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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by brooklynsea on April 18, 2010, at 22:08:12
hello there. first time, so not sure how this really goes. just goes, i guess! i'm looking for some help... i don't have health insurance at the moment and in the past when that happens i just buy meds online. i was on lexapro for 2 years and stopped about 6 months ago. i was diagnosed with bipolar II when i was 13 - i'm 32 now, and have tried pretty much everything. been on zoloft for 2 months now, and though i don't feel terrible, i don't feel good either. i can barely get out to see people. if anyone has any suggestions that would be great.
Posted by Deneb on April 18, 2010, at 23:46:10
In reply to zoloft doesn't seem to help..., posted by brooklynsea on April 18, 2010, at 22:08:12
Hello brooklynsea!
Welcome to Psycho-Babble. If you tell us what country you're from, it would make it easier for someone to give you some suggestions. I'm from Canada myself and psychiatrists are covered by the provincial health plan. Meds aren't covered, but I am enrolled in the Trillium program. It makes it so that I pay no more than 4% of my income on my meds.
I would be very careful with ordering meds off the Internet without a prescription. There is no way you can know for sure what you are getting. As well, something as serious as bipolar really should be monitored by a health professional.
Deneb
Posted by morganator on April 19, 2010, at 1:18:06
In reply to zoloft doesn't seem to help..., posted by brooklynsea on April 18, 2010, at 22:08:12
How much are you taking?
Are you taking the generic or brand?
Posted by brooklynsea on April 19, 2010, at 7:25:19
In reply to Re: zoloft doesn't seem to help..., posted by morganator on April 19, 2010, at 1:18:06
hello, thanks for your reply! yes, i am taking sertraline, the generic. i started at 50, and am now at 100. i upped the dosage as i had on a previous round with this medication a few years ago....
Posted by brooklynsea on April 19, 2010, at 7:27:36
In reply to Re: zoloft doesn't seem to help... » brooklynsea, posted by Deneb on April 18, 2010, at 23:46:10
thanks for your reply! i am from the US... unfortunately i lost my insurance last year when i was laid off -- insurance is just too much for me right now, as would be clinician visits. so, i'm just trying to do the best i can at the moment. i know it's not the safest thing to order off the net, but i have done it before and not had any problems... :)
Posted by manic666 on April 19, 2010, at 8:22:30
In reply to Re: zoloft doesn't seem to help..., posted by brooklynsea on April 19, 2010, at 7:27:36
100mg is cool but 8 weeks mabye anit long inough yet //took me 12weeks an i was sick all the time till 12 week
Posted by brooklynsea on April 19, 2010, at 8:46:37
In reply to Re: zoloft doesn't seem to help..., posted by manic666 on April 19, 2010, at 8:22:30
really? ok, that is good to know... i will stick it out. thanks!!
Posted by SLS on April 19, 2010, at 8:47:22
In reply to Re: zoloft doesn't seem to help..., posted by manic666 on April 19, 2010, at 8:22:30
> 100mg is cool but 8 weeks mabye anit long inough yet //took me 12weeks an i was sick all the time till 12 week
I went up to 200mg of sertraline (Zoloft) without suffering any physical side effects. I felt a little spacey, though. I experienced a "blip" brief antidepressant effect that lasted a few days. Ultimately, I did not respond to it.
- Scott
Posted by brooklynsea on April 19, 2010, at 9:06:29
In reply to Re: zoloft doesn't seem to help..., posted by SLS on April 19, 2010, at 8:47:22
yes, i feel extremely spacey as well. i remembered that from the first time i tried it many years ago. have you found an alternative that works better for you?
Posted by ace on April 19, 2010, at 9:07:42
In reply to zoloft doesn't seem to help..., posted by brooklynsea on April 18, 2010, at 22:08:12
> hello there. first time, so not sure how this really goes. just goes, i guess! i'm looking for some help... i don't have health insurance at the moment and in the past when that happens i just buy meds online. i was on lexapro for 2 years and stopped about 6 months ago. i was diagnosed with bipolar II when i was 13 - i'm 32 now, and have tried pretty much everything. been on zoloft for 2 months now, and though i don't feel terrible, i don't feel good either. i can barely get out to see people. if anyone has any suggestions that would be great.
I got a suggestion: get of this mediocre SSRI medication and try an TCA, MAOI, or remeron...
Posted by SLS on April 19, 2010, at 9:33:49
In reply to Re: zoloft doesn't seem to help..., posted by brooklynsea on April 19, 2010, at 9:06:29
> yes, i feel extremely spacey as well. i remembered that from the first time i tried it many years ago. have you found an alternative that works better for you?
I really don't know what to suggest for you. It depends upon how tolerable the side effects are. Are they currently preventing you from functioning? Zoloft and Lexapro are probably the SSRIs that are most commonly prescribed. I don't think that one can consider Zoloft fully explored until they reach a dosage of 200mg.
