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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by flip777 on December 3, 2008, at 20:31:51
Hello,
New to the forum. Currently taking valproic acid 1000mg, effexor 325mg, mitrazapine45mg, trazadone 75mg, buspar 5mg. PTU 25 mg for hypertyroidism.
Have had ect, ssri's, snri's, tricyclics, benzodiazepines, antipsychotics been hospitalized 6 times in the last 15 years. Stay stable for a few years, remission, and then crash again.
Any advice or help about current medications for treatment resistant depression and anxiety.
Thank You
Posted by azalea on December 3, 2008, at 22:42:00
In reply to Advice on effective antidepressant, posted by flip777 on December 3, 2008, at 20:31:51
Have you tried Lithium or Lamictal?
What about MAOIs such as Nardil or Parnate?
> Hello,
> New to the forum. Currently taking valproic acid 1000mg, effexor 325mg, mitrazapine45mg, trazadone 75mg, buspar 5mg. PTU 25 mg for hypertyroidism.
> Have had ect, ssri's, snri's, tricyclics, benzodiazepines, antipsychotics been hospitalized 6 times in the last 15 years. Stay stable for a few years, remission, and then crash again.
> Any advice or help about current medications for treatment resistant depression and anxiety.
> Thank You
Posted by Racer on December 3, 2008, at 23:15:54
In reply to Advice on effective antidepressant, posted by flip777 on December 3, 2008, at 20:31:51
> Hello,
> New to the forum.Welcome to Babble! There are a lot of great people here, and it can be a good place to find information and support. I hope you find it to your liking, and decide to stick around a while.
>Currently taking valproic acid 1000mg, effexor 325mg, mitrazapine45mg, trazadone 75mg, buspar 5mg. PTU 25 mg for hypertyroidism.
The best answer I have for what is an effective anti-depressant sounds flip -- "the one that works for you." The problem is, everyone reacts differently, your mileage will vary, etc. I can tell you that I couldn't survive on what you're taking, for example.
I've got a little more helpful advice, too, though -- at least, I hope it's helpful to you.
Effexor is often seen as the "old faithful" of psychopharmacology -- it seems to be effective and tolerable for many people. The problem is, it tends to stop working after a while. How long have you been on it? It may be that it's time to cycle off it -- often, people can take a break from a medication like Effexor, take something else for a while, and then come back to it and find it more effective again. If you've been on Effexor for a while, it is probably worth discussing alternatives with your doctor.
You don't mention your diagnosis, but with the valproic acid, I'm guessing some flavor of bipolar? If so, maybe trying another mood stabilizer, one known to help with depression, might help? Lamictal is quite good for many people, and if you haven't tried it, it's probably worth giving it a go. Lithium is another option to consider -- it is the gold standard, and is often used to augment antidepressants.
The Remeron Trazodone pairing makes me wonder, too -- Traz is more often used for sleep than depression, and Remeron often fills that purpose, too. Maybe another option would be more helpful? Rozerem, while not a "knock you out quick" drug, is often good for resetting sleep patterns, and augmenting antidepressants.
As far as anxiolytics, I like Buspar, because I react badly to most others. That's me, and I'm apparently quite weird...
Best luck to you, and I hope that was at least a bit helpful for you.
Posted by Phillipa on December 3, 2008, at 23:56:17
In reply to Re: Advice on effective antidepressant » flip777, posted by Racer on December 3, 2008, at 23:15:54
Sounds like you've had a horrible time. What is your diagnosis? And welcome. love Phillipa
Posted by desolationrower on December 4, 2008, at 0:32:32
In reply to Re: Advice on effective antidepressant, posted by Phillipa on December 3, 2008, at 23:56:17
Yeah, MAOIs. And, when you say you crash, does your med poop out? Some people just need to stay on antidperessants indefinately.
-d/r
Posted by Poet on December 4, 2008, at 10:40:36
In reply to Advice on effective antidepressant, posted by flip777 on December 3, 2008, at 20:31:51
Hi Flipp,
I was on paxil for about a year and it kicked out. Then I was on Effexor for two years and it kicked out. I switched to Lexapro which so far is working fine. Just to give you a withdrawal heads up. You have to slowly reduce the dose of Effexor, it took months before I could start something new. While I had anxiety and was depressed, it was better than withdrawal side effects which I had with paxil when I went cold turkey.
