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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by pedr on November 5, 2001, at 7:45:10
Hi there,
I've had severe depression for about 7 years and have tried sertraline, lustral, st john's wort and effexor xl [all seperately]. The sertraline, lustral and st john's wort made my depression unbearably worse [shaking, jelly legs, terrifying black visions].The effexor xl helped but gave me terrible stomach ache and constipation.
Now I've been on Surmontil [a.k.a. trimipramine] for 5 months. It's had the best effect so far out of the drugs I've tried but I still get terrible anxiety and feelings of depression most days. 3 weeks ago my shrink started me on a concurrent course of 8 mg reboxetine. It's not really helped as far as I can tell.
I want to hear people's opinions on the drug's I've tried. I also would like to hear what people think about my current combination. Even better, some suggestions for other drugs and drug combinations to try would be brilliant. Over here in the UK, drugs are only given one at a time from what I've experienced and heard.
Many thanks in advance,
pedr.
Posted by JahL on November 5, 2001, at 10:56:40
In reply to Opinions on drug combo please, posted by pedr on November 5, 2001, at 7:45:10
> Now I've been on Surmontil [a.k.a. trimipramine] for 5 months. It's had the best effect so far out of the drugs I've tried but I still get terrible anxiety and feelings of depression most days. 3 weeks ago my shrink started me on a concurrent course of 8 mg reboxetine. It's not really helped as far as I can tell.
> I want to hear people's opinions on the drug's I've tried. I also would like to hear what people think about my current combination. Even better, some suggestions for other drugs and drug combinations to try would be brilliant. Over here in the UK, drugs are only given one at a time from what I've experienced and heard.You've heard right. It's infuriating that UK pdocs refuse to prescribe more than one med at a time & in doing so demonstrate their abject ignorance. Probably has something to with NHS edicts (re: budget constraints) as well.
Sadly, the only way I could instigate polypharmacy was by ordering from abroad & self-medicating. Once I could prove that polypharmacy, by improving my mood, was preferable, one or two pdocs came round to my way of thinking. Getting a (genuine) dx of Bipolar, where polypharmacy is the norm, also helped.
In my experience the only way to beat the system is to educate y'self as well as possible (which, by reading this board, you're obviously doing). This allows you to aggressively (but calmly!) pursue appropriate treatment options since pdocs generally feel compelled to take you more seriously.
I'm not qualified to recommend any medication, tho' if, like me, SSRIs worsen yr depression, then I imagine some would suggest the addition of a mood-stabilizer.
Surmontil was the first AD I was prescribed by my GP (helped w/ sleep but generally made me wired. That's 'wired'.). I think Trimip. is liked for its sedative qualities, which obviously helps w/ insomnia. Cheap too. It's also 'tried & trusted'; IME GPs are terrified of prescribing anything new (& therefore 'unproven').
There seems to be a fad for prescribing Reboxetine presently, probably because it's the newest AD on the block. However I'm yet to speak to a pdoc who is anything but disappointed with it. I tried 12mg and it did nothing (but neither do any of the other ADs). I didn't find the side-effects nearly so bad as others here tho' & I'm sure it works for 'some'.
By how much did the Effexor & Surmontil help?
Good luck,
J.
Posted by pedr on November 5, 2001, at 11:59:37
In reply to Re: Opinions on drug combo please » pedr, posted by JahL on November 5, 2001, at 10:56:40
> By how much did the Effexor & Surmontil help?
>Thanks for the speedy reply JahL.
Without Efexor or Surmontil I'd say my quality of life is no higher than 0 - constant intense panic, immense fear of mundane activities, disasterous imagery of being rejected/insulted by friends and family, deep depression, suicidal ideation and so on.On Efexor and Surmontil my q.o.l. goes up to about 15% due to the fact that some of the time I feel ok but things are still dreadful on the whole. This is why I'm looking for my wonder drug / wonder combination that will sort me out.
Cheers,
pedr.
Posted by SLS on November 6, 2001, at 13:43:31
In reply to Re: Opinions on drug combo please » pedr, posted by JahL on November 5, 2001, at 10:56:40
>
> By how much did the Effexor & Surmontil help?
