Psycho-Babble Medication Thread 1036514

Shown: posts 1 to 23 of 23. This is the beginning of the thread.

 

Hospital over, but med. advice seriously needed

Posted by gpznos on January 26, 2013, at 7:13:30

At the end of November 2012 I went to the hospital because of a fast worsening depressive episode including suicide thoughts/plans one of the bad periods did not change back to normal as it normally does. At the time my meds were 110 mg Nortriptyline, 37,5 mg Valdoxan and 5 mg Mirtazapin. The doctors at the hospital raised the dosages to 145 mg Nort (I was within but at the low end of the therapeutic window w. 110 mg) and 15 mg Mirtazapin and also 750 mg Lithium was added which I agreed to earlier my regular p-doc and I had already considered Lithium as an augmenting possibility.

I was really supposed to be a simple case: First major depressive episode 5 years ago, stress-released, unipolar, but since then never really gotten to a point of constant relief for more than a couple of weeks/days, then a couple of depressed weeks/days, then back to normal again, then a bad period etc. Never any real reason for the shifting in my mood, even on 2 weeks summer vacation, one week can be good/normal, the other bad.
But I have learnt to sort of accept this, not letting it influence my work- or social life too much. Over the time we (p-doc and I) have tried to augment with Lacmital for almost a year, Abilify for 3 months (small dose).

After 2 weeks time the doctors at the hospital convinced me to go into ECT treatment and I had 12 sessions over 5 weeks duration, from mid December to mid January. My mood improved a lot (but my short-term memory suffered a great deal) and I was discharged from the hospital 10 days ago.

I now have a feeling that I do not recognize from earlier (from the past 5 years of ups and downs). I cant get real happy/normal, nor do I become very depressed, I feel sort of numb or grey in a disturbing way. This might sound as a step forward compared to being very depressed or suicidal but this feeling of NO joy/happiness at all has now gotten to me so I am now beginning to feel depressed also.
I have no drive to do anything more than small, routine like tasks.

I went to my p-doc 2 days ago and we agreed to lower the Lithium from 750 to 600 mg as he said the Lithium could cause this feeling, we would then make a blood sample on next Wednesday. So for the last 2 days I have gone to 600 mg but the situation has only gone in a worse direction.

I have been reading a lot on this forums posts and wondering if my medicine need a change and I am desperate to hear anyones opinion about this.

Please consider these things:
- My original medicine regime (110 mg Nort, 37,5 mg Valdoxan and 5 mg Mirtazapin) failed me seriously for no good reason (but have it ever really been working?)
- I remember reading that when Nortripyline is working well, the patient would be taking approx. 75 mg I am now taking almost 150 mg and still not doing well.
- Should I add Sertralin to the Nort as it has been mentioned recently in other postings?
- Should I switch to something else like Clomipramine or Imipramine instead of Nort?

I am really hoping for some inputs, thanks!

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by cellular on January 26, 2013, at 13:43:32

In reply to Hospital over, but med. advice seriously needed, posted by gpznos on January 26, 2013, at 7:13:30

