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Dr. Bob is Robert Hsiung, MD,
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Posted by jealibeanz on May 24, 2006, at 19:56:58
In reply to Re: What should I consider for long term treatment, posted by Phillipa on May 24, 2006, at 19:34:08
Well, my problem is that they've all put weight on, otherwise I'd be willing to explore another SSRI, but it would be ignorant to believe that my next trial would be greatly different from the others.
Posted by jealibeanz on May 24, 2006, at 20:04:48
In reply to Re: What should I consider for long term treatment, posted by Phillipa on May 24, 2006, at 19:31:46
I'm suprised you'd think that I'm not a good candidate. After recurrently battling nearly dehabilitating anxiety/depression I feel that I need a medication to give me a good quality of life. I have tried several medications and tolerable. What would be the next try past the SSRI, Wellbutrin, and SNRI trials? I know MAOI's were shied away from in the past, but isn't this a new and safer circumstance?
Posted by Phillipa on May 24, 2006, at 21:08:56
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 24, 2006, at 20:04:48
I think it is as you can just take it off. But I'm waiting for more positive responsives to come in. Love phillipa
Posted by Racer on May 24, 2006, at 22:19:13
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 24, 2006, at 19:27:37
> They all caused my to gain large amounts of weight (20 lbs on a small person!) in a short period of time. I was always very very active as an athlete and eat very well, so I know this is how my body reacts to the types of medications. That's going to make depression and anxiety worse for a female college student!
Yeah, you don't have to sell me on it -- you're preaching to the choir. Although, to put it in perspective for you, I gained OVER 50 POUNDS on virtually every AD I've taken. (So far, Wellbutrin doesn't seem to be doing it. Much.) And you're right -- there ain't no drug on earth that can make you feel OK if that happens.
There are drugs that can mitigate the weight gain, though. The two I've read about as being effective are Topomax and Metformin. Now, both have side effects, but they both work. I'd actually think about pointing you towards Effexor XR and Metformin to counter the weight gain, but I'm not a doctor, don't play one on TV, and try not to play one on Babble. That's just my take on what might be worth looking at.
How about this -- and this is coming from someone who is nuts when it comes to weight, and understands how frustrating it is to try to explain things to other people, and how easy it is to fly off into miseryville when someone suggests you rethink your priorities* -- how about you list your symptoms, rather than diagnosis, and let us know which are most problematic for you. Maybe that will help clear up that picture?
I suggest this because I was brought up short once, by a pdoc who asked, "What is your depression like?" Uh... I'd never thought about it -- I had depression, it had a name, it was like depression, right? But thinking about it kinda helped, at least in clearing my mind enough to think about which symptoms were most problematic for me, so that those could be addressed first. I hope that it might be a helpful exercise for you, and that it might lead to someone making a good suggestion for you.
*I've posted here that I will not take certain drugs again, and been told that I really need to get over that, it's worth it to gain the weight if I get over my depression, etc. And I've also had people tell me that it's a slap in the face for me to say that I won't take something that might work, because nothing works for them. Believe me -- I'm not suggesting you are wrong for feeling this way. I'm suggesting that if you look symptom by symptom, you might find something ala carte that wasn't included in the entree selections.
And I'll tell you right now that I agree that quality of life, which is what we're really talking about, does matter.
Good luck, and I hope something here helped, at least a bit.
Posted by Phillipa on May 24, 2006, at 22:46:46
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Phillipa on May 24, 2006, at 21:08:56
Everyone but blueberry and me seems to
report wt gain on meds. Wonder why we don't? Love Phillipa ps now I probably will
Posted by jealibeanz on May 25, 2006, at 0:35:21
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Racer on May 24, 2006, at 22:19:13
I've mentioned those adjunctive treatments to severaldoctors in my practice. They look at me with blank stares, and then explain there is not enough research on the matter and that they can have some pretty nasty and serious side effects that outweigh the potential benefits. Disappointing, but completely understandable.
