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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by zoe on January 22, 2002, at 14:40:05
hi,
i'm visiting my "prescriber" in a couple of weeks and am looking for some ideas/advice before i go.i've had mild/moderate depression/dysthymia for about 10 years now, with increasing social anxiety in the past several years.
i've tried most of the meds legal in the u.s. SSRIs and effexor all wiped out my sex life. serzone made me sleepy and dizzy. i'm currently on wellbutrin 200 bid which has made me feel about 80% of normal. i don't feel particularly depressed but don't feel quite 100% well. the social anxiety has not abated at all, if anything has gotten worse.
i occasionally use xanax.
i am considering:
adranfanil
amisulpride
klonopinany ideas or suggestions? thanks in advance
Posted by TSA West on January 22, 2002, at 22:45:59
In reply to suggestions, please, posted by zoe on January 22, 2002, at 14:40:05
I would suggest you try something like pindolol or buspirone to augment your current medication regimen: http://www.dr-bob.org/tips/split/Pindolol-as-augmenting-age.html
Another idea is to potentiate your medication with an anticonvulsant possessing definite antidepressant properties like Lamotrigine (Amer J of Psychiatry, November 1999. "Adjunctive Lamotrigine Treatment for Major Depression."
MALTESE, THOMAS M. M.D).In spiritual ranks for God,
----------------TSA West----------------
Posted by jane d on January 23, 2002, at 1:12:13
In reply to suggestions, please, posted by zoe on January 22, 2002, at 14:40:05
Hi Zoe. Have you tried Wellbutrin in combination with an SSRI yet? The Wellbutrin just might help with the side effects that were a problem before while the SSRI helped with the social anxiety. This has worked for me in the past. - Jane
Posted by zoe on January 23, 2002, at 13:22:05
In reply to Recommendations from Tips; anticonvulsants » zoe, posted by TSA West on January 22, 2002, at 22:45:59
thanks for the ideas.
the ssri are just not an option b/c of the sexual side effects. i've tried them w/ wellbutrin as well as other 'augmenters' and have never found anything to overcome the total lack of sexual interest/ability.
any particular anticonvul anyone has tried, esp that does not make you fatigued or gain weight (i'm picky, i know).
anyone have real success w/ pindolol.
Posted by tina on January 23, 2002, at 18:25:31
In reply to suggestions, please, posted by zoe on January 22, 2002, at 14:40:05
Have you tried an MAOI? The most recent one, Manerix/Aurorix didn't cause me any sexual side effects at all. Do you live in a country where you can get moclobemide? I paired it with klonopin/rivotril and it worked extremely well.
Good luck.> hi,
> i'm visiting my "prescriber" in a couple of weeks and am looking for some ideas/advice before i go.
>
> i've had mild/moderate depression/dysthymia for about 10 years now, with increasing social anxiety in the past several years.
>
> i've tried most of the meds legal in the u.s. SSRIs and effexor all wiped out my sex life. serzone made me sleepy and dizzy. i'm currently on wellbutrin 200 bid which has made me feel about 80% of normal. i don't feel particularly depressed but don't feel quite 100% well. the social anxiety has not abated at all, if anything has gotten worse.
> i occasionally use xanax.
> i am considering:
> adranfanil
> amisulpride
> klonopin
>
> any ideas or suggestions? thanks in advance
Posted by TSA West on January 23, 2002, at 22:05:30
In reply to Re: Recommendations from Tips; anticonvulsants, posted by zoe on January 23, 2002, at 13:22:05
> any particular anticonvul anyone has tried, esp that does not make you fatigued or gain weight (i'm picky, i know).
Lamictal is stimulating for some on this board.
>
> anyone have real success w/ pindolol.I had moderate success with pindolol and it was stimulating too.
Posted by mair on January 24, 2002, at 7:33:02
In reply to Re: Recommendations from Tips; anticonvulsants, posted by zoe on January 23, 2002, at 13:22:05
> I've had the same problems as you with any kind of WB-ssri combo. Serzone was a nightmare for me also as a WB augmenter. I've recently started lamictal. I'm not convinced of its effectiveness for me but I can say that it has not made me over-fatigued and I don't think its made me gain weight. I have gained some weight recently that I attribute more to lack of exercise and the holidays.
