Posted by Scott L. Schofield on March 15, 2000, at 10:06:30
In reply to medication poop-out/reply to KarenB, posted by Elizzy on March 13, 2000, at 18:57:06
> Whoa -- a lightbulb just went off in my head when I read your message. I've been on SSRIs -- and they work great for about three months, then they stop working and we increase the dose and the blues dissolve again after two weeks. Then three months later the meds poop out again. (Repeat that process till I reach the max dosage of Zoloft, Celexa, whatever, then switch to a new SSRI.)
> >
> > Recently my dr. switched me to Effexor (Wellbutrin had no effect), and while I don't feel like crying 24/7, I do still feel apathetic, lazy and like Human Slug Girl.
> >
> > Have you (or anyone else?) had similar reactions? How do you know what the problem is? The seratonin stuff works for a while, but eventually gives out, so do you think there's another brain feel-good thingy that's out of whack?
> >
> > Thanks for your help :) This board is really great.
> > lizzy
> Mine poop too, except only 2 mos!Once I got 50mg samples, thought they were 100, and got really depressed because I wasn't taking 2. Some say ritalin helps see Jan 20 posting, but that may poop out, too.
The Ritalin (methylphenidate) would be a good choice. Many people here say good things about it. It is just one of several options available as strategies to prevent or resolve the SSRI poop-out. Other stimulants may also help. I have seen numerous people respond well to a combination of Wellbutrin with either an SSRI or Effexor. The side benefit of any of these augmentation alternatives is that they often mitigate the sexual side effects that usually appear with SSRI treatment. Zoloft + Wellbutrin seems to work well. I know someone who is doing very well using a combination of Effexor and Wellbutrin. She did not respond adequately to either one by itself. Using the school of thought that JohnL has recently described, that she experienced a partial response to each drug monotherapeutically is clinically significant, and was used as the basis for choosing the combination.Adding pindolol (Visken) or lithium are also strategies that have helped some people. Although there are conflicting results from investigations testing the efficacy of adding pindolol to SSRIs in treatment-resistant cases, more confidence has been placed on its use in cases where there has been a partial antidepressant response. Adding lithium in low dosages (300mg - 600mg) sometimes works wonders. These dosages are high enough to illicit a response in depression, but are too low to treat bipolar disorder, especially mania.
If it were me, I would probably choose Wellbutrin first, then add or change to Ritalin.
Good luck.
- Scott
-------------------------------------
J Clin Psychiatry 1996 Feb;57(2):72-6
Methylphenidate augmentation of serotonin selective reuptake inhibitors: a case series.
Stoll AL, Pillay SS, Diamond L, Workum SB, Cole JO
Psycho-pharmacology Unit, Division of Psychiatry, Brigham and Women's Hospital, Boston, MA 02115, USA.
BACKGROUND: The serotonin selective reuptake inhibitors (SSRIs) are effective in treating major depressive episodes. However, for the subgroups of patients who remain refractory to therapy, augmentation strategies can improve the efficacy of these agents. METHOD: We report the results of an open trial of methylphenidate to augment SSRIs in the treatment of five consecutive cases of DSM-III- R diagnosed major depression. RESULTS: Self-reported symptom reduction was achieved rapidly in all cases, with methylphenidate dosages ranging from 10 to 40 mg/day. Symptom remission was independent of the presence of attention-deficit/hyperactivity disorder. Also, the beneficial effects of the methylphenidate-SSRI combination appeared to be robust and sustained. No patients abused or misused methylphenidate. CONCLUSION: The empirical use of methylphenidate added to ineffective or only partially effective SSRI treatment appeared to be a rapid, safe, and efficacious alternative to existing augmentation strategies for the treatment of major depression. Prospective controlled studies are required to confirm or refute these findings.------------------------------------
poster:Scott L. Schofield
thread:26793
URL: http://www.dr-bob.org/babble/20000312/msgs/27087.html