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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Greg on June 12, 2000, at 8:59:22
Cam/Anyone,
I have a friend who was diagnosed with depression about 3 years ago. She was given Zoloft and Xanax and says they worked really well for her. She continued to improve and eventually decided to discontinue the meds. She has recently had some major life changes and has started to become heavily depressed again and started back on the Zoloft. But she says that this time instead of helping, it seems to be making the depression worse and she is extermely tired all the time. She sees her pdoc on Thursday and wants to have some alternatives in mind.
Are there ADs that work better for a woman's physiology that a man's? Could you maybe give me suggestions for other things to try? I know that she (and I) would appreciate any input you may have.
And Cam, please don't trouble yourself with this if you're not feeling up to it.
My best,
Greg
Posted by Greg on June 12, 2000, at 9:00:44
In reply to Cam - A question for a friend?, posted by Greg on June 12, 2000, at 8:59:22
> Cam/Anyone,
>
> I have a friend who was diagnosed with depression about 3 years ago. She was given Zoloft and Xanax and says they worked really well for her. She continued to improve and eventually decided to discontinue the meds. She has recently had some major life changes and has started to become heavily depressed again and started back on the Zoloft. But she says that this time instead of helping, it seems to be making the depression worse and she is extermely tired all the time. She sees her pdoc on Thursday and wants to have some alternatives in mind.
>
> Are there ADs that work better for a woman's physiology that a man's? Could you maybe give me suggestions for other things to try? I know that she (and I) would appreciate any input you may have.
>
> And Cam, please don't trouble yourself with this if you're not feeling up to it.
>
> My best,
> Greg
Posted by Cam W. on June 12, 2000, at 9:25:01
In reply to Cam - A question for a friend?, posted by Greg on June 12, 2000, at 8:59:22
Greg - A couple of questions about your friend. How long has she been taking the Zoloft this time? What dose is she taking? (ie could these be 'start-up' side effects?) How long did it take her to respond to Zoloft the 1st time?The tired feeling could also be an effect of the depression and the Zoloft hasn't kicked in, yet. Has it been the 8 weeks taking Zoloft this time?
Tell her not to give up too soon. The next step, if she needs to take it (if necessary) is to probably try another SSRI (since responded to one before). Maybe Paxil, especially if there is an anxiety component to this depression, due to it's reactive nature (ie a depression caused by an acute stressor).
As to differences antidepressant response between males and females, I kinda glanced at a recent article before I left on vacation about this. It would be available on-line from one of the nice Journals (eg Archives of General Psychiatry, other Archives, British Medical Journal, British Journal of Psychiatry, JAMA, American Family Physician, or perhaps a paper published on Medscape - I can't recall). This paper is at work and I won't be going in for a week or two, just yet. I think (but am not certain) that the conclusion of the study said that there are no "clinical" differences in response to antidepressants between the sexes, at least none we can utilize, yet.
Hope this helps - Cam W.
Posted by Greg on June 12, 2000, at 9:46:38
In reply to Re: Cam - A question for a friend? » Greg, posted by Cam W. on June 12, 2000, at 9:25:01
Cam,
Thanks for the quick response.
She has been taking the Zoloft for about 3 weeks this time, I'm unsure about the dose, but will see her tonight and get back to you with it. I think her main concern is that she didn't have the fatigue effect the first time and doesn't understand why it is happening now. She said she responded to it very quickly the first time out.
She also told me that while she is experiencing the fatigue, she wakes up 4-5 times during the night like someone turning on a light switch. Is this common? I thought about suggesting Wellbutrin, but if she is having some insomnia, it might not be the right thing for her? Decided to keep my mouth shut and leave it up to the experts like yourself.
I was changed from WB (because of the irrating effect I was experiencing) to Prozac a while ago. The Prozac worked OK for a while and then the fatigue started coming back. So I was put on a combo of the two (which I am told is pretty common), and things seem to be stabilizing well. My thanks for all your input on the subject!
Thanks,
Greg
> Greg - A couple of questions about your friend. How long has she been taking the Zoloft this time? What dose is she taking? (ie could these be 'start-up' side effects?) How long did it take her to respond to Zoloft the 1st time?
>
> The tired feeling could also be an effect of the depression and the Zoloft hasn't kicked in, yet. Has it been the 8 weeks taking Zoloft this time?
>
> Tell her not to give up too soon. The next step, if she needs to take it (if necessary) is to probably try another SSRI (since responded to one before). Maybe Paxil, especially if there is an anxiety component to this depression, due to it's reactive nature (ie a depression caused by an acute stressor).