My depression symptoms:
-overwhelming sad feeling. The last few weeks have been beautiful and sunny. I hardly notice. I only notice gloom. I almost literally see clouds and darkness. I was shocked when a professor pointed out the wonderful weather and flowers. I can't even begin to see or appreciate such things.-When "depression" hits, it hits hard. It seemingly comes out of nowhere in my typical successful life, which is full of great opportunities and support. It's feels as if the ground has fallen out below me and I'm spiraling down uncontrollably into a negative, despondant, helpless, and hopeless mood.
-I walk around with tears in my eyes. There is nothing majorly upsetting going on in my life. There are no small things that I am crying about. It's just a physical reaction to being awake in a happy and well functioning world!
-I have difficulty laughing and jokes and relaxing at times when others normally do. My mind is either blank from a form of numbing I've created to stop the hurtful feelings to care or notice the humor, or I am so fixated on the pain that I cannot imagine how people are laughing at a time like this!
-I want to sleep. I want to sleep all day everyday. It's not because I'm lacking rest or truely tired. It's a foggy/groggy feeling. Lying in bed is also a way of not having to see the world of happy people.
-I don't care about future goals or responsibilities. I don't care about work, school, a future career. At very bad times I've skipped work or school, quit jobs, did little schooling, and withdrew from classes.
-My moods can be described as doom and gloom. Everyday is a battle to just get through in one piece, doing normal chores and activities. Everything is a huge effort, especially because I lack the desire and drive to do little more than sleep.
-I feel like I'm simply going through the motions of life. I don't seek out friends. I start skipping events. I give up on lifelong activities I've always enjoyed. I feel no pleasure. I have no desire to be alive and can't understand why anyone would.
Posted by nickguy on May 25, 2006, at 1:29:17
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 25, 2006, at 0:35:21
it's good to hear that you decided to go to school, I hope it works out for you. If not, no big deal, things will be o.k either way. Not saying you shouldn't pursue meds at all, but I'd still reccomend talking to a pyschologist, I know we all want a quick med fix but it's not that simple, and from my experience 2 months of CBT has been more eye opening and uplifting than 2 years of talking to a pyschiatrist.
As for meds, I'm going for an MAOI right now. You seem to have a similar med history to me but I've tried (and failed) a few more. I would bring up EMSAM with your doctor. Try to convey that you understand about the diet and medical restrictions and that your not completely ignorant on that subject. Also, a letter from a family member saying that they know about the risks of an MAOI and can help you might help persuade your doctor. I definetely wouldn't just take XANAX if you are feeling depressed. Xanax can be like alcohol for people with depression, which is not healthy.
Posted by bassman on May 25, 2006, at 6:47:18
In reply to Re: What should I consider for long term treatment, posted by nickguy on May 25, 2006, at 1:29:17
Saying taking Xanax is like alcohol is like saying CBT is like going to AA meetings...I think this is a support board, not a judgment-of-others board. Maybe you didn't mean it that way, but that's the way it came across to me.
Posted by B2chica on May 25, 2006, at 9:08:43
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Racer on May 24, 2006, at 22:19:13
> *I've posted here that I will not take certain drugs again, and been told that I really need to get over that, it's worth it to gain the weight if I get over my depression, etc.
i agree with racer. people can think, wow, wouldn't you rather gain weight than be depressed all the time. but it depends on the person. some of us are really sensitive to weight gain and though the AD helps with depression at first, when we gain all that stupid weight guess what comes back...that's right depression. so no, it doesn't always work. and i certainly understand.
but i wanted to ask if you've ever tried effexor. i'm not a big advocate of this drug as i had a cruddy experience but it seems to work wonders on many people and i did actually loose quite a bit of weight on it...have you tried this one?
