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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 48. This is the beginning of the thread.
Posted by Doll Face on November 14, 2011, at 8:27:19
I've just started (actually 6 months ago) adding AAPs to Effexor to fight my depression symptoms. So far I've been on Abilify, Geodon, Latuda, and now back on Abilify. Limited if any help from any of them.
I see my doc Friday and I'm wondering what other options I might discuss with him. Last I saw him he sounded optimistic about lots of AAPs I hadn't tried yet, but I'm starting to feel that class of drug is not the answer.
Thanks for any input you might have.
Sharon
Posted by gadchik on November 14, 2011, at 8:46:26
In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19
Hi! I added remeron 7.5mg & klonopin .5mg to my zoloft,and the combo pulled me out of my depression and anxiety.I tapered off of the zoloft and remeron after 2 yrs.Now just take the .5mg klonopin-doing well. I hope you come up w/a good combo.
Posted by Phillipa on November 14, 2011, at 9:32:10
In reply to Re: Other options besides AAP for depression?, posted by gadchik on November 14, 2011, at 8:46:26
Gadchik was that your first depression? Just curious as seems first followed same course for me. Now it's different. Phillipa
Posted by gadchik on November 14, 2011, at 10:13:32
In reply to Re: Other options besides AAP for depression? » gadchik, posted by Phillipa on November 14, 2011, at 9:32:10
phillipa,my first depression was after childbirth,started,as always w/intense anxiety,then no sleep,then no eat,and finally sliding down into the pit.I was 28.Had mild anxiety up to then.It seems to be a major change,where you have to find a "new normal",that gets me.I never took any meds until the most recent episode.Between the postpartum and the last one,I had an episode that almost went into depression,but I knew I had to be there for my child,and I just took care of the anxiety w/diet/sleep/exercise,and barely got out of it,so I didnt end up depressed.I went yrs,did fine, then the vertigo caused my major one,in fact,that one went into psychosis because i refused treatment. What has been your hx w/this terrible disease?
Posted by psychobot5000 on November 14, 2011, at 11:35:24
In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19
Do you know if you're doing the correct dosage with the AAPs? The antidepressant dosage for Geodon is probably no more than 10mg twice a day, which means splitting the smallest capsule in half for each dose. For Abilify, I know less, but you may wish to titrate from the 2mg dose. You might be able to get benefit at that level with fewer side-effects.
I don't know enough about your history to know what else you've tried and what you haven't, or I'd throw out some ideas.
Posted by Christ_empowered on November 14, 2011, at 13:28:57
In reply to Re: Other options besides AAP for depression?, posted by psychobot5000 on November 14, 2011, at 11:35:24
you're on adderall, right? When I took Tofranil-PM, a somewhat modified, old-school antidepressant with my Adderall, I got pretty good results. Less anxiety, better mood, more energy, and I even slept better (the Tofranil-PM is once-daily, so it kind of doubles as a sleeping pill, at least early on in treatment). If your Effexor isn't working and AAP drugs aren't helping, then I would think a TCA might be appropriate. There's also BuSpar, which is much cheaper than the AAP drugs and might relieve tension, although its anti-anxiety effects are often kind of unimpressive. Still, its a reasonable option, and you can get a 30 day supply for $4 or less at many chain pharmacies.
Posted by Doll Face on November 14, 2011, at 14:55:40
In reply to Re: Other options besides AAP for depression?, posted by gadchik on November 14, 2011, at 8:46:26
Thanks all,
Having been on Effexor and Adderall for the past 10 years and having it work for me was great. Then early this year I started feeling myself slip farther into my depression again. That's when we started adding AAPs. I don't mind trying new meds, but changing from one AAP to another has been causing overwhelming anxiety that is almost unbearable. My doc gave me Ativan for the anxiety but then how do I know when / if the AAP is starting to work?
I just want the best possible option for treatment and not the most popular choice "as seen on TV" if you know what I mean.
Posted by psychobot5000 on November 14, 2011, at 15:51:21
In reply to Re: Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 14:55:40
> Thanks all,
>
> Having been on Effexor and Adderall for the past 10 years and having it work for me was great. Then early this year I started feeling myself slip farther into my depression again. That's when we started adding AAPs. I don't mind trying new meds, but changing from one AAP to another has been causing overwhelming anxiety that is almost unbearable. My doc gave me Ativan for the anxiety but then how do I know when / if the AAP is starting to work?
