![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Bonnie on April 17, 2000, at 3:28:59
I have been depressed since September 1999 and still am. I was first put on Prozac, and that made me so anxious I couldn't even sleep. Then Wellbutrin gave me tenittus. Celexa didn't work for 2 months, and finally I am now taking Effexor and noticed a change last week, but things are back to crap. I am now experincing a lot of side effects, or there is something wrong with me. I have been having headaches, heat/cold flashes, stomach aches, body aches, and etc...I guess I have no choice but to wait it out! Please write me with any useful info or advice. Thank you.
Posted by JohnL on April 17, 2000, at 4:39:49
In reply to Taken Prozac, Wellbutrin, Celexa, and now on Effex, posted by Bonnie on April 17, 2000, at 3:28:59
> I have been depressed since September 1999 and still am. I was first put on Prozac, and that made me so anxious I couldn't even sleep. Then Wellbutrin gave me tenittus. Celexa didn't work for 2 months, and finally I am now taking Effexor and noticed a change last week, but things are back to crap. I am now experincing a lot of side effects, or there is something wrong with me. I have been having headaches, heat/cold flashes, stomach aches, body aches, and etc...I guess I have no choice but to wait it out! Please write me with any useful info or advice. Thank you.
Bonnie,
You bring up a tough situation. And I'm so sorry you're having such a rough go of it. Believe me, you aren't alone. Been there done that way too many times...and likely will again at some point. Hang in there as best you can for now.This might be a good time to review some basic theories that I subscribe to. It might help you to make sense of the situation.
To begin, depression can be caused by a variety of chemical imbalances. Just as diarrhea is caused by many things. The causes may vary, but the end-result symptoms are the same. Causes of depression include: low serotonin, low norepinephrine, low dopamine, elevated dopamine (too much is just as bad as not enough), elevated norepinephrine, chemical instability, electrical instability, GABA deficient, norepinephrine/dopamine failure (levels OK, but not functioning properly), and hormones (thyroid, estrogen, testosterone), or a blend of any of these various problems.
Each person's chemistry will prefer one medication molecule over others. The difficult part of treating depression is that we don't know in advance which molecule our system will respond to best. It's purely a guess and trial&error. Only through comparisons of medication reactions can we gather clues as to what the underlying chemical problem is. The wrong medication is characterized by these responses: slow (if any) response, worsening of symptoms, excessive side effects. The correct medication is characterized by: quick response, minimal side effects...evidence that the medication is a nearly perfect match for our chemistry.
So far the clues from your responses suggest that low serotonin might not be the issue with you. Otherwise, you would have probably experienced at least SOME response to Celexa or Prozac. But to complicate things, it might be that Paxil or Zoloft is the magic molecule your chemistry prefers. Generally though, I think each time we try and fail on several medications in a class of drugs, the less likely it is any of them are correct, and the more urgent it becomes to move to different classes of drugs that work on different chemistries.
Since you felt some improvement early with Effexor--but it then faded--that might be a clue that there is chemical or electrical instability involved. One drug that is showing promise as both an antidepressant and a stabilizer all in one is Zyprexa. It comes with side effects of intitial sedation (which fades in days) and weight gain. But for a blanket approach to correct a variety of chemistries, Zyprexa fits the bill.
Other things to consider would be: Desipramine or Nortriptyline (low norepinephrine)...expect dry mouth and constipation; Lamictal (anticonvulsant with stabilizing and antidepressant qualities), Risperdal (antipsychotic similar to Zyprexa, but with less sedation and less weight gain...I prefer to call these dopamine reducers rather than antipsychotics); Adderall or Ritalin (NE/dopamine failure). And of course there's always St Johnswort which really truly is a miracle for some people. And from overseas mailorder pharmacies two good choices are Amisulpride (increases dopamine transmission), and Adrafinil (NE failure).
