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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by NicScraps on August 17, 2007, at 18:33:22
Hi to all -
I'm newly registered here, but have read a number of posts previously. This seems like a very supportive and helpful group.
My issues are unipolar depression, anxiety and panic attacks, and some OCD thrown in for good measure. I have a few AD symptoms, but all are symptoms common to depression, so it's not clear whether I have ADD also. Maybe.
I have been on SSRIs for about 6 years, with one 12 month break when I was pregnant with my second child (not a fun time for me or my family). My issues predate the diagnosis and treatment by at least a decade, so I've been dealing with all this for a while.
To date, I've taken Zoloft, Paxil, Lexapro and Prozac. I only had a short trial of Lexapro (it's not on my formulary), so I can't really say much about it.
Any of these meds prevent my panic attacks and help to some extent with the anxiety. So, there seems to be no doubt that I have some type of serotonin issue. It's not clear whether I also have issues with the other two neurotrasmsmitters. In general, the depression is harder to control, and I have a problem with recurrent episodes of moderate to severe depression, even while medicated.
I also want to note that I have devoted a lot of time and money to therapy in addition to the meds. I initially had 6 months of weekly visits. I maintain a relationship with my therapist, and have seen her for a few visits now and then as needed. [Note to anyone taking meds who hasn't tried therapy, too. Try it! I had very low expectations about therapy, but ultimately found it to be a HUGE help.]
But therapy alone is not going to do the trick for me.
Zoloft make me very flat emotionally. It also seems to inhibit my ability to cry. I don't want to take Zoloft again.
Paxil was decent for the depression and anxiety, but the weight gain was really bad, and I had a pretty rough time when I discontinued it. I don't want to take Paxil again. I have high blood pressure, and my doctor completely freaked out about the weight gain.
Prozac has been my top choice so far. I've been on 20mg alternating with 40mg for about 18 months continuously as of this date.
Up until recently, Prozac seemed to give me decent help for the anxiety, depression and the mild OCD.
The side effects were so-so. Prozac never made me gain weight (didn't lose either), but the sexual side effects are annoying, and I find myself more and more unhappy with delayed orgasm and anorgasmia.Worst of all is that I recently had another episode of major depression. My therapist agrees that my lows should not be this low with meds on board, and the meds need adjustment.
So, what now? I can't have Wellbutrin due to having had two seizures in my teens (that was quite a long time ago, but still...). Lexapro and Cymbalta are non-formulary.
Celexa is a possibility, and I would love to hear if anyone has had success with a reduction in sexual side effects when going from something else to Celexa (not Lexapro).
Effexor seems like it has a worse side effect profile than anything I've taken, so it's not at the top of my list.
Remeron is available to me, but again the side effect profile seems a bit extreme. Anyone here have experience adding some Remeron to Prozac (or another SSRI) as a way of trying to improve the sexual side effects?
I've also considered asking to add a low dose of Strattera to the Prozac to help with the depression. I know this is off-label, but it would certainly answer the question as to whether norepi is a problem for me or not, which could be very helpful the next time I have to adjust my meds.
Another idea is a trial of T3/Cytomel. Another off-label use. I'm sure I can get the doc to do a T4/T3 combo if my thyroid comes back hypo, but it has been normal for several months now (??? I thought hypothyroid was a lifetime thing???) I don't know that he will try the T3 if my TSH is "within normal limits."
Pindolol augmentation is helpful early with an SSRI, but there doesn't seem to be any benefit to adding it later on.
Yes, I could really use a pdoc's help. However, we have a major shortage of pdocs in my community, and I can't get in until late December! So, in the mean time, I have to try to convince my internist to do something. I'd like to go to him next week with something specific in mind.
I know quite well that the only real way to see how a specific drug affects me is to try it. I just want to narrow down my options a bit before submitting myself to another round of being a human guinea pig.
Thanks so much for anything you can share that might help.
Nic
Posted by med_empowered on August 17, 2007, at 19:11:12
In reply to Advice wanted: which med to try next?, posted by NicScraps on August 17, 2007, at 18:33:22
have you tried lamictal? Its not just for bipolar anymore (not that it ever was, really)...
Also: buspar, benzos, wellbutrin, switch to EMSAM or another maoi, add in a low-dose tca, add in a low-dose atypical antipsychotic (not good first line, but who knows), use an anticonvulsant (lamictal, trileptal, depakote), low-dose lithium, a traditional stimulant (ritalin, etc.), buspar.....
....and then the nutritional options, like high dose niacinamide, 5htp, etc.You have plenty of options left, and you seem responsive to treatment, which is a good thing.
Posted by Quintal on August 17, 2007, at 20:56:31
In reply to Advice wanted: which med to try next?, posted by NicScraps on August 17, 2007, at 18:33:22
Yeah, Remeron can help with the sexual side effects of SSRIs, due to its 5-HT2 blocking thingy. The side effects, like sedation and weight gain, can be quite strong though. If you want a med to reverse Prozac-induced anorgasmia cyproheptadine might fit the bill. It's an antihistamine that blocks 5-HT2 receptors, temporarily reversing the sexual side effects that come along with excess stimulation of those receptors. I think you take it as required before sexual activity, a bit like Viagra.
As med_empowered said, buspirone could be another option to treat sexual side effects, and to augment the antidepressant effect of Prozac. I suppose your internist might be reluctant to prescribe an MAOI, but they would be a good option if you could get someone to prescribe them for you, ditto the TCAs.
Q
Posted by cactus on August 17, 2007, at 22:55:20
In reply to Advice wanted: which med to try next?, posted by NicScraps on August 17, 2007, at 18:33:22
Have you tried Luvox? It's got the lowest sexual side effect profile of all the SSRI's and is primairly used for OCD, anxiety, panic and depression. As long as the dose is kept under 150mg per day. Just another suggestion, I also found it to be weight neutral too.
Posted by NicScraps on August 20, 2007, at 17:26:35
In reply to Re: Advice wanted: which med to try next? » NicScraps, posted by cactus on August 17, 2007, at 22:55:20
Many thanks to all. You all mentioned several options that had not occurred to me.
I was able to get an earlier appt with the pdoc due to a cancellation, so I can see him in September.
We also received a brand new med formulary that begins in September. Lexapro is now available to me as a preferred med.
I think I will ask about either adding BuSpar to my Prozac or else switching to Lexapro. I will also inquire about the cryptoheptadine and get more info about Lamictal.
Thanks again -
NicScraps
This is the end of the thread.
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