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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Epiphanie on November 13, 2007, at 23:12:51
Hi everyone!
My DX PTSD and Bi-Polar.
Prozac worked for me for about 8 years then pooped out.
Bad reaction to Wellbutrin (Severe Constipation, Rage).
Lexapro works but makes me too sleepy.
I see my psychiatrist Thursday. I would be grateful for any and all suggestions. (Also Paxil made me too sleepy and Effexor made me too nauseas). THANKS!!!!!!!
Posted by torachan on November 13, 2007, at 23:34:27
In reply to Need Help ASAP finding New Antidepressant!!!!!!, posted by Epiphanie on November 13, 2007, at 23:12:51
Not Remeron, because the true meaning of the word sleep. Maybe Lamictal.
Posted by Phillipa on November 14, 2007, at 0:54:57
In reply to Re: Need Help ASAP finding New Antidepressant!!!!!, posted by torachan on November 13, 2007, at 23:34:27
Lamictal and luvox? Phillipa
Posted by tecknohed on November 14, 2007, at 8:09:15
In reply to Need Help ASAP finding New Antidepressant!!!!!!, posted by Epiphanie on November 13, 2007, at 23:12:51
Nardil, if your pdoc will allow it. Or Zoloft (sertraline) - most similar SSRI to Prozac IMO. Plus Lamictal for your BP.
Posted by yxibow on November 14, 2007, at 9:17:25
In reply to Re: Need Help ASAP finding New Antidepressant!!!!! » Epiphanie, posted by tecknohed on November 14, 2007, at 8:09:15
> Nardil, if your pdoc will allow it. Or Zoloft (sertraline) - most similar SSRI to Prozac IMO. Plus Lamictal for your BP.
I wouldn't go the MAOI route yet, that's a bit drastic. The rest sounds reasonable, or Cymbalta, which does take a long time to work but isn't nearly as touchy as Effexor for some.
Posted by rskontos on November 14, 2007, at 11:25:28
In reply to Re: Need Help ASAP finding New Antidepressant!!!!! » tecknohed, posted by yxibow on November 14, 2007, at 9:17:25
If anxiety is an issue cymbalta is not great with that and it can do a number on the gastro system. If effexor gaves nausea cymbalta might too so I might be careful and ask doc if side effects of one might be an indication of similar S/E on another. How were your S/E getting off effexor, because cymbalta withdrawal can be like effexor. rk
Posted by yxibow on November 14, 2007, at 15:12:28
In reply to Re: Need Help ASAP finding New Antidepressant!!!!!, posted by rskontos on November 14, 2007, at 11:25:28
> If anxiety is an issue cymbalta is not great with that and it can do a number on the gastro system. If effexor gaves nausea cymbalta might too so I might be careful and ask doc if side effects of one might be an indication of similar S/E on another. How were your S/E getting off effexor, because cymbalta withdrawal can be like effexor. rk
For some -- for others its hardly noticeable. It certainly wasn't as bad as Effexor. Gradual tapers on and off can eliminate that but I agree that withdrawal can be an issue. Some people only need a small amount of it anyhow.
Posted by tecknohed on November 14, 2007, at 16:03:06
In reply to Re: Need Help ASAP finding New Antidepressant!!!!! » tecknohed, posted by yxibow on November 14, 2007, at 9:17:25
> > Nardil, if your pdoc will allow it. Or Zoloft (sertraline) - most similar SSRI to Prozac IMO. Plus Lamictal for your BP.
>
> I wouldn't go the MAOI route yet, that's a bit drastic. The rest sounds reasonable, or Cymbalta, which does take a long time to work but isn't nearly as touchy as Effexor for some.Why is an MAOI drastic? For many they are ALOT more tolerable that SSRIs. And they only have some basic contraindications which anyone with half a brain can follow very easily. I think it would be an excellent med for Post Traumatic Stress Disorder.
OK so MAOIs aren't for everyone but keeping them as a last resort is ridiculous IMO. Apart from lofepramine they are the only ADs that have really helped me. Years of wasted time of trial & error with SSRIs & such like makes me angry. As you can probably tell.
