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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by fido on January 22, 2015, at 19:50:31
Hi folks!
I am pretty discouraged right now.
I have been on many antidepressants since 2012 and NONE worked!
I have been on:
Lexapro
Wellbutrin
Remeron
Stablon
Valdoxan
Memantine (no antidepressant)
Ritalin (no antidepressant)
Anafranil (could not tolerate side effects)Currently I am on Cymbalta 60mg. I started with cymbalta 11 days ago. Directly on the first day I had the impression that I felt better!
But around day 7 I started to feel depressed again. Then I increased to 60mg and don't notice much. I am depressed again.
I now worry that cymbalta also might not work.What do I do then?
I am running out of options.I was thinking about amitritypline but since I could not tolerate the anticholinergic side effects of anafranil (digestion problems, dry mouth, racing heart) I doubt that amitriptyline would be much better.
Do you have any ideas or suggestions?
I also have adhd. Ritalin doesn't work. I wanted to try adderall but my doctor is against it he said cymbalta + adderall is too risky because of serotonin syndrome. :(
Things I have:
depression (lethargy,sadness,menlancholy)
ocd
GAD
Posted by ed_uk2010 on January 22, 2015, at 20:19:21
In reply to What is stronger Amitriptyline or Cymbalta?, posted by fido on January 22, 2015, at 19:51:41
Hi there,
Sorry to hear you've not improved much with medication. Have any of the medications helped at all? Have you suffered many side effects or were side effects only a problem with Anafranil?
I don't think it would be a good idea to make treatment recommendations without knowing more about your problems/illness. For example, what are your worst symptoms at the moment? Have you suffered from depression for many years? How old were you when it started? Any history of manic episodes? You mentioned OCD, what are your symptoms and is this still a problem? With respect to the attention problems... were you diagnosed with ADHD as a child? Attention is normally impaired during episodes of depression.
>I was thinking about amitritypline but since I could not tolerate the anticholinergic side effects of anafranil (digestion problems, dry mouth, racing heart) I doubt that amitriptyline would be much better.Amitriptyline is highly anticholinergic. It wouldn't be the best choice for you at this stage.
>I started with cymbalta 11 days ago.
Well, it's still early days to be honest. You'll need to give it longer to decide whether or not it's going to help you.
Take care.
Posted by rjlockhart37 on January 22, 2015, at 20:25:25
In reply to What is stronger Amitriptyline or Cymbalta?, posted by fido on January 22, 2015, at 19:50:31
the doctor is wrong, adderall or amphetamine is dopamine stimulator, not serotonin, actually adding adderall to cymbalta would help vary much because it would activte sites that are not active, psychomotor stimulation, but adderall is not the best for depression, it's mainnly good for the ADHD, and narcolepsy, and there are other off lebel uses including depression.....
even if you where on Buspar which increases certain serotonin recpetors, it would not cause serotonin syndrome, i had a mini serotonin symnd. when i took l-typhtophan at a large dose because i read it helps anxiety, and im/was on prozac and it caused panic attack, sweating, heart, dizzy, it wasnt a full one but i rerember that night well.....
there are still the MAOI option, there are alot of posters here that take the MAOI antideprssant, but they are known for alot of side effects than others, and can't eat certain foods, yet nardil and parnate are amoung the most effective antidepressants there.....mainly from the posts i've read here on the boards over the years......
there is prozac which i take, but still.....if the previous ones wellbutrin, lexepro, SSRI class may not work that well, but you never know......
you might look into provigil but it is ... vary expensive, that or just energy supplements and coffee to get you going, until you find a med that is going to take care of your depression
i took cymbalta long time ago when they released it, 2003 or 04, it worked but then i switch to prozac.....it has worked well.....
adderall is not going to cause SERO syndrome.....
maybe work with your doctor and tell him your medication difficulties, they may move around and find something that will be good for you. My personal recomendation is Provigil, helps with fatigue and getting going in the mornings, adderall is a jet speed in the morning, but it wears off and creates mood swings
r
Posted by fido on January 22, 2015, at 21:06:19
In reply to Re: What is stronger Amitriptyline or Cymbalta?, posted by ed_uk2010 on January 22, 2015, at 20:19:21
Hello!