Mair
Posted by zoe on January 24, 2002, at 12:19:12
In reply to Re: Recommendations from Tips; anticonvulsants » zoe, posted by mair on January 24, 2002, at 7:33:02
thanks for the responses.
i'm from the u.s. so moclobemide is not an option. i'm not opposed to doing the order overseas route but it would be easier, obviously, if i could get meds thr my insurance.
mair, do you take the lamictal w/ the wellbutrin or alone?
has any one else used pindolol successfully?
any other ideas anyone?
thanks in advance, zoe
Posted by TSA West on January 24, 2002, at 16:50:07
In reply to social anxiety and depression, posted by zoe on January 24, 2002, at 12:19:12
I think you should go with the Lamictal or Neurontin (similar) if your doctor approves. Lamictal can be used for social anxiety because of its prominent effect on serotonin:
Southam E, Kirkby D, Higgins GA, Hagan RM. Lamotrigine inhibits monoamine uptake in vitro and modulates 5-hydroxytryptamine uptake in rats.
Eur J Pharmacol. 1998 Sep 25;358(1):19-24:
"The inhibition of the p-chloroamphetamine-induced 5-HT syndrome in rats suggests that lamotrigine also inhibits 5-HT uptake in vivo. These effects probably reflect an affinity for biogenic amine transporters..."Erfurth A, Amann B, Grunze H. Female genital disorder as adverse symptom of lamotrigine treatment. A serotoninergic effect?
Neuropsychobiology. 1998 Oct;38(3):200-1:
"The new anticonvulsant, lamotrigine, is becoming an important tool in the treatment of bipolar disorder, including bipolar depression. Its efficacy in bipolar depression might be linked to its inhibition of serotonin uptake..."Kumar TC, Khanna S.
Lamotrigine augmentation of serotonin re-uptake inhibitors in obsessive-compulsive disorder.
Aust N Z J Psychiatry. 2000 Jun;34(3):527-8.Shiah IS, Yatham LN, Lam RW, Zis AP. Effects of lamotrigine on the 5-HT1A receptor function in healthy human males.
J Affect Disord. 1998 May;49(2):157-62.
Posted by Chrissy on January 25, 2002, at 10:16:05
In reply to suggestions, please, posted by zoe on January 22, 2002, at 14:40:05
Zoe,
I took Paxil for Social anxiety disorder, and it worked miracles!
Problem is I started depakote at the same time, I started gaining weight, and stopped both, don't know which made me gain the weight, doc says most likely depakote. I'm going to try and get my mood stabilizing meds worked out and I may go back to paxil. But I def. reccmend it. It worked!
Chrissy
Posted by petters on January 25, 2002, at 11:09:07
In reply to Re: suggestions, please, posted by Chrissy on January 25, 2002, at 10:16:05
> Zoe,
> I took Paxil for Social anxiety disorder, and it worked miracles!
> Problem is I started depakote at the same time, I started gaining weight, and stopped both, don't know which made me gain the weight, doc says most likely depakote. I'm going to try and get my mood stabilizing meds worked out and I may go back to paxil. But I def. reccmend it. It worked!
> Chrissy
Hi...Try adding Lamictal. It´s a very good moodstailizing medication, without weightgain. It also have good antidepressant properties.
Best Wishes...//Petters
Posted by zoe on January 25, 2002, at 16:34:37
In reply to Re: suggestions, please, posted by Chrissy on January 25, 2002, at 10:16:05
thanks for the responses. those sSRIs, including paxil, were great for my mood but i really found the sexual side effects to be intolerable, like it just wiped out that whole arena of my life.
what about klonopin, anyone? my doc has been giving me xanax and says it has the same efficacy as all of the benzos, but what i have read here makes me wonder.
> Zoe,
> I took Paxil for Social anxiety disorder, and it worked miracles!
> Problem is I started depakote at the same time, I started gaining weight, and stopped both, don't know which made me gain the weight, doc says most likely depakote. I'm going to try and get my mood stabilizing meds worked out and I may go back to paxil. But I def. reccmend it. It worked!
