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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by denise1904 on November 23, 2004, at 10:30:57
Hi,
I'm currently taking Seroxat (Paxil) 40mg a day and they are helping although not half as much as they did when I took them last time I was unwell.
Anyway the psychiatrist has tried adding Lithium and other things to get a better affect but to no avail. I've also tried rTMS which didn't work and am trying EPS fish oil which doestnt seem to be doing anything.
I really think now I'm gonna be taking these for the rest of my life (that's if they don't completely stop working for me) because quite simply I don't feel fully recovered like I did before.
My issue is that I want to get better but I don't really want to keep piling on more drugs without knowing exactly what they are doing anymore. I mean I could try adding Wellbutrin (if I could get hold of some) but don't want to be taking Wellbutrin and Seroxat for the rest of my life.
Anybody got any suggestions?
Denise
Posted by ed_uk on November 23, 2004, at 10:49:10
In reply to In Limbo, not sure what the next step is., posted by denise1904 on November 23, 2004, at 10:30:57
Hi Denise,
I presume you're taking Seroxat for depression rather than anxiety. Am I right? If so, I'd suggest that you talk to your psychiatrist about the possibility of stopping the Seroxat and replacing it with a completely different type of antidepressant. You're clearly not happy with the Seroxat and taking a different antidepressant instead would almost certainly be a safer option than combining the Seroxat with Wellbutrin.
What country do you live in btw? I'm just asking because Seroxat is the trade name for paroxetine in England where I live.
All the best...
Ed.
Posted by slinky on November 24, 2004, at 5:09:50
In reply to Re: In Limbo, not sure what the next step is., posted by ed_uk on November 23, 2004, at 10:49:10
Hi Denise
I'm also on 40mg seroxat..the side effects are outnumbering the benefits..my doc is adding Lithium soon...
I'm very undecided whether to continue seroxat ( it helps just with obbsessive thoughts)
The only AD i'm trying next is duloxetine when it comes out in uk..otherwise I've had it with AD's
Posted by ed_uk on November 24, 2004, at 8:11:34
In reply to Re: In Limbo, not sure what the next step is., posted by slinky on November 24, 2004, at 5:09:50
Hi slinky,
Duloxetine is available in the UK but is only licensed for urinary incontinence and not depression. Even so, your doctor can still prescribe it for depression if he/she thinks that it is suitable. The brand name is Yentreve.
Ed
Posted by denise1904 on November 26, 2004, at 7:12:15
In reply to Re: In Limbo, not sure what the next step is., posted by ed_uk on November 24, 2004, at 8:11:34
Hi,
Well after two years of trying everything under the sun and now having found that seroxat 40mg helps to some extent I'm loathe to come off it to try something else.
But thanks for the advise anyway. I'll just have to see if there is anything I can add to what I'm already taking.
Denise
Posted by SLS on November 26, 2004, at 8:44:08
In reply to Re: In Limbo, not sure what the next step is., posted by ed_uk on November 23, 2004, at 10:49:10
> Hi Denise,
>
> I presume you're taking Seroxat for depression rather than anxiety. Am I right? If so, I'd suggest that you talk to your psychiatrist about the possibility of stopping the Seroxat and replacing it with a completely different type of antidepressant. You're clearly not happy with the Seroxat and taking a different antidepressant instead would almost certainly be a safer option than combining the Seroxat with Wellbutrin.Actually, I think the logical thing to do is to add the Wellbutrin rather than switching to it. There are too many success stories involving the combination of an SSRI or Effexor with Wellbutrin to leave this alternative unexplored. Upon adding it, if one responds robustly, one can later discontinue the SSRI to see if it was necessary. In my mind, to try monotherapy for 12 weeks and then attempt augmententation and waiting another 4 weeks is not an efficient use of these medications.
How old are you, Denise, and how many episodes of depression have you experienced? You might indeed need to be taking medication indefinitely. Sorry. :-(
- Scott
Posted by denise1904 on November 26, 2004, at 9:23:50
In reply to Re: In Limbo, not sure what the next step is., posted by SLS on November 26, 2004, at 8:44:08
Scott,
Yes I agree with you there, the only thing is I can't get any of my doctors to prescribe Wellbutrin for me and I tried asking one of them to prescribe Wellbutrin he said no too dangerous and they don't use it for depression so I went back to another doctor and tried asking him for Zyban, again he said no, too dangerous.