Sorry if I seem so argumentative :)
Posted by d0pamine on November 14, 2007, at 17:07:31
In reply to Re: Need Help ASAP finding New Antidepressant!!!!! » yxibow, posted by tecknohed on November 14, 2007, at 16:03:06
>Why is an MAOI drastic? For many they are ALOT more tolerable that SSRIs. And they only have some basic contraindications which anyone with half a brain can follow very easily.
IMHO there is no antidepressant but EMSAM. But that's just an opinion. :-)
Posted by War-Face on November 14, 2007, at 18:03:53
In reply to Re: Need Help ASAP finding New Antidepressant!!!!!, posted by d0pamine on November 14, 2007, at 17:07:31
D0pamine, are you back on Emsam after the jet-engine-in-ear thingie on Wellbutrin? If so, how's it going?
Posted by yxibow on November 15, 2007, at 0:25:21
In reply to Re: Need Help ASAP finding New Antidepressant!!!!! » yxibow, posted by tecknohed on November 14, 2007, at 16:03:06
> > > Nardil, if your pdoc will allow it. Or Zoloft (sertraline) - most similar SSRI to Prozac IMO. Plus Lamictal for your BP.
> >
> > I wouldn't go the MAOI route yet, that's a bit drastic. The rest sounds reasonable, or Cymbalta, which does take a long time to work but isn't nearly as touchy as Effexor for some.
>
> Why is an MAOI drastic? For many they are ALOT more tolerable that SSRIs. And they only have some basic contraindications which anyone with half a brain can follow very easily. I think it would be an excellent med for Post Traumatic Stress Disorder.
>
> OK so MAOIs aren't for everyone but keeping them as a last resort is ridiculous IMO. Apart from lofepramine they are the only ADs that have really helped me. Years of wasted time of trial & error with SSRIs & such like makes me angry. As you can probably tell.
>
> Sorry if I seem so argumentative :)Diet restrictions, hypertensive crisis, etc. I should have emphasized the word -yet-. I would try a few more things before jumping directly to them. There are even older antidepressants to try that have been little used but can work for someone and have the benefit of patient years.
If it works for you, then fine, I think what works for someone is not at all what works for someone else. It wasn't a personal statement.
Posted by d0pamine on November 15, 2007, at 19:05:37
In reply to Re: Need Help ASAP finding New Antidepressant!!!!! » d0pamine, posted by War-Face on November 14, 2007, at 18:03:53
> D0pamine, are you back on Emsam after the jet-engine-in-ear thingie on Wellbutrin? If so, how's it going?
>Yeah. Back to the old stand by. Trying to find a decent compromise that allows AD effect and sleep.
Posted by War-Face on November 15, 2007, at 21:21:45
In reply to Re: Need Help ASAP finding New Antidepressant!!!!!, posted by d0pamine on November 15, 2007, at 19:05:37
I wonder if you couldn't try cutting the patch in half before application, and peeling one half off before sleep? That seems to help me when I'm having trouble. Although I really haven't had too much difficulty sleeping on Emsam. I've been leaving the whole 6 mgs on all night and sleeping 7-8 hours. It could be Provigil that is "regulating" sleep.
I am over 3 weeks in on Emsam, with about a week spent on 3 mgs in week 2 because of anxiety, which seems to have subsided. So far, pretty good. Some days are better than others, still not feeling as good as I did on Wellbutrin XL and low dose adderall. My only real problem now is my inattentive ADD, which is frustrating and leaving me sometimes depressed. It can be pretty bad and I haven't been getting everything done that I am supposed to, but I've been keeping my head above water and holding out hope that the inattentiveness will improve as Emsam's action does (fingers crossed for the 6 week threshold).
Started taking Provigil to transition from the stimulant and to keep me awake in the afternoon. It's not doing much for concentration and I hope to drop it within the next few weeks, esp. if the Emsam really kicks in. My pdoc was not interested in adding low dose adderall, which is fine with me for now, because I am hoping to break the stim cycle. But this ADD is a real bummer.
Any thoughts?
Posted by Squiggles on November 18, 2007, at 9:47:07
In reply to Re: Need Help ASAP finding New Antidepressant!!!!! » tecknohed, posted by yxibow on November 15, 2007, at 0:25:21
>
> > OK so MAOIs aren't for everyone but keeping them as a last resort is ridiculous IMO. Apart from lofepramine they are the only ADs that have really helped me. Years of wasted time of trial & error with SSRIs & such like makes me angry. As you can probably tell.