> At the end of November 2012 I went to the hospital because of a fast worsening depressive episode including suicide thoughts/plans one of the bad periods did not change back to normal as it normally does. At the time my meds were 110 mg Nortriptyline, 37,5 mg Valdoxan and 5 mg Mirtazapin. The doctors at the hospital raised the dosages to 145 mg Nort (I was within but at the low end of the therapeutic window w. 110 mg) and 15 mg Mirtazapin and also 750 mg Lithium was added which I agreed to earlier my regular p-doc and I had already considered Lithium as an augmenting possibility.
>
> I was really supposed to be a simple case: First major depressive episode 5 years ago, stress-released, unipolar, but since then never really gotten to a point of constant relief for more than a couple of weeks/days, then a couple of depressed weeks/days, then back to normal again, then a bad period etc. Never any real reason for the shifting in my mood, even on 2 weeks summer vacation, one week can be good/normal, the other bad.
> But I have learnt to sort of accept this, not letting it influence my work- or social life too much. Over the time we (p-doc and I) have tried to augment with Lacmital for almost a year, Abilify for 3 months (small dose).
>
> After 2 weeks time the doctors at the hospital convinced me to go into ECT treatment and I had 12 sessions over 5 weeks duration, from mid December to mid January. My mood improved a lot (but my short-term memory suffered a great deal) and I was discharged from the hospital 10 days ago.
>
> I now have a feeling that I do not recognize from earlier (from the past 5 years of ups and downs). I cant get real happy/normal, nor do I become very depressed, I feel sort of numb or grey in a disturbing way. This might sound as a step forward compared to being very depressed or suicidal but this feeling of NO joy/happiness at all has now gotten to me so I am now beginning to feel depressed also.
> I have no drive to do anything more than small, routine like tasks.
>
> I went to my p-doc 2 days ago and we agreed to lower the Lithium from 750 to 600 mg as he said the Lithium could cause this feeling, we would then make a blood sample on next Wednesday. So for the last 2 days I have gone to 600 mg but the situation has only gone in a worse direction.
>
> I have been reading a lot on this forums posts and wondering if my medicine need a change and I am desperate to hear anyones opinion about this.
>
> Please consider these things:
> - My original medicine regime (110 mg Nort, 37,5 mg Valdoxan and 5 mg Mirtazapin) failed me seriously for no good reason (but have it ever really been working?)
> - I remember reading that when Nortripyline is working well, the patient would be taking approx. 75 mg I am now taking almost 150 mg and still not doing well.
> - Should I add Sertralin to the Nort as it has been mentioned recently in other postings?
> - Should I switch to something else like Clomipramine or Imipramine instead of Nort?
>
> I am really hoping for some inputs, thanks!
>

Hi Gpznos,

Sorry to read of your ordeal.
My hunch is that nortripyline is not doing you any good. If I were you, I'd ask the pdoc to if he/she were willing to prescribe a different tricylic such as the imipramine or clomipramine you've mentioned, or one of the SSRI class.
It's basically a trial and error process you'd need to through until you find the med or most likely the combination of meds that will bring you acceptable relief.

Hang on in there,

cellular

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by ChicagoKat on January 26, 2013, at 15:21:20

In reply to Hospital over, but med. advice seriously needed, posted by gpznos on January 26, 2013, at 7:13:30

Hi gpznos,

What other meds have you tried? Have you been on SSRIs or SNRIs or MAOIs? It does sound like the Nortriptyline is not doing anything for you. Maybe a different TCA would help, but in my personal experience, I failed one TCA and then none of the others worked either. But again, that's just my personal experience. How about Wellbutrin? Many people are successful on that.

It would really help us all to know what other, if any, meds you have tried.

And this is just an fyi, and it probably has nothing to do with how you are feeling, but I had ECT too, and afterwards, I felt really weird and kind of numb the way you described. It was a very unpleasant feeling. Like I said, probably not related at all, but I just thought I'd throw it out there. The good news is the weird feeling went away after a few weeks.

Post back and share with us your med history, it will really help to know it. And there are lots of really smart people here who will be able to offer good advice. :)
Kat

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by Phillipa on January 26, 2013, at 15:34:03

In reply to Hospital over, but med. advice seriously needed, posted by gpznos on January 26, 2013, at 7:13:30

Yes med history is so important. Can you provide the information? Thanks Phillipa

 

Re: Hospital over, but med. advice seriously needed

Posted by gpznos on January 26, 2013, at 17:16:05

In reply to Re: Hospital over, but med. advice seriously needed gpznos, posted by ChicagoKat on January 26, 2013, at 15:21:20

> Hi gpznos,
>
> What other meds have you tried? Have you been on SSRIs or SNRIs or MAOIs? It does sound like the Nortriptyline is not doing anything for you. Maybe a different TCA would help, but in my personal experience, I failed one TCA and then none of the others worked either. But again, that's just my personal experience. How about Wellbutrin? Many people are successful on that.
>
> It would really help us all to know what other, if any, meds you have tried.
>
> And this is just an fyi, and it probably has nothing to do with how you are feeling, but I had ECT too, and afterwards, I felt really weird and kind of numb the way you described. It was a very unpleasant feeling. Like I said, probably not related at all, but I just thought I'd throw it out there. The good news is the weird feeling went away after a few weeks.
>
> Post back and share with us your med history, it will really help to know it. And there are lots of really smart people here who will be able to offer good advice. :)
> Kat