So I need to get it online but want to find a good reputable site to get it from first.
As far as length of being depressed, I guess I would say since I was 17 although I never thought of it as depression then and I've never thought of them as episodes either.
It's strange really, the only reason I say or now believe that depression is what I suffer from is the fact that I started taking antidepressants when I was 24 and they stopped me feeling ill and took away all of the symptoms I'd been complaining about for years. If I'd have taken an antibiotic and that had taken the symptoms away, I guess now I would be saying I've suffered from an ongoing infection but now the antibiotics don't work anymore:-)
To give you an idea
17 - 22 mild depression, stopped wanting to go out, lost interest in doing the things I used to do. Started feeling more tired than I used to. Thought I had Leukemia or something, I really did.
22 - 24 Started feeling worse (no obvious reason), breathing, backache, stiffness, irritability no amount of exercise helped just made me feel worse.
24 - Started taking Prothiaden and Ureka, my life began again.
27 - Prothiaden started losing it's affect, started taking Seroxat which worked.
31 - Decided to come off antidepressants, was fine for about 3 or 4 years.
35 - 38 (present day) Started having constant suicidal feelings, no energy, anxiety, apathy, back pains, cold feelings, lack of interest and so the search begins.
Denise
Posted by ed_uk on November 26, 2004, at 9:38:30
In reply to Re: To Scott, posted by denise1904 on November 26, 2004, at 9:23:50
Hi,
Have you had your thyroid function checked? BTW, what country do you live in?
Regards,
Ed.
Posted by SLS on November 26, 2004, at 12:39:37
In reply to Re: To Scott, posted by denise1904 on November 26, 2004, at 9:23:50
Dear Denise,
Unfortunately, it is quite common for one to become more and more resistant to responding to medication with each subsequent usage. If you do find something that works, stay with it. If you must, think of medication as a temporary bridge to a future cure.
> Yes I agree with you there, the only thing is I can't get any of my doctors to prescribe Wellbutrin for me and I tried asking one of them to prescribe Wellbutrin he said no too dangerous and they don't use it for depression so I went back to another doctor and tried asking him for Zyban, again he said no, too dangerous.
Are they saying that Wellbutrin is dangerous to combine, or is it that it is dangerous to use even monotherapeutically? There is an interaction between Paxil and Wellbutrin that results in a significant increase in the levels of Wellbutrin and its active metabolite. This complicates matters somewhat, however, one can simply titrate more slowly on the Wellbutrin and initially target a dosage of 150mg. Perhaps your having reported a prior seizure dissuades them from Wellbutrin. I believe the risk of seizure on Wellbutrin has been greatly exaggerated. Perhaps it does make sense, as Ed suggests, to switch from Paxil to another drug and reserve Wellbutrin for later if it becomes necessary. I know one person who does well when combining Wellbutrin with either Effexor (venlafaxine) or Lexapro (escitalopram). Effexor + Remeron is sometimes useful.
The only time I was ever well was at age 27 when I combined Parnate 60mg + desipramine 150mg. I would still be well today if the doctor had not have me discontinue it. I had become manic on the combination after about 6 months of euthymia. This was his reason for discontinuation. I don't fault him on that. I do, however, blame him for being too stubborn to return to the same combination as soon as I relapsed into depression. It had already been established that I was extremely treatment-resistant. Part of the problem was that Prozac had just been approved, and the first thing he wanted to do was to play with the new toy. When I eventually returned to the combination, it no longer worked. Unfortunately, combining Parnate + imipramine + Lamictal is now the best I can do to keep me at least minimally functional. I still can't read more than a few sentences at a time. Unfortunately, I can't really keep up with all of the new research. Because of this, I need to rely on other people to inform me as to what's going on. I don't like that. Cognitively, I am very much impaired - believe it or not. During the time I was well, I read my first and only book cover to cover as an adult and understood it. It was "Dance of the Wu Li Masters".