> >
> > Sorry if I seem so argumentative :)
>
> Diet restrictions, hypertensive crisis, etc. I should have emphasized the word -yet-. I would try a few more things before jumping directly to them. There are even older antidepressants to try that have been little used but can work for someone and have the benefit of patient years.
>
> If it works for you, then fine, I think what works for someone is not at all what works for someone else. It wasn't a personal statement.Excuse me for interrupting here, but the MAOIs
caught my eye as a very good antidepressant, which has been demonized for dietary restrictions. Some people are lucky not to like
eating that stuff anyway, e.g. cheese, but if you can be a vegetarian you can organize your diet for this drug -- which is supposed to very good.
I just want to say that sometimes an urban pharamcology myth develops or is blown out of proportion and stays there, steady and unwavering. There are other meds which have deadly interactions. I will bring up an example of what happened to me when i drank some wine which was home-brewed and contained a certain kind of yeast -- with lithium, and clonazepam -- my meds-- the result was frightening. I got something like a concussion with severe vertigo and migraine. I went to ER. Just an example of food-drug interactions which are not always put on the brochure.Squiggles
Posted by yxibow on November 22, 2007, at 2:22:54
In reply to Re: Need Help ASAP finding New Antidepressant!!!!! » yxibow, posted by Squiggles on November 18, 2007, at 9:47:07
> >
> > > OK so MAOIs aren't for everyone but keeping them as a last resort is ridiculous IMO. Apart from lofepramine they are the only ADs that have really helped me. Years of wasted time of trial & error with SSRIs & such like makes me angry. As you can probably tell.
> > >
> > > Sorry if I seem so argumentative :)
> >
> > Diet restrictions, hypertensive crisis, etc. I should have emphasized the word -yet-. I would try a few more things before jumping directly to them. There are even older antidepressants to try that have been little used but can work for someone and have the benefit of patient years.
> >
> > If it works for you, then fine, I think what works for someone is not at all what works for someone else. It wasn't a personal statement.
>
> Excuse me for interrupting here, but the MAOIs
> caught my eye as a very good antidepressant, which has been demonized for dietary restrictions. Some people are lucky not to like
> eating that stuff anyway, e.g. cheese, but if you can be a vegetarian you can organize your diet for this drug -- which is supposed to very good.
> I just want to say that sometimes an urban pharamcology myth develops or is blown out of proportion and stays there, steady and unwavering. There are other meds which have deadly interactions. I will bring up an example of what happened to me when i drank some wine which was home-brewed and contained a certain kind of yeast -- with lithium, and clonazepam -- my meds-- the result was frightening. I got something like a concussion with severe vertigo and migraine. I went to ER. Just an example of food-drug interactions which are not always put on the brochure.
>
> Squiggles
You were more likely allergic to the yeast, the campden tablets (sodium metabisulfite preservative) that were used in the wine than a food-drug interaction (except a paradoxical alcohol-clonazepam reaction) but I was not the attending doctor nor do I have a license to practice medicine. The result in any case I am sure and not denying was frightening.
Let's just agree to disagree, I place the psychological burden of maintaining a MAOI compatible diet, including the discontinuation of half of the over the counter common health aids out there and some that are prescribed, on the sufferer who may genuinely benefit, just as I have a burden to think about the consequences and possible benefits in the future of switching from Seroquel to using Clozaril for an offlabel purpose and disorder I have had for 6 years with no multi-drug free respite.
And no, I could not take an MAOI even if it was appropriate for my disorder as 1) I'm a vegan and have been for 15 years and soy products, nutritional yeast, and other ingredients packaged into food would kill me or give me multiple hospital bills, 2) I'm on polypharmacy and there would be multiple drug-drug risks that would also kill me or give me multiple hospital bills and 3) just as ECT there is no clear benefit and even if there was I would have to win the lottery to do so.
