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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by jerrypharmstudent on November 16, 2009, at 12:05:45
I've been on Lexapro for many years and I don't think it's doing ANYTHING. So I want to change to another SSRI or SNRI but problem is that I've been on them all numerous times before. I was thinking about asking my GP for Effexor XR since I haven't been on that one for a long time and it's supposed to help with treatment-resistant depression. Here's my current list of meds:
Geodon 40mg x2daily
Adderall 20mg x3daily
Lexapro 15mg
Klonopin 1 mg 3xdaily then 2 at bedtimeMy current symptoms right now are severe anxiety/dread and depression. The Geodon was helping tremendously at first but petered out and I can't raise it because 60mg x2daily makes it hard for me to swallow food.
I know everyone responds differently to meds but any advice would help.
thanks Jerry
Posted by Phillipa on November 16, 2009, at 12:25:34
In reply to Need help choosing a new SSRI/SNRI, posted by jerrypharmstudent on November 16, 2009, at 12:05:45
Jerry since you like effexor how bout pristiq? Just a thought. Love Phillipa
Posted by jerrypharmstudent on November 16, 2009, at 13:10:53
In reply to Re: Need help choosing a new SSRI/SNRI » jerrypharmstudent, posted by Phillipa on November 16, 2009, at 12:25:34
> Jerry since you like effexor how bout pristiq? Just a thought. Love Phillipa
I've read that Pristiq doesn't work any better than Effexor and that it was made just to extend the patent. But I DID think about that. Check out this link:
http://wiki.answers.com/Q/What_advantage_does_pristiq_desvenlafaxine_have_over_effexor_venlafaxine
Posted by maxime on November 16, 2009, at 15:40:27
In reply to Need help choosing a new SSRI/SNRI, posted by jerrypharmstudent on November 16, 2009, at 12:05:45
Have you ever tried Cymbalta? It got me out of a deep depression over a year ago. Since then I have switched to Parnate, but only because the Cymbalta stopped working as meds often do with me.
Posted by jerrypharmstudent on November 16, 2009, at 15:48:13
In reply to Re: Need help choosing a new SSRI/SNRI » jerrypharmstudent, posted by maxime on November 16, 2009, at 15:40:27
> Have you ever tried Cymbalta? It got me out of a deep depression over a year ago. Since then I have switched to Parnate, but only because the Cymbalta stopped working as meds often do with me.
I tried Cymbalta when it first came out and I didn't think it was working well for me - but that could have been due to not giving it as much time as it may have needed. So that is another choice. Thanks!
Posted by jerrypharmstudent on November 16, 2009, at 16:29:57
In reply to Re: Need help choosing a new SSRI/SNRI » maxime, posted by jerrypharmstudent on November 16, 2009, at 15:48:13
Hmm...so now I don't know weather to ask for Cymbalta or Effexor. Anyone know which has better efficacy for TRD?
Posted by SLS on November 16, 2009, at 17:07:13
In reply to Effexor vs. Cymbalta for TRD?, posted by jerrypharmstudent on November 16, 2009, at 16:29:57
> Hmm...so now I don't know weather to ask for Cymbalta or Effexor. Anyone know which has better efficacy for TRD?
I don't think there is any universal hierarchy of antidepressants arranged by efficacy to treat TRD. I have seen some people respond to Cymbalta whom did not respond to Effexor. For others, the reverse is true. One thing that is often suggested, though, is that polypharmacy is often the key to treating TRD successfully. A few doctors regularly combine antidepressants from different classes, hoping to produce a synergism to effect a treatment response. I was impressed by what I experienced using a combination of Effexor and nortriptyline. Combining any SSRI with a tricyclic is worth a try. Also, combining Wellbutrin with either Lexapro or Effexor seems to be particularly effective.