>
> Good luck,
> J.
Hi JahL and Pedr.Did you find trimipramine sedating or soporific? After being on it for a while, did you feel sedated or fatigued during the day. I'm interested in trimipramine, but I'm afraid that it will be too sedating. I'm real sensitive to that.
Also, did you gain weight on it?
Thanks.
- Scott
Posted by JahL on November 6, 2001, at 21:22:13
In reply to Re: Opinions on drug combo please, posted by SLS on November 6, 2001, at 13:43:31
> Did you find trimipramine sedating or soporific?Soporific. It's probably telling that Trimip. was first prescribed to me as a sleep aid (classic lifetime depressive; saw my GP for everything *but* depression 'cause I knew no different). It was about as effective (at 50mg/hs) as any legal med I've taken for this purpose.
When we got round to dealing with the depression itself we raised the dose, with 200mg the target. During the day it wasn't particularly sedating (the soporific effects would wear off overnight); in fact if I remember rightly, I was pretty wired/agitated throughout the day. The problem was staying awake after dosing (soln: take at bed-time,) and waking up (alarm clock *not* a soln.). Above 100mg & I would sleep like a baby for 15/16 hours at a time. I like my sleep but that's overdoing it...
I had a similar problem with Dothiepin, another AD beloved of UK pdocs, again because of its sedative 'qualities' (& cheapness).
>After being on it for a while, did you feel sedated or fatigued during the day. I'm interested in trimipramine, but I'm afraid that it will be too sedating. I'm real sensitive to that.
So am I. My brain is slow enough; it needs no help in that direction. My guess is that you might have problems with it, but YMMV & all that. My brother (soft bipolar) tried it recently & gave up after a couple of days. Said it left him 'down a hole'. I think I know that feeling.
> Also, did you gain weight on it?
No, but then I'm not a good measure. It goes against all my instincts to have an appetite. It never occurs to me to eat so I have to force myself. If anything it reduced my appetite. All that agitation y'see.
In terms of A-C side-effects I found it similar to Dothiepin and preferable to Imipramine, Nortriptylene & Chloripramine (in that order). Generally pretty tolerable.
It was some time ago, but I think I remember my depersonalisation worsened considerably.
Er, that's about it,
J.PS That Biploar URL you posted the other day was pretty good. Ta. Feel free to post anything along similar lines...
Posted by pedr on November 7, 2001, at 5:57:16
In reply to Re: Opinions on drug combo please, posted by SLS on November 6, 2001, at 13:43:31
> Hi JahL and Pedr.
>
> Did you find trimipramine sedating or soporific? After being on it for a while, did you feel sedated or fatigued during the day. I'm interested in trimipramine, but I'm afraid that it will be too sedating. I'm real sensitive to that.
>
> Also, did you gain weight on it?
>
> Thanks.
>
>
> - ScottScott,
I find that my general awareness is blunted and my thinking [e.g. retrieving things from memory, simple arithmetic, working with dates] is somewhat retarded. It's tolerable but not ideal.I also find I can sleep a lot [13hrs plus on weekend] which I never used to be able to do due to waking anxiety/depression.
I feel fatigued and tired a lot and often can't face getting out of bed but I think most of that is down to depression rather than the trimipramine.
I've not noticed any substantial weight gain either.
HTH,
pedr.
Posted by caroline on November 11, 2001, at 4:07:11
In reply to Opinions on drug combo please, posted by pedr on November 5, 2001, at 7:45:10
Hi,
I too am in the UK. I couldn't get a pdoc to try an augmentation therapy so I went to my GP and explained why I thought it would work for me (using advice and info partly gleaned from these fantastic people on this board) and my GP went for it. He said that for as long as I do all my own research he's quite happy to give me repeat prescriptions for poly drug use. BTW I'm on 45-75mg remeron (dependent on time of month) + 75mg anafranil + 22.5mg zimovane.
Do you reckon your GP might help you out?
I no longer bother seeing the pdoc
All the best and good luck!Caroline
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