>
> I just want the best possible option for treatment and not the most popular choice "as seen on TV" if you know what I mean.Often old, well-tested drugs are better, though they may not be the first ones your doc will turn to, so, yes, something like Tofranil could help, I'd think.
If the new AAP is causing more anxiety, can you talk to your pDoc about discontinuing it and trying something else?
Posted by Doll Face on November 14, 2011, at 16:04:51
In reply to Re: Other options besides AAP for depression?, posted by psychobot5000 on November 14, 2011, at 15:51:21
> > Thanks all,
> >
> > Having been on Effexor and Adderall for the past 10 years and having it work for me was great. Then early this year I started feeling myself slip farther into my depression again. That's when we started adding AAPs. I don't mind trying new meds, but changing from one AAP to another has been causing overwhelming anxiety that is almost unbearable. My doc gave me Ativan for the anxiety but then how do I know when / if the AAP is starting to work?
> >
> > I just want the best possible option for treatment and not the most popular choice "as seen on TV" if you know what I mean.
>
> Often old, well-tested drugs are better, though they may not be the first ones your doc will turn to, so, yes, something like Tofranil could help, I'd think.
>
> If the new AAP is causing more anxiety, can you talk to your pDoc about discontinuing it and trying something else?
>That's exactly what I plan to do. I would rather try an old school, tried and true AD and see how it goes~
Thanks again for your input~
Posted by psychobot5000 on November 14, 2011, at 16:12:51
In reply to Re: Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 16:04:51
> > > Thanks all,
> > >
> > > Having been on Effexor and Adderall for the past 10 years and having it work for me was great. Then early this year I started feeling myself slip farther into my depression again. That's when we started adding AAPs. I don't mind trying new meds, but changing from one AAP to another has been causing overwhelming anxiety that is almost unbearable. My doc gave me Ativan for the anxiety but then how do I know when / if the AAP is starting to work?
> > >
> > > I just want the best possible option for treatment and not the most popular choice "as seen on TV" if you know what I mean.
> >
> > Often old, well-tested drugs are better, though they may not be the first ones your doc will turn to, so, yes, something like Tofranil could help, I'd think.
> >
> > If the new AAP is causing more anxiety, can you talk to your pDoc about discontinuing it and trying something else?
> >
>
> That's exactly what I plan to do. I would rather try an old school, tried and true AD and see how it goes~
> Thanks again for your input~Of course--hope I wasn't condescending, and best wishes that the new med, whatever it is, works out better.
Posted by Doll Face on November 14, 2011, at 16:28:29
In reply to Re: Other options besides AAP for depression?, posted by psychobot5000 on November 14, 2011, at 16:12:51
> > > > Thanks all,
> > > >
> > > > Having been on Effexor and Adderall for the past 10 years and having it work for me was great. Then early this year I started feeling myself slip farther into my depression again. That's when we started adding AAPs. I don't mind trying new meds, but changing from one AAP to another has been causing overwhelming anxiety that is almost unbearable. My doc gave me Ativan for the anxiety but then how do I know when / if the AAP is starting to work?
> > > >
> > > > I just want the best possible option for treatment and not the most popular choice "as seen on TV" if you know what I mean.
> > >
> > > Often old, well-tested drugs are better, though they may not be the first ones your doc will turn to, so, yes, something like Tofranil could help, I'd think.
> > >
> > > If the new AAP is causing more anxiety, can you talk to your pDoc about discontinuing it and trying something else?
> > >
> >
> > That's exactly what I plan to do. I would rather try an old school, tried and true AD and see how it goes~
> > Thanks again for your input~
>
> Of course--hope I wasn't condescending, and best wishes that the new med, whatever it is, works out better.
>Oh no, not condescending at all - I appreciate your thoughts and best wishes as well.
Posted by jono_in_adelaide on November 14, 2011, at 16:47:17
In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19
You could try repeacing the effexor with (say) Zoloft 100mg in the morning, and Nortriptyline 75mg at night - this combo is a more effective inhibitor of noradrenalin reuptake than Effexor, and so can have more "kick"
Another option would be Zoloft 100mg in the morning, and Welbutrin XL 300mg in the morning.