I don't mean to overwhelm you with complications and choices. But as you can see, that's what we are up against when treating depression. In your shoes, I would strongly urge my physician to go in this direction:
Start Adderall immediately. It was used to treat depression before antidepressants came to be, and is still used commonly as an add-on. If it is to work, it will do so in 24 to 72 hours. No long wait. If you have a negative or neutral reaction, switch immediately to Ritalin. The reason I mention these stimulants is because when they work, they work fast. I believe quick therapy is crucial in your condition. We can always experiment with other antidepressants after getting out of the hole with a stimulant. Eventually when the best drugmatch is found, we can probably discontinue the stimulant. But for immediate results--and I think they are warranted in your case--stimulants should be considered. It will only take two weeks total to give both of these a try.With or without the stimulant, Zyprexa would be at the top of my list. Sometimes a stimulant over-corrects, and a tiny dose of a dopamine reducer is needed to balance it out. But for its wide range of therapeutic action, covering a lot of bases, I would definitely consider Zyprexa or Risperdal.
Basically--in your shoes--I think I would pass over the serotonin drugs at this time. I would instead move on with a sense of urgency to stimulants and/or antipsychotics and/or tricyclic antidepressants. You are at a stage where quick comparisons of different classes is warranted in order to gather clues as to what is going on. Since it's all a guessing game anyway, it makes sense to add some organization and reason to the process. Hope this helps more than it confuses! :-) JohnL
Posted by elise on April 17, 2000, at 8:39:52
In reply to Re: Taken Prozac, Wellbutrin, Celexa, and now on Effex, posted by JohnL on April 17, 2000, at 4:39:49
> > I have been depressed since September 1999 and still am. I was first put on Prozac, and that made me so anxious I couldn't even sleep. Then Wellbutrin gave me tenittus. Celexa didn't work for 2 months, and finally I am now taking Effexor and noticed a change last week, but things are back to crap. I am now experincing a lot of side effects, or there is something wrong with me. I have been having headaches, heat/cold flashes, stomach aches, body aches, and etc...I guess I have no choice but to wait it out! Please write me with any useful info or advice. Thank you.
>
> Bonnie,
> You bring up a tough situation. And I'm so sorry you're having such a rough go of it. Believe me, you aren't alone. Been there done that way too many times...and likely will again at some point. Hang in there as best you can for now.
>
> This might be a good time to review some basic theories that I subscribe to. It might help you to make sense of the situation.
>
> To begin, depression can be caused by a variety of chemical imbalances. Just as diarrhea is caused by many things. The causes may vary, but the end-result symptoms are the same. Causes of depression include: low serotonin, low norepinephrine, low dopamine, elevated dopamine (too much is just as bad as not enough), elevated norepinephrine, chemical instability, electrical instability, GABA deficient, norepinephrine/dopamine failure (levels OK, but not functioning properly), and hormones (thyroid, estrogen, testosterone), or a blend of any of these various problems.
>
> Each person's chemistry will prefer one medication molecule over others. The difficult part of treating depression is that we don't know in advance which molecule our system will respond to best. It's purely a guess and trial&error. Only through comparisons of medication reactions can we gather clues as to what the underlying chemical problem is. The wrong medication is characterized by these responses: slow (if any) response, worsening of symptoms, excessive side effects. The correct medication is characterized by: quick response, minimal side effects...evidence that the medication is a nearly perfect match for our chemistry.
>
> So far the clues from your responses suggest that low serotonin might not be the issue with you. Otherwise, you would have probably experienced at least SOME response to Celexa or Prozac. But to complicate things, it might be that Paxil or Zoloft is the magic molecule your chemistry prefers. Generally though, I think each time we try and fail on several medications in a class of drugs, the less likely it is any of them are correct, and the more urgent it becomes to move to different classes of drugs that work on different chemistries.
>
> Since you felt some improvement early with Effexor--but it then faded--that might be a clue that there is chemical or electrical instability involved. One drug that is showing promise as both an antidepressant and a stabilizer all in one is Zyprexa. It comes with side effects of intitial sedation (which fades in days) and weight gain. But for a blanket approach to correct a variety of chemistries, Zyprexa fits the bill.
>
> Other things to consider would be: Desipramine or Nortriptyline (low norepinephrine)...expect dry mouth and constipation; Lamictal (anticonvulsant with stabilizing and antidepressant qualities), Risperdal (antipsychotic similar to Zyprexa, but with less sedation and less weight gain...I prefer to call these dopamine reducers rather than antipsychotics); Adderall or Ritalin (NE/dopamine failure). And of course there's always St Johnswort which really truly is a miracle for some people. And from overseas mailorder pharmacies two good choices are Amisulpride (increases dopamine transmission), and Adrafinil (NE failure).
