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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 Mr. Scott on April 22, 2004, at 22:22:49
I have been diagnosed as bipolar spectrum, but my main symptoms are depression and anxiety. I have developed an intolerance to many antidepressants I used to be able to take.Obviously my next question will differ on an individual basis, but generally speaking which Antidepressants are most likely to cause Agitation, anxiety, dysphoria and which are least likely. For me Wellbutrin is terrible and Effexor seems close to it. Any ideas?
Thanks,
Scott
Posted by King Vultan on April 23, 2004, at 8:00:58
In reply to Which AD's are most and least agitating, posted by Mr. Scott on April 22, 2004, at 22:22:49
Of the ones I've tried, I would rank these as the most activating (particularly when first beginning them):
1) Effexor
2) Prozac
3) desipramineAll three of the above were very activating and tended to increase anxiety, but I did get used to them after a while
4) Zoloft
5) Vivactil (protriptyline) stimulating but did not noticeably increase anxiety
6) Wellbutrin--terribly activating at first, but no problem after a week or so
Nortriptyline was by far the least activating of any of the drugs I've tried.Todd
Posted by SLS on April 23, 2004, at 11:18:40
In reply to Re: Which AD's are most and least agitating, posted by King Vultan on April 23, 2004, at 8:00:58
> Nortriptyline was by far the least activating of any of the drugs I've tried.
I found it to be smooth as well, although it had a soporific effect on me when I first started it. Unfortunately, it doesn't appear that I have a therapeutic window for nortriptyline. 75mg was too little and 100mg was too much. The only times I felt improved were during the first 36 hours after a change in dosage, either up or down. There wasn't so much as a sliver of a dosage range at which the antidepressant effect would stabilize. This probably isn't so rare an event I imagine. For most people, the therapeutic window for nortriptyline lies with blood levels between 50-150 ng/ml. One of my doctors once told me that there is a tendency for an individual to respond to either desipramine or nortriptyline but not to both. I'm not sure how true this is.
- Scott
Posted by King Vultan on April 23, 2004, at 12:45:42
In reply to Re: Which AD's are most and least agitating, posted by SLS on April 23, 2004, at 11:18:40
> > Nortriptyline was by far the least activating of any of the drugs I've tried.
>
> I found it to be smooth as well, although it had a soporific effect on me when I first started it. Unfortunately, it doesn't appear that I have a therapeutic window for nortriptyline. 75mg was too little and 100mg was too much. The only times I felt improved were during the first 36 hours after a change in dosage, either up or down. There wasn't so much as a sliver of a dosage range at which the antidepressant effect would stabilize. This probably isn't so rare an event I imagine. For most people, the therapeutic window for nortriptyline lies with blood levels between 50-150 ng/ml. One of my doctors once told me that there is a tendency for an individual to respond to either desipramine or nortriptyline but not to both. I'm not sure how true this is.
>
>
> - Scott
Interesting, as I found desipramine to be relatively effective and the only AD I've been able to tolerate a full therapeutic dosage of up until now. Nortriptyline, OTOH, was only just barely tolerable, even at only 50 mg/day, which had some antidepressant effect--but not nearly enough--and was dreadfully sedating. When I went up to 75 mg/day, I experienced even worse sedation and drowsiness and was forced to go back down to 50 mg/day. I switched to desipramine soon after, which I was on for a few months before venturing on to other things.It would obviously be an impossibility for me to tolerate the parent molecule of nortriptyline, amitriptyline, but I get the feeling that I would be able to handle imipramine, which desipramine is a metabolite of. Perhaps a relationship similar to what you mentioned also exists between amitriptyline and imipramine.
Todd
Posted by Mr. Scott on April 23, 2004, at 13:49:11
In reply to Re: Which AD's are most and least agitating, posted by SLS on April 23, 2004, at 11:18:40
Scott thats interesting and thanks for sharing with me your experiences.
Are bipolar or unipolar? I'm just wondering about the inability to stabilize the antidepressant effect you mentioned and also I have become obsessive about bipolar disorders thanks to all the marketing and increased awareness of them.
Posted by Mr. Scott on April 23, 2004, at 13:55:46
In reply to Re: Which AD's are most and least agitating, posted by King Vultan on April 23, 2004, at 8:00:58
Thanks for sharing!
I find Effexor drives me up the wall and gives me anxiety, agitation, and dysphoria after a couple hours of true antidepressant relief. It's very strange. I tend to be highly anxious and depressed, but everyone's got me convinced I have some "strange bipolar variant" and that these feelings are actually a mixed state? I'm not so sure because I just sought a second opinion and he said I should go the tricyclic rought even though I mentioned I had been labeled bipolar II. He asked me if I ever blew all my money on a new boat or took off to a foreign country on a whim. I said no, and he said well then don't worry about bipolar try the tricyclics if the SSRI/Effexors don't work for you anymore. I'm scared I'll go nuts though as I've heard they are bad for bipolars.Rambling...Thanks...
