Posted by medlib on December 7, 2002, at 2:13:28
In reply to Stimulants for Refractory Depression?, posted by jralphc on December 6, 2002, at 12:39:59
Hi jralphc--
Toprol XL is a beta blocker type of antihypertensive, and beta blockers have been known to cause or worsen depression in some (often enough that that SE is listed fairly prominently in the drug lit). A Beta blocker (Tenormin) made me suicidal within 5 days. So, before you try any more psych med alternatives, you might want to ask your cardiologist or internist about trying a different type of BP-lowering med, such as a calcium-channel blocker like Verapamil, or better yet, an ACE inhibitor like enalapril maleate. ACE inhibitors have far fewer SEs than other classes of antihypertensives and don't cause depression.
As far as stimulants go, you are wise to be concerned. All can raise resting pulse rate and BP; and while a modest increase isn't a problem for most, your cardiac history may make even a small increase problematic. I'd urge you to consult your cardiac doc about taking any stimulant, especially if you experience a l0 point or more rise in either resting PR or systolic BP after adding a stim. I think Adderall and dex more often raise BP than ritalin, but any are capable of that in the wrong person. You might want to look into Provigil. Another little caveat: Both Wellbutrin and ritalin act powerfully on dopamine receptors. I had to discontinue ritalin when I started Wellbutrin because of EPS (although I'm at higher risk for EPS than you would be, and I also take Effexor; so EPS might not be a relevant risk for you.)
Fortunately, or unfortunately depending on how you look at it, the same lifestyle changes which help your heart can help your depression--moderate, pulse-monitored exercise and a high fiber, low fat diet. Borrrring, I know, and a lot tougher than taking pills. On the other hand, the antidepressant effect of exercise, though modest, is a whole lot reliable any pill combo.
You've taken a lot of different meds, and that by itself is both depressing and exhausting. (I got off the musical meds merry-go-round 6 mo.s ago after a 3 year ride not because I found the right combo, but because I just couldn't handle the stress of constant change any longer.) That said, there are classes of meds you haven't tried--neuroleptics like Geodon, and ACs like lamictal come to mind.
Hang tough, but make your docs *talk* to one another! You shouldn't have to play moderator between them, or monitor your own drug interactions; that's part of what you're paying *them* for. Regards---medlib
poster:medlib
thread:130779
URL: http://www.dr-bob.org/babble/20021203/msgs/130870.html