I also take clonazepam as needed for anxiety and Seroquel to sleep.
Good luck.
Posted by bleauberry on December 4, 2008, at 18:02:33
In reply to Advice on effective antidepressant, posted by flip777 on December 3, 2008, at 20:31:51
It would be really really hard, but you could wean off of all meds except depakote, just lower it to 500mg, wash out for a couple weeks, and then start Parnate.
It amazes me that the best antidepressants ever invented, and maybe the only true antidepressants, are so often ignored as if they don't exist.
Posted by desolationrower on December 4, 2008, at 18:45:15
In reply to Re: Advice on effective antidepressant, posted by bleauberry on December 4, 2008, at 18:02:33
> It would be really really hard, but you could wean off of all meds except depakote, just lower it to 500mg, wash out for a couple weeks, and then start Parnate.
>
> It amazes me that the best antidepressants ever invented, and maybe the only true antidepressants, are so often ignored as if they don't exist.I assume one would need to continue the thyroid medication. And keep the trazodone, because dollars to donuts you'll need it once you start the parnate, especially if you need it now.
And good luck getting off of 325mg of effexor.
-d/r
Posted by Racer on December 4, 2008, at 18:52:39
In reply to Re: Advice on effective antidepressant, posted by bleauberry on December 4, 2008, at 18:02:33
>
> It amazes me that the best antidepressants ever invented, and maybe the only true antidepressants, are so often ignored as if they don't exist.I realize that we're unlikely ever to agree on this issue, but I'd like to add my opposing view to this statement. Respectfully, of course, because I don't expect you to agree with me, and that's fine.
The biggest reason for the algorithm so often used in choosing anti depressants has nothing to do with efficacy -- because most of the anti-depressants are about equally likely to be successful -- but with tolerability. Most of the studies I've read about use of MAOIs have mentioned that tolerability is a large factor in people discontinuing their use. The side effect profile is part of the problem, the dietary restrictions are another part.
Sure, there are a lot of doctors out there these days who won't prescribe MAOIs, or who will prescribe them only after adequate trials of the newer drugs and at least one TCA have failed. That doesn't mean they're wrong -- they're looking at factors other than the ones you're looking at.
I believe both views are quite valid. I, for one, would not take an MAOI. That's my choice. If you have found one that works for you, that's great -- it's simply not my choice. And despite the possibility that I am just biased, I think my choice is equally valid. ;-)
Posted by greywolf on December 4, 2008, at 19:51:57
In reply to Advice on effective antidepressant, posted by flip777 on December 3, 2008, at 20:31:51
I have been treating for many years for BP with treatment resistant depression, anxiety and severe OCD. I've been on just about every known med at therapeutic levels.
Right now I'm on Remeron 45mg, Abilify 20mg, Luvox 200mg, and Xanax. The Remeron and Abilify are fine in terms of side effects, though I don't really see efficacy. I can't stand the Luvox because of the SEs; it does reduce the mental aspect of the anxiety better than the Xanax--but basically that just means flattening my affect, so overall it's not a great trade-off.
I've got a well-respected psychiatrist in terms of pharmacology (I've actually had pharmacists bring that to my attention), so I will stick to this regimen to see if it works even though it's not working out too well right now. But the combo might be helpful to others, so I mention it.
Greywolf
Posted by flip777 on December 4, 2008, at 20:38:10
In reply to Advice on effective antidepressant, posted by flip777 on December 3, 2008, at 20:31:51
Hello All, Thank you! for the responses.
I have always felt on my own with this and this forum sure helps. I have been diagnosed with treatment resistant depression, ocd, anxiety/panic disorder, complicated grief, social anxiety disorder, etc
I have taken prozac, zoloft, paxil, effexor, wellbutrin, lexapro, luvox, the tricyclics, seroquel, haloperidol, zyprexa, librium, clonazepam, restoril, immovane, ativan, haldol, xanax, diazepam.
Been on medication for 15 years, some don't work, some work for awhile, some work great then just stop. I don't drink or do drugs, I have a good full time job a good spouse and family.
Haven't tried maoi's always considered that a last resort but maybe it's time.
Appreciate the advice on effexor, been on it for about 3 years doesn't seem to cut it anymore. Hospitalized Feb 08 for 4 months. Off effexor onto lexapro, no result, changed to prozac, no result so back to effexor and current meds then ect.
