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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Hobbyhawk on May 15, 2008, at 12:49:44
I am having bad side-effects, still, after 7 weeks on Mirtazapine (4wks @ 15mg, 3wks @ 30mg) - the common increased appetite accompanied by weight gain, for me about 2lbs a week and I was already overweight (30% greater than normal) to start with; an extremely dry mouth; and, worst of, all oedema, numbness and pins-and-needles in my legs and feet. Mirtazapine was chosen because of its additional anti-anxiety effects.
I am pleased to read that, generally, the side-effects of coming off this are not, generally, as bad as with Efexor (Venlafaxine) which I have also used in the past. Incidentally I also had weight gain with Efexor, weight which I have never managed to shed.
Now, I need to find another anti-depressant, but I really don't want to be bothered, as I feel there aren't any that can be taken without side effects.
I have previously been prescribed Imipramine which had absolutely no effect on the dosage prescribed, Efexor, Lofepramine which I tolerated fairly well but I have been told is not often prescribed thesse days, and the notorious Seroxat (Paroxetine) which was all my worst nightmares and more rolled up into one tiny murderous little pill.I don't know what to do about medication. I don't know why I bother. I guess it is just easier to be compliant.
Posted by Hobbyhawk on May 15, 2008, at 12:52:12
In reply to Changing medication, posted by Hobbyhawk on May 15, 2008, at 12:49:44
Mirtazapine is also known as Remeron
Posted by Racer on May 15, 2008, at 13:12:48
In reply to Changing medication, posted by Hobbyhawk on May 15, 2008, at 12:49:44
Hm...
Well, you've been on two TCAs, one SNRI, one SSRI, and mirtazapine... That does leave a lot of ground to cover...
Cymbalta is related to Effexor, but in my personal experience a much friendlier medication. It was far easier in terms of side effects, and about equally effective. If Effexor was helpful for you, it might be worth trying Cymbalta.
Paroxetine is kinda like one end of the SSRI spectrum, with a lot of friendlier medications at the other end -- my favorite being sertraline (Zoloft), with fluoxetine coming in second. If you got any relief from either Effexor or paroxetine, it might be worth trying one of those.
Some of the other TCAs might be easiser on you -- desipramine and nortiptyline come to mind. They tend to come with more side effects than most of the newer medications, but many people find them much more effective. It might be worth trying.
Buproprion comes to mind, as a novel agent, although it doesn't work well for everyone. Many people consider it a much less robust medication, although I've taken it for some time and like it fine. (Although I admit it's not brought me to remission.) It might also be a good choice to add to another antidepressant.
All medications will have side effects. The best advice I can offer is to sit down and list the side effects you've experienced, which ones you can tolerate, which ones you simply can't tolerate -- and which ones you can tolerate if the medication is optimally effective for you.
Also, many side effects can be mitigated. It's worth discussing with your doctor what steps can be taken to mitigate the side effects you're experiencing, or may experience on a new medication.
I hope that's helpful. Good luck.
Posted by Phillipa on May 15, 2008, at 13:24:37
In reply to Re: Changing medication » Hobbyhawk, posted by Racer on May 15, 2008, at 13:12:48
Luvox? It is now out in time release form. I never had side effects on it. But that is me. At one time it did work very well. That was the short acting. Good luck. What is your diagnosis? Love Phillipa
Posted by Hobbyhawk on May 15, 2008, at 13:38:58
In reply to Re: Changing medication » Hobbyhawk, posted by Racer on May 15, 2008, at 13:12:48
Thanks. That was very helpful. I'll research and talk to my GP about Cymbalta and buproprion. Lofepramine is desipramine and my GP says they don't really prescribe it any more, because it is old-fashioned (probably something to do with cost in reality). Whether that is true for nortiptyline as well, I don't know. I can at least ask.
I realise that these drugs all have side effects but some are so bad that they prevent me even having the limited life I have now. Any drug I take must give me a better life than I am having now, even if only slightly. It is a delicate balance, I accept.
Posted by Hobbyhawk on May 15, 2008, at 13:42:28
In reply to Re: Changing medication, posted by Phillipa on May 15, 2008, at 13:24:37
Thanks Philippa. That's another one to look out for.
Diagnosis - depression with a massive overlay of anxiety (social phobia?)
