Posted by metric on March 14, 2009, at 19:27:57
In reply to Sertraline: the best ssri - your thoughts?, posted by West on March 4, 2009, at 4:53:46
> The SSRI escitalopram is probably (marginally) the leader of its class.
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> However, all drugs have side effects which may conflict with the ability to remit and compromise drug compliance.
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> My question is whether the 3% or so difference in remission rate with escitalopram over sertraline is significant if somebody finds escitalopram to have distressing side effects, such as overeating (3 successive bowls of country crisp AFTER a heart and fulsome dinner), somnolence (zombie, blah) and poor motivation (as above)
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> It is great for panic and anxiety but achieves this through ways i'm not entirely comfortable with.
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> Though i anticipate a lot of shared side effects among all ssris, how was sertraline for you in regards to:
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> * Mood - specifically related to depressed feelings. Were you buoyant and hopeful. making plans, getting out and seeing old friends etc. or a bit flat and downbeat?
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> * Anxiety - did you feel calm in public and around strangers as well as friends/associates. How was your 'follow through' with seeing people?
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> * Sleep - did you have any trouble getting off to sleep (ignorong the adjustment period)? Could you maintain a night's sleep without too much waking up?
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> * Energy - did you find yourself motivated or would you prefer to curl up with a book or film?
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> * Cognition - I've read, as have many of you i'm sure, of sertraline's neutral effects on cognition? Please opine.
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> In a nutshell, I have a feeling that modafinil, the glue of my treatment, will very soon be pulled from underneath my feet by my doctor.
>How much modafinil do you take? Have you tried it by itself? I found modafinil to be a decent antidepressant by itself, though the minimum effective dose was about 400 mg. It can cause some tension and anxiety at high doses, but this is amenable to modest doses of benzodiazepines (clonazepam or alprazolam work well IME).
I think dextroamphetamine is much more efficacious than modafinil for augmentation of SSRIs, although doctors favor the former because it has less "abuse potential". OTOH, modafinil seems to uniquely complement mirtazapine IME, but I wouldn't recommend the long-term use of mirtazapine.
> It is stopping escitalopram's side effects of lethargy and dullness. Therefore, i need to know if switching ssris is a sensible move. Sertaline is the only one i'm interested in moving to.
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>Unfortunately, none of the SSRIs work for depression, and they all have horrible side-effects.
> Thanks
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> West
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poster:metric
thread:883663
URL: http://www.dr-bob.org/babble/20090313/msgs/885341.html