Kat and all others, thanks for replying, here is my medicine history:

2008: started out on 50-60 mg Mirtazapin alone,
later that year Lexapro 10-15 mg was added. My mood was not stable at all and towards the end of the year Nort was added and I finally was at 15 mg Mirt, 15 mg Lex and 85 mg Nort, things were going okay at this time

2009: after some time, I got tired of the way Lexapro made me feel so during the first 7 weeks I tapered the Lex completely and then gradually raised the Nort to 120 mg. But after a few weeks I decided to start on the Lex again, this time to 10 mg. Year ended with Mirt 10 mg, Lex 10 mg and Nort 110 mg (to reach serum level)

2010: I continued with the same formula until week 20 where I started a slowly taper until week 48. At this time I sadly ran into a new full scale depression and was forced to start all over again during December.

2011: I only slowly raised the dosages, hoping I could do well on only a minimum of meds. By week14 I was at 100 mg Nort, 50 mg Valdoxan and 3,75 mg Mirt. The Valdoxan was supposed to do a better job than the Lex did - it gave me this numbing feeling of being unable to be real happy.
However I am very doubtful in terms of the Valdoxan doing any good (but costing a lot) - it has very few SE but is there any effect at all?
At week 36 Lamictal was added as augmentor. In total this year was worse than 2009 and 2010.

2012: Start of year 110 mg Nort, 37,5 Valdoxan, 7,5 Mirt and 50 mg Lamictal. The Lamictal did not do any real difference, so at week 25 it was removed. Instead I tried a small dose Abilify 2,5 mg (after reading about it here) and at first it seemed to work and the period week 32-44 actually was some of the most stable and normal weeks during the last 5 years. But the positive effect went away and I ran into a bad period, therefore I was afraid to continue the Abilify.
And one week later I crashed for reasons I do not know and ended in the hospital.

Nort - being the backbone of my regime - has been doing something good for me but not enough. When reading through my notes I can tell that I was maybe more stable when the SSRI Lexapro was present. This drug was later replaced by Valdoxan which I do not know was/is working.

Wellbutrin I do not know, what is it?

I am glad to hear that this ECT-feeling probably will go away. But I am also suspecting the 750 mg Lithium to do bad things...

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by Phillipa on January 26, 2013, at 21:18:14

In reply to Re: Hospital over, but med. advice seriously needed, posted by gpznos on January 26, 2013, at 17:16:05

What country do you live in don't recognize one of the meds? I also hope you return to a normal base. Phillipa

 

Re: Hospital over, but med. advice seriously needed

Posted by bleauberry on January 27, 2013, at 12:21:57

In reply to Hospital over, but med. advice seriously needed, posted by gpznos on January 26, 2013, at 7:13:30

Wow, so sorry to hear of your battles. I had ECT also, failed, and have studied it a lot, and I do not think the emotional numbness you are feeling is from that. More likely it is one of the meds, with lithium being the most suspicious in my mind. I like the idea of adding zoloft to the nortriptyline. I've never been a fan of mirtazapin because I've not seen it work great very often or for very long in many postings on it. For me it was a great sleep med for a while but was somewhat numbing emotionally. The f*rt that you say you don't have any drive is a decent clue that the dopamine circuits are somehow involved, much more likely than the serotonin circuits, but they all work in concert. Too much nortriptyline can numb things down too.

 

Re: Hospital over, but med. advice seriously needed bleauberry

Posted by gpznos on January 27, 2013, at 16:11:11

In reply to Re: Hospital over, but med. advice seriously needed, posted by bleauberry on January 27, 2013, at 12:21:57

> Wow, so sorry to hear of your battles. I had ECT also, failed, and have studied it a lot, and I do not think the emotional numbness you are feeling is from that. More likely it is one of the meds, with lithium being the most suspicious in my mind. I like the idea of adding zoloft to the nortriptyline. I've never been a fan of mirtazapin because I've not seen it work great very often or for very long in many postings on it. For me it was a great sleep med for a while but was somewhat numbing emotionally. The f*rt that you say you don't have any drive is a decent clue that the dopamine circuits are somehow involved, much more likely than the serotonin circuits, but they all work in concert. Too much nortriptyline can numb things down too.