Don't worry, Denise, you will definitely find something that works. It may take some time though, so you will need to be both resolved and patient.
Take care.
- Scott
Posted by denise1904 on November 26, 2004, at 12:42:14
In reply to Re: To Denise, posted by ed_uk on November 26, 2004, at 9:38:30
Hi Ed,
Yes I've had my thyroid levels checked out and had a T3 test as well, both checked out ok (damn). I really wish they'd find something wrong related to this particular condition I mean.
I'm from the UK, see you are too, whereabouts, if you don't mind me asking?
Denise
Posted by ed_uk on November 26, 2004, at 12:55:18
In reply to Re: To Ed, posted by denise1904 on November 26, 2004, at 12:42:14
Hi Denise,
I'm from West Yorkshire but I'm living in Manchester at the moment.
Getting bupropion prescribed in the UK is difficult, it's got a lot a bad publicity. Unfortunately, bupropion is only licensed for smoking cessation and the CSM (a government organisation) has warned doctors never to prescribe bupropion in combination with antidepressants. It might be best to explore other treatment options before considering bupropion. Most psychiatrists have probably never prescribed it!!
What other ADs have you tried apart from paroxetine and dothiepin?
Ed.
Posted by ravenstorm on November 26, 2004, at 20:20:23
In reply to Re: To Denise, posted by ed_uk on November 26, 2004, at 12:55:18
Scott, couldn't you try one of the other MAOI's if parnate doesn't work for you anymore?
Posted by SLS on November 26, 2004, at 21:46:00
In reply to Re: To Denise, posted by ravenstorm on November 26, 2004, at 20:20:23
> Scott, couldn't you try one of the other MAOI's if parnate doesn't work for you anymore?
Thanks for your input.
I have used Nardil on and off in the past. It does help a bit, but not enough to justify staying on it. I never gave Marplan a fair trial. I was on it for only 2 weeks because I was too impatient. I have tried selegiline, but only to a dosage of 30mg.
Argh.
- Scott
Posted by denise1904 on November 28, 2004, at 5:08:18
In reply to Re: To Denise, posted by ed_uk on November 26, 2004, at 12:55:18
Hi Ed,
I've also tried lithium, remeron (mirtazapine), rTMS, Lamictal, Prozac, Citalopram, Zyprexa 10mg (really helped take away the suicidal thoughts and anxiety), Effexor, Trileptal (but only small dose and a short while) and Nardil.
Denise
Posted by denise1904 on November 28, 2004, at 5:17:06
In reply to Re: To Scott » denise1904, posted by SLS on November 26, 2004, at 12:39:37
Thanks, Scott,You always seem to know exactly the right things to say to re-assure me :-)
It's really odd that Parnate 60mg + desipramine 150mg worked really well for you and then didn't when you went back on it (that must have been a nasty shock). I'd love to know why this happens, I wonder if they had taken a brain scan when it worked and compared it to one taken when it didn't work they would have seen a difference.
I'm glad you have at least something to rely on, same as me with 40mg of Seroxat but it just can't compare to how they work when they really work can it? I guess if I'd never known the drugs to work as well as they can then maybe I'd be satisfied with the way I feel now on 40mg.
Anyway, I hope you find something that makes you feel 100% because chances are if you do then I will too :-)
Denise> Dear Denise,
>
> Unfortunately, it is quite common for one to become more and more resistant to responding to medication with each subsequent usage. If you do find something that works, stay with it. If you must, think of medication as a temporary bridge to a future cure.
>
> > Yes I agree with you there, the only thing is I can't get any of my doctors to prescribe Wellbutrin for me and I tried asking one of them to prescribe Wellbutrin he said no too dangerous and they don't use it for depression so I went back to another doctor and tried asking him for Zyban, again he said no, too dangerous.
