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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by h0dge on May 16, 2001, at 15:44:50
I think I'm dysthymic. I've always just had a negative mood, been low energy, and generally just been a misanthrope of sorts. :) I occasionally get to more severe depression, but nothing so bad as to contemplate suicide or anything really rash like that. Just lots of self-flagellation... I'm generally pretty anti-social, have trouble making decisions, things like that. I never have manic phases.
I've been on Zoloft and Wellbutrin before. Zoloft I tried for a while, and I think it had some beneficial effects. However, the delayed/non-existent orgasm made me stop - I didn't have reduced desire (more, actually), but it was just too frustrating. I can't precisely remember the dose I was on, but it was probably 150 mg or so. Wellbutrin I tried recently, at 300 mg or so for 10 weeks, and I don't think it had much effect at all.
So, getting to the AD bit - I'm going to start up medication again (waiting til insurance kicks in to be able to go to psychiatrist/therapy, but until then I have a good family doc who can get samples and is somewhat experienced in mental health issues). My main concern is that I find something that improves my mood/personality without significant long-term sexual side effects - I know, probably what lots of other people are looking for.
My thoughts so far:
-I believe a SSRI would work, based on my experience with Zoloft. I've been thinking that Prozac might be a good choice, since it sounds like it's energizing, and that might be good for me since I'm pretty low energy. I wouldn't mind some ejaculatory delay (it would be nice actually!) but not if it blocks orgasm altogether, reduces my libido, or otherwise wreaks sexual havoc. It sounds like Zoloft is the worst as far as that goes, so I'm hoping maybe Prozac won't be as bad. Some of my blood relatives are on Paxil or Prozac, and that seems to work for them.
-I've been contemplating Remeron, since it seems to have no sexual effect, from what I've read. The tendancy towards sedation is a bit worrisome - I don't need to be more tired! Possibly in concert with wellbutrin or effexor? I know Wellbutrin doesn't have sexual side effects for me, although it doesn't improve mood too much. Effexor sounds like it has a short-term effect on orgasm, which tends to subside after 2 months or so.
-I think I'd prefer to avoid MAO inhibitors since I really like a lot of the foods that are no-nos while taking a MAOI, like aged cheese, wine, coffee, etc.
Does anyone have advice on which course might be best to try first, or any alternatives that might prove fruitful? At this point I'm pondering either trying Prozac and seeing how the sexual effects go, or trying Remeron and seeing if the sedation is bad alone/with other things in the morning to energize. I have access to samples of Prozac (20mg), Remeron (30mg), and (probably) Effexor XR (75mg), along with a remaining bottle of Wellbutrin XR (100mg).
Any advice in followups/email would be greatly appreciated!
-jon
Posted by CraigF on May 16, 2001, at 16:06:20
In reply to Several questions about potential AD stuff..., posted by h0dge on May 16, 2001, at 15:44:50
Instead of Prozac, perhaps try Celexa. For me it was more of a fine-tuned drug. If the sexual side effects kick in, try adding WB and Ginkgo.
If you're considering taking Remeron to avoid sexual side effects, I wouldn't go adding Effexor.
It sounds like we have similar types of depression/anxiety. I will be looking to try Amisulpride, an atypical anti-psychotic that supposedly works well for depression in low doses. It is available overseas (if you're not in the US).
I tried Remeron for one day and I ate SO MUCH FOOD! If weight gain is a concern, I'd avoid Remeron.
Good luck
Posted by SalArmy4me on May 16, 2001, at 16:44:30
In reply to Several questions about potential AD stuff..., posted by h0dge on May 16, 2001, at 15:44:50
I thought of Serzone as an alternative to SSRI's and their sexual dysfunction.
Posted by loosmrbls on May 17, 2001, at 12:15:41
In reply to Several questions about potential AD stuff..., posted by h0dge on May 16, 2001, at 15:44:50
You really have a lot of options.
1) Serzone is an weak SSRI that blocks 5HT-2 and 5HT-3 receptors, which are the receptors implicated in sexual side effects, anxiety, nausea, and other side effects of SSRI's -- it's a clean SSRI.
2) Remeron works sort of like serzone, but also stimulates norepinephrine pathways. Unfortunately, it also acts like an antihistamine and seems to increase appetite. However, the degree of this seems to vary greatly from person to person. And it seems to be a great antidepressant, apart from it's side effects.
3) Wellbutrin works on NE and dopamine, and can be used alone or in combo with an SSRI to get a good response with less sexual side effects.
Now as far as tricyclics, SSRI's, and Effexor -- all of these stimulate multiple serotonin receptors and all can cause varying degrees of sexual side effects. I think it varies from person to person, even the same drug.
I would try serzone first, if you had a good response to an SSRI in the past.
This is the end of the thread.
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