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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 AnyHeart on January 20, 2012, at 2:53:08
I wonder what this means. After almost 20 years on SSRIs, and then taking a break and falling apart, I am now unable to tolerate sub therapeutic doses, such as 5 mg Lexapro, 5 mg Prozac, etc. The only thing I could tolerate was 7 mg (liquid) Celexa, which worked briefly and then did nothing. I'm still on it, but it does nothing and new pdoc wants to put me on Lamictal. I'm tired of the med go round.
Anyway, what does the SSRI intolerance mean? Bipolar II? I don't really have the symptoms. Just depression much the time, with occasional side dishes of GAD and social anxiety. Weird thing is, I have days where I am nearly normal. But otherwise, I'm a physical and emotional slug.
-AnyHeart
Posted by Phillipa on January 20, 2012, at 9:40:54
In reply to Total SSRI intolerance after many years?, posted by AnyHeart on January 20, 2012, at 2:53:08
Been on them about 15 years and at first couldn't tolerate them always stopped them after a day or so. Then all of a sudden they didn't effect me at all. Now back to taking small doses and nothing. Also seems benzos no longer work. I feel I'm no better than ever was so wonder what the meds are supposed to do. Get a person through a rough patch and then we should stop them?. Why would you think bipolar II? Or your doc any bipolar symptoms? Phillipa
Posted by Phillipa on January 20, 2012, at 9:42:25
In reply to Total SSRI intolerance after many years?, posted by AnyHeart on January 20, 2012, at 2:53:08
Sometimes I also think that we forget what normal ups and downs are? Could that be what you are experiencing? Phillipa
Posted by papillon on January 21, 2012, at 8:40:21
In reply to Re: Total SSRI intolerance after many years?, posted by Phillipa on January 20, 2012, at 9:42:25
Lamictal is indicated for bipolar disorder, but it doesn't mean your psych necessarily thinks you have bipolar II. It can be prescribed off label for a number of illnesses including treatment resistant depression. Though in this instance it's usually prescribed to augment an anti-depressant (perhaps your sub-therapeutic SSRI dose?).
You could try anti-depressants from other classes - SNRIs, TeCAs, TCAs, MAOIs - but the side effects are generally worse than SSRIs, which means your intolerance may be greater. Your psychiatrist might foresee the same problem, hence recommending Lamictal.
I know someone who is very sensitive to medication, it doesn't change her diagnosis, it just means her psychiatrist has to work harder and think more creatively to find medication to which her body is not going to have some weird reaction. I think prescribing psychoactive medication can be as much of an art as it is a science.
Why not ask your psychiatrist what his/her thoughts are about your diagnosis and why s/he has prescribed Lamictal? If you're happy with the reasoning, give it a shot. The med-go-round sucks, but perhaps this is the last turn you'll have to make for a while. You'll only know if you give it a try.
Posted by phidippus on January 22, 2012, at 22:19:01
In reply to Total SSRI intolerance after many years?, posted by AnyHeart on January 20, 2012, at 2:53:08
When you get to the point where one class of drugs doesn't seem to work for you, move onto another. You have the choice of SNRI's, TCAs and other antidepressants such as Mirtazapine.
Another approach would be to augmment your SSRI treatment with another class of antidepressant-TCA, SNRI, etc. I currently take Viibryd, an SSRI with Mirtazapine for depression and OCD.
You can also augment with other drugs that have proven to treat depression, like Memantine, Buprenephrine, etc.
Eric
Posted by AnyHeart on January 23, 2012, at 12:25:50
In reply to Re: Total SSRI intolerance after many years? » AnyHeart, posted by phidippus on January 22, 2012, at 22:19:01
Hi all.
Thanks for your input. Forgot to say that SNRIs are out, too--I REALLY do not tolerate them (and on top of it, I had an allergic reaction to Pristiq. Joy.).Remeron is out because it gave me motion trails and other wonky vision issues.
That leaves TCAs, which I refuse because of a strong family history of early cardiac fatalaties. That leaves MAOIs and mood stabilizers.
I don't have any hope that those will be any more tolerable. I get side effects in general from meds--I may be the only person whose doctor took her off h. pylori treatment because of side effects.
Bipolar. My pdoc said that intolerance of ADs is one sign of bipolar II, as is agitated depression (I had one period marked by anxiety and depression mixed).
But otherwise, no.
It's not that ADs haven't worked, it's that every one of them have caused issues that became worse over time, not better. Even baby doses.
I'd like to chuck the whole thing and try TMS. Know of any clinical trials out there?
Posted by phidippus on January 23, 2012, at 13:09:18
In reply to Re: Total SSRI intolerance after many years?, posted by AnyHeart on January 23, 2012, at 12:25:50
I think your pdoc may be right about BPII. Try the Lamictal.
Eric
Posted by jerseygal111 on January 28, 2012, at 16:38:45
In reply to Re: Total SSRI intolerance after many years? » AnyHeart, posted by Phillipa on January 20, 2012, at 9:40:54
I'm going through the same thing right now. I took prozac for 11 years until it pooped out on me. Then the pdoc tried lexapro, pristiq, and viibryd, all with no success. He thinks my non-response to these meds may be a sign that my unipolar depression is now more on the spectrum of bipolar II. I'm currently titrating up on lamictal and I hope and pray that it works. Otherwise, I don't know what other options there are other than tricyclics or MAOI's. Good luck with the lamictal if you decide to go that route.
This is the end of the thread.
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