I am only partially responsive to a combination of a MAOI and TCA. I have also found Effexor to be helpful. I am seemingly refractory to all currently available treatments, so I don't think that I represent the average case of depression.
Currently:
nortriptyline 150mg
Savella 200mg
Lamictal 200mg
Abilify 10mg
lithium 300mg
- Scott
Posted by Phillipa on April 19, 2010, at 11:06:55
In reply to Re: zoloft doesn't seem to help... » brooklynsea, posted by SLS on April 19, 2010, at 9:33:49
My Sister, her Daughter, my Son all did well on zoloft as well. I took it only to 50mg and stopped. Neighter my pdoc or I remember why I stopped. I do remember I didn't have side effects though all this is with a benzo. At one times years ago tried it and did feel spacey but also had the flu at the time. Phillipa oh my Son went to 200mg then just didn't want to take meds and stopped. That was years ago to and he doesn't take meds but he's not bipolar. No mood stablizer for you? Phillipa
Posted by bleauberry on April 19, 2010, at 17:35:04
In reply to zoloft doesn't seem to help..., posted by brooklynsea on April 18, 2010, at 22:08:12
Ok, so two things stood out, in my eyes.
1. Zoloft is helping somewhat, but obviously is not going to do the trick by itself.
2. No insurance, comfortable with choosing and buying one's own meds (me too).
Given that scenario, I can think of no other single best thing to do than order Nortriptyline and add it to the Zoloft. I could go into a long explanation as to why, but let's just say there are good reasons. I didn't just pull the zoloft+nortriptyline thing out of mid air.
Psycotropical.com is a cool place to go read some stuff. You'll find better explanations for things there than I could do here.
Not only is the combo a very good one, doing what neither drug alone can do, but nortriptyline is dirt cheap. Excellent for someone without insurance.
Posted by morganator on April 19, 2010, at 22:54:51
In reply to Re: zoloft doesn't seem to help..., posted by brooklynsea on April 19, 2010, at 7:27:36
I would try to get the name brand and try it if you can. Then stay on 100 mg for at least 6 weeks.
Posted by morganator on April 19, 2010, at 22:58:12
In reply to Re: zoloft doesn't seem to help..., posted by bleauberry on April 19, 2010, at 17:35:04
Ahh you don't have insurance. Yeah Zoloft would be expensive. Brand name may make some difference though, it did with me. I agree with Bleauberry, it's something I should have and wish I had done when Zoloft wasn't working for me as well the second and third times around.
Posted by tim123 on April 20, 2010, at 16:20:44
In reply to Re: zoloft doesn't seem to help..., posted by brooklynsea on April 19, 2010, at 7:25:19
> hello, thanks for your reply! yes, i am taking sertraline, the generic. i started at 50, and am now at 100. i upped the dosage as i had on a previous round with this medication a few years ago....
I was recently told by a psychopharmacologist that the generic (or white) zoloft may be as much as 20% less potent than the blue pill. I went thru a "crash" on the white pill, whereas the same dose of the blue seems to have gotten me back on top of things.
Posted by Deneb on April 20, 2010, at 19:05:26
In reply to Re: zoloft doesn't seem to help..., posted by tim123 on April 20, 2010, at 16:20:44
Hello Tim123!
Welcome to Psycho-Babble! I've also read that generics don't always have the same potency as their brand name counterparts. I however, have only had experience with generics, so I wouldn't know. My generics seem to work just fine for me.
Deneb
Posted by brooklynsea on April 20, 2010, at 21:07:07
In reply to Re: zoloft doesn't seem to help..., posted by bleauberry on April 19, 2010, at 17:35:04
Thanks so much to everyone for their suggestions... It is so overwhelmingly nice to have an informed place to discuss this. Thanks :)
I remember being on Nortriptylene (sp?) in my teens, but not with the Zoloft combination. I think I've only taken Zoloft with Lithium, which I recall as feeling sort of numb... So I did go to the psychotropical site -- it's very impressive, though a little heavy on the biology for me, but I will give it a closer look later.
How much Nort do you take with the Zoloft?
Thanks again! M
Posted by Bob on April 20, 2010, at 21:10:07
In reply to Re: zoloft doesn't seem to help... » brooklynsea, posted by SLS on April 19, 2010, at 9:33:49
>
> I am only partially responsive to a combination of a MAOI and TCA. I have also found Effexor to be helpful. I am seemingly refractory to all currently available treatments, so I don't think that I represent the average case of depression.
>
> Currently:
>
> nortriptyline 150mg
> Savella 200mg
> Lamictal 200mg
> Abilify 10mg
> lithium 300mg
>
>
> - Scott
I would also like to add that your brain seems to be made of cast iron. From reading your posts over time, you seem to be able to go on and off these meds with hardly a second thought and almost negligible side effects in most cases.If you can believe such a thing, I envy that in you. Every new med I try to take is a new exercise in testing my mettle, and then there's the withdrawl. That means that I can't really even get to therapeutic levels to see if they work properly.