>
> I don't mean to overwhelm you with complications and choices. But as you can see, that's what we are up against when treating depression. In your shoes, I would strongly urge my physician to go in this direction:
> Start Adderall immediately. It was used to treat depression before antidepressants came to be, and is still used commonly as an add-on. If it is to work, it will do so in 24 to 72 hours. No long wait. If you have a negative or neutral reaction, switch immediately to Ritalin. The reason I mention these stimulants is because when they work, they work fast. I believe quick therapy is crucial in your condition. We can always experiment with other antidepressants after getting out of the hole with a stimulant. Eventually when the best drugmatch is found, we can probably discontinue the stimulant. But for immediate results--and I think they are warranted in your case--stimulants should be considered. It will only take two weeks total to give both of these a try.
>
> With or without the stimulant, Zyprexa would be at the top of my list. Sometimes a stimulant over-corrects, and a tiny dose of a dopamine reducer is needed to balance it out. But for its wide range of therapeutic action, covering a lot of bases, I would definitely consider Zyprexa or Risperdal.
>
> Basically--in your shoes--I think I would pass over the serotonin drugs at this time. I would instead move on with a sense of urgency to stimulants and/or antipsychotics and/or tricyclic antidepressants. You are at a stage where quick comparisons of different classes is warranted in order to gather clues as to what is going on. Since it's all a guessing game anyway, it makes sense to add some organization and reason to the process. Hope this helps more than it confuses! :-) JohnLJohn --
Since I can't quite grasp what drugs do what to what neurotransmitters, maybe you can help me!! Like I have told you in previous posts, any of the "stimulating" meds I have taken make me feel horrible and more anxious then ever...wellbutrin, adderall, now provigil, too much prozac. Prozac seems to make me want to do nothing a lot --- no motivation to do much of anything. Can you suggest anything that would be kind of in the middle??????HELP! elise
Posted by ChrisK on April 17, 2000, at 13:45:01
In reply to Taken Prozac, Wellbutrin, Celexa, and now on Effex, posted by Bonnie on April 17, 2000, at 3:28:59
I am also very resistant to meds and fought for a long time to find the best one(s) for me. At one time or another I had tried prozac, Paxil, Remeron, Effexor, Neurontin, and Celexa. Years ago I had gotten some relief from Immiprimine so I asked to go back to a TCA. After some discussion I started on a low-medium dose of Nortriptyline.
That was the first time in years I had felt some relief from anything. I still had nagging thoughts of suicide so we added Zyprexa to the TCA. Within a week I was feeling much better but not "good." I was still fighting with my alcoholism (great self medication)so I asked to try Naltrexone to help with the cravings. Surprise not only did it help the alcohol problem but it had the extra benefit of further reducing my depression.
That brings us up to the last couple of months. Anhedonia is the best word. I can walk around and function like a "normal" person but I don't really feel much joy. That's when I tried a small dose of Wellbutrin and Adderall. That's where I stand until my next appt. which is tomorrow. I'm ready to ditch the Adderall and look for another stimulant. There have been many suggestions around here and I'll probably ask to try Provigil.
I guess what I want you to know that I am getting healthier and may actually be happy someday but it has taken me two years to get where I am today. There is no magic cure for all people but there is a good chance that there will be help for you. Ask your doctor to try a TCA or MAOI. From my experience you should also listen to JohnL about augmenting an AD that has shown some promise. I've been doing 1000 percent better since I started Zyprexa. It lifted a very dark fog.
Hope this helps. Keep on trying. SOMETHING will start to help.
ChrisK
Posted by bob on April 17, 2000, at 22:49:52
In reply to Re: John!, posted by elise on April 17, 2000, at 8:39:52
Any place we can put that post of JohnL's for simple reference in the future? ;^)
Bonnie, similar to what JohnL and ChrisK had to say, I was a non-responder to seratonin-based meds. Nortriptyline made a huge difference. Getting off of SSRIs, for me, made an even bigger difference! I've also added Ritalin and its helping me punch some holes in that anhedonia an AD can get you to but, sometimes, not get you past. My pdoc just switched me to desiprimine -- we think that the nortrip might be just a little too sedating. Desiprimine tends to be more activating ... otherwise, the two TCAs have favorable side effect profiles compared to the rest of this class. Desiprimine also has been used as an anti-anxiety/panic med ... another issue of mine that resurfaced when I left zoloft behind (it did do that ONE thing for me).