>
> Are they saying that Wellbutrin is dangerous to combine, or is it that it is dangerous to use even monotherapeutically? There is an interaction between Paxil and Wellbutrin that results in a significant increase in the levels of Wellbutrin and its active metabolite. This complicates matters somewhat, however, one can simply titrate more slowly on the Wellbutrin and initially target a dosage of 150mg. Perhaps your having reported a prior seizure dissuades them from Wellbutrin. I believe the risk of seizure on Wellbutrin has been greatly exaggerated. Perhaps it does make sense, as Ed suggests, to switch from Paxil to another drug and reserve Wellbutrin for later if it becomes necessary. I know one person who does well when combining Wellbutrin with either Effexor (venlafaxine) or Lexapro (escitalopram). Effexor + Remeron is sometimes useful.
>
> The only time I was ever well was at age 27 when I combined Parnate 60mg + desipramine 150mg. I would still be well today if the doctor had not have me discontinue it. I had become manic on the combination after about 6 months of euthymia. This was his reason for discontinuation. I don't fault him on that. I do, however, blame him for being too stubborn to return to the same combination as soon as I relapsed into depression. It had already been established that I was extremely treatment-resistant. Part of the problem was that Prozac had just been approved, and the first thing he wanted to do was to play with the new toy. When I eventually returned to the combination, it no longer worked. Unfortunately, combining Parnate + imipramine + Lamictal is now the best I can do to keep me at least minimally functional. I still can't read more than a few sentences at a time. Unfortunately, I can't really keep up with all of the new research. Because of this, I need to rely on other people to inform me as to what's going on. I don't like that. Cognitively, I am very much impaired - believe it or not. During the time I was well, I read my first and only book cover to cover as an adult and understood it. It was "Dance of the Wu Li Masters".
>
> Don't worry, Denise, you will definitely find something that works. It may take some time though, so you will need to be both resolved and patient.
>
> Take care.
>
>
> - Scott
Posted by ed_uk on November 28, 2004, at 6:51:50
In reply to Re: To Ed, posted by denise1904 on November 28, 2004, at 5:08:18
Hi,
Have you tried any other TCAs apart from dothiepin? There are some major differences between the various tricyclics. Have you considered lofepramine (Gamanil) or nortriptyline (Allegron)?
Regards,
Ed.
Posted by denise1904 on November 28, 2004, at 16:38:17
In reply to Re: To Denise, posted by ed_uk on November 28, 2004, at 6:51:50
Hi Ed,
No I haven't, I suppose I thought prothiaden used to work so well at 75mg you would have thought it would have worked at 300mg! I just can't get my head round why a drug can work so well for so many years at one time and then you try it again later on and it's like taking a different drug completely. I just wish someone could give me a logical explanation because it really felt as though someone had played a cruel joke on me.
Anyway, I'm loathe to come off Paxil because at least it is helping me at 40mg but will maybe consider adding Nortryptaline at some stage.
Thanks for the advice, what are you taking now and what do you suffer from?Denise
Posted by ed_uk on November 28, 2004, at 17:01:26
In reply to Re: To Denise, posted by denise1904 on November 28, 2004, at 16:38:17
Hi,
I have problems with anxiety and OCD. I have had one episode of depression. At the moment I take citalopram 60mg/day for anxiety/OCD and lofepramine 140mg/day for depression. I am relatively well at the moment.
If you decide to add nortriptyline to paroxetine, be sure to start with a really low dose of nort because paroxetine may increase nort plasma levels. You could start with half a 10mg tablet of nort per day, and increase gradually.
Regards,
Ed.
Posted by denise1904 on December 1, 2004, at 11:40:35
In reply to Re: To Denise, posted by ed_uk on November 28, 2004, at 17:01:26
Hi Thanks Ed but I don't think I'll bother with Nortryptaline because the prothiaden didn't work at 300mg so I wouldn't hold out much hope fr Nortryptaline either, I'm gonna try and find something else to try.
But thanks for the advice anyway.
Denise
Posted by denise1904 on December 1, 2004, at 14:46:02
In reply to Re: To Denise, posted by denise1904 on December 1, 2004, at 11:40:35
Hi,
The previous note was meant to say to you and not to myself. Just a thankyou for the advice.
Denise
This is the end of the thread.
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