Posted by SLS on April 21, 2010, at 6:32:57
In reply to Re: zoloft doesn't seem to help... » SLS, posted by Bob on April 20, 2010, at 21:10:07
> I would also like to add that your brain seems to be made of cast iron. From reading your posts over time, you seem to be able to go on and off these meds with hardly a second thought and almost negligible side effects in most cases.
I look at my tolerance of these medications to be a bad thing. I don't think my brain is likely to respond positively to such changes in drug exposure. My only robust and sustained response to medication was when using a treatment that produced pronounced side effects.
I wish I knew how to approach a case such as yours. I find it interesting that people report an increasing sensitivity to the negative effects of antidepressants as a result of previous exposures. Perhaps there is a sensitization (upregulation) of postsynaptic receptors as a result of a precipitous drop in neurotransmitter levels during drug discontinuation. I guess the genes that get turned on to produce this condition remain on. It might take an agent that inhibits second messenger cascades to turn these genes off. Lithium perhaps? I'm reaching. It is almost as if there is a kindling process occurring. Perhaps low dosages of AEDs would help.
- Scott
Posted by Laney on April 21, 2010, at 12:42:40
In reply to Re: zoloft doesn't seem to help... » Bob, posted by SLS on April 21, 2010, at 6:32:57
Would you say that if your experiencing no side effects whatsoever that the drug probably isn't working??
Thanks! Laney
I'm having absolutely no side effects from Zoloft. It's like taking a sugar pill.
Posted by Phillipa on April 21, 2010, at 19:45:33
In reply to Re: zoloft doesn't seem to help..., posted by Laney on April 21, 2010, at 12:42:40
Laney if you feel fine depression gone anxiety gone that's great. You responded so well to paxil. Hope you get the same mileage from zoloft. I used to get horrible side effects don't anymore either. Two ad's worked that's it. Love Phillipa
Posted by Bob on April 21, 2010, at 22:16:15
In reply to Re: zoloft doesn't seem to help... » Bob, posted by SLS on April 21, 2010, at 6:32:57
>
> I look at my tolerance of these medications to be a bad thing. I don't think my brain is likely to respond positively to such changes in drug exposure. My only robust and sustained response to medication was when using a treatment that produced pronounced side effects.
>I'm not sure there is any link between how many side effects one gets and what type of therapeutic effect is achieved. There have been many meds which have seemed to help for awhile but produced many side effects which I could not tolerate. Then there are meds which just produced side effects and possibly made me more depressed. I have gotten some of the short therapeutic windows you describe that quickly fade away, but I'd much rather experience these things without the ridiculous side effects and med sensitivity.
> I wish I knew how to approach a case such as yours. I find it interesting that people report an increasing sensitivity to the negative effects of antidepressants as a result of previous exposures. Perhaps there is a sensitization (upregulation) of postsynaptic receptors as a result of a precipitous drop in neurotransmitter levels during drug discontinuation. I guess the genes that get turned on to produce this condition remain on. It might take an agent that inhibits second messenger cascades to turn these genes off. Lithium perhaps? I'm reaching. It is almost as if there is a kindling process occurring. Perhaps low dosages of AEDs would help.
>What is an 'AED'... an anti-epileptic? Which meds in particular would you be referring to, and why do you think they'd be helpful in the application you mention?
Your train of thought on increased sensitivity to treatment is interesting, and a little beyond my current understanding of psychopharmacology. Something has definitely changed for me over the years though, and I no longer respond anything like I did in the beginning few years. The one treatment that probably changed my sensitivity the most was ECT. After my course of treatments, I literally could hardly touch an antidepressant or any other drug for that matter except in miniscule dosages. It was very scary and I thought I really might not make it past that point. Also over the years my body has developed many somatic problems that complicate my illness - something that wasn't a part of the problem in the beginning years. I guess maybe I've got some severe form of fibromyalgia, or maybe I'm in the pre-diagnostic stages of another illness, such as MS. I've been checked for all kinds of things and nothing has ever turned up. Anyway, I digress.
-Bob
Posted by brooklynsea on April 21, 2010, at 22:28:35
In reply to Re: zoloft doesn't seem to help... » SLS, posted by Bob on April 21, 2010, at 22:16:15
Bob, I had a similar reaction to ECT... It forever changed the way my body responded to meds and I feel affected me in ways I can't quite explain. It was terrible.
Posted by Bob on April 21, 2010, at 22:36:09
In reply to Re: zoloft doesn't seem to help..., posted by brooklynsea on April 21, 2010, at 22:28:35
> Bob, I had a similar reaction to ECT... It forever changed the way my body responded to meds and I feel affected me in ways I can't quite explain. It was terrible.
What's equally dismaying to me is that I've never found any accounts of serious negative effects like that in the literature. All I've ever seen is statements like "80% effective". In the medical literature there only seems to be responders and non-responders. No accounting for someone who sustains significant negative effects from the treatment. I guess maybe that might be why there is controversy surrounding the treatment.
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