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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by julie1977 on July 24, 2010, at 11:33:15
I'd welcome any suggestions, i've tried most of the SSRIs, a tricyclic, venlafaxine, mirtazapine, moclobemide, lamotrigine, olanzapine, and currently nardil.
Nardil has lost alot of its effectiveness and I experience chronic 'dysthymia', anhedonia, limited emotions, flat affect. Life isn't pleasant for me.
I suffer double depression with Social Anxiety. I did take olanzapine with nardil but that lost its effectiveness too and I no longer found it worth the constant ravenous appetite and weight gain I had.
Does anyone have any suggestions, either of augmenting, or trying a new med.
Thanks in advance.
Posted by Phillipa on July 24, 2010, at 12:53:08
In reply to Feel like i've tried everything, posted by julie1977 on July 24, 2010, at 11:33:15
When's the last time you were med free? Some say a period of that and meds again work? Phillipa
Posted by ed_uk2010 on July 24, 2010, at 17:44:37
In reply to Feel like i've tried everything, posted by julie1977 on July 24, 2010, at 11:33:15
>a tricyclic
Which one? It might be helpful to try a different TCA. The various TCAs have different properties.
Posted by julie1977 on July 24, 2010, at 19:03:43
In reply to Re: Feel like i've tried everything, posted by ed_uk2010 on July 24, 2010, at 17:44:37
I was last med free about 9 months ago when I weaned off and on nardil, it had a renewed effect for a while but being off it was extremely unpleasant, not to be taken lightly again.
I tried Lofepramine, which got me up early and gave me a lifted mood in the morning, which wore off fairly quickley.
I'm thinking of adding Amisulpride to the nardil I take, it has an antidepressant effect at a low dose of 50mg. Any ideas about this? thanks
Posted by Justherself54 on July 24, 2010, at 21:02:59
In reply to Re: Feel like i've tried everything, posted by julie1977 on July 24, 2010, at 19:03:43
I felt like you a couple of months ago. We were going to retry all the SSRI's again, when my pdoc suggested I give clomipramine a trial. I had a pretty rough time when I tried amitriptaline and nortriptaline, as the sedation was unbearable.
I was very reluctant to try another TCA and much to my surprise I'm doing quite well on it. Go figure.
Posted by ed_uk2010 on July 24, 2010, at 21:09:11
In reply to Feel like i've tried everything, posted by julie1977 on July 24, 2010, at 11:33:15
>Nardil has lost alot of its effectiveness
What dose do you take? Assuming that you're not already on the maximum recommended dose of 90mg per day, would you be able to increase?
>lofepramine
Are you in the UK? Lofepramine is only marketed in a few countries, including the UK.
In terms to trying a different tricyclic, clomipramine (Anafranil) is one of the most effective - both for depression and for anxiety.
>any suggestions
Have you tried bupropion (Wellbutrin, Zyban)? Bupropion is very widely used in the US for depression. In the UK, it is only approved for smoking cessation. Nevertheless, your doctor may be willing to consider it at this stage. It is not proven to help with social anxiety, however. In some cases, it can cause people to feel agitated. Still, it causes fewer adverse effects than many antidepressants. You would have to come off Nardil if you want to try it.
Posted by julie1977 on July 25, 2010, at 12:52:14
In reply to Re: Feel like i've tried everything, posted by ed_uk2010 on July 24, 2010, at 21:09:11
I'm glad that you're having success with clomipramine Justherself
I take 60mg Nardil, I have tried 75mg but didn't feel any better and the tiredness was unbearable (I was putting my head on my desk at work)
Yup i'm in the UK. I'm a bit scared to come off nardil as it is somewhat effective, i'd rather augment it. HOwever i've just found out that amisulpride is a no-no due to raised prolactin levels. I had felt quite hopeful about that when I read up on it too, grr.
Bupropion is one I have thought about for a while as I know it acts quite uniquely on the neurotransmitters.
I need to have a good think.
Thanks for your input.
Posted by ed_uk2010 on July 25, 2010, at 13:22:54
In reply to Re: Feel like i've tried everything, posted by julie1977 on July 25, 2010, at 12:52:14
>However I've just found out that amisulpride is a no-no due to raised prolactin levels. I had felt quite hopeful about that when I read up on it too, grr.
Why is it a no-no? Do you have high prolactin already?