I have always had anxiety and ocd, since childhood.
I have also always been pessimistic and easily gave up on things. I have a very low stress tolerance.
Now due to personal problems and health problems I have also become more and more depressed.
I feel like this is getting out of my hands. I mean I don't want to be depressed but I simply am.
I also tried psychotherapy but it was totally useless and disappointing.
I would say that right now depression is the biggest issue. OCD is also present but it's not that debilitating. Anxiety is also a problem.I dont know if prozac would work when 20mg lexapro did nothing.
I wish I at least knew what kinds of neurotransmitters I need to hit!I know that there are also MAOI but with my anxiety I don't think I could take them. I would live in fear all the time of eating something wrong. I also dont know if I could live that way and not eat a lot of things which I like to eat, like bacon. Maybe this would feel like being in prison.
When I was on anafranil I couldnt take ritalin. My doc said it's not safe and I totally missed the ritalin. I couldnt really deal with not being able to take it when I want it.
I have been diagnosed with possible ADD in 2012.
I have some symptoms of ADHD but not all. I am hypoactive. I'm really not sure if I have it or not. I only know that I have many debilitating symptoms which sound like ADD. Since ritalin doesnt work I wanted to try amphetamines. But then I found this here:http://www.drugs.com/drug-interactions/adderall-with-cymbalta-190-1645-949-2273.html
Prior FH, Isbister GK, Dawson AH, Whyte IM "Serotonin toxicity with therapeutic doses of dexamphetamine and venlafaxine." Med J Aust 176 (2002): 240-1
This is VERY scary!
Obviously you can get serotonin syndrome from SSRI + amphetamines.
Posted by fido on January 22, 2015, at 21:07:59
In reply to Re: What is stronger Amitriptyline or Cymbalta?, posted by fido on January 22, 2015, at 21:06:19
I know provigil.
But it is way too expensive for me.
I also once tested it (50mg) and didn't feel much. Maybe the dosage was too low.
But from what I heard provigil only makes you more awake but does not lift mood.
But I needed something which lifts your mood, which could be taken as a "booster".
Posted by Phillipa on January 22, 2015, at 21:37:05
In reply to Re: What is stronger Amitriptyline or Cymbalta?, posted by fido on January 22, 2015, at 21:07:59
What are your health problems and age bracket? Phillipa
Posted by rjlockhart37 on January 23, 2015, at 1:05:41
In reply to Re: What is stronger Amitriptyline or Cymbalta?, posted by fido on January 22, 2015, at 21:06:19
wow, you are right i didnt think amphetamine had any impact with adderall, i took it with cybalta, yet i was not on a stong dose, thats why i thought that....yea your right it's saying it does cause those symptoms, but whats ... wierd is adderall has main effect on dopamine, through psychomotor stimulation, not much on serotonin, because i've taken various amphetamines types over the years with prozac and the prozac actually increased some of it's effects, but thats long time ago.....
well, i don't want to encourage non medical advise treatment, but they do have energy supplements, caffeine, it's not treating anything, but reason im saying it will help your energy levels until you get onto a medication that will help you, just be careful because some of the over the counter stimulants are nasty......look into ginseng and B12, maybe a little caffeine with it but keep it a low dose.......
thats what i had to do before i got on nuvigil, but im also having a not so fun time with my body being resistant to many drugs, vary hard time for me right now, but ... try that
strattera is nasty for some people, but you may.....just give it a try. but it works on NE nothing else......
have you asked about TCA antidepressnts, some of the ones you hvent tried?