> Chrissy
Posted by petters on January 26, 2002, at 2:34:03
In reply to Re: suggestions, please, posted by zoe on January 25, 2002, at 16:34:37
> thanks for the responses. those sSRIs, including paxil, were great for my mood but i really found the sexual side effects to be intolerable, like it just wiped out that whole arena of my life.
>
> what about klonopin, anyone? my doc has been giving me xanax and says it has the same efficacy as all of the benzos, but what i have read here makes me wonder.
>
>
> > Zoe,
> > I took Paxil for Social anxiety disorder, and it worked miracles!
> > Problem is I started depakote at the same time, I started gaining weight, and stopped both, don't know which made me gain the weight, doc says most likely depakote. I'm going to try and get my mood stabilizing meds worked out and I may go back to paxil. But I def. reccmend it. It worked!
> > ChrissyHi...
Many pdoc in my country don´t use Paxil at all, because it is the ssri witch cause the most serve sympom when you will get off from it. It is also the most sedative ssri on the market.
Citalopram (Celexa) is as effectiv as Paxil for social anxiety disorders. It don´t cause the drowsyness or cause weightgain (often loss of weight)It´s the drug of choise, when using ssri.
Depakota is associated with weightgain. Try Lamictal or Topamax instead. Both are good moodstabilizer and don´t cause weightgain. My favorite is Lamictal because it´s unike antidepressant propreties. Social phobias is often associated with depression, either primary or secondary.
Sorry for my sometimes bad spelling. It will hopefully gets better in the future.
Best Wishes...//Petters
Posted by anniebananie on January 27, 2002, at 2:43:57
In reply to Re: Recommendations from Tips; anticonvulsants, posted by zoe on January 23, 2002, at 13:22:05
> any particular anticonvul anyone has tried, esp that does not make you fatigued or gain weight (i'm picky, i know).Lamictal is the only one that has not made me into slowmotion me. I have gained a bit of weight but not as much as I've gained on other anticonvulsants. Topamax is great for weight loss, but if you try it, be on the lookout for increasing stupidity.
I don't think you're being picky at all. Why should you put up with feeling out of it and fat if there is an alternative?
Annie
Posted by zoe on January 28, 2002, at 10:23:26
In reply to Re: Recommendations from Tips; anticonvulsants, posted by anniebananie on January 27, 2002, at 2:43:57
i appreciate those comments, esp about not feeling picky. my psych doc does not seem to be too into polypharmacy and instead seems to want to stick with the standard meds: ssri or wellbutrin alone.
i found celexa to have the exact same sexual side effects as all of the other SSRIs. it is like an off-on switch for me.
> > any particular anticonvul anyone has tried, esp that does not make you fatigued or gain weight (i'm picky, i know).
>
> Lamictal is the only one that has not made me into slowmotion me. I have gained a bit of weight but not as much as I've gained on other anticonvulsants. Topamax is great for weight loss, but if you try it, be on the lookout for increasing stupidity.
>
> I don't think you're being picky at all. Why should you put up with feeling out of it and fat if there is an alternative?
>
>
> Annie
Posted by anniebananie on January 29, 2002, at 0:02:53
In reply to Re: Recommendations from Tips; anticonvulsants » anniebananie, posted by zoe on January 28, 2002, at 10:23:26
> my psych doc does not seem to be too into polypharmacy
Mine either. Any idea if there is any advantage to taking fewer drugs?
Posted by Chrissy on March 21, 2002, at 17:57:16
In reply to Re: Recommendations from Tips; anticonvulsants » zoe, posted by anniebananie on January 29, 2002, at 0:02:53
So besides the sexual side effects, can someone tell me which med works best with Topamax? Having a hard time with the Prozac with it. (causing lots of anxiety) have xanax as back up but don't want to rely on that. Anything info will help!
Chrissy
Posted by Anna P. on March 21, 2002, at 23:17:37
In reply to Re: Recommendations from Tips; anticonvulsants, posted by Chrissy on March 21, 2002, at 17:57:16
The best combo for me was Topamax with Tianeptine. It gives the weight loss and no sexual effects. Some cognitive problems with Topamax unfortunately. But besides that, this is almost perfect combo.
Anna P.
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