Thanks for your reply.
Can you please explain this: "The f*rt that you say you don't have any drive is a decent clue that the dopamine circuits are somehow involved,"
I am in need of dopamine?
What can be done?

I am also considering desipramine instead of nortriptyline. And let the valdoxan be replaced by sertraline as the first thing to do.
Mirtazapin could be cut back to just 5 mg for sleep as very small doses enhance the anti-histaminic effect.

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by ChicagoKat on January 30, 2013, at 9:34:00

In reply to Re: Hospital over, but med. advice seriously needed, posted by gpznos on January 26, 2013, at 17:16:05

Sorry for the late reply gpznos. I think you are lucky b/c it seems there are lots of things you have not tried yet. I wonder if trying a different SSRI might help. I know you were on Lexapro, but only at a low dose, so you may well not be resistant to SSRIs yet. So maybe Zoloft or Prozac might help.

I did see that you said that you didn't like the way Lexapro made you feel, so if you're not keen on the idea of another SSRI, there are still other options. It doesn't seem you've tried an SNRI like Effexor or Cymbalta. They can make some people jittery or anxious, but some people do great on them.

And of course, Wellbutrin is another option. It works on Norepi and Dopamine receptors. It works *great* for lots of people - my husband takes it and loves it - but for some people it can cause anxiety, which is a real shame. Because a lot of people lose weight on it - hubby lost 70 pounds! - and it has no sexual side effects which is a problem with lots of antidepressants.

It really does seem that the Nortriptyline has pooped out on you. But there are still lots of other TCAs you haven't tried, but stay away from amitriptyline, it is really the same thing as Nortrip, just one enzyme reaction away. Plus it is very sedating. I actually use it to help me sleep.

This is a start. There are other options too, but the heavier guns I think should be held in reserve until all of the above options prove to not work for you, have intolerable side effects, or poop out on you.

Good luck, and let me know if you have any questions.
Kat

 

Re: Hospital over, but med. advice seriously needed ChicagoKat

Posted by gpznos on January 31, 2013, at 4:25:45

In reply to Re: Hospital over, but med. advice seriously needed gpznos, posted by ChicagoKat on January 30, 2013, at 9:34:00

ChicagoKat
Thank you so much for your answer. I am really in need for a plan, here is the situation right now:
I have lost confidence in some of my current drugs, especially Nort and Valdoxan, since these drugs where the main drugs back in November when I was hospitalized. The hospital doctor just raised the Nort-dose and added Lithium and pushed me to do ECT. There never was a talk about changing the Nort or Valdoxan.
I am now very worried that something, like what happened in November, might happen again, it feels like it is only the Lithium and maybe the after effects of the ECT holding it together

As described my mood is blah at the most and rather worried - I dont get normal happy for more than short periods and sometimes in the evenings. Another problem has come up as my sex-drive is really low, I have problems to get erections and when I finally do have sex, I can last for 1-2 min before I come which med is causing this SE?
I also have a small, tinnitus-like sound in my head when trying to sleep.

I am home until week 8 where I am supposed to start working (part-time) again. In that week I also have the next appointment with my pdoc. Now he is willing to do changes but for now he would like to see how it goes with the Lithium at 600 mg (together with the Nort, Vald etc.). And normally he will only change ONE thing at the time.
So the big question is what should be tried first and in which order?

Should there be a TCA as a backbone med? If so could it be desipramine (instead of Nort)? If so, should it be the first med to change?
Valdoxan should also be changed but for what? Sertraline maybe, but I am not happy about SSRIs after trying Lexapro. Then there is Wellbutrin as you mentioned.
I guess I will keep the Lithium at some level and perhaps small dose Mirt for sleep
I am so confused

 

Re: Hospital over, but med. advice seriously needed ChicagoKat

Posted by gpznos on January 31, 2013, at 6:26:57

In reply to Re: Hospital over, but med. advice seriously needed gpznos, posted by ChicagoKat on January 30, 2013, at 9:34:00

Oh, I just went through my storage of old meds and found Lexapro (- on the package it says; should be used before June 2012, is that a problem?).
I am considering to ad something like 5 or 10 mg right now to establish if SSRI might be an option of value BEFORE going to the pdoc 20. Februar. And at the same time reduce the Valdoxan.

what do you think of this plan?