Posted by rjlockhart37 on January 23, 2015, at 1:13:38
In reply to What is stronger Amitriptyline or Cymbalta?, posted by fido on January 22, 2015, at 19:51:41
i just googled the comparison of the 2, amitriptyline has much more side effects than cymbalta, http://treato.com/Amitriptyline,Cymbalta/?a=s
found this just to read for ssri and tca comparison
http://www.emedexpert.com/compare/ssris-vs-tca.shtmlill have to stack through google articles to find a good comparison report, but basically they are similar in effects ,but the amitroptline has many more side efffects
Posted by ed_uk2010 on January 23, 2015, at 5:04:40
In reply to Re: What is stronger Amitriptyline or Cymbalta?, posted by fido on January 22, 2015, at 21:06:19
Hi Fido,
>I have always had anxiety and ocd, since childhood.
>LexaproHow long did you try Lexapro for? SSRIs are useful for OCD but usually start to work very gradually. The onset of action in OCD is often very delayed. A therapeutic trial of an SSRI in OCD is 12 weeks at the maximum dose. If one SSRI is not effective, a different SSRI (or SNRI) can be tried. SSRIs work considerably more slowly for chronic OCD than they do for depression. If you have both, the depressive symptoms should therefore improve first.
SNRIs such as Cymbalta are no more effective than SSRIs for OCD but can, for certain people, give additional relief from depressive symptoms. Overall, the effectiveness of Cymbalta for depression is similar to SSRIs - but some people respond better to one than the other. You'll have to give it longer to decide whether it works better for you.
>I dont know if prozac would work when 20mg lexapro did nothing.
It's possible, but I think you should give Cymbalta a proper trial first. If depression is your main problem and Cymabalta alone isn't working, you could look at taking an 'augmenting' medication. A low dose of Abilify is a common choice.
>Since Ritalin doesn't work I wanted to try amphetamines.
I think you need to treat your depression before you even look at the possibility of ADD. You can't diagnose ADD based on the presence of attentional problems during a depressive episode. Most people have substantial attentional impairment during depressive illness. And remember, amphetamines are rarely effective antidepressants. They may be mood elevating in the short term but this is no good for someone like yourself with long term depression. It's pointless having a short term boost when it's likely to be followed by a crash.
I hope Cymbalta works out for you. Its serotonergic properties can help anxiety and OCD as well as depression. Its noradrenergic effect could improve attentional impairment as well as depression. I think you should ask your doctor about augmenting it if there's no relief after a couple more weeks.
>Obviously you can get serotonin syndrome from SSRI + amphetamines.
It's possible but very uncommon. Still, amphetamine is not a first-line strategy for augmenting antidepressants. Neither is Provigil. Provigil is not an antidepressant and it is not likely to help your depression. It doesn't help OCD or anxiety either.
Common strategies for resistant depression include adding an augmenting med to an antidepressant. Common choices include:
Abilify - 5mg initially, then 10mg to continue.
Seroquel - could be a good choice if insomnia is a problem. You might find it too sedating. Abilify could be a better choice perhaps.
Lithium - low dose. You don't have to be bipolar to use lithium augmentation. Some people respond remarkably well, others don't. You don't have to take it for months to find out either, you should know whether it suits you in a few weeks at most. Some people notice an improvement within days of a small dose.
Posted by fido on January 23, 2015, at 17:48:31
In reply to Re: What is stronger Amitriptyline or Cymbalta? » fido, posted by ed_uk2010 on January 23, 2015, at 5:04:40
Hi,
I'm 30 years old.
I have lot of other health issues. I wonder if they could somehow be connected. But doctors usually don't know anything about this or don't care.
I have:
multiple Lipomas
frequent pains in multiple joints (rheumatologist found nothing)
visual disorders (visual snow, floaters, seeing white blood cells in the vision field which is totally annoying)
seborrheic eczema
hypothyroidism (i take T3 + T4)
hypogonadism (TRT with T injections)
I have been on Lexapro 20mg for at least 3 months. I really couldn't tell a difference. If it's that weak that I cannot clearly tell a difference then it's useless.I'm scared of Abilify.