Posted by gardenergirl on May 25, 2006, at 9:35:08
In reply to What should I consider for long term treatment?, posted by jealibeanz on May 23, 2006, at 19:05:53
You might want to look into Lamictal. It's a drug used to combat the depressive side of bipolar, and now it's being used for unipolar depression. I take 100 mg along with an MAOI (Nardil), and it's really helped me.
And I'd definitely consider getting a referral to a psychiatrist. I sought treatment from my GP for awhile, but he simply is not familiar or skilled enough with pyschotropics to treat me most effectively.
Also, I agree with others who mention therapy. You might be able to do this through school. If not, your doc can probably provide some referrals. A lot of the literature suggests that meds and therapy together are more likely to lead to remission versus one or the other alone.
Good luck. Depression can be horribly debilitating. I hope you find what's the best course of treatment for you.
gg
Posted by nickguy on May 25, 2006, at 11:52:19
In reply to Re: What should I consider for long term treatment » nickguy, posted by bassman on May 25, 2006, at 6:47:18
> Saying taking Xanax is like alcohol is like saying CBT is like going to AA meetings...I think this is a support board, not a judgment-of-others board. Maybe you didn't mean it that way, but that's the way it came across to me.
I was saying that xanax is in a way kind of a depressant, like alcohol. So theres nothing wrong with taking it for anxiety, but it's probably not a good treatment for depression.
Posted by bassman on May 25, 2006, at 11:58:42
In reply to Re: What should I consider for long term treatment, posted by nickguy on May 25, 2006, at 11:52:19
I was going on the "Xanax almost has a slight antidepressant effect I feel" on the original post-I find that Xanax has an antidepressant effect, too. But you sure are right about some benzos-I find Klonopin depressing..
Posted by Racer on May 25, 2006, at 12:32:42
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 25, 2006, at 0:35:21
Have you considered trying Parnate? It's said to be the most weight neutral of the MAOIs, and one of the most consistently weight neutral ADs in general, and it is a bit activating, which sounds like something that would help you. There is the Diet to consider, of course, and a few other things regarding blood pressure, etc. Otherwise, that's where my mind went. (If I wasn't trying to get pregnant, I would consider it my next choice. My T and my pdoc disagree, though, because of my eating disorder. They don't want any excuses for me to restrict more.)
Otherwise, Lamictal is probably a good one to try, because it does seem to help a lot of people, and it doesn't seem to cause any weight gain. Other people have also said it seems activating, but I didn't experience that. (Then again, it increased my depression, so I'm not exactly a typical user...)
Mostly, though, you know what I think I'd offer up as an option? Combine one of the ADs, almost any one of them, with Provigil. Heck, combine Lamictal and Provigil. Provigil can be a very good augmenting agent, it will provide some stimulation to counter any sedation from the AD, and it should also help avoid any weight gain. It's also a fairly safe drug. For a while, it was ALL that I was taking, and while I was definitely not well, at least I was functioning. (Functioning better than I think I am right now, even...)
Hope that helps, and good luck.
Posted by Phillipa on May 25, 2006, at 18:25:29
In reply to Re: What should I consider for long term treatment, posted by nickguy on May 25, 2006, at 11:52:19
Xanax has some antidepressive proterties as well. I took it for years and never increased my dose. And when on it I didn't need an antidepressant as my anxiety was so well controlled. IMO anxiety leads to depression. Love Phillipa
Posted by Phillipa on May 25, 2006, at 18:29:27
In reply to Re: What should I consider for long term treatment » nickguy, posted by Phillipa on May 25, 2006, at 18:25:29
And don't forget excercise aerobic is it's own natural antidepressant created endorphins. The feel good stuff. So if the xanax takes away your anxiety about doing stuff and you add excercise you pay not even need an ad. Love Phillipa
Posted by jealibeanz on May 25, 2006, at 19:35:22
In reply to Re: What should I consider for long term treatment, posted by B2chica on May 25, 2006, at 9:08:43
yes, Effexor was my most recent one this past fall. The depression lifted because I felt nothing at all! I was totally apathetic. I couldn't eat a thing, but did gain 20 lbs in 6-7 weeks.
