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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Mandy on April 26, 2002, at 16:04:51
I have been taking prozac for years with trials of other AD's but always back to prozac and am at max dose of 80mg. I still have a hopeless, joyless attitude and my doc wants to augment with
25-50 mg of desipramine. Does anyone have any experience with this drug--will it make me sleepy or gain wt?? Any other ideas for a good med that augments prozac. I tried zyprexa but gained wt. I also have total lack of energy and motivation but am afraid my anxiety would get out of control on a stimulant. Any thoughts, suggestions would be most welcome.
Posted by katekite on April 26, 2002, at 17:11:19
In reply to Best med to augment Prozac, posted by Mandy on April 26, 2002, at 16:04:51
I'm sure this is beating a dead horse, I've posted so much on it, but don't be afraid to try a stimulant because of anxiety. My anxiety issues, a problem as long as I can recall, are as close to gone as I know what is, on ritalin. An ocean of calm. Obviously that's probably not what the majority of people experience. Caffeine isn't a good way to tell if you'd respond because the heart rate and jumpiness/trembly effects are so much stronger than any helpful cognitive effects. If you were prescribed a short acting one first then at most a worsening of anxiety would only last a few hours. Pretty quick to know if something hurts or helps. Seems most anything is worth a short try.
The one thing I've learned after so many med trials is don't take for granted how you might respond to anything, based on any other experience, yours or your doctors or what the media says. There are no shortcuts and every brain is unique and responds uniquely.
Hope desipramine helps.
I never thought I'd sound like a speed junkie saying "here, take some, you'll like it", LOL. I guess I can't really contain my relief and surprise at having found something that helps so much in such a short time. It makes me want everyone else to feel better immediately. Obviously I'll be in error telling most people to try ritalin, but I never ever would even have considered it had I not researched it.
-- kate
Posted by Ron Hill on April 26, 2002, at 17:15:47
In reply to Best med to augment Prozac, posted by Mandy on April 26, 2002, at 16:04:51
Mandy,
Perhaps you could do a trial of SAM-e to augment the Prozac. I had your same symptoms (anergy and anhedonia), caused by SSRI induced lowering of dopamine, six months ago when my pdoc suggested SAM-e. SAM-e almost immediately solved the problem. It saved my life! If you want to know more, reply to this post.
-- Ron
--------------------> I have been taking prozac for years with trials of other AD's but always back to prozac and am at max dose of 80mg. I still have a hopeless, joyless attitude and my doc wants to augment with
> 25-50 mg of desipramine. Does anyone have any experience with this drug--will it make me sleepy or gain wt?? Any other ideas for a good med that augments prozac. I tried zyprexa but gained wt. I also have total lack of energy and motivation but am afraid my anxiety would get out of control on a stimulant. Any thoughts, suggestions would be most welcome.
Posted by JonW on April 26, 2002, at 17:33:03
In reply to Best med to augment Prozac, posted by Mandy on April 26, 2002, at 16:04:51
Hi Mandy,
You may want to try Provigil. I experience major anxiety when on the regular psychostimulatnts, and having social phobia this is a major problem. When I tried Provigil I thought it was so cool that I was getting the same positive effects without any of the anxiety. I've pasted an abstract below that suggests Provigil may be useful for the symptoms you describe.
Modafinil augmentation of antidepressant treatment in depression.
Menza MA, Kaufman KR, Castellanos A.
Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway 08854, USA. [email protected]
BACKGROUND: Despite a relative lack of controlled data, stimulants are often used to augment antidepressant treatment in patients who have had only a partial response to first-line therapy. Modafinil is a novel psychostimulant that has shown efficacy in, and was recently marketed for, treating excessive daytime sleepiness associated with narcolepsy. The mechanism of action of modafinil is unknown, but, unlike other stimulants, the drug is highly selective for the central nervous system, has little effect on dopaminergic activity in the striatum, and appears to have a lower abuse potential. METHOD: In this retrospective case series, we describe 7 patients with DSM-IV depression (4 with major depression and 3 with bipolar depression) for whom we used modafinil to augment a partial or nonresponse to an antidepressant. The Hamilton Rating Scale for Depression was administered as part of routine clinical practice prior to treatment and at each subsequent visit. RESULTS: At doses of 100 to 200 mg/day, all 7 patients achieved full or partial remission, generally within 1 to 2 weeks. All patients had some residual tiredness or fatigue prior to starting modafinil, and this symptom was particularly responsive to augmentation. Side effects were minimal and did not lead to discontinuation of the drug in any of the patients. CONCLUSION: Modafinil appears to be a drug with promise as an augmenter of antidepressants, especially in patients with residual tiredness or fatigue. It is a particularly attractive alternative to other stimulants because of its low abuse potential and Schedule IV status.
PMID: 10847314 [PubMed - indexed for MEDLINE]
Posted by Mandy on April 26, 2002, at 17:41:53
In reply to Re: Best med to augment Prozac » Mandy, posted by Ron Hill on April 26, 2002, at 17:15:47
Thanks to all for suggestions--what dosage of the meds did each of you start with? Thanks
Posted by TSA West on April 27, 2002, at 2:42:40
In reply to Best med to augment Prozac, posted by Mandy on April 26, 2002, at 16:04:51
Prozac + Desipramine: Archives of General Psychiatry. 48(4):303-7, 1991 Apr.
