Posted by med_empowered on August 5, 2005, at 8:43:40
In reply to Re: What about PROZAC?, posted by blueberry on August 5, 2005, at 5:44:52
It really depends. Prozac is more activating than most other SSRIs..its also less potent on serotonin re-uptake inhibition (mg per mg) than the other drugs. If you experienced anxiety, insomnia, etc. on the other SSRIs, you might want to avoid Prozac. If you tolerated the other SSRIs pretty well, it could be worth a try. Just keep in mind that Prozac has a freakishly long half-life: it takes 5 weeks to wash out completely. So...withdrawal symptoms are better than with other SSRIs (*especially* compared to Paxil), but if you have problems with it...you could be dealing with side effects for a while after you stop taking it. Anyway...usually, an "adequate trial" of two anti-depressants from a given class constitutes an overall "adequate trial" of that class...so, at this point you could, technically, be considered resistant to SSRI therapy. If you have severe depression (but no psychosis or suicidal inclinations), tricyclics may be the way to go, at least for a while; overall, SSRIs and TCAs are equally effective, but TCAs may be better for hard-core "endogenous" depression; "reactive" depression may respond better to the SSRIs. From my experience, I think that if you've had problems treating depression, it may be best to start out your new trial *with* augmenting agents, instead of waiting for a response and *then* augmenting. Buspar, Dexedrine, Adderall, Ritalin, Provigil, Straterra, and the atypical antipsychotics (especially Abilify and Zyprexa) are all potential augmenting agents. Lamictal and Lithium are also sometimes used, but, personally, I'd avoid the side-effects associated with those if possible...however, it depends on your symptoms. One option would be (short-term) treatment with amoxapine, brand name "Asendin". Its a double-whammy: an anti-depressant with antipsychotic effects as well. No one really knows WHY, but it can often treat resistant depression QUICKLY..if it works, it often works within 4-14 days (without augmenting agents). There's a big "poop-out" problem with it though, and it carries the EPS/TD risks associated with antipsychotics (probably at about the same level as the atypicals, but no one seems really sure)....it might be wise to do a switch-over to something else after a while (I did this with Tofranil...I switched to Cymbalta. It worked reasonably well). Anyway, sorry this was so long, but I wish you the best of luck.
poster:med_empowered
thread:537646
URL: http://www.dr-bob.org/babble/20050803/msgs/537794.html