Posted by Racer on May 15, 2008, at 14:57:46
In reply to Re: Changing medication, posted by Hobbyhawk on May 15, 2008, at 13:38:58
> Lofepramine is desipramine and my GP says they don't really prescribe it any more, because it is old-fashioned (probably something to do with cost in reality). Whether that is true for nortiptyline as well, I don't know.
It will be true of nortriptyline as well, I can virtually guarantee it.
There are several reasons why TCAs are used less frequently these days. One is that they are more dangerous in overdose than newer medications. That's just the nature of the beast -- when you're discussing medications for depression, you have to keep in mind the danger of suicide associated with depression.
Another reason, though, has to do with what we're discussing here: side effects. The TCAs as a whole tend to have more frequent and more burdensome side effects than do the newer medications. Statistically -- and a lot of people will disagree with me on this, but I'm talking statistics, not individuals -- statistically all the antidepressants are about equally effective. That means that the choice for which medication to use for any individual patient is often based on side effect profile. For many people who walk into their GP's office for a prescription, the side effects associated with the older antidepressants won't be tolerable. Those of us here tend to be more willing to tolerate some of those side effects, in order to get relief which the newer medications simply do not provide.
That's a long way of saying, "It might be worth trying another TCA, but they do have more side effects than the newer meds."
>
> I realise that these drugs all have side effects but some are so bad that they prevent me even having the limited life I have now.Oh, I hear you. I have the same issue, and battle a lot with myself over my decision not to take certain medications which might actually reduce my mood-related distress. My experience of those drugs, though, is that I was too apathetic and flat to feel any real distress -- and that just isn't good enough for me anymore. So, instead, I take medications that keep me marginally functional, I work in therapy on ways to improve my functioning -- and feel a hell of a lot of despair about my future.
It's a hard balance, and it's not a pleasant place to be. I very much hope that something I've offered helps you find an effective compromise for your situation.
Posted by Hobbyhawk on May 15, 2008, at 15:35:12
In reply to Re: Changing medication » Hobbyhawk, posted by Racer on May 15, 2008, at 14:57:46
You have helped, thank you. At least I have some ideas to focus on. I keep finding there are contra-indications that apply to me, for the drugs that I look at.
However, Cymbalta looks a possible. It has only been licensed since 2005 in the UK so my GP may not be aware of it. I think I have that date right.
Posted by Quintal on May 15, 2008, at 16:46:21
In reply to Changing medication, posted by Hobbyhawk on May 15, 2008, at 12:49:44
Would you mind telling me what you experience with lofepramine was like? I'm going to ask my pdoc for a trial next Thursday and I've been trying to gather experiences, but so far nobody has replied.
Thanks.
Q
Posted by Jay_Bravest_Face on May 15, 2008, at 17:01:42
In reply to Re: Changing medication, posted by Hobbyhawk on May 15, 2008, at 13:38:58
Regarding tricyclics: I have had a very positive, lengthy (12 year) experience with them. But, only used in combination with an SSRI or an SNRI. Nortriptyline is still a popular medication, often prescribed. I used to be on 100mg of nortriptyline and 60mg of Prozac, and the start up of the nortriptyline took getting used of for the first week, but my gosh did it ever lift me out of deep dark depression! It was actually a bit too much, so we switched to imipramine and Prozac. I take 50mg of imipramine and 60mg of Prozac, 4mg of clonazepam(sometimes, usually, less) plus 200mg of Topomax and 2mg of Risperdal at bedtime. I've been remarking to myself lately at what such a 'smooth' attitude I have about life, my feelings, everything. I have TONS of tolerance to help other people in a good way (I still get angry at bad people too...) It's taken me many years and trials to get here, and no I don't believe I am now immune, as I always know my illness is in me. I'd highly advise you though not to discount any drug or combination as being too 'unusual' or whatever. Textbook 'formulas' quite often don't work, as different and unique as we all are, so don't be afraid to chart a new path.
Posted by Hobbyhawk on May 16, 2008, at 5:51:17
In reply to Re: Changing medication » Hobbyhawk, posted by Quintal on May 15, 2008, at 16:46:21
Lofepramine was the first anti-depressant that I was prescribed that worked. It was about 15 years ago. I do remember waking up one morning, looking out of the window and thinking how bright all the colours were - an indication of my seeming sudden mood uplift. That stuck with me but I don't remember what the side-effects were, except a dry mouth but not as bad as Mirtazapine. Unfortunately, this not going to help you. Sorry
Posted by Hobbyhawk on May 16, 2008, at 5:57:00
In reply to Re: Changing medication » Hobbyhawk, posted by Jay_Bravest_Face on May 15, 2008, at 17:01:42
That must have taken ages to balance out that complex combination of drugs. I hope I can sort out my meds in a more simple way.
