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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 sam K on September 8, 2008, at 20:32:19
I am on Pristiq and I'm doing good although I really can't get over my fear of going to school. Nor can I exercise that much due to being depressed afterward (hmm..?) I dont know what to do really.. I'm not sure if I want to go off of Pristiq or try something else like an MAOI.
I have:
Social phobia (pretty bad)
some eating disorder (fear of being fat)
bad depression!
Parinoia
agorophobia (i guess)Im just so confused on what to do, Im just sick of being on a thread of depression, Pristiq isnt as potent as other ssri ssnris ive tried. I hate my life in alot of ways, I just cant seem to find the right track. I cant make freinds because of my inconsistant mood. Ive been thinkig alot about suicide lately and it seems like the only way. I want to try an MAOI maybe..... My mind takes off with these ideas, so maybe its a bad one.
I just want to not have fear and I want the best for myself!
Ive tried alot of meds!I dont feel like naming them. Pristiq is the best so far, but I want more... for some reason. I hate my life sometimes
Posted by Phillipa on September 9, 2008, at 0:17:47
In reply to Not sure what to do..?, posted by sam K on September 8, 2008, at 20:32:19
Hi Sam and welcome to babble glad you're here. There's a wealth of knowledge here. Bet someone who has been on pristiq will be along to answer questions . And a lot of posters on MAOi's. Yes it's hard to feel bad. Hope we can help you find a place where you feel safe to share you med trials and stories. I haven't taken that med but there are so many treatment resistant posters here I feel confident you indeed will find sound and great info again welcome!!! Love Phillipa
Posted by manic666 on September 9, 2008, at 4:29:26
In reply to Not sure what to do..?, posted by sam K on September 8, 2008, at 20:32:19
hey sam baby .why so sad is there any bands you like , lose yourself in your own world is cool. depression is s/it of the worst kind. it seem,s worse when your young , all those times walking on your own people everywhere,but you dont see them cos your brain is in the fog.you will come out of it in time , out the fog an in the clouds an the normals , thats my name for poeple not ill, will still be in there own boreing world but you will live 6 of there lives . thats what happen we have none, an then 6 . you will get excited at life they will just muddle along. its a cycle and at the moment your at the wrong end . come on baby up is the only way to go. tell me a band you like an iwill find a vid for you while you think about going up not down. tell me what makes you hurt the most an lets work on that baby manic666
Posted by B2chica on September 9, 2008, at 8:10:03
In reply to Not sure what to do..?, posted by sam K on September 8, 2008, at 20:32:19
i'm no expert, just trying to help. do you have bipolar or unipolar?
are you on any benzo's? like xanax or anything?
my first instinct says maybe something like zyprexa would help more with suicidal depression, paranoia and such just to get that in check, then maybe some lexapro in the mix?you mention pristiq, did you ever try effexor?
if MAOI, try nardil i hear its one of the better ones.
i'm sure some of the pro's will come around and list off some great med combo for you to try out.
Posted by Racer on September 10, 2008, at 10:14:09
In reply to Not sure what to do..?, posted by sam K on September 8, 2008, at 20:32:19
Hm...
So, Pristiq is helpful, although it's not enough, and we don't know what you've taken before, so forgive me if I only repeat meds which have failed in the past.
First, some similarities, so that you get an idea of any reason I might have OK advice for you: my dx's are depression, anxiety, anorexia, and "obsessive compulsive personality traits." (Only because my doctor didn't notice in time to add "and avoidant personality traits -- and maybe dependent personality traits, too since you mention it...") My anxiety is generalized, rather than social, but when it's bad I do have some agoraphobia. My mother has fairly classic agoraphobia, so I'm familiar with it from both sides. I've been on many, many medications and combinations, and found some things helpful, many things partially helpful, and some things really bad. And I would guess that you're afraid of weight gain from meds, and I'd imagine that third dx might suggest to you that I understand that. (I gained between 45 and 70 pounds on the first three antidepressants I took. I leave it to your imagination how that went over.)