Scott
Posted by noa on April 23, 2004, at 14:15:42
In reply to Re: Which AD's are most and least agitating » King Vultan, posted by Mr. Scott on April 23, 2004, at 13:55:46
I take Effexor and Serzone. FWIW--Serzone is definitely NOT agitating. For me, it actually blocks some of the agitating effects of Effexor. On the other hand, Serzone is sedating for me, so I only take it at night. I have no idea how well it would do for me as an AD by itself, or whether I'd be able to function through the sedative effect.
Posted by SLS on April 23, 2004, at 14:28:27
In reply to Re: Which AD's are most and least agitating » SLS, posted by Mr. Scott on April 23, 2004, at 13:49:11
Hi Scott
> Are bipolar or unipolar?
It appears that I am what may eventually be called bipolar III. In this condition, the prevailing state is depression. Mania appears only during drug treatment, and is not part of the natural course of the illness.
> I'm just wondering about the inability to stabilize the antidepressant effect you mentioned and also I have become obsessive about bipolar disorders thanks to all the marketing and increased awareness of them.
What do you mean by being obsessive? Maybe you are just committed to finding a successful treatment for your condition. Keep working. :-)
- Scott
Posted by Sad Panda on April 23, 2004, at 14:29:47
In reply to Re: Which AD's are most and least agitating » King Vultan, posted by Mr. Scott on April 23, 2004, at 13:55:46
> Thanks for sharing!
> I find Effexor drives me up the wall and gives me anxiety, agitation, and dysphoria after a couple hours of true antidepressant relief. It's very strange. I tend to be highly anxious and depressed, but everyone's got me convinced I have some "strange bipolar variant" and that these feelings are actually a mixed state? I'm not so sure because I just sought a second opinion and he said I should go the tricyclic rought even though I mentioned I had been labeled bipolar II. He asked me if I ever blew all my money on a new boat or took off to a foreign country on a whim. I said no, and he said well then don't worry about bipolar try the tricyclics if the SSRI/Effexors don't work for you anymore. I'm scared I'll go nuts though as I've heard they are bad for bipolars.
>
> Rambling...Thanks...
>
> ScottHi all,
This is a very interesting thread & proves how much we are all different. I have been lucky so far. Prozac was a total disaster for me & I found it to be agitating in the extreme, OTOH, Effexor has been pretty good for me & is only mildy agitating during the first week of a doseage increase. Valium for a week or two leaves my in a pleasant mild hypomanic state & by week 3 after an dosage increase everything is smooth sailing. I also take Remeron.
If a couple of SSRI's & Effexor have failed & you have tried each for atleast 4 weeks, then it's possibly time for a TCA like Clomipramine or maybe an MAOI like Nardil. Other TCA's may be worth a trial too. SSRI's are more likely to drive you into mania if you are BP, so I wouldn't worry about taking TCA's or MAOI's
Cheers,
Panda.
Posted by Sad Panda on April 23, 2004, at 14:37:14
In reply to Re: Which AD's are most and least agitating » Mr. Scott, posted by SLS on April 23, 2004, at 14:28:27
> Hi Scott
>
> > Are bipolar or unipolar?
>
> It appears that I am what may eventually be called bipolar III. In this condition, the prevailing state is depression. Mania appears only during drug treatment, and is not part of the natural course of the illness.
>
> > I'm just wondering about the inability to stabilize the antidepressant effect you mentioned and also I have become obsessive about bipolar disorders thanks to all the marketing and increased awareness of them.
>
> What do you mean by being obsessive? Maybe you are just committed to finding a successful treatment for your condition. Keep working. :-)
>
>
> - Scott
>Hi Scott,
When you say BP3 is that just transient hypomania from increasing or reducing AD intake?
Cheers,
Panda.
Posted by SLS on April 23, 2004, at 16:27:42
In reply to Re: Which AD's are most and least agitating » SLS, posted by Sad Panda on April 23, 2004, at 14:37:14
> When you say BP3 is that just transient hypomania from increasing or reducing AD intake?No, it is not necessarily transient nor involves only changes in dosage.
I didn't become manic the first time until after being at the same dosages of medication for several months. While I remained hypomanic for a month or so, it escalated into a delusional mania. The mania continued for weeks despite the discontinuation of the antidepressants and the introduction of lithium. Unfortunately, after relapsing into depression two months later, the same medication no longer worked. (Actually, the story is a bit more complicated than that, but I'll spare you the details). I once became severely manic after having discontinued Nardil a few weeks prior. This is not such a rare thing with Nardil. For me, discontinuation of medication is not enough to manage these acute manias. Zyprexa and Depakote have worked great.