On xanax and diazepam for about three years. Really was hard to come off, so that's where the trazadone and buspar come in, for anxiety.
Since feb 08 feeling extreme sadness, grief, crippling anxiety and panic attacks, dont socialize anymore, mood swings from irratible to low. Consistent thoughts of death or having to return to the psychiatric ward, numb, detached, exhausted, I'm sure you all know.
Thanks
Posted by azalea on December 4, 2008, at 21:19:32
In reply to Re: Advice on effective antidepressant, posted by flip777 on December 4, 2008, at 20:38:10
Lithium and MAOIs are both old medications, but good ones. They work well combined, using Lithium to augment MAOI response if incomplete.
Trying an MAOI would involve discontinuing Effexor and Buspar and then doing a 2 week wash-out. It's definitely a commitment, but might be worth a try, IMHO.
Keep us updated!> Hello All, Thank you! for the responses.
> I have always felt on my own with this and this forum sure helps. I have been diagnosed with treatment resistant depression, ocd, anxiety/panic disorder, complicated grief, social anxiety disorder, etc
> I have taken prozac, zoloft, paxil, effexor, wellbutrin, lexapro, luvox, the tricyclics, seroquel, haloperidol, zyprexa, librium, clonazepam, restoril, immovane, ativan, haldol, xanax, diazepam.
> Been on medication for 15 years, some don't work, some work for awhile, some work great then just stop. I don't drink or do drugs, I have a good full time job a good spouse and family.
> Haven't tried maoi's always considered that a last resort but maybe it's time.
> Appreciate the advice on effexor, been on it for about 3 years doesn't seem to cut it anymore. Hospitalized Feb 08 for 4 months. Off effexor onto lexapro, no result, changed to prozac, no result so back to effexor and current meds then ect.
> On xanax and diazepam for about three years. Really was hard to come off, so that's where the trazadone and buspar come in, for anxiety.
> Since feb 08 feeling extreme sadness, grief, crippling anxiety and panic attacks, dont socialize anymore, mood swings from irratible to low. Consistent thoughts of death or having to return to the psychiatric ward, numb, detached, exhausted, I'm sure you all know.
> Thanks
Posted by bleauberry on December 5, 2008, at 19:46:03
In reply to Re: Advice on effective antidepressant » bleauberry, posted by Racer on December 4, 2008, at 18:52:39
Hi Racer,
I completely agree with. I am very keen on everything you mentioned, but glad you took the time to write it anyway.
The difference in this particular case is the history and the current state. This person is way beyond where you and I are talking about.
> >
> > It amazes me that the best antidepressants ever invented, and maybe the only true antidepressants, are so often ignored as if they don't exist.
>
> I realize that we're unlikely ever to agree on this issue, but I'd like to add my opposing view to this statement. Respectfully, of course, because I don't expect you to agree with me, and that's fine.
>
> The biggest reason for the algorithm so often used in choosing anti depressants has nothing to do with efficacy -- because most of the anti-depressants are about equally likely to be successful -- but with tolerability. Most of the studies I've read about use of MAOIs have mentioned that tolerability is a large factor in people discontinuing their use. The side effect profile is part of the problem, the dietary restrictions are another part.
>
> Sure, there are a lot of doctors out there these days who won't prescribe MAOIs, or who will prescribe them only after adequate trials of the newer drugs and at least one TCA have failed. That doesn't mean they're wrong -- they're looking at factors other than the ones you're looking at.
>
> I believe both views are quite valid. I, for one, would not take an MAOI. That's my choice. If you have found one that works for you, that's great -- it's simply not my choice. And despite the possibility that I am just biased, I think my choice is equally valid. ;-)
Posted by Racer on December 6, 2008, at 2:41:25
In reply to Re: Advice on effective antidepressant » Racer, posted by bleauberry on December 5, 2008, at 19:46:03
Thank you, Bleauberry. It was nice of your to take the time to write that, and I think it was a great model of respectful communication.
You're right, of course, that in this case MAOIs are a very valid option. I get a little defensive on the subject, since I've been told now and again that I "should" just take one. It has sometimes been a bit painful for me, so it's a bit of a soapbox for me.
Thank you again.
Peace.
This is the end of the thread.
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