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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Temmie on October 31, 2004, at 20:33:03
It's been a long time since I've posted here, and I'm not at all sure I'm in the right place -- so someone -- please let me know if I need to "move."
My depression has come back pretty full-swing this weekend. I'm finding myself daydreaming about suicide as a pleasant alternative to despair -- and now I'm doubly concerned, as I learned this evening Nefazadone is no longer covered by my insurance -- and I can't afford $68 montly out-of-pocket. It seems I've tried everything ... Prozac ... Paxil ... Wellbutrin ... Effexor ... and others I can't even think of. Dare I ask -- what's working for you all -- or what's up-and-coming? From alternative therapies (Bach flower remedies, gem elixers, Chinese medicine, energy work, etc.), and all the rest I've tried, I'm feeling pretty tapped out and worried I'll never get out of this hole. :-( Hopeful someone will have some encouraging words.
Thanks, Temmie.
Posted by King Vultan on October 31, 2004, at 23:19:31
In reply to Nefazadone (Not Covered) Running Out of OptIons, posted by Temmie on October 31, 2004, at 20:33:03
Trazodone is really pretty close to nefazodone. About two thirds of the molecule is identical if you look at them side by side, and I believe the mCPP metabolite is common to both. Trazodone is more sedating, but nefazodone is not without sedative qualities, either. There is no way trazodone would not be covered under your insurance--it might be worth giving it a try unless you already have tried this at some time in the past.
After trazodone, the next closest would be the tricyclics, such as imipramine and nortriptyline. Imipramine would be closer to nefazodone but is much more anticholinergic (dry mouth, constipation, etc.). Nortriptyline is more noradrenergic than nefazodone, but it has relatively mild side effects for a tricyclic and works in a very different manner than do the SSRIs or Effexor. Both imipramine and nortriptyline are moderately sedating, probably less than trazodone, which is considered to be quite sedating.
Todd
Posted by dove on November 1, 2004, at 11:49:41
In reply to Re: Nefazadone (Not Covered) Running Out of OptIons, posted by King Vultan on October 31, 2004, at 23:19:31
I replaced Nefazadone with low dose Prozac and some Remeron at night, although I ended up adding Effexor (which is not covered by my insurance) to the mix later on.
I know there are many other combo's and TCAs that have potential, but those are what worked for me.
Good Luck!
dove
Posted by Temmie on November 1, 2004, at 12:24:29
In reply to Re: Nefazadone (Not Covered) Running Out of OptIons, posted by King Vultan on October 31, 2004, at 23:19:31
Thank you, K.V. -- it strikes me, "how you're all doing, and what's working for you" is/was not the best approach. We are all so uniquely different. I appreciate the breakdown, however, and to the molecular level at that! I'll keep you (and others) posted as to how things unfold. To-date, it seems I've tried everything but Selexa and Remeron (sp?) ... or are they the same? In any event, I'll let you know. Have been using Trazadone for sleep. Never occurred to me to try it during the waking hours. Again, my thanks.
Temmie
Posted by jboud24 on November 2, 2004, at 19:06:54
In reply to Re: Nefazadone (Not Covered) Running Out of OptIons, posted by Temmie on November 1, 2004, at 12:24:29
Just to clarify, Celexa and Remeron are two very different drugs, just so you'd know. Celexa is an SSRI type anti-depressant like Prozac but 'cleaner' and 'weaker' in its effects. Remeron is a different animal altogether, and it has no comparable drug like it. It is a strong anti-histamine (causes sedation), a strong serotonin 2a/2c receptor antagonist (anti-anxiety effect, more sedation), a serotonin 3 receptor antagonist (causes hunger/relieves nausea), and finally an alpha2-noradrenergic antagonist (causes the release of serotonin and norepinephrine) although this effect is only apparent at the higher dosages. Remeron is great for the following condition (I even take it myself): insomnia, anxiety of different types, nausea, and weak additive anti-depressant effects.
Hope that heps you out,
Justin
Posted by Temmie on November 2, 2004, at 19:27:45
In reply to Re: Nefazadone (Not Covered) Running Out of OptIons » Temmie, posted by jboud24 on November 2, 2004, at 19:06:54
You guys are awesome! I'm taking some time here to digest what you've shared. What a wealth of intelligent, caring, and talented individuals on board here. Turns out I was able to get a special authorization to remain on Nefazodone, but I will be back to talk more -- as I'm whalloped with depression, I'm not sure Nefazodone is working as well as it could/should be -- and I've tried so many different Rx. I especially enjoy the descriptions, which I believe will be helpful for me, of how these drugs differ and compare (and how they might best be suited to different issues of the things that ail us). You rock, guys. Thanks a lot ...
Anxious, insomniotic, and depressed ... ever yours on Nefazodone, Xanax, Trazodone/Seroquel (for sleep, take your pick, neither one works anymore) and Lamictal,
Temmie
Posted by dove on November 4, 2004, at 9:15:51
In reply to Re: Nefazadone (Not Covered) Running Out of OptIons, posted by Temmie on November 2, 2004, at 19:27:45
For me, Remeron was a much better choice for *good*, *fitful* sleep than Trazadone. And the higher dose (45mg vs 15mg) had a very positive effect on insomnia, depression and anxiety (along with no weight gain). It is a very interesting medication, with the potential to enhance other meds taken concurrently.
just some more thoughts... Good Luck!
dove
Posted by Temmie on November 4, 2004, at 13:02:45
In reply to Re: Nefazadone (Not Covered) Running Out of OptIons, posted by dove on November 4, 2004, at 9:15:51
Wheee! Thank you all! I am printing these out to share with my P-Doc. Incidentally, I've lost a ton of weight -- from well-over-my-zone, to fitting back in a size 6/8. I wonder if any of my medications has had this unexpected (although charming) side-effect. Would hate to pile it all back on through use of other meds I've heard about.
In any event, thank you all once again. I love having this site as a resource for support, information and camaraderie. Wishing you all much goodness, if not downright moments of happiness and joy.
Temmie
This is the end of the thread.
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