But that is just my biochemical situation. Yours is obviously quite different. In fact it is my personal observation [please don't flag me for trying to make a gross generalization] that a number of people on here have quite different disorders yet I feel rush to try to get the same new medications, not discounting myself included [no gross generalization], because they're fresh and the latest thing out there. And then we discover that 1) its wonderful or 2) they have side effects and they're not so wonderful.
Its ultimately a choice to treat an illness and live with side or permanent effects or as the saying goes, the treatment is worse than the cure, the surgery was successful and the patient died.
Most medications, including psychotropics are palleatives. That is, once you stop taking them, unless you don't have an organic (genetic, biological) component or reason for taking them (say you took Prozac because you're perfectly "well-adjusted" or whatever euphamism we want to say for the fact that nobody is perfect but you had a traumatic event in your life but have no trace of lifelong mental illness), you lose all or most of the benefits and hopefully all the side effects.
Vaccines, some successful chemotherapy processes, early developments in genetic therapy, and some antibiotic and antimalarial agents, blood transfusions, liniments and other dermatological agents, antidotes and other ER heroic agents, are among some things I can think of that defy this confounding reality of even the most modern medicine.
Posted by tecknohed on November 22, 2007, at 5:52:50
In reply to Re: Need Help ASAP finding New Antidepressant!!!!! » Squiggles, posted by yxibow on November 22, 2007, at 2:22:54
Maois are a lot more safer than you appear to think. Soy is generally caleed soya here in the UK - there the same thing, as in soya milk (from soy/soya beans) I drink soya milk every day, now (with Marplan) & when I took Nardil. Fermented soya is the one to watch for but Yofu - soya based yogurt 'live' is fine. You could easily eat a healthy vegan diet with MAOIs.
And the contraindicated drugs are really quite obvious - you only need to do a simple web search to find them & of course check with a doc before taking an OTC product if you're not sure.
Of course if the meds you are on are contraindicated with MAOIs then indeed you are best to avoid, of course. Which ones are they by the way?
Posted by yxibow on November 22, 2007, at 11:57:38
In reply to Re: Need Help ASAP finding New Antidepressant!!!!! » yxibow, posted by tecknohed on November 22, 2007, at 5:52:50
> Maois are a lot more safer than you appear to think. Soy is generally caleed soya here in the UK - there the same thing, as in soya milk (from soy/soya beans) I drink soya milk every day, now (with Marplan) & when I took Nardil. Fermented soya is the one to watch for but Yofu - soya based yogurt 'live' is fine. You could easily eat a healthy vegan diet with MAOIs.
Well Tempeh is fermented soy and I eat it. I don't think my doctor would want me running around with an MAOI diet, he's seen a pretty fair number of patients and is experienced and that's already scratched off the list, not to mention it would have nothing to do with my form of MDD for risk vs. benetfit and it wouldn't attack my rare OCD/D2/somatiform/you name it disorder.
"...foods and beverages that contain significant amounts of amines include beans, red wine, yeast extract, some imported beers, chicken/beef liver, cavier, pickled herring, fermented sausage (eg, bologna, pepperoni, salami, summer sausage), overripe avocados and various cheeses (eg, Brie, cheddar, mozzarella, parmesan, romano, and others)..."FOOD may interact with PHENELZINE (in Nardil)
This interaction is well-documented and is considered major in severity
http://www.drugdigest.org
Thre you have it, accidental ingestion of cheddar and parmesan when eating out and getting a nonvegan burger because I don't particularly care when I eat out, burrito/wraps even without cheese, etc. A toast of red wine on sabbath and holiday (Jewish), etc. A smidgen of beer (Valium nono for lots). Vegetable sushi or guacamole left out too long for aesthetics but enough to cause a problem.
Luvox would kill me. (drug-drug)>
> And the contraindicated drugs are really quite obvious - you only need to do a simple web search to find them & of course check with a doc before taking an OTC product if you're not sure.
>
> Of course if the meds you are on are contraindicated with MAOIs then indeed you are best to avoid, of course. Which ones are they by the way?Luvox (medium dose)
Neurontin
Robaxin
Seroquel
Tenex (temporary)
Trazodone (sleep, trial)
crapload of Valium
casual use of pseudoephedrine for sinusYes, Luvox and Paxil would be the only SSRIs I can stand given my inclination towards anxiety and my shift to sleepy things.
This is the end of the thread.
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