Posted by julie1977 on July 25, 2010, at 15:18:01
In reply to Re: Feel like i've tried everything, posted by ed_uk2010 on July 25, 2010, at 13:22:54
high prolactin causes hair loss, i'm a woman and I already suffer from Androgenetic alopecia and couldn't face losing anymore hair than I already am doing :-(
Posted by ed_uk2010 on July 25, 2010, at 15:33:06
In reply to Re: Feel like i've tried everything, posted by julie1977 on July 25, 2010, at 15:18:01
>high prolactin causes hair loss, i'm a woman
Perhaps you could still consider a trial of low-dose amisulpride? If it hasn't helped after a few weeks you could discontinue. I'm pretty sure that hair loss is not a common side effect.
Posted by Emily Elizabeth on July 25, 2010, at 15:36:44
In reply to Feel like i've tried everything, posted by julie1977 on July 24, 2010, at 11:33:15
How about Abilify? It was my dream drug after trying everything else. I only saw one AAP on your list, so this one might be worth a try. It has a better side effect profile than other AAP's.
Good luck!
Best,
EE
Posted by julie1977 on July 25, 2010, at 15:37:35
In reply to Re: Feel like i've tried everything, posted by ed_uk2010 on July 25, 2010, at 15:33:06
apparently amisulpride increases prolactin regardless of dose, ie. its not dose dependant. I'm looking into aripiprazole now.
As you're from the UK do you find you have trouble getting your psychiatrist to prescribe meds which you suggest? I'm always scared I won't get prescribed what I want, which hasn't actually happened yet (unbelievably) but I can see happening at some point. I see my psychiatrist on the NHS, do you too?
Posted by ed_uk2010 on July 25, 2010, at 15:50:46
In reply to Re: Feel like i've tried everything, posted by julie1977 on July 25, 2010, at 15:37:35
>apparently amisulpride increases prolactin regardless of dose, ie. its not dose dependant.
That's true. The reason I suggested a low dose is because it minimises other side effects and seems to be optimal for depression.
>I'm looking into aripiprazole now
Aripiprazole is an interesting one. It does not increase prolactin.
>As you're from the UK do you find you have trouble getting your psychiatrist to prescribe meds which you suggest?
Yes, I do.
Posted by ed_uk2010 on July 25, 2010, at 15:52:04
In reply to Re: Feel like i've tried everything, posted by Emily Elizabeth on July 25, 2010, at 15:36:44
> How about Abilify? It was my dream drug after trying everything else. I only saw one AAP on your list, so this one might be worth a try.
What dose do you take? Up to 10mg/day seems to be the norm for depression.
Posted by bleauberry on July 25, 2010, at 19:55:10
In reply to Feel like i've tried everything, posted by julie1977 on July 24, 2010, at 11:33:15
Well, it wasn't mentioned which meds were taken together.
For example, was the TCA nortriptyline? And if it was, was it taken in combination with zoloft or prozac? If not, then that trial was meaningless. Was it zyprexa with prozac? If not, then the zyprexa trial was in doubt. What about ssri with ritalin? Ever tried that? SSRI+TCA+ritalin? Some of these combinations take on a whole new life of their own that none of the ingredients alone can do.
It doesn't sound like nardil is going anywhere for you. Just thought I would mention some things that are very potent, right in front of us but usually overlooked.
Posted by Emily Elizabeth on July 26, 2010, at 11:28:49
In reply to Re: Feel like i've tried everything, posted by ed_uk2010 on July 25, 2010, at 15:52:04
> > How about Abilify? It was my dream drug after trying everything else. I only saw one AAP on your list, so this one might be worth a try.
>
> What dose do you take? Up to 10mg/day seems to be the norm for depression.
>
>
I take 5mg right now and it seems to be sufficient. At one point I was up to 30, but new pdoc says the literature doesn't necessarily support such a high dose for depression. 5 is doing the trick right now. No complaints here! :)Best,
EE
Posted by emmanuel98 on July 26, 2010, at 20:48:49
In reply to Re: Feel like i've tried everything, posted by Emily Elizabeth on July 26, 2010, at 11:28:49
Abilify was like a magic charm for me, except it caused rapid weight gain (doesn't usually, apparently). I found 10mg completely put my depressiion in remission. 5mg worked well enough so I still had some negative emotions to be worked on in therapy, but was not a slave to them.
This is the end of the thread.
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