Elise -- panic or anxiety often goes hand in hand with depression, so if you don't treat both you may not find the relief you need. It never occurred to my "team" and I, even though I first started seeing my therapist because of some severe, daily panic attacks, that we should be treating my panic disorder until a drug interaction created a bit of a crisis for me. My pdoc put me on klonopin, and ever since then a big, nasty part of my life is just plain gone ... and I don't miss it one bit. Since I went off zoloft about 6-8 months back, there's always been a bit of an edge that the klonopin hasn't been able to tackle, but the ritalin I've just started has taken some of that away and I've got my fingers crossed on desiprimine handling the rest.
Anyway, maybe this is one issue to raise with your pdoc. A lot of folks don't like using benzodiazepines like klonopin long-term, since they can be addictive, so as JohnL suggests, zyprexa may be another good option. [as a result of that little crisis of mine, the ER psychiatrist put me on zyprexa for a few weeks ... my pdoc favored switching to klonopin ... everyone has their favorites.]
cheers,
bob
Posted by JohnL on April 18, 2000, at 2:11:17
In reply to Re: John!, posted by elise on April 17, 2000, at 8:39:52
Elise,
Your responses so far to Adderall, Prozac, Celexa, or Provigil do give some clues.
First, there may be a low serotonin component. But only slightly low. I say that because Prozac is somewhat helpful. But higher doses turn negative. That indicates a low dose may be the optimum way to go for this chemistry. The non response to Celexa kind of puts the whole low serotonin theory in question. But the partial response to Prozac is worth noting and may be an important clue. It's just that a small dose might be best. Negative responses to higher doses prove this.
The negative responses to everything else point to norepinephrine and/or dopamine malfunction...but not due to low levels of these neurotransmitters. If anything, they might actually be elevated. In your shoes I would consider one of two strategies.
My first priority would be to explore the atypical antipsychotics. They have a wide range of therapeutic action, and are very useful for many symptoms besides schizophrenia...even in the total absence of any schizo symptoms. Top three choices would be: Zyprexa (sedating at first, take at dinnertime, often causes weight gain. Dose to try would be in the 2.5mg to 7.5mg range); Risperdal (less sedating, less weight gain, dose 2mg to 4mg); Stelazine (least sedating, actually somewhat alerting, the closest thing to Amisulpride available). In a perfect world with a cooperative physician, it would be nice to compare these to find which is the best match for your chemistry. That would mean trying each for about two weeks with a day or two washout inbetween. Then go with the best for a longer trial. In a not so perfect world with a resistant physician, I would go with Zyprexa because it overall has the strongest track record and is becoming rather popular for a variety of psychiatric conditions, including depression. Improvement is very often noted rather quickly, like from day 2 to day 7.
Another strategy would be to explore the anticonvulsants, especially the ones noted for antidepressant qualities and minimal side effects. Top choice in that category meeting those criteria would be Lamictal. Its only serious side effect is a dangerour rash which is almost always a result of increasing dose too fast. Must increase by 25mg a week. Target range is 100mg to 400mg.
In your shoes I would be looking at Zyprexa and its cousins first, and Lamictal second. I would for the time being steer away from other SSRIs and tricyclics in your case. If both the antipsychotics and anticonvulsants disappoint, then we can always come back and explore the other more common antidpressants not yet tried. But negative results to them so far justifies--in my nonprofessional opinion only--exploring different drug classes. I'm no doctor, and I'm not pretending to play one, I'm just telling you what I personally would do if I were in your shoes, and why. I hope it helps. :-) JohnL
Posted by elise on April 18, 2000, at 8:03:35
In reply to Re: Elise, posted by JohnL on April 18, 2000, at 2:11:17
> Elise,
>
> Your responses so far to Adderall, Prozac, Celexa, or Provigil do give some clues.
>
> First, there may be a low serotonin component. But only slightly low. I say that because Prozac is somewhat helpful. But higher doses turn negative. That indicates a low dose may be the optimum way to go for this chemistry. The non response to Celexa kind of puts the whole low serotonin theory in question. But the partial response to Prozac is worth noting and may be an important clue. It's just that a small dose might be best. Negative responses to higher doses prove this.
