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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 Penny on October 2, 2003, at 9:28:49
Hi - I'm currently taking Remeron, Wellbutrin SR and weaning off of Lamictal, and have been on all of the SSRIs (minus Prozac), Effexor XR, and various other meds for treatment resistant depression - wondering about others' experiences with Elavil for hard to treat depression. I think I remember reading somewhere that it was effective for folks who didn't respond well to the SSRIs, but wanted to hear others' thoughts.
Thanks!
P
Posted by John1022 on October 2, 2003, at 9:33:09
In reply to Thoughts on Elavil?, posted by Penny on October 2, 2003, at 9:28:49
I might be a rare case, but I once responded to Effexor twice over a 4 years period. Recently I started taking it again and had an opposite reaction of feeling absolutely 100X's worse.
Stopped taking it, felt a little better about a week later and started taking Elavil. Same effect, much worse so I stopped taking it. I guess it all just depends on the person though, you might have some luck and it might be worth trying. Good luck
Posted by Penny on October 2, 2003, at 9:58:40
In reply to Re: Thoughts on Elavil?, posted by John1022 on October 2, 2003, at 9:33:09
> I might be a rare case, but I once responded to Effexor twice over a 4 years period. Recently I started taking it again and had an opposite reaction of feeling absolutely 100X's worse.
>
> Stopped taking it, felt a little better about a week later and started taking Elavil. Same effect, much worse so I stopped taking it. I guess it all just depends on the person though, you might have some luck and it might be worth trying. Good luckYeah, Effexor worked pretty well for me the first time I took it - my mood was flattened a bit, but I was definitely not depressed. After being off of everything for 6 months, my depression relapsed and I tried Effexor again, but it didn't work the second time and I had terrible side effects. Unfortunately, I haven't found anything that really has worked for me since. Haven't ventured into the waters of the TCAs yet, though, which is why I'm asking.
Thanks!
P
Posted by DSCH on October 2, 2003, at 10:05:23
In reply to Re: Thoughts on Elavil? » John1022, posted by Penny on October 2, 2003, at 9:58:40
> Haven't ventured into the waters of the TCAs yet, though, which is why I'm asking.
You might find this post of mine helpful then...
http://www.dr-bob.org/babble/20030917/msgs/262225.htmlElavil is amitriptyline, which tends to be the worst among the tricyclics as far as side effects go, but mileage varies of course.
Posted by jay on October 2, 2003, at 17:10:16
In reply to Thoughts on Elavil?, posted by Penny on October 2, 2003, at 9:28:49
> Hi - I'm currently taking Remeron, Wellbutrin SR and weaning off of Lamictal, and have been on all of the SSRIs (minus Prozac), Effexor XR, and various other meds for treatment resistant depression - wondering about others' experiences with Elavil for hard to treat depression. I think I remember reading somewhere that it was effective for folks who didn't respond well to the SSRIs, but wanted to hear others' thoughts.
>
> Thanks!
> P
It's hard to say Penny, because so many react differently to Elavil (generic name amitriptyline). It was my very first antidepressant, and I too had 'up' and 'down' experience with it. If you suffer from the type of depression where your depression is worse in the morning (and with lethargy, anxiety, etc..), you may want to consider nortriptyline (brand name Aventyl, Pamelor)It is a metabolite of Elavil. I have found taking a low-medium dose of this worked 80 percent + better than Elavil for morning, early day depression/anxiety. A benzodiazepine is very helpful in these cases too, keeping the anxiety at bay.I am certainly not one to discount the benefits of these older meds, which have stood their test of time against the 'newer' psych meds. There is no 'hard' evidence the newer meds are superior to these meds (as often advertised..for profit sake of course), and for many with various types of depression and anxiety, the older meds sometimes work better.
Let us know how you make out..and remember, it may take awhile of usage to notice positive effects.
Best wishes,
Jay
Posted by Penny on October 3, 2003, at 8:06:33
In reply to Re: Thoughts on Elavil? » Penny, posted by DSCH on October 2, 2003, at 10:05:23
Very interesting - thanks!