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by ChicagoKat on January 31, 2013, at 10:36:14

In reply to Re: Hospital over, but med. advice seriously needed ChicagoKat, posted by gpznos on January 31, 2013, at 6:26:57

Hi gpznos,

As far as the negative sexual side effects go, my guess would be it's the Nortrip. I honestly don't know a lot about Valdoxan since it's not approved here in the US, but I just read a quick bit about it on wikpedia, and it doesn't affect serotonin, so it's less likely.
So if you're concernted about sexual side effects, definitely stay away from any SSRIs, they are notorious for causing these problems, and I believe the TCAs can cause problems too. And the SNRIs.

More and more it's seeming to me that maybe you should give Wellbutrin a try. It causes no sexual side effects, and is a very good antidepressant; the only major problem with it is that it can cause anxiety in some people. But if you're one of the lucky ones, and don't get anxiety when taking it, it should really help with your depression, without giving you the undesirable sexual side effects.
Good luck, and keep us posted!
Kat

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by ChicagoKat on January 31, 2013, at 13:03:40

In reply to Hospital over, but med. advice seriously needed, posted by gpznos on January 26, 2013, at 7:13:30

p.s. Are you still on Lithium? Why did your pdoc put you on that? Are you diagnosed as bipolar, or are you experiencing mood swings? Or is it just for augmentation?

If it's the latter reason, I'd give it up if you switch to another AD like Wellbutrin, at least for now. Chances are a new AD will really help so there will be no need for Lithium, and Lithium does have some potentially bad side effects. Good luck and speak soon!
Kat

 

Re: Hospital over, but med. advice seriously needed ChicagoKat

Posted by gpznos on January 31, 2013, at 15:12:40

In reply to Re: Hospital over, but med. advice seriously needed gpznos, posted by ChicagoKat on January 31, 2013, at 13:03:40

> p.s. Are you still on Lithium? Why did your pdoc put you on that? Are you diagnosed as bipolar, or are you experiencing mood swings? Or is it just for augmentation?
>
> If it's the latter reason, I'd give it up if you switch to another AD like Wellbutrin, at least for now. Chances are a new AD will really help so there will be no need for Lithium, and Lithium does have some potentially bad side effects. Good luck and speak soon!
> Kat

Thanks for your input
No, I am not bipolar. The hospital doctor put on Lithium as augmentor or as extra AD on its own. I have a history of mood swings as you might recall.

Do you think I should have a new TCA like Imipramine AND Wellbrutin or just Wellbrutin on its own?

I will add a small dose Lexapro as this is my only possible move right now. Managed to get hold on the pdoc today and he is convinced that the Lithium wll kick in sometime soon - I have been on Lithium for 8 weeks by now...

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by novelagent on January 31, 2013, at 23:49:59

In reply to Hospital over, but med. advice seriously needed, posted by gpznos on January 26, 2013, at 7:13:30

First, there's Emsam. Take the patch, 6mg, along with 500mg of PEA in the morning.

Second, drugs besides that combo don't work. And in case Emsam+PEA don't work, although they did for me after I tried everything else for a couple of years, and worked fast, well, that's when you need to see if you can get ECT or at least a transcranial stimulation therapy (the one that's not an implant, I think, right? I might be confusing one with the implant).

Yes, yes, I know, ECT is bad, yes yes, gentle reader. Well, tell that to the Hunchback of Notre Dame who I saw in the hospital of a reputable and prestigious hospital on the East Coast, who went from walking with his spine and head curved toward the floor to in a single day the next day entirely straight posture, head high, and smiling for what appeared as though was the first time in years.