Because it's an antipsychotic and no antidepressant and also because it can cause TD.
I also don't really know how Abilify is supposed to help me. Why should I have too much dopamine?
When I have adhd then I should rather have too little dopamine.Are there other reasonable add on options?
I cannot take anything which has too scary side effects.
But does it even make sense to think about add ons when I haven't even found an antidepressant which works?Lithium is also scary it can have many side effects.
Posted by Phillipa on January 23, 2015, at 18:55:36
In reply to Re: What is stronger Amitriptyline or Cymbalta?, posted by fido on January 23, 2015, at 17:48:31
Fido since you already have thyroid problems lithium isn't a good choice for you. Since I do know what lipomas are fatty tissue tumors but not dangerous at all. Have you had your eyes examined as have had floaters myself. But you do need an eye exam if haven't to make sure this is what they are. You sound knowledgeable about your medical issues. Age would be next question. Phillipa
Posted by baseball55 on January 23, 2015, at 20:27:59
In reply to Re: What is stronger Amitriptyline or Cymbalta?, posted by fido on January 23, 2015, at 17:48:31
> I'm scared of Abilify.
> Because it's an antipsychotic and no antidepressant and also because it can cause TD.
> I also don't really know how Abilify is supposed to help me. Why should I have too much dopamine?
> When I have adhd then I should rather have too little dopamine.
>
> Are there other reasonable add on options?
> I cannot take anything which has too scary side effects.
> But does it even make sense to think about add ons when I haven't even found an antidepressant which works?
>
> Lithium is also scary it can have many side effects.Abilify worked well for me for severe depression. It often does. It's effect on dopamine is complicated. It's worth a try. TD is rare on abilify. Lithium side effects are minimal at the doses used for depression (600-900mg). In response to an earlier post, MAOIs have few food interactions - bacon is not one of them. Just cheeses and dried meats like salami and pepperoni.
If you're going to scare yourself to death worrying about all the possible side effects and things that could go wrong, you're going to have a very hard time finding meds that work.
Posted by fido on January 24, 2015, at 21:27:30
In reply to Re: What is stronger Amitriptyline or Cymbalta? » fido, posted by baseball55 on January 23, 2015, at 20:27:59
Hi,
I know someone personally who got TD on Abilify. That's why I'm scared of it.Could one take ritalin when on abilify? I assume not. I really don't know how to decide what to do. I mean when I go to my psychiatrist there is always so little time to really talk and discuss options. I feel like unless I KNOW what I want I'm pretty much lost. Cause then he will simply suggest to me whatever comes to his mind in a few seconds. :(
Would Lamictal also be an option against depression?
Yes of course I had my eyes checked. I have also been to a neurologist cause of the visual snow. Everything "normal". They basically have no clue what causes it and then act like it's harmless.
When I look at a white paper and it's bright then I can see my own blood cells moving around everywhere! I didn't have this up until a few years ago. Why did I get it?I also know that I have elevated oxidative stress and nitrosative stress. I told this to my psychiatrist and intern but they both acted like this is irrelevant.
It really sucks. I wish I had a good alternative health practioner but I don't know how to find a good one. There are also many ones which only rip you off and simply sell you all kinds of dubious therapies. Also my insurance won't cover alternative stuff. But I am sure that there are things which are wrong with me and I simply don't know what it is.
Posted by fido on January 24, 2015, at 21:33:45
In reply to Re: What is stronger Amitriptyline or Cymbalta? » fido, posted by Phillipa on January 23, 2015, at 18:55:36
I'm 32 by the way.
I was relatively healthy til around 20. Then one thing came to the other. First the lipomas, the more and more joint pains, couldnt go to the gym anymore, then around 27 the visual disorders.
Posted by ed_uk2010 on January 25, 2015, at 4:36:16
In reply to Re: What is stronger Amitriptyline or Cymbalta?, posted by fido on January 23, 2015, at 17:48:31
Hi,
>multiple Lipomas
I doubt that's connected to your depression.