>
> The negative responses to everything else point to norepinephrine and/or dopamine malfunction...but not due to low levels of these neurotransmitters. If anything, they might actually be elevated. In your shoes I would consider one of two strategies.
>
> My first priority would be to explore the atypical antipsychotics. They have a wide range of therapeutic action, and are very useful for many symptoms besides schizophrenia...even in the total absence of any schizo symptoms. Top three choices would be: Zyprexa (sedating at first, take at dinnertime, often causes weight gain. Dose to try would be in the 2.5mg to 7.5mg range); Risperdal (less sedating, less weight gain, dose 2mg to 4mg); Stelazine (least sedating, actually somewhat alerting, the closest thing to Amisulpride available). In a perfect world with a cooperative physician, it would be nice to compare these to find which is the best match for your chemistry. That would mean trying each for about two weeks with a day or two washout inbetween. Then go with the best for a longer trial. In a not so perfect world with a resistant physician, I would go with Zyprexa because it overall has the strongest track record and is becoming rather popular for a variety of psychiatric conditions, including depression. Improvement is very often noted rather quickly, like from day 2 to day 7.
>
> Another strategy would be to explore the anticonvulsants, especially the ones noted for antidepressant qualities and minimal side effects. Top choice in that category meeting those criteria would be Lamictal. Its only serious side effect is a dangerour rash which is almost always a result of increasing dose too fast. Must increase by 25mg a week. Target range is 100mg to 400mg.
>
> In your shoes I would be looking at Zyprexa and its cousins first, and Lamictal second. I would for the time being steer away from other SSRIs and tricyclics in your case. If both the antipsychotics and anticonvulsants disappoint, then we can always come back and explore the other more common antidpressants not yet tried. But negative results to them so far justifies--in my nonprofessional opinion only--exploring different drug classes. I'm no doctor, and I'm not pretending to play one, I'm just telling you what I personally would do if I were in your shoes, and why. I hope it helps. :-) JohnLjohn-
i have never taken celexa------do you think it is worth a try????thanks again - you are wonderful.
p.s. I keep on going back to the provigil...i took 100 mg. of it yesterday and it wasn't too bad.
Posted by Denise528 on September 24, 2001, at 8:17:29
In reply to Re: Taken Prozac, Wellbutrin, Celexa, and now on Effex, posted by JohnL on April 17, 2000, at 4:39:49
> > John/Bonnie,
It's probably a bit late in the day as it is now 20001 but I'd really like to continue this thread, firstly because the Note from John was so encouraging and offered such practical advise and secondly I'd like to know how Bonnie is getting on as I myself am experiencing the same problems. I am currently on Prothiaden which seems to be having very little effect and was on the Seroxat for two weeks but it only made me worse. The awful thing is that I have been on these drugs in the past and they worked (like you said John) so quickly with very few side effects. So I am at my wits end because I don't understand why they aren't working now. I'm really confused. Can you help?
Posted by KarenRB53 on December 18, 2007, at 19:26:59
In reply to Re: Taken Prozac, Wellbutrin, Celexa, and now on Effex, posted by JohnL on April 17, 2000, at 4:39:49
> > I have been depressed since September 1999 and still am. I was first put on Prozac, and that made me so anxious I couldn't even sleep. Then Wellbutrin gave me tenittus. Celexa didn't work for 2 months, and finally I am now taking Effexor and noticed a change last week, but things are back to crap. I am now experincing a lot of side effects, or there is something wrong with me. I have been having headaches, heat/cold flashes, stomach aches, body aches, and etc...I guess I have no choice but to wait it out! Please write me with any useful info or advice. Thank you.
>
> Bonnie,
> You bring up a tough situation. And I'm so sorry you're having such a rough go of it. Believe me, you aren't alone. Been there done that way too many times...and likely will again at some point. Hang in there as best you can for now.
>
> This might be a good time to review some basic theories that I subscribe to. It might help you to make sense of the situation.
>
> To begin, depression can be caused by a variety of chemical imbalances. Just as diarrhea is caused by many things. The causes may vary, but the end-result symptoms are the same. Causes of depression include: low serotonin, low norepinephrine, low dopamine, elevated dopamine (too much is just as bad as not enough), elevated norepinephrine, chemical instability, electrical instability, GABA deficient, norepinephrine/dopamine failure (levels OK, but not functioning properly), and hormones (thyroid, estrogen, testosterone), or a blend of any of these various problems.