"Responses in depression were retrospectively compared with those of 52 inpatients who were descriptively similar and previously treated in the same setting with desipramine alone. Response was significantly more rapid in the group that received both drugs. One week after treatment began, the mean change in Hamilton Depression Rating Scale scores was 42% in the group that received both drugs and 20% in the group that received desipramine alone. Two weeks after administration of the drugs, the mean change in scores of the group that received both drugs was 60%, while a 30% change was noted in the patients treated with desipramine alone. Ten (71%) of the 14 patients in the group that received both drugs completely remitted (change in Hamilton Depression Rating Scale score of greater than 75%, and final score of less than 7) within 4 weeks, while few patients treated with desipramine alone met these criteria within 4 weeks. This study suggests that treatment with both desipramine and fluoxetine is a rapid and effective strategy for treatment of major depression, and supports recent hypotheses of synergism."
A real church is where the best family of all is offered: the family of God. It is the place specific where people are loved into the kingdom. {The Salvation Army USA West}
Posted by paulb on April 27, 2002, at 5:15:53
In reply to Best med to augment Prozac, posted by Mandy on April 26, 2002, at 16:04:51
It may be worth your while considering switching to a different SSRI. Im not sure on this but I have heard Prozac can be addictive and that some people need up to 200mg and in rare cases 400mg. Zyprexa is a common augmentation strategy for Prozac but if weight gain was the problem you may do better with Risperidone. Pindolol may also be useful. Good luck.
paulb
Posted by Phil on April 27, 2002, at 8:03:32
In reply to Re: Best med to augment Prozac, posted by paulb on April 27, 2002, at 5:15:53
Im not sure on this but I have heard Prozac can be addictive and that some people need up to 200mg and in rare cases 400mg.
__________________________________The above post is totally incorrect. AD's are not addictive and I have never heard of anyone taking 200-400mg Prozac. 100 mg is about the highest I've heard about.
As far as sam-E, if you have a lot of money, it would be a good choice but an effective dose can be as high as 1200-1600 mg. That's 6-8 200 mg pills a day at at least a dollar each. I can't afford $8 a day for any drug.
Desip. is a relatively activating tricyclic and is worth a shot. And it's dirt cheap.
Posted by tb on April 27, 2002, at 14:51:20
In reply to Re: Best med to augment Prozac++Mandy/caution, posted by Phil on April 27, 2002, at 8:03:32
I'm similar to you Mandy. I have been on Prozac forever, at 80mgs. I'm also on Wellbutrin, Respirdol (sp?) and ritalin. My doctor just started me on Desipramine. I'm being treated for bulimia so the "weight gain" side-effect scares the you-know-what out of me.
I'm willing to give the desipramine a few weeks...
We'll see.
tb
Posted by jay on April 27, 2002, at 15:48:52
In reply to Best med to augment Prozac, posted by Mandy on April 26, 2002, at 16:04:51
Hi Mandy:If you are concerned about weight and possible fatigue, than Welbutrin is another good possible choice. Desipramine has shown to be a good augmentor with Prozac, but I think Welbutrin, when all is said and done, is a great med to augment SSRI's with. You will have to take it slow, as it may cause some irritability at first, and enough to make you want to quit, but after a few days to a week, things *really* smooth out.
Many people even find that once adjusted to Welbutrin, they can lower their SSRI dose, and maybe even just go with Welbutrin. After my first week on Welbutrin, I found a bit more energy and LESS anxiousness then any SRI/SNRI I have ever been on. I'd also say go with the 'SR' version.
Give it a shot...best wishes
Jay
> I have been taking prozac for years with trials of other AD's but always back to prozac and am at max dose of 80mg. I still have a hopeless, joyless attitude and my doc wants to augment with
> 25-50 mg of desipramine. Does anyone have any experience with this drug--will it make me sleepy or gain wt?? Any other ideas for a good med that augments prozac. I tried zyprexa but gained wt. I also have total lack of energy and motivation but am afraid my anxiety would get out of control on a stimulant. Any thoughts, suggestions would be most welcome.
Posted by Sarahmarie on April 27, 2002, at 15:51:03
In reply to Best med to augment Prozac, posted by Mandy on April 26, 2002, at 16:04:51
I have been on Prozac for the last three years and I truly believe it to be my miracle drug. Recently though, I had a major relapse in my depression and my dosage was gradually increased to 160 mg. I also have OCD. At this dosage my depression has improved dramatically, however, a feeling of sadness remains. I have heard that sometimes Tegretol is added to Prozac. I will be asking my pdoc tomorrow about this -- perhaps others have heard of this regimen. SaraMarie
> I have been taking prozac for years with trials of other AD's but always back to prozac and am at max dose of 80mg. I still have a hopeless, joyless attitude and my doc wants to augment with
> 25-50 mg of desipramine. Does anyone have any experience with this drug--will it make me sleepy or gain wt?? Any other ideas for a good med that augments prozac. I tried zyprexa but gained wt. I also have total lack of energy and motivation but am afraid my anxiety would get out of control on a stimulant. Any thoughts, suggestions would be most welcome.
Posted by Dr. Bob on April 27, 2002, at 18:42:11
In reply to Re: Best med to augment Prozac » Mandy, posted by TSA West on April 27, 2002, at 2:42:40
> A real church is where the best family of all is offered: the family of God. It is the place specific where people are loved into the kingdom. {The Salvation Army USA West}
Please avoid promotional material in your tag lines:
http://www.dr-bob.org/babble/admin/20010718/msgs/1854.html
Thanks,
Bob
PS: Follow-ups regarding posting policies, or complaints about posts, should be redirected to Psycho-Babble Administration.
Posted by paulb on April 28, 2002, at 9:04:15
In reply to Re: Best med to augment Prozac, posted by paulb on April 27, 2002, at 5:15:53
Also a small dose of Anafranil can be helpful in some cases.
This is the end of the thread.
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