Based on what little you've written, it sounds as though what Pristiq is doing isn't really hitting your depression very well. Yes, the anxiety component is prominent, but it sounds as though there's a hopelessness that really indicates a higher level of depression. So, let's look at antidepressants which might help:
Cymbalta is another SNRI; Effexor is the parent molecule to Pristiq. If you haven't tried one of them, it might be worth giving it a shot. Cymbalta is seen by many as the less effective of these two; I found it an easier ride in terms of adverse effects; it's a muddy picture, and if one doesn't work, it's probably worth trying the other as well.
You don't mention having tried any of the TCAs, MAOIs, etc. Virtually all the TCAs are known for causing weight gain in some people. That's individual, though, and those who are at a lower BMI are said to have a higher risk of gaining, and of gaining more weight. In some cases, there are ways to mitigate this gain, but for some drugs it's the nature of the beast -- their effects on weight are direct, they cause metabolic changes which lead your body to change the way it absorbs energy (calories) so addressing the weight gain is much harder. The benefit of the TCAs, though, is that they tend to be focused away from serotonin, and for many people they're a bit more robust. They're often avoided in those with eating disorders, due to the potential cardiac risks.
MAOIs are often known to cause weight gain, AND many doctors are very, very reluctant to prescribe them to anyone with any sort of eating disorder. EMSAM, the new transdermal MAOI, is an exception to this sensible rule, because it does not require dietary restrictions. There are very good reasons for avoiding MAOIs in eating disordered patients. One good and sufficient reason is pretty simple: the goal is an end to obsessive and restricting dietary patterns, and MAOIs necessitate exactly that sort of obsessive and restrictive focus on eating. In addition to this, of course, there are issues like bulimics or other bingers who might trance out and consume restricted foods; the physical damage caused by some EDs could be exacerbated by the drugs; etc.
Wellbutrin is a weight neutral option; although it's officially contraindicated for those with eating disorders. The primary danger with Wellbutrin is for those with bulimic symptoms, and some doctors are willing to prescribe it for some non-purging ED pts. It's not a medication I've seen many people here rave about, but I've taken it for years now -- despite the frustration that it's not the most potent antidepressant I can imagine... I am not in remission from it, and I always have to take at least one other med with it. It's frustrating, and often I fall into a very dark place while on it. Sometimes I wonder if I hold onto it like a security blanket -- but I tried to taper down a couple of years ago, and collapsed, so it's doing something real, even if not quite enough. It could be that a combination of Wellbutrin and low dose SSRI might be a good answer for you, and it's probably worth a try. You'd essentially be combining mechanisms of action in a way that resembles Pristiq pretty strongly. The Wellbutrin would target NE and DA, while the SSRI would cover the serotinergic component. Depending on the specifics of your disordered eating symptoms, that would be my strongest suggestion.
EMSAM is also a strong contender. Many people find it good for anxiety, it avoids the dietary restrictions of other MAOIs, and should be more weight neutral than the other MAOIs.
Remeron is often combined with Effexor, in what's colloquially known as "California Rocket Fuel," but Remeron is also associated with a lot of weight gain. I have yet to hear much about effective strategies to mitigate weight gain on Remeron, but it may be less of a problem at higher doses. If you can get past the fear of weight gain, it might be worth trying it.
For anxiety, the best I ever tried was BuSpar. Many who are used to benzos don't find it helpful, but that's theorized to be related to its subtlety -- with benzos, you can feel them hit shortly after you take them, while BuSpar is much more subtle. It takes a few weeks to ramp up, but at that point those who find it effective say they suddenly realize they're just not all that anxiety. I know that it was by far the best thing I ever took for anxiety -- I get a paradoxical reaction to benzos, and often find that they worsen anxiety for me. This isn't a common reaction to benzos, but anecdotally it's more common in those with eating disorders. BuSpar had no side effects to mention for me, which was another reason I liked it.
Those are all that I can think of right now. If you give some idea of what you've tried, that might help narrow the field.
Good luck.
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