- Scott
Posted by bleauberry on November 16, 2009, at 18:01:09
In reply to Need help choosing a new SSRI/SNRI, posted by jerrypharmstudent on November 16, 2009, at 12:05:45
. Here's my current list of meds:
>
> Geodon 40mg x2daily
> Adderall 20mg x3daily
> Lexapro 15mg
> Klonopin 1 mg 3xdaily then 2 at bedtime
>
> My current symptoms right now are severe anxiety/dread and depression. The Geodon was helping tremendously at first but petered out and I can't raise it because 60mg x2daily makes it hard for me to swallow food.
>My take on this is a little different.
First of all, with the severity of your symptoms at present, one of your meds is working against you...completely wiping out any good the others are doing...or they are all impotent. Either way, I think at this time it is very important to eliminate one. On that list of meds, the most likely to cause or worsen depression in the longterm...Adderall. Short term excellent, longterm different story.
I would think adding a tricyclic to Lexapro would be a safer more effective option than replacing Lexapro. Especially considering you've been on the other ssris already. Why go backwards? Move forward. SSRI+TCA. I suspect the Lexapro could be restored to full efficacy with a TCA, and that neither a TCA or Lexapro will do much good on their own. And that one of the other meds is interfering in the whole thing. But I don't think Lexapro itself is the problem, and I do not think switching from it to another ssri/snri is going to make any difference at all.
Different topic...snri...I don't know why they call them that...marketing I guess? Their action on NE compared to 5ht is negligible. For a true balanced NE/5htp, SSRI + TCA.
Posted by jerrypharmstudent on November 16, 2009, at 18:24:06
In reply to Re: Need help choosing a new SSRI/SNRI, posted by bleauberry on November 16, 2009, at 18:01:09
> . Here's my current list of meds:
> >
> > Geodon 40mg x2daily
> > Adderall 20mg x3daily
> > Lexapro 15mg
> > Klonopin 1 mg 3xdaily then 2 at bedtime
> >
> > My current symptoms right now are severe anxiety/dread and depression. The Geodon was helping tremendously at first but petered out and I can't raise it because 60mg x2daily makes it hard for me to swallow food.
> >
>
> My take on this is a little different.
>
> First of all, with the severity of your symptoms at present, one of your meds is working against you...completely wiping out any good the others are doing...or they are all impotent. Either way, I think at this time it is very important to eliminate one. On that list of meds, the most likely to cause or worsen depression in the longterm...Adderall. Short term excellent, longterm different story.
>
> I would think adding a tricyclic to Lexapro would be a safer more effective option than replacing Lexapro. Especially considering you've been on the other ssris already. Why go backwards? Move forward. SSRI+TCA. I suspect the Lexapro could be restored to full efficacy with a TCA, and that neither a TCA or Lexapro will do much good on their own. And that one of the other meds is interfering in the whole thing. But I don't think Lexapro itself is the problem, and I do not think switching from it to another ssri/snri is going to make any difference at all.
>
> Different topic...snri...I don't know why they call them that...marketing I guess? Their action on NE compared to 5ht is negligible. For a true balanced NE/5htp, SSRI + TCA.
>
>I actually agree about the Adderall and have been giving it a rest for while now. But as for the TCA - which to choose? Nortriptyline? Amitriptyline? I'm lost? And at what dosages?
Posted by West on November 16, 2009, at 18:56:41
In reply to Need help choosing a new SSRI/SNRI, posted by jerrypharmstudent on November 16, 2009, at 12:05:45
It's true that effexor doesn't represent a balanced effect on both norepinephrine and serotonin, for some this may be an advantage, myself included.Despite duloxetine's greater affinity for NE I found it to cause a great deal of fatigue with its serotonergic effect being quite prominent, warranting the addition of modafinil. My advice would be to forget neurotransmitter hypotheses altogether and go with a realistic list of drugs with known efficacy in treating each disorder. More often than not they serve only to bolster drug marketing data and distinguish it from existing molecules. Many find the NRI reboxetine a horrible drug, adding stress or worsening anxiety and sleep. Duloxetine as with other second generation NRIs does precipitate sleeplessness . In my experience this was more serious than with Effexor XR, which I feel is a much easier drug to live with all round. I second bleaberrry's concerns about adderall perhaps being a culprit. I suggest lowering the dose and assessing any changes with each drop. A lower dose might represent a better alternative to stopping altogether.