- Scott
Posted by Sad Panda on April 23, 2004, at 16:45:48
In reply to Re: Which AD's are most and least agitating » Sad Panda, posted by SLS on April 23, 2004, at 16:27:42
>
> > When you say BP3 is that just transient hypomania from increasing or reducing AD intake?
>
> No, it is not necessarily transient nor involves only changes in dosage.
>
> I didn't become manic the first time until after being at the same dosages of medication for several months. While I remained hypomanic for a month or so, it escalated into a delusional mania. The mania continued for weeks despite the discontinuation of the antidepressants and the introduction of lithium. Unfortunately, after relapsing into depression two months later, the same medication no longer worked. (Actually, the story is a bit more complicated than that, but I'll spare you the details). I once became severely manic after having discontinued Nardil a few weeks prior. This is not such a rare thing with Nardil. For me, discontinuation of medication is not enough to manage these acute manias. Zyprexa and Depakote have worked great.
>
>
> - Scott
>
>Thanks Scott,
I am now a lot clearer on what BP3 actually is. I am thankfull that I am 'just' unipolar because here is Australia I can have any Mood Stabilizer or that I want provided that it is Lithium.
Cheers,
Panda.
Posted by greywolf on April 23, 2004, at 19:08:04
In reply to Which AD's are most and least agitating, posted by Mr. Scott on April 22, 2004, at 22:22:49
I've been on every SSRI out there, and I've tried others like Effexor, and none of them were the least bit agitating. In fact, I gave up on them because of the sedating effect, and switched to Wellbutrin.
Now there's some agitating med. I was on Wellbutrin for about 4 days at a low dose, and I was almost out of my mind with anxiety--not my usual state. I quickly revisited my doctor, who asked me not to give up so easily. I got a scrip for Xanax and continued on with the Wellbutrin. A few weeks later, I'm now up to 300mg/day with no agitation and no need for the Xanax. Unfortunately, I've seen no therapeutic value either, so this looks like another failed med trial. Oh well.
One plus is I've got a doc who encourages me to give what he's prescribing a fair chance. A few times I've dropped some of the SSRIs pretty quickly because I saw the same old SEs popping up and there was no point trying to wait out SEs I knew weren't going to disappear. But I've taken longer with a couple of the tricyclics and Wellbutrin, and I've at least discovered an ability to get by most of the SEs associated with them in a relatively short period of time (of course, trazodone will always put me to sleep, but it's easier for me to regulate than, for instance, Lexapro or Effexor).
I would just try out what you can, but have an up front discussion about what to do if you develop an unacceptable level of anxiety. Knowing I can get in to my doc the same day and he doesn't treat me as if I'm abusing a privilege helps. Of course, I try hard not to abuse the privilege to begin with. In addition, the Xanax helped get over the bumps, but I wouldn't suggest any long-term dependence on it.
Best of luck.
Posted by Mr. Scott on April 24, 2004, at 11:49:31
In reply to Re: Which AD's are most and least agitating » Mr. Scott, posted by SLS on April 23, 2004, at 14:28:27
Thanks Bro!
I feel like a weirdo obsessively trying to get this illness under control, but your right on. It's difficult to not be self absorbed and searching for always answers when your in pain and scared and your whole life is affected.
The three best women in my life left me because I was too depressive, and I have made many poor choices professionally because of this disease. I have a right to obsess about it I guess.
Thanks.
Posted by Mr. Scott on April 24, 2004, at 11:51:44
In reply to Re: Which AD's are most and least agitating » SLS, posted by Sad Panda on April 23, 2004, at 14:37:14
Exactly! Transient hypomania from a new antidepressant or dosage increase.
Have you experienced this?
Posted by Mr. Scott on April 24, 2004, at 11:55:33
In reply to Re: Which AD's are most and least agitating » Sad Panda, posted by SLS on April 23, 2004, at 16:27:42
See...I experience the same thing Scott when increasing and decreasing only it's so mild and shortlived that it's nothing short of pure enjoyment and the way I want to feel forever. I never go beyond "actually getting things done around the house" and "looking forward to going to work." These are states I NEVER feel except when taking amphetamines, starting a new AD, or coming off an old one.
So Weird.
Posted by Sad Panda on April 25, 2004, at 1:03:30
In reply to Re: Which AD's are most and least agitating » Sad Panda, posted by Mr. Scott on April 24, 2004, at 11:51:44
> Exactly! Transient hypomania from a new antidepressant or dosage increase.
>
> Have you experienced this?
>
>Yes I have, but I don't think it qualifies as BP & requiring a mood stabilizer.
Cheers,
Panda.
Posted by Mr.Scott on April 25, 2004, at 1:55:55
In reply to Re: Which AD's are most and least agitating » Mr. Scott, posted by Sad Panda on April 25, 2004, at 1:03:30
I agree.
This is the end of the thread.
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