17:03:04
In reply to Whats my next med option ??? Help please !!!, posted by ben on March 5, 2001, at 11:54:21
Ben,
Wow, I sure empathize with you. I've been in your shoes exactly, for way too long, so I can relate.When you say that maybe serotonin is not the only thing involved with your kind of depression, I tend to agree. The good news is that there are lots of options. The bad news as you know is that it so hard and so frustating to guess at each new drug only to find it's not what was hoped for. You sound strong though. Hang in there.
Since you could be sensitive to side effects, I would stay away from the tricyclics. One of them, like either Nortriptyline or Desipramine, could work very well for your, but I doubt the side effects would be agreeable with you.
The two chemistries most likely involved, as I see it, are noradrenaline and dopamine. The addition of 2.5mg Zyprexa, increased to 5mg in one to two weeks, could work magic. It has for a lot of people. The main drawbacks are early sedation, which DOES go away fairly soon, and weight gain, which tends to level off in time and can be counteracted by lifestyle choices in eating or exerting energy. Zyprexa seems to do real well for a whole wide variety of symptoms, including anhedonia and melancholia. This may because it does have mechanisms which affect both NE and dopamine in addition to serotonin.
Outside of your average mainstream pharmacy you could venture into the world of online pharmacies and try Adrafinil, Amisulpride, or both. Both together totally wiped out my longstanding anhedonia/melancholia. But so does Zyprexa+Prozac.
To narrow a long list of options down to a few, I would place my bets for you on Zyprexa, Risperdal, Amisulpride, Adrafinil. In a worst case scenario where none of them were helpful (I highly doubt that), then Ritalin or Adderal could be tried.
And it's worth mentioning not to rule out other SSRIs. There is usually one that stands out as being a strong favorite, but we would never know which one it was if we didn't try them and sample them for comparison.
Anyway, hope there are some ideas here that might help.
John
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