Posted by jono_in_adelaide on November 14, 2011, at 17:10:05
In reply to Re: Other options besides AAP for depression?, posted by jono_in_adelaide on November 14, 2011, at 16:47:17
Oh, final option would be Effexor XR 150mg in the morning, and Remeron 30-45mg at bedtime
All are very good combos, that hit depression through multiple effects on different neurotransmitters, and are all well worth trying.
Posted by herpills on November 14, 2011, at 17:12:59
In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19
> I've just started (actually 6 months ago) adding AAPs to Effexor to fight my depression symptoms. So far I've been on Abilify, Geodon, Latuda, and now back on Abilify. Limited if any help from any of them.
>
> I see my doc Friday and I'm wondering what other options I might discuss with him. Last I saw him he sounded optimistic about lots of AAPs I hadn't tried yet, but I'm starting to feel that class of drug is not the answer.
>
> Thanks for any input you might have.
>
> SharonYou might think about trying Lamictal? I got a boost in mood with as little as 100mg. It doesn't have as many side effects as the AAPs... herpills
Posted by psychobot5000 on November 14, 2011, at 17:56:12
In reply to Re: Other options besides AAP for depression?, posted by jono_in_adelaide on November 14, 2011, at 17:10:05
> Oh, final option would be Effexor XR 150mg in the morning, and Remeron 30-45mg at bedtime
>
> All are very good combos, that hit depression through multiple effects on different neurotransmitters, and are all well worth trying.I agree with both the options suggested by jono--those are good combinations. However, I do not agree with the use of Lamictal in unipolar depression. I have not been active in reading the research the last few years, but the last time I checked, the evidence was very much against any such use. It offers the possibility of quick improvement in first weeks, followed by a gradual return to baseline mood, and possibly below, and with the addition of any side-effects you may end up with (it's a relatively low-side-effect med for an anticonvulsant, but that's not saying all that much).
A quick check of the internet confirms that there have been no changes in the state of the research since I last checked, not for unipolar depression. Stay away. Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).
Here's a useful blog on the subject. Take note that the positive study (on bipolar, not unipolar) at the end occurred in a study that was deliberately done on a short time-scale.
http://knowledgeisnecessity.blogspot.com/2011/01/lamictal-strange-tale-of-med-with-no.html
Posted by ed_uk2010 on November 15, 2011, at 7:32:36
In reply to Re: Other options besides AAP for depression?, posted by psychobot5000 on November 14, 2011, at 17:56:12
>Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).
That's the thing about Lamictal, I'm never quite sure what it's supposed to be good for.
Posted by SLS on November 15, 2011, at 8:14:54
In reply to Re: Other options besides AAP for depression? » psychobot5000, posted by ed_uk2010 on November 15, 2011, at 7:32:36
> >Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).
>
> That's the thing about Lamictal, I'm never quite sure what it's supposed to be good for.Lamotrigine might be more of a potentiator of psychotropic drugs than it is a monotherapeutic agent. There is no question in my mind that it can produce robust antidepressant effects. Unfortunately, these improvements last only briefly; with the drug sometimes yielding a partial response thereafter.
- Scott
Posted by creepy on November 15, 2011, at 8:31:37
In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19
The AAPs all do some serotonin receptor antagonism. Not much different than trazodone / nefazodone I think.
If thats not doing it, you might want to try TCA's next.
Posted by psychobot5000 on November 15, 2011, at 10:39:21
In reply to Re: Other options besides AAP for depression?, posted by SLS on November 15, 2011, at 8:14:54
> > >Though there may be a role for it, particularly in rapidly cycling bipolar disorder, lamotrigine has failed to show any positive results on its primary endpoint in seven major studies (!), and shown a semi-positive result only once, and then only on a secondary endpoint (the CGI).
> >
> > That's the thing about Lamictal, I'm never quite sure what it's supposed to be good for.
>
> Lamotrigine might be more of a potentiator of psychotropic drugs than it is a monotherapeutic agent. There is no question in my mind that it can produce robust antidepressant effects. Unfortunately, these improvements last only briefly; with the drug sometimes yielding a partial response thereafter.