However, it does show that perseverance pays off, and I will try and bear that in mind and be patient and open-minded. Its hard to not give into the "I just can't be bothered" feelings.
Posted by Quintal on May 16, 2008, at 8:22:40
In reply to Re: Changing medication (Lofepramine), posted by Hobbyhawk on May 16, 2008, at 5:51:17
Yes, that was exactly what I wanted. It was very helpful, thank you. Lofepramine alledgedly has a mildest side effect profile of all the TCAs, so manybe that's why you don't remember having many? It's a shame they won't give you it now. The first antidepressant I responded to was dothiepin, but I noticed it's now listed as 'less suitable for prescribing' due to the high rate of fatality in overdose. I don't think they have this excuse with lofepramine though.
Q
Posted by Hobbyhawk on May 16, 2008, at 8:29:24
In reply to Re: Changing medication (Lofepramine) » Hobbyhawk, posted by Quintal on May 16, 2008, at 8:22:40
You could well be right about the side-effects with Lofepramine, that I don't remember any because they were only slight. And I also believe you are right about the relative lack of overdose "problems".
Posted by Jay_Bravest_Face on May 16, 2008, at 14:05:58
In reply to Re: Changing medication » Jay_Bravest_Face, posted by Hobbyhawk on May 16, 2008, at 5:57:00
> That must have taken ages to balance out that complex combination of drugs. I hope I can sort out my meds in a more simple way.
>
> However, it does show that perseverance pays off, and I will try and bear that in mind and be patient and open-minded. Its hard to not give into the "I just can't be bothered" feelings.
>
>Hi:
Yes, it does take time, but this time with this current combination was much shorter. Trust me, once you start feeling better, you won't want to go back!..hahaaa. Usually the first things to improve are the ones that are giving you the most trouble: be they sleep/insomnia, apathy, and eventually, anhedonia (inability to experience pleasure.). Anxiety also improves, but sometimes the occasional 'jumpy' anxiety takes a little longer to overcome. But, that really bad, acute anxiety does ease up, though. It is one of the first things to go. Geezz...I sound like I am 'cured' or something like that...and I am far from it!..hah. But, life becomes 'livable' again, after being to the 'darkest of dark' places. There are tons of people with lots of good help for your journey back to feeling better on here. Just remember that, you *deserve* to feel better, much better. You can, and will. It certainly is not always 'fun' and such as you already know. Try to educate yourself, because you can and will become your best advocate. Your doctor doesn't know the pain you are feeling at 3 in the morning. Anytime you want to chat about whatever......we are here!...
Please take good care,
Jay
Posted by Hobbyhawk on May 17, 2008, at 5:51:14
In reply to Re: Changing medication » Hobbyhawk, posted by Jay_Bravest_Face on May 16, 2008, at 14:05:58
Jay
That was a lovely reply. It sounded very caring, and I really appreciate that. You don't sound as if you were /completely/ cured, just at a much, much better place which allows you to be more optimistic and have a future, and give lots of encouragement and hope to the other souls more lost than you. At the moment, I just can't see a future through the thick, turgid and viscous grey fog that holds in me its grasp and smothers me. If I am honest, in so many ways I don't even want to. There is something "safe" about my pit.
My GP on reviewing my side-effects has decided to reduce the mirtazapine back to 15mg, and I did not have enough "energy" to say "No, please, can I try a different drug, because I had side-effects even when I was on the lower dose". He is hoping to draw on its anti-anxiety properties at this dose.
I have the habit, developed in childhood, of behaving in a compliant manner with authority figures while having contradictory private thoughts. Past 50 and I am still ruled by these childhood survival behaviours. They have long outlived their usefulness, and are now acting against my best interest. However, faced with a medical professional, I go into child mode and just say "yes" to whatever is proposed. I have decided to keep a side-effects diary. With this in front of me I hope I will break out and say what I am thinking, as I have some factual proof, which cannot be gainsayed without calling me a fantasist or a liar.