ECT works when you go to a hospital that knows what they're doing, and does it all the time, like the hospital I'm referring to, I think you all know the name. It's like surgeries, I mean, you go to the surgeon who does 200 surgeries of the same operation a year, you don't go to some random place in Olkeda Oklahoma with a private practice guy who just bought the cheapest ECT machine he could justify buying.

I dare anyone to give me horror stories out of a Harvard teaching hospital's ECT procedure. And as far as memory goes, it's for the 2 weeks leading up to the event that gets hazy, and if you're depressed, you probably haven't done much that bears remembering during those 2 weeks anyway.

 

Re: Hospital over, but med. advice seriously needed novelagent

Posted by gpznos on February 1, 2013, at 4:22:27

In reply to Re: Hospital over, but med. advice seriously needed gpznos, posted by novelagent on January 31, 2013, at 23:49:59

Thanks novelagent

PEA is nothing I believe I can get here in Europe and even so I dont think my pdoc would allow it - or that I would dare try it.

As far as ECT goes, I have just had 12 sessions (as you can see from my first post in this thread) and it did give me some relief from session no. 3 and approx. 1 week after the last session.
But now I am in a blah/depressed state looking for new drug combo...

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by ChicagoKat on February 2, 2013, at 19:04:24

In reply to Re: Hospital over, but med. advice seriously needed ChicagoKat, posted by gpznos on January 31, 2013, at 15:12:40

> > p.s. Are you still on Lithium? Why did your pdoc put you on that? Are you diagnosed as bipolar, or are you experiencing mood swings? Or is it just for augmentation?
> >
> > If it's the latter reason, I'd give it up if you switch to another AD like Wellbutrin, at least for now. Chances are a new AD will really help so there will be no need for Lithium, and Lithium does have some potentially bad side effects. Good luck and speak soon!
> > Kat
>
> Thanks for your input
> No, I am not bipolar. The hospital doctor put on Lithium as augmentor or as extra AD on its own. I have a history of mood swings as you might recall.
>
> Do you think I should have a new TCA like Imipramine AND Wellbrutin or just Wellbrutin on its own?
>
> I will add a small dose Lexapro as this is my only possible move right now. Managed to get hold on the pdoc today and he is convinced that the Lithium wll kick in sometime soon - I have been on Lithium for 8 weeks by now...

I was put on Lithium once. It did squat for me. And I experience mood swings too: depressed to anxious, back to depressed, to - and this is the best one of all - depressed and anxious at the same time. So fun!
Please excuse my sarcasm. My day today has been pretty bad. But 8wks seems long enough to give a med a chance. I would think if it's not working by now, it's not gonna. And seriously, don't take Lithium unless you need to or if it does help. It can have some pretty bad side effects.

As far as a different TCA as well as Wellbutrin...well, I think it would probably be smartest to try Wellbutrin on its own first, give it a few weeks to see if it kicks in, or if you can't tolerate it, before I would add a second new agent. That way, you'll know for sure what is helping and what isn't. Just my opinion, of course. But if you are one of the lucky ones who doesn't get anxious on Wellbutrin I'm willing to bet it will really help you. Good luck!
Kat

 

Re: Hospital over, but med. advice seriously needed ChicagoKat

Posted by gpznos on February 3, 2013, at 5:54:47

In reply to Re: Hospital over, but med. advice seriously needed gpznos, posted by ChicagoKat on February 2, 2013, at 19:04:24

> I was put on Lithium once. It did squat for me. And I experience mood swings too: depressed to anxious, back to depressed, to - and this is the best one of all - depressed and anxious at the same time. So fun!
> Please excuse my sarcasm. My day today has been pretty bad. But 8wks seems long enough to give a med a chance. I would think if it's not working by now, it's not gonna. And seriously, don't take Lithium unless you need to or if it does help. It can have some pretty bad side effects.
>
> As far as a different TCA as well as Wellbutrin...well, I think it would probably be smartest to try Wellbutrin on its own first, give it a few weeks to see if it kicks in, or if you can't tolerate it, before I would add a second new agent. That way, you'll know for sure what is helping and what isn't. Just my opinion, of course. But if you are one of the lucky ones who doesn't get anxious on Wellbutrin I'm willing to bet it will really help you. Good luck!
> Kat

Hi Kat
Hope you are doing better now?
Thank you so much for your inputs. I am very much in doubt about in which direction to go. This change of medicine should have been done while I was at the hospital, they just added Lithium and gave me ECT.
I am due to start working part time in 2 weeks time (part time first) and I have to choose right the first time if possible. This is my third seek period with depression, I am hoping to keep my job. And therefore I am not to keen on taking too many chances and making clean cuts from one drug to the next.
Right now I am considering Wellbrutin, another TCA (than Nort) or Marplan as new main drug.