>frequent pains in multiple joints (rheumatologist found nothing)
Widepread pain without an identifiable cause is often associated with chronic fatigue states and depression. The pain may respond to Cymbalta, so it's probably a good medication to be trying.
>visual disorders (visual snow, floaters, seeing white blood cells in the vision field which is totally annoying)
I doubt this is related to your depression.
>seborrheic eczema
This is often associated with the presence of a microscopic yeast on the skin, malassezia. Do you use a cream with a combination of an antifungal and a mild antiinflammatory steroid?
Less commonly, a seborrheic eczema-like condition has been reported to occur in vitamin B deficiency states. I do not know whether you have any risk factors for these deficiencies... they tend to be seen in people with a poor diet who drink too much alcohol. Other symptoms may include a sore tongue, irritation around the corners of the mouth, anemia, fatigue and depressive/psychiatric problems. Deficiencies of more than one B vitamin may occur together. Doctors often assess levels of vitamin B12 and folic acid if anemia is found on a complete blood count. Other B vitamins are not usually measured. If you are concerned that you may be at risk due to your diet or alcohol intake, you may wish to take a vitamin B complex, if you don't already. There is some evidence that folic acid helps SSRIs and related antidepressants to work more effectively. It's probably a good idea to choose a B complex which contains some folic acid as well as all the other B vitamins.
> hypothyroidism (i take T3 + T4)
> hypogonadism (TRT with T injections)Do you have a pituitary disorder? This is sometimes the cause when hypothyroidism and hypogonadism occur together. Do you have your latest thyroid blood results? eg. TSH level, free T4 etc. Inadequate thyroid hormone replacement may render depression poorly responsive to treatment and widespread aches and pains may be a problem. I'm not saying your thyroid hormone dose is too low, just that it would be useful to see your lab results complete with reference ranges for the lab which performed them. Are you taking levothyroxine? If so, how much?
>I have been on Lexapro 20mg for at least 3 months. I really couldn't tell a difference.
More than enough time for it to work, or not.... Glad you're trying something else.
>But does it even make sense to think about add ons when I haven't even found an antidepressant which works?
Give Cymbalta a chance first. You mentioned Lamictal as an option. It's used more in bipolar disorder than unipolar depression but might still have utility for you.
Posted by Christ_empowered on January 26, 2015, at 14:44:04
In reply to What is stronger Amitriptyline or Cymbalta?, posted by fido on January 22, 2015, at 19:50:31
Adding a stimulant to an AD can cause serotonin syndrome. I don't know if Ritalin or Adderall is safer in that regard. Amphetamines+Tricylics can be particularly problematic.
Posted by fido on January 29, 2015, at 18:57:12
In reply to Re: What is stronger Amitriptyline or Cymbalta? » fido, posted by ed_uk2010 on January 25, 2015, at 4:36:16
Hi,
I am on 90mg cymbalta now. I am giving it 2 weeks if it doesn't work then I will get off it.I take 125mg T4 + 10mg T3. Unfortunately I cannot find my last lab results now. My doc told me to add some T3 cause my ft3 levels were only around 50%.
But since I have been depressed and anxious since being a child this is clearly not the cause!
I don't really know if I have pituitary issues. I know that my LH is too low which is why my Testosterone is low, too.
But other than that the other hormones were normal.
If I had hypopituitarism then wouldn't TSH be low, too? My TSH was high at 4 which is why I was put on thyroid meds.I also asked my psychiatrist about lamotrigene and he wasn't for it he said it had stronger side effects. :/
Posted by fido on January 29, 2015, at 18:58:36
In reply to Re: What is stronger Amitriptyline or Cymbalta?, posted by Christ_empowered on January 26, 2015, at 14:44:04
Ritalin is safer. I have tried Ritalin + Cymbalta. It only doesn't work but no side effects.
But there are also people who take cymbalta + adderall.
This is the end of the thread.
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