I see my pdoc today and we have lots to discuss.P
Posted by Penny on October 3, 2003, at 8:12:10
In reply to Re: Thoughts on Elavil? » Penny, posted by jay on October 2, 2003, at 17:10:16
> > Hi - I'm currently taking Remeron, Wellbutrin SR and weaning off of Lamictal, and have been on all of the SSRIs (minus Prozac), Effexor XR, and various other meds for treatment resistant depression - wondering about others' experiences with Elavil for hard to treat depression. I think I remember reading somewhere that it was effective for folks who didn't respond well to the SSRIs, but wanted to hear others' thoughts.
> >
> > Thanks!
> > P
>
>
> It's hard to say Penny, because so many react differently to Elavil (generic name amitriptyline). It was my very first antidepressant, and I too had 'up' and 'down' experience with it. If you suffer from the type of depression where your depression is worse in the morning (and with lethargy, anxiety, etc..), you may want to consider nortriptyline (brand name Aventyl, Pamelor)It is a metabolite of Elavil. I have found taking a low-medium dose of this worked 80 percent + better than Elavil for morning, early day depression/anxiety. A benzodiazepine is very helpful in these cases too, keeping the anxiety at bay.
>
> I am certainly not one to discount the benefits of these older meds, which have stood their test of time against the 'newer' psych meds. There is no 'hard' evidence the newer meds are superior to these meds (as often advertised..for profit sake of course), and for many with various types of depression and anxiety, the older meds sometimes work better.
>
> Let us know how you make out..and remember, it may take awhile of usage to notice positive effects.
>
> Best wishes,
> Jay
>
>
My depression has no clear pattern - no worse time of day (it depends on the day), and I'm all over the board with mood swings. Don't have too much problem with anxiety, except when spurred by the SSRIs. A couple of the SSRIs (Celexa, Zoloft) were effective for my depression for a while but then stopped working, even with augmentation. Effexor worked for me the first time around but then didn't work when I took it the second time. My history is that I might initially have a good response to a med, but then it will stop working.My doc mentioned the TCAs, though he doesn't like the side effects, and also mentioned Lithium with my "favorite of the serotonergic meds." Ha. I told him I didn't have a favorite... :-(
We'll see.
Thanks!
P
Posted by Penny on October 3, 2003, at 8:12:44
In reply to Re: Thoughts on Elavil?, posted by Penny on October 3, 2003, at 8:12:10
Posted by DSCH on October 3, 2003, at 11:06:48
In reply to Re: Thoughts on Elavil?, posted by Penny on October 3, 2003, at 8:12:10
> My depression has no clear pattern - no worse time of day (it depends on the day), and I'm all over the board with mood swings. Don't have too much problem with anxiety, except when spurred by the SSRIs. A couple of the SSRIs (Celexa, Zoloft) were effective for my depression for a while but then stopped working, even with augmentation. Effexor worked for me the first time around but then didn't work when I took it the second time. My history is that I might initially have a good response to a med, but then it will stop working.
>
> My doc mentioned the TCAs, though he doesn't like the side effects, and also mentioned Lithium with my "favorite of the serotonergic meds." Ha. I told him I didn't have a favorite... :-(
>
> We'll see.
>
> Thanks!
> PLITHIUM
This is what SLS reports on Li on his chart:
http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
5-HT autoreceptor antagonist (serotonin)
GLU decreased (glutamate)
PI turnover decreased (phosphoinositide)
PKC decreased (protein kinase-C)
GSK-3b decreased (glycogen synthase kinase)
MAP kinase increase (mitogen-activated protein)
Bcl-2 increase (B-cell lymphoma protein-2)
BDNF increase (brain derived neurotrophic factor)
NFG increase (nerve growth factor)Don't expect me to explain any of that right now. I haven't gotten beyond the monoamines yet. :-)
DIAGNOSIS
Are you hypersomniac, insomniac, or bounce between those? You might want to see what the formal definitions of 'dysthymia' and 'cyclothymia' are to see if they fit well or not.