>
>
> - ScottI agree, of course, about the rapid improvements the drug can offer, and also that they disappear. However, I think any partial response is an illusion--based largely on the fact that, when the drug is withdrawn, you temporarily do worse (until your body readjusts to the new baseline). This is based, in part, on anecdotal watching of people on message boards over the years ("It doesn't seem to help, but then I get worse if I stop, so I guess I'll keep taking it."), part on a relatively recent trial against that prozac-zyprexa combination, the only decent numbers the drug has gotten, uh...ever, in a study designed to be extra short, so that Lamictal would still be titrating and thus wouldn't work as well as the other drug...missing the point that Lamictal ONLY works when it's still being titrated upward. And of course there's my own experience. There's a danger, of course, in extrapolating too much from one experience, and I usually try to avoid that, constantly qualifying, (i.e. "as with other drugs, mileage varies, so you'll just have to try it and see if it's helpful for you.")...but, consider this:
I get a response to EVERY antidepressant and augmentor I've ever taken. MAOis, every one I've ever taken (high dose selegiline, tranylcipromine (sp?) phenelzine), tricyclics, SSRIs, all the modern atypical antidepressants, as well as atypical antipsychotics, and even stimulants in a way (though their effect is different)...the list goes on for days. Also vagal nerve stimulation and cranial electrotherapy stimulation, St John's Wort (a little). They all make my depression recede (though stimulants only in proportion to your blood-levels of the drug at any given time). If you can name it and call it an antidepressant, it works for me. Here, in contrast, is the list of every antidepressant drug EVER that offered me no net benefit:
Lamictal.I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work. I very much doubt it works as an augmentor (for what it's worth, I've tried that, too). It does, however, offer many a transient (though very substantial!) benefit during upward titration, juxtaposed against a corresponding transient lowering of mood when the drug is discontinued or titrated downward. I think that's the entire story. Obviously, I don't know enough to be certain about that (no one does), but it all fits together pretty neatly and matches all the available evidence.
Posted by SLS on November 15, 2011, at 15:09:59
In reply to Re: Other options besides AAP for depression? » SLS, posted by psychobot5000 on November 15, 2011, at 10:39:21
> I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
- Scott
Posted by psychobot5000 on November 15, 2011, at 16:03:12
In reply to Re: Other options besides AAP for depression?, posted by SLS on November 15, 2011, at 15:09:59
> > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
>
>
> My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
>
>
> - ScottYou say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
Posted by SLS on November 15, 2011, at 18:32:42
In reply to Re: Other options besides AAP for depression? » SLS, posted by psychobot5000 on November 15, 2011, at 16:03:12
> > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
> > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
> You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
No.I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.
- Scott
Posted by Phidippus on November 15, 2011, at 20:34:37
In reply to Other options besides AAP for depression?, posted by Doll Face on November 14, 2011, at 8:27:19
Lots of options. You can try augmenting with a different class of AD, such as Wellbutrin, an NDRI or perhaps a TCA, like Clomipramine (the risk of seratonin syndrome is exaggerated).
You can try stimulants, like Methylphenidate, Dextroamphetamine or Nuvigil.
You can try Tramadol, a pain drug which has been found useful in the treatment of depression. It is an opiate, so there is some risk of dependence. Tramdol is also an SNRI and NMDA antagonist.
You can try regular opiates, but they are tricky.
The last I can think of is Memantine, an NMDA antagonist. Originally created as an Alzheimer's treatment, it has been studied for the treatment of depression, anxiety, OCD, etc.
Eric
Posted by Bob on November 15, 2011, at 20:42:40
In reply to Re: Other options besides AAP for depression? » psychobot5000, posted by SLS on November 15, 2011, at 18:32:42
> > > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
>
> > > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
>
> > You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
>
>
> No.
>
> I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.
>
>
> - Scott
Scott, do you still have Abilify on board?Bob
Posted by psychobot5000 on November 15, 2011, at 20:54:12
In reply to Re: Other options besides AAP for depression? » psychobot5000, posted by SLS on November 15, 2011, at 18:32:42
> > > > I combine that with the clinical evidence, so resoundingly against the drug, and...yeah, it doesn't work.
>
> > > My experience with lamotrigine indicates otherwise. I do poorly without it, even when I attempt to discontinue it using a very gradual taper.
>
> > You say 'attempt' to discontinue...I'm guessing that was just an idiosyncrasy of the way you put it and I read it, but...you have gotten all the way off and stayed off for a good number of weeks...right?
>
>
> No.
>
> I elected to restart treatment before allowing myself to agonize for that length of time. I only had to convince one person, though.
>
>
> - ScottI suppose there's no reason there couldn't be a niche where the med is useful. Best of luck in maintaining a regimen that works for you.
-PB
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