Posted by bulldog2 on May 17, 2008, at 8:40:19
In reply to Re: Changing medication » Jay_Bravest_Face, posted by Hobbyhawk on May 17, 2008, at 5:51:14
> Jay
>
> That was a lovely reply. It sounded very caring, and I really appreciate that. You don't sound as if you were /completely/ cured, just at a much, much better place which allows you to be more optimistic and have a future, and give lots of encouragement and hope to the other souls more lost than you. At the moment, I just can't see a future through the thick, turgid and viscous grey fog that holds in me its grasp and smothers me. If I am honest, in so many ways I don't even want to. There is something "safe" about my pit.
>
> My GP on reviewing my side-effects has decided to reduce the mirtazapine back to 15mg, and I did not have enough "energy" to say "No, please, can I try a different drug, because I had side-effects even when I was on the lower dose". He is hoping to draw on its anti-anxiety properties at this dose.
>
> I have the habit, developed in childhood, of behaving in a compliant manner with authority figures while having contradictory private thoughts. Past 50 and I am still ruled by these childhood survival behaviours. They have long outlived their usefulness, and are now acting against my best interest. However, faced with a medical professional, I go into child mode and just say "yes" to whatever is proposed. I have decided to keep a side-effects diary. With this in front of me I hope I will break out and say what I am thinking, as I have some factual proof, which cannot be gainsayed without calling me a fantasist or a liar.
>Sounds a lot like my case. To this day speaking to an authority figure where we speak face to face such as in a room at a desk can provoke a panic anxiety attack..Needless to say this put a severe rimp in my professional life.
Posted by Hobbyhawk on May 18, 2008, at 5:58:38
In reply to Re: Changing medication, posted by bulldog2 on May 17, 2008, at 8:40:19
> Sounds a lot like my case. To this day speaking to an authority figure where we speak face to face such as in a room at a desk can provoke a panic anxiety attack. Needless to say this put a severe rimp in my professional life.
While I do understand how your type of anxiety arises and the debilitating problems that come about (I have suffered as well), what I was trying to describe was a type of compliant behaviour where a person doesn't want to cause trouble or be demanding or have an argument; where they try to blend into the background. I must be passive, I must have things done to/for me, I must not have an opinion, I /must not contradict or question an authority figure/. As I said, this was a habit that I learnt in childhood as a defence against irrational adult behaviour. Sadly, it failed frequently then and acts against my best interests now.
Posted by bulldog2 on May 18, 2008, at 14:40:04
In reply to Re: Changing medication » bulldog2, posted by Hobbyhawk on May 18, 2008, at 5:58:38
> > Sounds a lot like my case. To this day speaking to an authority figure where we speak face to face such as in a room at a desk can provoke a panic anxiety attack. Needless to say this put a severe rimp in my professional life.
>
>
>
> While I do understand how your type of anxiety arises and the debilitating problems that come about (I have suffered as well), what I was trying to describe was a type of compliant behaviour where a person doesn't want to cause trouble or be demanding or have an argument; where they try to blend into the background. I must be passive, I must have things done to/for me, I must not have an opinion, I /must not contradict or question an authority figure/. As I said, this was a habit that I learnt in childhood as a defence against irrational adult behaviour. Sadly, it failed frequently then and acts against my best interests now.yes that is very much my case. My parents were very strict and I dared not voice an opinion or I risked a beating or a slap across the face. They extinguised my self esteem and my ability to lead a normal life.To this day my old mother attempts to control and squash any bit of happiness in my life..Feels I was born to serve her.
Posted by Hobbyhawk on May 19, 2008, at 4:31:26
In reply to Re: Changing medication, posted by bulldog2 on May 18, 2008, at 14:40:04
Yes, that's it.
My parents, however, were not strict beyond being sensible (the effect of my unfortunately frequently absent father?) but my mother was domineering, irrational and frequently selfish in her behaviour and demands. The unpredicatablility was scary.An example. I was a mental health patient (my first diagnosed "breakdown" after serious illness, bereavement and divorce) in a small private clinic. My mother rang up, demanding to speak to me, "I want you to come and carry my bags, when I go on holiday. That will be very nice for me as it is so difficult to find porters these days."
She considered she was being kind and thoughtful and caring. She has also offered me considerable sums of money to go and visit her, telling a relative that I would soon come because of her financial incentive. Of course, I can go on, and on, ..........
I don't know what her diagnosis would be, but I am sure she is/was ill.
This is the end of the thread.
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