>
> Each person's chemistry will prefer one medication molecule over others. The difficult part of treating depression is that we don't know in advance which molecule our system will respond to best. It's purely a guess and trial&error. Only through comparisons of medication reactions can we gather clues as to what the underlying chemical problem is. The wrong medication is characterized by these responses: slow (if any) response, worsening of symptoms, excessive side effects. The correct medication is characterized by: quick response, minimal side effects...evidence that the medication is a nearly perfect match for our chemistry.
>
> So far the clues from your responses suggest that low serotonin might not be the issue with you. Otherwise, you would have probably experienced at least SOME response to Celexa or Prozac. But to complicate things, it might be that Paxil or Zoloft is the magic molecule your chemistry prefers. Generally though, I think each time we try and fail on several medications in a class of drugs, the less likely it is any of them are correct, and the more urgent it becomes to move to different classes of drugs that work on different chemistries.
>
> Since you felt some improvement early with Effexor--but it then faded--that might be a clue that there is chemical or electrical instability involved. One drug that is showing promise as both an antidepressant and a stabilizer all in one is Zyprexa. It comes with side effects of intitial sedation (which fades in days) and weight gain. But for a blanket approach to correct a variety of chemistries, Zyprexa fits the bill.
>
> Other things to consider would be: Desipramine or Nortriptyline (low norepinephrine)...expect dry mouth and constipation; Lamictal (anticonvulsant with stabilizing and antidepressant qualities), Risperdal (antipsychotic similar to Zyprexa, but with less sedation and less weight gain...I prefer to call these dopamine reducers rather than antipsychotics); Adderall or Ritalin (NE/dopamine failure). And of course there's always St Johnswort which really truly is a miracle for some people. And from overseas mailorder pharmacies two good choices are Amisulpride (increases dopamine transmission), and Adrafinil (NE failure).
>
> I don't mean to overwhelm you with complications and choices. But as you can see, that's what we are up against when treating depression. In your shoes, I would strongly urge my physician to go in this direction:
> Start Adderall immediately. It was used to treat depression before antidepressants came to be, and is still used commonly as an add-on. If it is to work, it will do so in 24 to 72 hours. No long wait. If you have a negative or neutral reaction, switch immediately to Ritalin. The reason I mention these stimulants is because when they work, they work fast. I believe quick therapy is crucial in your condition. We can always experiment with other antidepressants after getting out of the hole with a stimulant. Eventually when the best drugmatch is found, we can probably discontinue the stimulant. But for immediate results--and I think they are warranted in your case--stimulants should be considered. It will only take two weeks total to give both of these a try.
>
> With or without the stimulant, Zyprexa would be at the top of my list. Sometimes a stimulant over-corrects, and a tiny dose of a dopamine reducer is needed to balance it out. But for its wide range of therapeutic action, covering a lot of bases, I would definitely consider Zyprexa or Risperdal.
>
> Basically--in your shoes--I think I would pass over the serotonin drugs at this time. I would instead move on with a sense of urgency to stimulants and/or antipsychotics and/or tricyclic antidepressants. You are at a stage where quick comparisons of different classes is warranted in order to gather clues as to what is going on. Since it's all a guessing game anyway, it makes sense to add some organization and reason to the process. Hope this helps more than it confuses! :-) JohnLJust wondering if you're still posting. I just found this posting and your information is so very helpful.
Hope to hear from you, Karen
Posted by KarenRB53 on May 16, 2008, at 10:44:26
In reply to Re: Taken Prozac, Wellbutrin, Celexa, and now on Effex, posted by JohnL on April 17, 2000, at 4:39:49
> > I have been depressed since September 1999 and still am. I was first put on Prozac, and that made me so anxious I couldn't even sleep. Then Wellbutrin gave me tenittus. Celexa didn't work for 2 months, and finally I am now taking Effexor and noticed a change last week, but things are back to crap. I am now experincing a lot of side effects, or there is something wrong with me. I have been having headaches, heat/cold flashes, stomach aches, body aches, and etc...I guess I have no choice but to wait it out! Please write me with any useful info or advice. Thank you.