Do you know how many of my current meds I should discontinue to try Wellbrutin? Can Wellbrutin be taken together with a TCA? SSRI? Lithium? Please forgive me all these questions but it seems you know so much about Wellbrutin...

 

Re: Hospital over, but med. advice seriously needed

Posted by Fondafilm on February 6, 2013, at 10:57:14

In reply to Re: Hospital over, but med. advice seriously needed ChicagoKat, posted by gpznos on January 31, 2013, at 4:25:45

I have no problem with Wellbutrin whatsoever. I took for a time at very high dose 600 mg? Caused tinnitis. But for MDD I feel that SSRIs and SNRIs, NSRIs are the worst drugs on the market! I don't know your age but I would stay away from neuroleptics old or new. If you are over 40 they cause all sorts of problems. I took Abilify at 2 mg for 4 years and developed Tardive Dyskensia. I found that the older tricyclics like Doxepin had less bad side effects. But I am sorry to tell you that almost any antidepressant is going to have negative sexual side effects in men. That said, if you can view this as a temporary time in your life, sometimes it is worth it to sacrifice a part of your happiness with the knowledge that you will get to a better time and resume a good sex life. I know, hard to believe. I can now look back on all of the meds I have taken, and I believe even the ones I hated, Abilify, Lexapro, Lamictal, Effexor, Risperdal, educated me as to what I didn't need, couldn't tolerate and just plain refused to take. It sounds as if you don't like Lithium. As you say you are not bipolar I would find out how to titrate off of it. If your doctor is treating you like a "bad patient" for disagreeing with his course for you, then find someone else. Just find someone who suits you as a person. Please don't go off of any med before you have a new doc who will help you, if that's what you want. You have to become your own advocate and sometimes that involves taking a stand and not backing down. As a doc told me a long time ago, you know your body (and mind) parenthesis mine, so let that be your guide. My best wishes for you.

 

Re: Hospital over, but med. advice seriously needed

Posted by Fondafilm on February 6, 2013, at 12:20:37

In reply to Re: Hospital over, but med. advice seriously needed, posted by Fondafilm on February 6, 2013, at 10:57:14

Hello again. I cannot understand why your doctor does not offer more options than you have conveyed. After looking more closely at your meds, I am suspicious that since you are taking a minimum of 3 meds which are all involved in the regulation of Serotonin and that your last hospitalization, which you describe as ending in hospital for reasons you do not know, that you possibly did not, in fact, have a depressive episode but Serotonin Syndrome, which mimics a depressive episode in every way. You do not describe your symptoms, but if they were serious enough for you to go to the hospital I suspect Serotonin Syndrome. I recommend you read Peter Breggin MD books regarding how many psychiatric meds can make one sicker and more depressed. Also, you don't mention if you are also in therapy with a person licensed to treat depressive illnesses. If you look at the research on treating depression with medication alone, it has a very large failure rate. I would never have been able to recover without both and I don't know of anyone else who has been able to only take medication and experience a positive outcome. Whether our depression is genetically linked or the result of trauma, or both, it is still largely within our power to learn ways to change our thinking when we can, to accept what has happened to us without blame or self-pity, and to make creative use of our experiences. Not that I hear any blame or self-pity coming from you. Again, my best wishes for your future happiness.