Posted by jealibeanz on May 25, 2006, at 20:12:23
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Racer on May 25, 2006, at 12:32:42
I like Provigil, I don't think this doc does though. Parnate? Hmm... are GP's open to this?
Posted by jealibeanz on May 25, 2006, at 20:33:05
In reply to Re: What should I consider for long term treatment, posted by Phillipa on May 25, 2006, at 18:29:27
yes, aerobic exercise is a major part of my life. it's my strongest tool and coping skill. i love it and am barely functional without a good workout! it energizes me, boosts my mood, and calms anxiety.
Posted by Caedmon on May 25, 2006, at 22:45:42
In reply to What should I consider for long term treatment?, posted by jealibeanz on May 23, 2006, at 19:05:53
Zoloft may work, and not cause weight gain. Paxil is notorious for weight gain. Effexor may cause weight gain based on endocrine system funnies, or it may have been edema. Unfortunately, EMSAM is no less likely to cause weight gain statistically speaking than Wellbutrin; if anything, more so.
If Xanax is giving you a response, it may be worth considering modifying the dose of that first. No need to polymedicate unless it's necessary.
I think that most GPs aren't going to prescribe EMSAM or any MAOI. MAOIs are used almost exclusively for refractory disorders, which warrants a referral to a psychiatrist.
- Chris
Posted by jealibeanz on May 26, 2006, at 0:36:21
In reply to Re: What should I consider for long term treatment, posted by Caedmon on May 25, 2006, at 22:45:42
Just another wondering... if Straterra does not cause weight gain, does that mean that it's most likely linked to Serotonin reuptake in my case? I know it's impossible to actually say one way or the other. Would EMSAM have much Serotonin action. I understand that it's not the same as a reuptake inhibitor, however, is the end result somewhat similar?
Posted by Racer on May 26, 2006, at 0:54:09
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 26, 2006, at 0:36:21
> Just another wondering... if Straterra does not cause weight gain, does that mean that it's most likely linked to Serotonin reuptake in my case? I know it's impossible to actually say one way or the other. Would EMSAM have much Serotonin action. I understand that it's not the same as a reuptake inhibitor, however, is the end result somewhat similar?
1. Serotonin is most likely part of the mechanism for weight gain. Three of the major serotonin receptor types are directly involved in the whole hunger/motility/digestion thing. In general, about 95% of the serotonin in your body is in your gut. That means that anything that changes the serotonin system is likely to change eating behaviors.
2. MAOIs do affect serotonin, but in a very different way. Rather than interfering with the serotonin transportase, they interfere with monoamine oxydase, which is the mopping up crew for worn out monoaminic neurotransmitters. I don't know much about how it all works, but it does mean that there are similarities, but also great differences.
Nardil, though, is known for weight gain, but Parnate is said to be weight neutral.
Hope that helps, and is not too incoherent...
Posted by jealibeanz on May 26, 2006, at 1:48:50
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Racer on May 26, 2006, at 0:54:09
So, if increased hunger were not an issue, could the serotonin cause some other change in the body that would cause rapid and abnormal weight gain? Why would Nardil, but not Parnate cause this side effect as well? I know these are not questions that can truely be answered, I'd just like the best accepted theory! Thanks for everyones help!
Posted by Racer on May 26, 2006, at 10:30:38
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 26, 2006, at 1:48:50
> So, if increased hunger were not an issue, could the serotonin cause some other change in the body that would cause rapid and abnormal weight gain?
Well, you're right that no one really knows why these drugs cause weight gain, but that doesn't mean that they don't. And it'snot really surprising that the mechanism isn't well known yet, since the idiots who prescribe them sometimes *still* tell you that Prozac causes weight loss! Sure, it does, yeah -- for the first three months, then it changes...