>
> Bonnie,
> You bring up a tough situation. And I'm so sorry you're having such a rough go of it. Believe me, you aren't alone. Been there done that way too many times...and likely will again at some point. Hang in there as best you can for now.
>
> This might be a good time to review some basic theories that I subscribe to. It might help you to make sense of the situation.
>
> To begin, depression can be caused by a variety of chemical imbalances. Just as diarrhea is caused by many things. The causes may vary, but the end-result symptoms are the same. Causes of depression include: low serotonin, low norepinephrine, low dopamine, elevated dopamine (too much is just as bad as not enough), elevated norepinephrine, chemical instability, electrical instability, GABA deficient, norepinephrine/dopamine failure (levels OK, but not functioning properly), and hormones (thyroid, estrogen, testosterone), or a blend of any of these various problems.
>
> Each person's chemistry will prefer one medication molecule over others. The difficult part of treating depression is that we don't know in advance which molecule our system will respond to best. It's purely a guess and trial&error. Only through comparisons of medication reactions can we gather clues as to what the underlying chemical problem is. The wrong medication is characterized by these responses: slow (if any) response, worsening of symptoms, excessive side effects. The correct medication is characterized by: quick response, minimal side effects...evidence that the medication is a nearly perfect match for our chemistry.
>
> So far the clues from your responses suggest that low serotonin might not be the issue with you. Otherwise, you would have probably experienced at least SOME response to Celexa or Prozac. But to complicate things, it might be that Paxil or Zoloft is the magic molecule your chemistry prefers. Generally though, I think each time we try and fail on several medications in a class of drugs, the less likely it is any of them are correct, and the more urgent it becomes to move to different classes of drugs that work on different chemistries.
>
> Since you felt some improvement early with Effexor--but it then faded--that might be a clue that there is chemical or electrical instability involved. One drug that is showing promise as both an antidepressant and a stabilizer all in one is Zyprexa. It comes with side effects of intitial sedation (which fades in days) and weight gain. But for a blanket approach to correct a variety of chemistries, Zyprexa fits the bill.
>
> Other things to consider would be: Desipramine or Nortriptyline (low norepinephrine)...expect dry mouth and constipation; Lamictal (anticonvulsant with stabilizing and antidepressant qualities), Risperdal (antipsychotic similar to Zyprexa, but with less sedation and less weight gain...I prefer to call these dopamine reducers rather than antipsychotics); Adderall or Ritalin (NE/dopamine failure). And of course there's always St Johnswort which really truly is a miracle for some people. And from overseas mailorder pharmacies two good choices are Amisulpride (increases dopamine transmission), and Adrafinil (NE failure).
>
> I don't mean to overwhelm you with complications and choices. But as you can see, that's what we are up against when treating depression. In your shoes, I would strongly urge my physician to go in this direction:
> Start Adderall immediately. It was used to treat depression before antidepressants came to be, and is still used commonly as an add-on. If it is to work, it will do so in 24 to 72 hours. No long wait. If you have a negative or neutral reaction, switch immediately to Ritalin. The reason I mention these stimulants is because when they work, they work fast. I believe quick therapy is crucial in your condition. We can always experiment with other antidepressants after getting out of the hole with a stimulant. Eventually when the best drugmatch is found, we can probably discontinue the stimulant. But for immediate results--and I think they are warranted in your case--stimulants should be considered. It will only take two weeks total to give both of these a try.
>
> With or without the stimulant, Zyprexa would be at the top of my list. Sometimes a stimulant over-corrects, and a tiny dose of a dopamine reducer is needed to balance it out. But for its wide range of therapeutic action, covering a lot of bases, I would definitely consider Zyprexa or Risperdal.
>
> Basically--in your shoes--I think I would pass over the serotonin drugs at this time. I would instead move on with a sense of urgency to stimulants and/or antipsychotics and/or tricyclic antidepressants. You are at a stage where quick comparisons of different classes is warranted in order to gather clues as to what is going on. Since it's all a guessing game anyway, it makes sense to add some organization and reason to the process. Hope this helps more than it confuses! :-) JohnL
I just found this post and I find your information so helpful. I was wondering if you're still posting to this site and it you are could you post back. I would apprecite so much your input into my medication dilemma.Thanks
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