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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by CareBear04 on November 23, 2004, at 23:20:22
hey all,
i've tried old and new drugs in every class except the antidepressants. in this class, i've taken lexapro, paxil, effexor, zoloft, and wellbutrin. my current AD is zoloft 50mg. i think i need a higher dose because i don't feel it working anymore, but i'm "bipolar spectrum" (where in the spectrum, no one can accurately place) and SSRIs tend to cause agitation and insomnia, even with mood stabilizers, and i haven't been able to increase the zoloft past 50mg. i'm working between lithium and lamictal, but i would like a more reliable AD on board. a big problem recently has been weight loss due to things like stimulants, drug toxicities, nausea and indigestion, and swallowing problems. in a recent hospital stay, they diagnosed me with anorexia as primary disorder, even though i don't have any history of eating disorders and had valid medical reasons for weight loss. a few doctors have suggested remeron as a good choice to cut back my benzo use and address sleep problems with the added bonus of increased appetite at lower doses. the problem is that i also have no energy, and i don't want to be even more sedated by something like remeron. when i took zyprexa, i couldn't get up to function, even at the lowest dose. i'm also not sure i trust my doctors enough to control the dose-- low for now and higher when sleep, anxiety, and appetite get better. that's why i was thinking more seriously about the old ADs like the tricyclics or the MAOIs, which may have more risks, but which seem to have more predictable side effects. an AD that would increase appetite in the short-term would be nice, but ultimately, i just want something that will help with energy and not be too sedating. any experience or suggestions? any reasons why i should definitely not take the old antidepressants? thanks!!!!
Posted by Bill LL on November 24, 2004, at 10:10:08
In reply to old antidepressants or new?, posted by CareBear04 on November 23, 2004, at 23:20:22
Maybe you should try either increasing the Zoloft, or Remeron. If you have too much fatigue, ask your doctor about adding Wellbutrin or Provigil.
If I remember correctly, the older TCA drugs are just as effective as the new for alleviating depression. But I think they generally cause as much or even more tiredness as the SSRI's. They also cause constipation. Also, the TCA's are more dangerous than SSRI's in the event of an overdose. On the positive side, I think that the TCA's are lower in sexual side effects.
> hey all,
> i've tried old and new drugs in every class except the antidepressants. in this class, i've taken lexapro, paxil, effexor, zoloft, and wellbutrin. my current AD is zoloft 50mg. i think i need a higher dose because i don't feel it working anymore, but i'm "bipolar spectrum" (where in the spectrum, no one can accurately place) and SSRIs tend to cause agitation and insomnia, even with mood stabilizers, and i haven't been able to increase the zoloft past 50mg. i'm working between lithium and lamictal, but i would like a more reliable AD on board. a big problem recently has been weight loss due to things like stimulants, drug toxicities, nausea and indigestion, and swallowing problems. in a recent hospital stay, they diagnosed me with anorexia as primary disorder, even though i don't have any history of eating disorders and had valid medical reasons for weight loss. a few doctors have suggested remeron as a good choice to cut back my benzo use and address sleep problems with the added bonus of increased appetite at lower doses. the problem is that i also have no energy, and i don't want to be even more sedated by something like remeron. when i took zyprexa, i couldn't get up to function, even at the lowest dose. i'm also not sure i trust my doctors enough to control the dose-- low for now and higher when sleep, anxiety, and appetite get better. that's why i was thinking more seriously about the old ADs like the tricyclics or the MAOIs, which may have more risks, but which seem to have more predictable side effects. an AD that would increase appetite in the short-term would be nice, but ultimately, i just want something that will help with energy and not be too sedating. any experience or suggestions? any reasons why i should definitely not take the old antidepressants? thanks!!!!
Posted by linkadge on November 24, 2004, at 12:16:00
In reply to old antidepressants or new?, posted by CareBear04 on November 23, 2004, at 23:20:22
I, like others have found remeron very stimulating.
It is sedating in that it has a strong antihistamine component. However, this wore off in about 2 weeks and I found it much more stimulating than zoloft or prozac. I could still sleep on it despite the sedation wear off. Probably due to the strong 2a/c blocade of this drug.
Some bipolars find it usefull. It can cause irritability thought, if this is a problem of yours.
Linkadge
Posted by King Vultan on November 24, 2004, at 12:31:58
In reply to old antidepressants or new?, posted by CareBear04 on November 23, 2004, at 23:20:22
Many of the tricyclics that increase appetite also tend to be sedating, such as amitriptyline. Desipramine is activating but would be more likely to reduce appetite than increase it. Imipramine and nortriptyline are both moderately sedating and may or may not increase appetite. In the MAOIs, Parnate is activating but generally is not associated with weight gain, while weight gain with Nardil is fairly common. I felt Nardil was fairly neutral in terms of activation/sedation, but if SSRIs cause you insomnia, I think it is very likely Nardil will also (as would Parnate). I agree that Remeron might be worth considering in this particular case.
Todd
Posted by Paul Smith on November 24, 2004, at 13:05:33
In reply to Re: old antidepressants or new?, posted by King Vultan on November 24, 2004, at 12:31:58
Zoloft or Paxil?
My doc gave me a starter kit for Zoloft. But several have told me that Paxil is less likely to cause anxiety and that it is more effective against anxiety. What does anyone here think? Thanks.
Posted by CareBear04 on November 24, 2004, at 17:07:00
In reply to Re: old antidepressants or new?, posted by Paul Smith on November 24, 2004, at 13:05:33
hey everyone! thanks for your input.
Paul Smith-- I liked Zoloft a lot better than Paxil. I was put on Paxil for the same reasons-- lots of anxiety, psychological and physical-- but i only lasted about 3 weeks on it. i dont think it did anything for me, and it caused a lot of constipation and nausea, especially when my dose was doubled from 20mg to 40mg at discharge. zoloft has been a lifesaver at times, but it's much more activating, at least for me.
i had a psychopharm consult this morning, and i asked about the antidepressants. the dr is old, enough to have used the old antidepressants at least as much as the new. he said no to the TCAs because they (according to him) cause cycling in bipolar patients. he was not for or against the MAOIs except that they have a lot of interactions and that remeron is probably a better first choice. he, too, pushed for increasing the zoloft, but the problem is that i can't seem to without becoming agitated and racey. he also said that xanax is a bad benzo for bipolars because it promotes euphoria. that's the first time i've ever heard that, and it hasn't been a problem in the year or more i've been on it.
thanks again!
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