TRICYCLICS
Desipramine and nortriptyline are generally the best tolerated of the TCs according to D. Perrine (less beta blocking, less anti-histamine, less anti-acetylcholine). I believe both are more weighted towards norepinepherine rather than serotonin (seeing as you've already gone through many SSRIs this might be a point in their favor).
Posted by Penny on October 3, 2003, at 12:45:19
In reply to Li action, etc. » Penny, posted by DSCH on October 3, 2003, at 11:06:48
> LITHIUM
>
> This is what SLS reports on Li on his chart:
>
> http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
>
> 5-HT autoreceptor antagonist (serotonin)
> GLU decreased (glutamate)
> PI turnover decreased (phosphoinositide)
> PKC decreased (protein kinase-C)
> GSK-3b decreased (glycogen synthase kinase)
> MAP kinase increase (mitogen-activated protein)
> Bcl-2 increase (B-cell lymphoma protein-2)
> BDNF increase (brain derived neurotrophic factor)
> NFG increase (nerve growth factor)
>
> Don't expect me to explain any of that right now. I haven't gotten beyond the monoamines yet. :-)
>
> DIAGNOSIS
>
> Are you hypersomniac, insomniac, or bounce between those? You might want to see what the formal definitions of 'dysthymia' and 'cyclothymia' are to see if they fit well or not.I do cycle, but very rapidly, usually multiple times in a day and not with a definitive time schedule. My 'official' dx is Mood Disorders NOS. My former therapist dxed me with dysthymia and major depressive disorder recurrent. But even in my worst depressions (when I'm seriously suicidal), I'm still 'functioning' - i.e. I can still make myself go to work, walk the dogs, etc. I've never been affected by depression such that I can't get out of bed, though it's been hard at times. Still, even when I'm functioning, like I said, I will remain seriously suicidal, and I can appear fine (and feel *okay*) one minute and then my mood will crash at the drop of a hat - doesn't always have to be triggered - and I'll go from *okay* to *I think I'll kill myself.*
But I do go through periods of insomnia and periods of hypersomnia, and have taken multiple meds (Provigil, trazodone, ambien, sonata, Adderall) to try to keep me awake when I'm supposed to be awake and asleep when I'm supposed to be asleep. Sleep has been a long standing problem - even went for a sleep study where they determined that I don't have sleep apnea (a concern) and I don't have restless limbs, but that I experience a good deal of alpha-delta sleep, which they described as me waking, not completely, frequently throughout the night for no real reason. The sleep doc's suggestion was "Try to get your medications regulated." Yeah, right.
> TRICYCLICS
>
> Desipramine and nortriptyline are generally the best tolerated of the TCs according to D. Perrine (less beta blocking, less anti-histamine, less anti-acetylcholine). I believe both are more weighted towards norepinepherine rather than serotonin (seeing as you've already gone through many SSRIs this might be a point in their favor).Yes, that's what I'm thinking. Wellbutrin hasn't been too bad for me, and Effexor was more effective for a longer time period than any of the SSRIs, I suspect due to the effect on norepinephrine. Lamictal has been my mood stabilizer for about a year now, and was working pretty well until a couple of months ago, when I crashed. At that time I was on a Lamictal-Zoloft-Geodon-Wellbutrin combo. But it just stopped working - we fiddled with my dosages just a bit, when working on the lethargy in the daytime, insomnia at night thing, and it must have completely thrown me off. I ended up in the hospital for a week, where they increased my Wellbutrin and Zoloft a bit, to no avail. Most recently my doc tried me on Topamax, but it made me feel quite drugged, even at a lose dose, so we stopped it. He'd mentioned Lithium to me before, but then we tried the Lamictal, and so on.
Anyway, thanks for this! Fortunately, my pdoc is very well versed in polypharmacy and up-to-date on the latest research (he's a neuropsychiatrist and molecular geneticist). Doesn't tolerate major side effects with me and hasn't given up yet. I'm trying to hold out hope, and also trying to educate myself more on other possible meds.
