Posted by psychobot5000 on March 1, 2007, at 0:30:18
In reply to Re: which drug? please help! (dep, ocd, insomnia), posted by randermin on February 25, 2007, at 12:32:14
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> I think I might have over stated the ocd element. I haven't actually been diagnosed with ocd, but I do have atypical elements to my depression that manifest themselves sometimes in a very compulsive or obsessive way.
>...I hate to use all of these diagnostic terms...but atypical depression seemes the safest term to use.
>>
>>I have a mess of symptoms too--hard to decide how to describe myself sometimes--anxiety, atypical depression, OCD, insomnia...it's all an interrelated jumble for me, and hard to decide how to treat.
So, not that I'm an expert on theory or anything--because I'm not--but here's what I can suggest. I think CrazyHorse's suggestion of Anafranil is probably a good idea. You've tried the SSRI/Effexor class, if I remember right, and I think you're right to look for something else. Anafranil/clomipramine has a long track record for OCD, and is sometimes considered the -most effective- tricyclic for depression. That's saying something, too.
But I, personally, think you're ideas on seeking dopaminergic drugs are sensible--though it seems to me important to remember that all these meds have individual effects for everyone, and you'll likely have to find the one that's best for you. Trial and error.
It should be noted that, for atypical depression, MAO inhibitors are theoretically considered the proper treatments, based on some substantial evidence. So EMSAM would be the one to go for based on that.
So let's see: tianeptine, EMSAM, lamictal, wellbutrin...I've have experience with these. They're all effective drugs, except (probably) Lamictal. Lamictal has been pushed fairly hard by its manufacturer, but just recently a bunch of studies have come to light (seven studies) on its mood benefits, that did not show efficacy. So the new word on lamictal is that it's not very useful for mood disorders. It tends to make people feel rapidly better for a few days, then return to baseline (or worse), leaving a burden of side-effects.
As for tianeptine, it is the only medication that helps me substantially, without unacceptable side-effects (such as sleep problems). It helps modestly with my anxiety, OCD, and low mood, and some other people seem to have the same experienc. However, some others don't. And for some it troubles sleep.
Wellbutrin can be bad for anxiety, or it might help your mood a lot. ...It's really more of a noradrenergic drug, though, because it's dopaminergic effects are rather contradictory. ...It does have a short half-life, though, so some people get away with taking it early enough in the day that it doesn't bother their sleep. It seems a good drug to try, but I might go with others first, for your symptoms.
If you can afford EMSAM, or your insurance covers it, it seems to me that it might be the best choice. Some people find it bad for anxiety, and for some it seems to help, from what I hear. ...If you were willing to do the MAO inhibitor dietary restrictions, though, Nardil might have the best chance to be an effective drug. Like EMSAM, but possibly more powerful, and better for anxiety. It indirectly increases the anxiety-relieveing neurotransmitter GABA, as well as acting more powerfully on serotonin through MAO-a, so theoretically, it might be more powerful at relieving anxiety, OCD, and depression. Sleep could be a serious problem on EMSAM or Nardil, though.
Hope that helps some...others no doubt will know more.
P-bot
poster:psychobot5000
thread:735900
URL: http://www.dr-bob.org/babble/20070224/msgs/737253.html