5mg of clonazepam is certainly enough to cause depression and I would repeat the same sentiments as above with the aim of perhaps halving this dose.Finally I don't know if adding a tricyclic to lexapro would do much for all round vim (though yes, technically you would be raising Ne levels).I suggest: a painless switch to Effexor XR from Lexapro, titrating up to no <225mg, and leaving no more than 3 weeks per dose escalation. Aiming to halve clonazepam and adderall doses by 6 months time, perhaps with a view to crossing over to a long acting methyphenidate preparation in the long term, and adding a hypnotic/sedating antidepressant/promethazine to replace the 2mg klonopin dose at night. Keep the Geodon if it's of help.
West
Posted by West on November 16, 2009, at 19:08:45
In reply to Re: Need help choosing a new SSRI/SNRI, posted by West on November 16, 2009, at 18:56:41
I find the panic blocking effects of Effexor and effects on social anxiety to be robust. It shouldn't create the 'goldfish bowl' effect es/citalopram can produce either.
Posted by floatingbridge on November 16, 2009, at 20:23:37
In reply to Need help choosing a new SSRI/SNRI, posted by jerrypharmstudent on November 16, 2009, at 12:05:45
Jerry, for what it's worth, I found Effexor more energizing than pristiq. It had some uncomfortable (irritating) side-effects for me, like jaw-clenching. Pristiq is more sedating for me-- I take it at night.
I have not tried cymbalta.
Good luck, and my pdoc whipped out a new drug for TRD the other day a mix of prozac and zyprexa which I declined. (Symbyax) I can't remember your med history--I apologize if this is something you've tried.
best,
fb
Posted by jerrypharmstudent on November 16, 2009, at 20:36:12
In reply to Re: Need help choosing a new SSRI/SNRI » jerrypharmstudent, posted by floatingbridge on November 16, 2009, at 20:23:37
> Jerry, for what it's worth, I found Effexor more energizing than pristiq. It had some uncomfortable (irritating) side-effects for me, like jaw-clenching. Pristiq is more sedating for me-- I take it at night.
>
> I have not tried cymbalta.
>
> Good luck, and my pdoc whipped out a new drug for TRD the other day a mix of prozac and zyprexa which I declined. (Symbyax) I can't remember your med history--I apologize if this is something you've tried.
>
> best,
>
> fbThanks for sharing! Yes I have been on Zyprexa +SSRi but I gained 20 pounds in 6 weeks on it!
Posted by Phillipa on November 16, 2009, at 21:41:46
In reply to Re: Need help choosing a new SSRI/SNRI » floatingbridge, posted by jerrypharmstudent on November 16, 2009, at 20:36:12
I was on 60mg of cymbalta when first released and valium and I think still chloral hydrate then was very active walked five miles on beach and worked out at the gym lifting and rode my bike and all it did was relieve back pain I didn't know I had til went off it. Then when moved here a pdoc here didn't trust or like him said cymbalta again 30mg a week, then 60, then 90, then 120mg a week in a month. He scared me so much could no longer tolerate even 30mg of cymbalta so got off it. My point being I think trust has a lot to do with a med working. Love Phillipa ps was on the 60mg for 90days and found babble the rest is history.
Posted by maxime on November 17, 2009, at 11:34:30
In reply to Effexor vs. Cymbalta for TRD?, posted by jerrypharmstudent on November 16, 2009, at 16:29:57
I had a positive reaction to both. I think the Cymbalta was better in that it didn't give me the anxiety that Effexor did. Cymbalta also worked better on my depression. The normal dose for Cymbalta is 60 mg but you can go up to 120 mg so there is some room to play around with it.
Since the Cymbalta didn't help you much the first time you were on it, maybe you will need a mood stabiliser to help you. You never know what will work until you try it!
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