Theory I read that makes most sense has the three pronged approach, and I'm brain dead right now, so will likely get this wrong:
5-HT3 receptor mediates bowel motility. That would cause the inital GI distress a lot of people get with SSRIs, as those receptors get stimulated by the 5-HT hanging out in those synapses. Then, once you've been on it a while, your 5-HT3 receptors start to say, 'ah, geeze -- that's too much, I'm not listening to you anymore...' and get less responsive. Now, that's adaptive, but it can also mean that everything in your GI tract slows down. So, if you're constipated on these drugs, as I always am, then you may gain weight as there's more time for nutrients to be pulled from your gut.
They also affect the receptors that tell you you're hungry, or you're full. Those are probably pretty important, although they're not the whole story. I can't speak to the issue of whether they cause more eating, but they DO cause more hunger/appetite. That's not the whole story, either, though.
They also sedate a lot of people, and that includes biological processes. Basically, your metabolism gets groggy. That's got a LOT to do with it. I can barely get out of bed on most of the SSRIs -- other than those that have me turning inside out with miserable anxiety -- and that gets reflected in my weight. Even if I made it to the gym on Paxil, and got through my whole routine, I know I wasn't using nearly as many calories to do it, because I was so groggy through the whole thing.
Sucked a lot.
>Why would Nardil, but not Parnate cause this side effect as well?
Because they're different drugs?
Probably because, while these drugs are in the same class, and have the same basic mechanism of action, they act differently. Even if the main effect is to destroy MAO, they'll both have minor effects, too. Weight gain on Nardil is one, agitation on Parnate is another. And they don't happen for everyone, but that really doesn't help when it happens to you. (I can never understand why someone would think we'd feel better hearing that they *didn't* gain weight on these drugs -- just makes me sure that there's something wrong with me. {shrug} Guess it makes sense to them...)
Anyway, I hope you find something that helps. But I also hope that you get evaluated by someone with a specialty in eating disorders. I am certainly not saying that your weight gain on the meds isn't real. I'm sure it is. What I know, though, is that you're writing things here that I have written; and I know that those most likely to gain weight from these drugs are those who are underweight to begin with, often those with eating disorders.
Good luck.
Posted by jealibeanz on May 26, 2006, at 11:00:45
In reply to Re: What should I consider for long term treatment » jealibeanz, posted by Racer on May 26, 2006, at 10:30:38
Thanks for the explanation. I've heard these points before, but they're so hard to remember! I want to have hope that there is an AD that will help me, but I've had such a hard time getting a pdoc, let alone one who would help or take me seriously, so I'm back to my GP. I don't know if I should mention Parnate. Agitation probably wouldn't be a major issue, especially if I have the Xanax. I'm not an angry person, so it wouldn't push me over the edge in rage, maybe just get me to a normal level! I understand what you mean about the fact that many underweight people gain. I was about 5 lbs under standard, but didn't look too thin at all, perfectly healthy and eating huge amounts prior to my begining of AD trials. They all significantly decreased my appetite, but I remained very active through intense athletic training. Since then, my metabolism has been shot! I'm a small framed short person, the amount gained is significant on my and unnecessary. It definitely pushed me into the overweight category. Haha, you right, hearing that someone else doesn't gain, especially the whole Wellbutrin thing, doesn't help, it just makes me feel abnormal! I hope there is something out there to help lift my mood, provide a little motivation, pleasure, and desire to really live!
Posted by Caedmon on May 26, 2006, at 13:17:12
In reply to Re: What should I consider for long term treatment, posted by jealibeanz on May 26, 2006, at 11:00:45
My pet theory is that Nardil causes weight gain because it is a GABA transaminase inhibitor, like valproate [Depakote, etc]. So it can cause hunger and possibly some metabolic syndrome - but, like valproate, this is probably dose-dependent and is less likely to occur in younger males who exercise regularly.
Yeah, Parnate might work too. It is probably just as anxiolytic as EMSAM, if not more so, and is an excellent choice for treatment-resistant depression.
- Chris
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