Posted by elise on April 17, 2000, at 8:39:52
In reply to Re: Taken Prozac, Wellbutrin, Celexa, and now on Effex, posted by JohnL on April 17, 2000, at 4:39:49
> > I have been depressed since September 1999 and still am. I was first put on Prozac, and that made me so anxious I couldn't even sleep. Then Wellbutrin gave me tenittus. Celexa didn't work for 2 months, and finally I am now taking Effexor and noticed a change last week, but things are back to crap. I am now experincing a lot of side effects, or there is something wrong with me. I have been having headaches, heat/cold flashes, stomach aches, body aches, and etc...I guess I have no choice but to wait it out! Please write me with any useful info or advice. Thank you.
>
> Bonnie,
> You bring up a tough situation. And I'm so sorry you're having such a rough go of it. Believe me, you aren't alone. Been there done that way too many times...and likely will again at some point. Hang in there as best you can for now.
>
> This might be a good time to review some basic theories that I subscribe to. It might help you to make sense of the situation.
>
> To begin, depression can be caused by a variety of chemical imbalances. Just as diarrhea is caused by many things. The causes may vary, but the end-result symptoms are the same. Causes of depression include: low serotonin, low norepinephrine, low dopamine, elevated dopamine (too much is just as bad as not enough), elevated norepinephrine, chemical instability, electrical instability, GABA deficient, norepinephrine/dopamine failure (levels OK, but not functioning properly), and hormones (thyroid, estrogen, testosterone), or a blend of any of these various problems.
>
> Each person's chemistry will prefer one medication molecule over others. The difficult part of treating depression is that we don't know in advance which molecule our system will respond to best. It's purely a guess and trial&error. Only through comparisons of medication reactions can we gather clues as to what the underlying chemical problem is. The wrong medication is characterized by these responses: slow (if any) response, worsening of symptoms, excessive side effects. The correct medication is characterized by: quick response, minimal side effects...evidence that the medication is a nearly perfect match for our chemistry.
>
> So far the clues from your responses suggest that low serotonin might not be the issue with you. Otherwise, you would have probably experienced at least SOME response to Celexa or Prozac. But to complicate things, it might be that Paxil or Zoloft is the magic molecule your chemistry prefers. Generally though, I think each time we try and fail on several medications in a class of drugs, the less likely it is any of them are correct, and the more urgent it becomes to move to different classes of drugs that work on different chemistries.
>
> Since you felt some improvement early with Effexor--but it then faded--that might be a clue that there is chemical or electrical instability involved. One drug that is showing promise as both an antidepressant and a stabilizer all in one is Zyprexa. It comes with side effects of intitial sedation (which fades in days) and weight gain. But for a blanket approach to correct a variety of chemistries, Zyprexa fits the bill.
>
> Other things to consider would be: Desipramine or Nortriptyline (low norepinephrine)...expect dry mouth and constipation; Lamictal (anticonvulsant with stabilizing and antidepressant qualities), Risperdal (antipsychotic similar to Zyprexa, but with less sedation and less weight gain...I prefer to call these dopamine reducers rather than antipsychotics); Adderall or Ritalin (NE/dopamine failure). And of course there's always St Johnswort which really truly is a miracle for some people. And from overseas mailorder pharmacies two good choices are Amisulpride (increases dopamine transmission), and Adrafinil (NE failure).
>
> I don't mean to overwhelm you with complications and choices. But as you can see, that's what we are up against when treating depression. In your shoes, I would strongly urge my physician to go in this direction:
> Start Adderall immediately. It was used to treat depression before antidepressants came to be, and is still used commonly as an add-on. If it is to work, it will do so in 24 to 72 hours. No long wait. If you have a negative or neutral reaction, switch immediately to Ritalin. The reason I mention these stimulants is because when they work, they work fast. I believe quick therapy is crucial in your condition. We can always experiment with other antidepressants after getting out of the hole with a stimulant. Eventually when the best drugmatch is found, we can probably discontinue the stimulant. But for immediate results--and I think they are warranted in your case--stimulants should be considered. It will only take two weeks total to give both of these a try.
>
> With or without the stimulant, Zyprexa would be at the top of my list. Sometimes a stimulant over-corrects, and a tiny dose of a dopamine reducer is needed to balance it out. But for its wide range of therapeutic action, covering a lot of bases, I would definitely consider Zyprexa or Risperdal.
>
> Basically--in your shoes--I think I would pass over the serotonin drugs at this time. I would instead move on with a sense of urgency to stimulants and/or antipsychotics and/or tricyclic antidepressants. You are at a stage where quick comparisons of different classes is warranted in order to gather clues as to what is going on. Since it's all a guessing game anyway, it makes sense to add some organization and reason to the process. Hope this helps more than it confuses! :-) JohnLJohn --
Since I can't quite grasp what drugs do what to what neurotransmitters, maybe you can help me!! Like I have told you in previous posts, any of the "stimulating" meds I have taken make me feel horrible and more anxious then ever...wellbutrin, adderall, now provigil, too much prozac. Prozac seems to make me want to do nothing a lot --- no motivation to do much of anything. Can you suggest anything that would be kind of in the middle??????HELP! elise
poster:elise
thread:30297
URL: http://www.dr-bob.org/babble/20000411/msgs/30317.html