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by ChicagoKat on February 7, 2013, at 13:46:22

In reply to Re: Hospital over, but med. advice seriously needed ChicagoKat, posted by gpznos on February 3, 2013, at 5:54:47

> > I was put on Lithium once. It did squat for me. And I experience mood swings too: depressed to anxious, back to depressed, to - and this is the best one of all - depressed and anxious at the same time. So fun!
> > Please excuse my sarcasm. My day today has been pretty bad. But 8wks seems long enough to give a med a chance. I would think if it's not working by now, it's not gonna. And seriously, don't take Lithium unless you need to or if it does help. It can have some pretty bad side effects.
> >
> > As far as a different TCA as well as Wellbutrin...well, I think it would probably be smartest to try Wellbutrin on its own first, give it a few weeks to see if it kicks in, or if you can't tolerate it, before I would add a second new agent. That way, you'll know for sure what is helping and what isn't. Just my opinion, of course. But if you are one of the lucky ones who doesn't get anxious on Wellbutrin I'm willing to bet it will really help you. Good luck!
> > Kat
>
> Hi Kat
> Hope you are doing better now?
> Thank you so much for your inputs. I am very much in doubt about in which direction to go. This change of medicine should have been done while I was at the hospital, they just added Lithium and gave me ECT.
> I am due to start working part time in 2 weeks time (part time first) and I have to choose right the first time if possible. This is my third seek period with depression, I am hoping to keep my job. And therefore I am not to keen on taking too many chances and making clean cuts from one drug to the next.
> Right now I am considering Wellbrutin, another TCA (than Nort) or Marplan as new main drug.
>
> Do you know how many of my current meds I should discontinue to try Wellbrutin? Can Wellbrutin be taken together with a TCA? SSRI? Lithium? Please forgive me all these questions but it seems you know so much about Wellbrutin...

Hi gpznos,

I apologize for the delay in my reply; I was unable to sign on for a while, then medical issues took over limiting my time here on PB.

You could definitely take Wellbutrin with either an SSRI or a TCA, b/c Wellbutrin does not act on serotonin...I'd be more cautious about using an SSRI with a TCA b/c they both increase serotonin in the brain and together they could potentially cause serotonin syndrome. Sorry, my memory is bad, did you say that you've been on Lithium for 8wks (9 by now I suppose) and it hadn't been helpng at all? If that is indeed the case, frankly I'd drop the Lithium like a hot potato. a. If it hasn't had any efficacy for you by now, it ain't gonna b. Why take a drug that is not efficacious that has some potentially pretty bad side effects.

I seem to remember also, weren't you the guy whose Nortriptyline had pooped out on him? If you go with a TCA, definitely go with a different one than that. But do a TCA + Wellbutrin or an SSRI + Wellbutrin. I wouldn't do all three. And, fyi, a lot of people do great just on Wellbutrin alone. Every case varies.

Oh, and with Marplan, you're gonna need to do a washout for 2wks, longer if you're on Prozac before you can start taking it.

Again, sorry for late reply; maybe you've already made up your mind and are doing well with something new. Anyways, I wish you luck!
Kat

 

Re: Hospital over, but med. advice seriously needed ChicagoKat

Posted by gpznos on February 7, 2013, at 16:19:42

In reply to Re: Hospital over, but med. advice seriously needed gpznos, posted by ChicagoKat on February 7, 2013, at 13:46:22

Hi
Well the last week I have been more or less stabile, from ok to good to so so, so I will give the Lithium a little longer before I decide in what direction I will go.
Doctors around here say I should wait for up to 6 months (!) for the Lithium to show if it works.
I will drop the Valdoxan as the first thing when I am a little loger in the proces.

But thanks for all your inputs so far

 

Re: Hospital over, but med. advice seriously needed gpznos

Posted by ChicagoKat on February 8, 2013, at 15:28:23

In reply to Re: Hospital over, but med. advice seriously needed ChicagoKat, posted by gpznos on February 7, 2013, at 16:19:42

> Hi
> Well the last week I have been more or less stabile, from ok to good to so so, so I will give the Lithium a little longer before I decide in what direction I will go.
> Doctors around here say I should wait for up to 6 months (!) for the Lithium to show if it works.
> I will drop the Valdoxan as the first thing when I am a little loger in the proces.
>
> But thanks for all your inputs so far

6 months!! Wow, that's a new one to me. But the main thing is you say you are feeling a little better :) Take care and feel free to ask me if you have questions anytime
Kat


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