Posted by JohnL on March 14, 2001, at 4:20:45
In reply to Much needed advice.., posted by Mr. Scott on March 12, 2001, at 9:51:31
> I have been taking Zoloft for 4 years now, and for some reason over time I have developed MORE side effects as time has passed. I had to reduce initial dosage from 100mg to 75mg and then to 50mg because of severe muscle pain that my doc thought was an extrapyramidal side effect like the side effects people often get from Antipsychotics. So he convinced me to come off of it and try selegeline which I am about to do. I am scared though.. because I know at doses where selegiline (eldepryl) doesn't require dietary restrictions (MAOI) (10mg and below) it will not reach serotonin which I FEEL is Important. For 12 years now I have been suffering from a cluster of chronic anxiety, and dysthymia or Atypical depression. I am crawling out of my skin with irritability with out the Zoloft in me. I have used most of the benzo's and SSRI's which seem although far from perfect my best bet. I am scared of this selegiline stuff (an MAOI)..
> Does anyone have any advice for me either having used selegiline or having a set of symptoms similar to what I described above. My doc seems "gung ho" on MAO inhibitors, and I don't want to offend him by suggesting something else perhaps a little less drastic..But then perhaps drastic is a relative term given how "drastic" I feel right now..
>
> Thanks for any response.. ScottScott,
With anxiety as a component of your symtoms, I think Selegiline is the wrong way to go. Selegiline is going to increase dopamine, which is not likely to help with anxiety at all. If anything, it is likely to worsen it. Of course, anything's possible and we are all different, but I have never heard of anxiety being treated with Selegiline. That's a stretch, as I see it. There are other drugs with better track records that would increase your odds of success.Again it is just my opinion, but I think your best bet will be in the antipsychotic category, with a little bit of an SSRI in the background. There is a ton of clinical research that supports this opinion, but not much evidence supporting Selegiline for your symptoms. Your doc might be gung ho on MAOIs, but if he were for example to take a look at all the clinical data on Zyprexa, he might realize treatment is available with higher odds for success and few side effects.
I am just absolutely sold on the antipsychotic category. Those meds are far superior to other categories as I see it. I have seen so many people with resistant depression, long standing dysthymia, untreatable anxiety, etc, get magical results with antipsychotics. As respected as they are, I think drugs like Zyprexa, Risperdal, or Amisulpride are highly under-rated. I think a lot of suffering could be avoided if doctors turned to these meds sooner in treatment. Obviously SSRIs are the place to start. But if results are less than desired, I feel going straight to the antipsychotic category is the best move with the highest odds for success.
In your case I could envision one of two paths to take:
1) Get back on Zoloft for a week, introduce Zyprexa into the mix, give the combination about two weeks to see what happens. You may find Zyprexa abolishes the side effects of Zoloft and cures your symptoms simultaneously. That would not surprise me. If for any reason Zyprexa turns out to be a bad choice, then try Risperdal and Amisulpride instead.
2) Choose two or three other SSRIs and try them each for about two weeks, back to back, with a one day washout inbetween. The purpose is to discover which in the group is a favorite. You want to be sure you are on the best one for you. The best one will make itself known in a two week period, either by lack of side effects and/or fairly good rapid response. Not a complete response, but enough to prove you are on the right track. Once the superior match in the group has been identified, then add to it Zyprexa, Risperdal, and Amisulpride each for about two to four weeks.No matter what you do, it looks like there will be a few months of agony, trial, and error to test out some new treatments. However, by using the above methods, you can cut do it in an organized manner with the odds stacked in your favor, and do it in less time. I hope something here is helpful to you.
When I think about drug choices in the psychiatry world, it really is like throwing the dice. You just never know what will end up working. But there are some things that seem to have more of a chance of working than others. Higher odds of success. More success stories. So when I throw the dice, I want to throw the ones that win more often than the others. With that in mind I suggest antipsychotic+SSRI combo to treat anxiety and dysthymia simultaneously with excellent results. I would not even consider the MAOI category until these other options had been totally exhausted first.
John
poster:JohnL
thread:56285
URL: http://www.dr-bob.org/babble/20010310/msgs/56468.html