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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by papillon on January 23, 2011, at 10:07:30
Hello,
I am new to Psycho Babble and wanted to introduce myself and brainstorm options for a new anti-depressant. There is a lot of first-hand knowledge and empathy in this group, which is something that doctors and our non-suffering friends/family can't offer.
I have major depression and am S-L-O-W-L-Y tapering off Effexor XR. After working pretty well for 6 years (excellent milleage) it "pooped out" about 6 months ago = relapse. I'm currently on 375mg, down from 450mg.
I also take Epilim (Sodium Valporate) which was added in an attempt to boost / salvage the Effexor. Unfortunately it didn't have that effect, but my pdoc wants me to stay on it for the time being.
It's been suggested that I go on Cymbalta or Amitripyline once I'm off Effexor. Cymbalta since it's another SNRI, amit. as I haven't tried a tricyclic before. Does anyone have any other suggestions? Any experiences with the above meds that you'd be willing to share? Noting of course that everyone reacts differently.
Without knowing my baseline, I'm after something activating that will specifically target fatigue, poor concentration and brain fog / woolliness. SSRI's are out of the question - they work well for some but for me they either don't work or make me worse.
I know a new AD is a long way off thanks to Effexor's withdrawal hell, but researching makes me feel like I'm at least doing SOMETHING. That and it's somewhat of a distraction from worrying about coming off Effexor and not finding anything that gives some relief.
Anyway, enough about me. How are you? Please drop in and say hello.
Posted by Phillipa on January 23, 2011, at 10:48:03
In reply to An introduction + request for ideas, posted by papillon on January 23, 2011, at 10:07:30
Since I have no experience either with TCA'a other than l day trials years ago. I stopped by to welcome you to babble hoping those with great ideas for you answer your questions. Phillipa
Posted by merpmerp on January 23, 2011, at 11:03:11
In reply to An introduction + request for ideas, posted by papillon on January 23, 2011, at 10:07:30
Welcome! Cymbalta is worth a shot... also... what about Pristiq? The only thing is since it's an active metabolite of Effexor, I'm not sure if it would also be subject to the "poop out". But it might be worth a try?
You will find something to help you again. If nothing else Effexor may work again after a short break!
Posted by Christ_empowered on January 23, 2011, at 15:51:16
In reply to Re: An introduction + request for ideas » papillon, posted by merpmerp on January 23, 2011, at 11:03:11
Sorry you're having a relapse. I've never taken Elavil, but I did take Tofranil-PM (its a once-daily tricyclic; some of the older drugs require multiple doses throughout the day). I was taking other meds, too, but the Tofranil-PM lifted my mood a bit and helped lower my anxiety. Also, since its sedating, it kind of doubles as a sleeping pill.
Posted by MissThang on January 23, 2011, at 21:30:01
In reply to An introduction + request for ideas, posted by papillon on January 23, 2011, at 10:07:30
The obvious choice to me seems like wellbutrin. It's activating without being a true stim and is excellent for motivation, clarity in thought and adding interest without messing with your serotonin. The ssri's have been awful for me in the past, but as soon as I went on wellbutrin, I felt so much better. Cymbalta affected me just like ssri's (flatness, apathy, weight gain, sexual dysfunction), whereas wellbutrin kicked up my sex drive and diminished my appetite. It pooped out on me after a while as well, but I just took a short break from it and am slowly reintroducing it again and it seems to be helping again. Good luck!
Posted by surferchica on February 1, 2011, at 13:08:58
In reply to Re: An introduction + request for ideas, posted by MissThang on January 23, 2011, at 21:30:01
I was on Cymbalta--up to 60mg, but had side effects of SEVERE constipation, difficulty urinating & sweating. Tapering off was hell. Severe body pains was the main withdrawal problem as well as dysphoria. These occurred even with a very gradual withdrawal.
I'm still stuck on 20mg Cymbalta. My mood becomes too unstable even trying to decrease to 10mg (((but, this is just me. Your experience may be totally different)))
Sigh, getting the med mix "right" is a difficult process at times. Trial and error.
I think one thing to consider with Cymbalta is its short half life. For me, it was just too short and led to too much mood instability. (I have BP2)
What about Prozac? or the supplement Sam-e? or adding low dose Abilify to help with the depression along with an AD. Abilify is FDA approved for this purpose.
Good luck.
Posted by Chairman_MAO on February 2, 2011, at 8:36:53
In reply to An introduction + request for ideas, posted by papillon on January 23, 2011, at 10:07:30
Tranylcypromine (Parnate), 0.7mg/kg/day up to 1.5mg/kg/day in divided doses. You _will_ need something for insomnia.
http://www.ncbi.nlm.nih.gov/pubmed/8139763
http://www.ncbi.nlm.nih.gov/pubmed/2710808
Posted by BetweenDreams81 on February 4, 2011, at 9:06:31
In reply to Re: An introduction + request for ideas » papillon, posted by Chairman_MAO on February 2, 2011, at 8:36:53
Well, just thought I would stop by to say hello and welcome :o) Everyone here is so helpful and supportive. I wish you the best of luck finding the right 'thing' that works...I am in that process myself. Unfortunately, I developed a rash while titrating up on Lamictal (lamotrigine) and had to stop. Too bad, it was really starting to kick in with the AD qualities. Might be something to look at? I didn't 'feel' much difference at the 25mg dose, but the 3 days I was at 50 mg was heaven. Brain fog gone, woke up entirely on my own before my alarm clock and was ready to jump out of bed. The sun shined brighter and I finally had energy. BUT...experiencing the adverse reaction to it was not fun.
Good luck and take care!
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