P
Posted by DSCH on October 3, 2003, at 13:10:41
In reply to Re: Li action, etc. » DSCH, posted by Penny on October 3, 2003, at 12:45:19
> > DIAGNOSIS
> >
> > Are you hypersomniac, insomniac, or bounce between those? You might want to see what the formal definitions of 'dysthymia' and 'cyclothymia' are to see if they fit well or not.
>
> I do cycle, but very rapidly, usually multiple times in a day and not with a definitive time schedule. My 'official' dx is Mood Disorders NOS. My former therapist dxed me with dysthymia and major depressive disorder recurrent. But even in my worst depressions (when I'm seriously suicidal), I'm still 'functioning' - i.e. I can still make myself go to work, walk the dogs, etc. I've never been affected by depression such that I can't get out of bed, though it's been hard at times. Still, even when I'm functioning, like I said, I will remain seriously suicidal, and I can appear fine (and feel *okay*) one minute and then my mood will crash at the drop of a hat - doesn't always have to be triggered - and I'll go from *okay* to *I think I'll kill myself.*OK, to me that sounds more like mood stabilizer or anticonvulsant territory rather than a tricyclic. But then I'm not a professional. :-)
I was achieving only very marginal functionality with reactive and generally not overly-depressed mood. Hypersomina was pretty consistent if I wasn't in a reactive panic mode. SSRIs made me complacent. Provigil kept me awake but didn't give me more focus. More dopaminergic and especially noradrenergic activity are what I believe I needed (and am fortunately getting more of now). :-) My latest combo is DLPA + multivitamin/mineral + tincture of yohimbe bark (+ grape seed extract, but I keep that going more for long term health benefit rather than any mood or energy/focus lift).
>Anyway, thanks for this! Fortunately, my pdoc is very well versed in polypharmacy and up-to-date on the latest research (he's a neuropsychiatrist and molecular geneticist). Doesn't tolerate major side effects with me and hasn't given up yet. I'm trying to hold out hope, and also trying to educate myself more on other possible meds.
Wow, that sounds pretty cool. How did you find him?
Posted by Penny on October 3, 2003, at 13:31:04
In reply to Re: Li action, etc. » Penny, posted by DSCH on October 3, 2003, at 13:10:41
> >Anyway, thanks for this! Fortunately, my pdoc is very well versed in polypharmacy and up-to-date on the latest research (he's a neuropsychiatrist and molecular geneticist). Doesn't tolerate major side effects with me and hasn't given up yet. I'm trying to hold out hope, and also trying to educate myself more on other possible meds.
>
> Wow, that sounds pretty cool. How did you find him?Pure luck - I had a *terrible* pdoc who left me on 80 mgs Paxil, major side effects and no refill prescription and I needed to find another pdoc quickly - this one just happened to be able to see me on the next day (I later found out b/c, as he says, "emergencies can't wait"). I get to his office and had to take several tests and then they took me in an examining room, like at a regular doc's office, and he came in and gave me a neurological exam, mini-physical, etc. Had a stethoscope around his neck and everything. Then he took me in his office and explained to me why the Paxil was not working for me and so on. I saw him weekly for about 6 months, and then was doing better so only seeing him monthly, then recently started heading downhill again. He's not a 15-minute visit - here's a script - out the door kind of doc either - I'm usually in with him for about an hour. Not psychotherapy (he actually referred me to my current psychologist), but he just really likes to know his patients. He's extremely intelligent, but very down-to-earth, really listens, really cares, and takes the time to explain things to me. I even have his pager and home phone number in case I need him "anytime, day or night." I feel very fortunate. He's the third pdoc I've had though, with the first two being nothing to brag about!
P
Posted by DSCH on October 3, 2003, at 13:59:17
In reply to Re: Li action, etc. » DSCH, posted by Penny on October 3, 2003, at 13:31:04
This is the end of the thread.
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