>
> As to differences antidepressant response between males and females, I kinda glanced at a recent article before I left on vacation about this. It would be available on-line from one of the nice Journals (eg Archives of General Psychiatry, other Archives, British Medical Journal, British Journal of Psychiatry, JAMA, American Family Physician, or perhaps a paper published on Medscape - I can't recall). This paper is at work and I won't be going in for a week or two, just yet. I think (but am not certain) that the conclusion of the study said that there are no "clinical" differences in response to antidepressants between the sexes, at least none we can utilize, yet.
>
> Hope this helps - Cam W.
Posted by Cam W. on June 12, 2000, at 10:08:11
In reply to Re: Cam - A question for a friend? » Cam W., posted by Greg on June 12, 2000, at 9:46:38
Greg - BTW, info for a friend, huh? ;^)Tell her to ride it out for a couple more weeks if possible. If she responded to Zoloft the first time there is a good chance of responding this time. This is on the unfounded assumption that the biochemical breakdown that caused the first depression would probably be the weak link in the stress chain that would presumably result in this depression.
The fatigue effect this time may be an unresolved depression effect or an initial side effect of the Zoloft that she didn't notice the first time around or something else.
- Cam
Posted by NikkiT on June 12, 2000, at 10:25:19
In reply to Cam - A question for a friend?, posted by Greg on June 12, 2000, at 8:59:22
Only people I know RT (real time, not virtual time!) that take AD's of any shape or form or men... So when I mention side affects, they often don't know what I mean.. they all seem more suited than I do...
Cam - Could the Serzone or propanalol be causing really bad swollen feet for me. I've never suffered before, and I know I've put on weight, but I'm not HUGE yet.. but the last few days my feet have started to swell more and more... to the point I can't wear any of my nice shoes.. only the comfy pumps I have (which, by the way are Prada, (my shopping to cheer me up thing struck BADLY!!) so I don't wanna wear them too much!)
A hobbling Nikki xx
Posted by Cam W. on June 12, 2000, at 11:14:34
In reply to Women different form men???, posted by NikkiT on June 12, 2000, at 10:25:19
Nikki - I would suspect the propranolol. Decreased tension on the blood vessels caused by propranolol can cause pooling of blood in the legs resulting in the swelling. It might be wise to report this to your doc so that he/she can possibly adjust the dose. In the meantime, rest in a comfortable chair with your feet above your waist. The pooling is caused by gravity, so you can ease some of it by lounging with your feet up. (Good excuse to loaf around, huh.)Hope this helps - Cam
Posted by NikkiT on June 12, 2000, at 12:03:22
In reply to Re: Women different form men???, posted by Cam W. on June 12, 2000, at 11:14:34
The problem with this is as soon as I try that (seemed the obvious thing to do!), I get terrible pins and needles in my feet, and within a few minutes lose ALL feeling in them... But I've also been waking up regularly when asleep with no feeling in my hands either!!
Seeing Pdoc tomorrow morning! I'll mention it to him...
Thanks Cam
xx
> Nikki - I would suspect the propranolol. Decreased tension on the blood vessels caused by propranolol can cause pooling of blood in the legs resulting in the swelling. It might be wise to report this to your doc so that he/she can possibly adjust the dose. In the meantime, rest in a comfortable chair with your feet above your waist. The pooling is caused by gravity, so you can ease some of it by lounging with your feet up. (Good excuse to loaf around, huh.)
>
> Hope this helps - Cam
Posted by bob on June 12, 2000, at 15:41:17
In reply to Re: Cam - A question for a friend? » Greg, posted by Cam W. on June 12, 2000, at 10:08:11
Hey Greg, your friend's circumstances sound awfully familiar.
Zoloft was the first psychmed I was ever on. After 6 months on 100mg/d, my gp and I thought I was done with being depressed, it had worked so well ... so he pulled me off of it. (Yeah, cold turkey ... only made THAT mistake this once.)
Six weeks later, I was a basketcase. Far worse than I was before I went on Zoloft. He put me back on it, I started consulting a pdoc, and after another 4-5 months of being on Z at 150mg/d we gave up on it. It had nothing like it's original response for me. Subsequently, I tried paxil and prozac and zoloft again, the last two in combination with wellbutrin (P), lithium (P & Z), and finally nortriptyline (Z).
I don't know if my initial response to Z was a fluke or what, given my almost total non-response to SSRIs since ... given some of my behaviors towards the end of that initial trial of Z I think I was having a manic response to it more than anything. Anyway, once I started taking a TCA it didn't take long for me to figure out that I *did* respond to, well, at least nortriptyline better than any other AD I've been on.
I just hope you friend doesn't have the same experience I had -- that's two years I'd gladly forget (except for those first six months, maybe ...).
cheers
bob
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