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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by M on April 3, 2000, at 9:52:15
Anyone know of a non-stimulant with stimulating attributes? I've been taking 400 mgs Wellbutrin for quite a long time, and it just doesn't seem to be very effective for lack of energy, apathy, and lack of motitvation (sometimes I don't leave the house for weeks at a time...very difficult to get anything done at all.) I'm not able to take SSRIs, tricyclics, MAO inhibitors, or the usual stimulants Dexedrine, Ritilan, or Synthroid. Tried and failed with Serzone. Trazodone was GREAT but only worked for a few months before pooping out; reintroduction several months later failed. Also tried Wellbutrin with Trazodone which made no difference. I'd like to try Reboxetine when it becomes available in the US since all reports seem to indicate that it's been particularly effective for this type of "melancholic/vegetative" depression, but that could be a while. I'm also going to be retested for thyroid; however, as I said, have been refused Synthroid in the past (due to CAD.) Klonopin (up to 2mg at bedtime) was added recently for sleeplessness.
Anyone have any other ideas? I'm seeing the pdoc in a couple of days and would like to be armed with a couple of possible options.
Posted by AndrewB on April 3, 2000, at 11:33:46
In reply to Stimulants, posted by M on April 3, 2000, at 9:52:15
I'm sure others can give you more informed advice, however it occurred to me, since Trazadone is a serotonin agonist and you had such luck with it in the past, perhaps you could try Trazadone again in combination with a med. known to prevent SSRI poop out, such as pinoldol (spelling?), naltrexone, or bromocriptine. Another possibility is trying another serotonin agoninst or 5htp.
AndrewB
Posted by DC on April 3, 2000, at 17:35:38
In reply to Re: Stimulants, posted by AndrewB on April 3, 2000, at 11:33:46
M, are you saying that you found trazodone stimulating? If you are I wonder if you might be thinking of another drug. Trazodone is extremely sedating, and is often used to treat insomnia.
Posted by M on April 3, 2000, at 18:28:35
In reply to Trazadone stimulating?!, posted by DC on April 3, 2000, at 17:35:38
> M, are you saying that you found trazodone stimulating? If you are I wonder if you might be thinking of another drug. Trazodone is extremely sedating, and is often used to treat insomnia.
You're quite right, trazodone was not stimulating. In fact, I always took it right before I went to bed for insomnia...within ten minutes I was sound asleep and stayed that way until 6:00 am or so. When I awake I felt refreshed and ready to start the day (not at all the norm for me.) Even better, however, it:
* increased motivation; I actually ENJOYED getting out and doing things. I was sociable. I wanted a life again and made steps toward that end (exercising, school, considering job options, etc.)
* decreased anxiety; in fact, the worries and anxieties that sometimes controlled my life in the past just didn't seem very important to me anymore. Everything felt "controllable."
* increased libido; I hadn't had much of a sex drive in years...literally. Not only did it reappear, it was fanf***ingtastic!
* decreased brain fog; I felt smart and self-confident again. I could think clearly and not feel as though I was continually searching for words.
* increased self-esteem; for the first time in years, I actually felt good about "me"
* decreased sadness; yes, I had my moments of sadness, sometimes even tears, but not nearly as it had been previously.Most importantly, I felt joy again. I was happy. I laughed out loud. I wanted to live life. In short, I felt better than I had in a very, very long time. Obviously, the depression had lifted.
That's the "me" I want back.
Posted by M on April 3, 2000, at 18:44:19
In reply to Re: Stimulants, posted by AndrewB on April 3, 2000, at 11:33:46
> I'm sure others can give you more informed advice, however it occurred to me, since Trazadone is a serotonin agonist and you had such luck with it in the past, perhaps you could try Trazadone again in combination with a med. known to prevent SSRI poop out, such as pinoldol (spelling?), naltrexone, or bromocriptine. Another possibility is trying another serotonin agoninst or 5htp.
>
> AndrewBThanks, Andrew, that's helpful. I'll do a little research on these drugs and see what might make sense.
Posted by N on April 4, 2000, at 0:43:53
In reply to Re: Stimulants, posted by M on April 3, 2000, at 18:44:19
> > I'm sure others can give you more informed advice, however it occurred to me, since Trazadone is a serotonin agonist and you had such luck with it in the past, perhaps you could try Trazadone again in combination with a med. known to prevent SSRI poop out, such as pinoldol (spelling?), naltrexone, or bromocriptine. Another possibility is trying another serotonin agoninst or 5htp.
> >
> > AndrewB
>
> Thanks, Andrew, that's helpful. I'll do a little research on these drugs and see what might make sense.Maybe moderately high doses of B complex and a good multivitamin might help. Also, try not to get too much sleep. There is a limit to what medications can do.
Posted by M on April 4, 2000, at 7:25:55
In reply to Re: Stimulants, posted by N on April 4, 2000, at 0:43:53
> > > I'm sure others can give you more informed advice, however it occurred to me, since Trazadone is a serotonin agonist and you had such luck with it in the past, perhaps you could try Trazadone again in combination with a med. known to prevent SSRI poop out, such as pinoldol (spelling?), naltrexone, or bromocriptine. Another possibility is trying another serotonin agoninst or 5htp.
> > >
> > > AndrewB
> >
> > Thanks, Andrew, that's helpful. I'll do a little research on these drugs and see what might make sense.
>
> Maybe moderately high doses of B complex and a good multivitamin might help. Also, try not to get too much sleep. There is a limit to what medications can do.I do take a multivitamin every day so it's certainly easy enough to add B complex.
As far as sleep is concerned, "lack of" is a much bigger problem than "too much." Yes, I do sleep at night, but generally it's not more than three or four hours and, even then, I'm restless and don't sleep very soundly. I very rarely sleep during the day. That was one area where Trazodone helped tremendously. It allowed me to fall into a sound sleep quickly and easily and stay that way for 7 to 8 hours, and I'd awake feeling refreshed and energized.
The main problem seems to be lethargy and lack of motivation. I feel absolutely immobilized, sometimes not leaving the house or talking to anyone for weeks at a time. The smallest things seem a major effort, like getting showered and dressed, and most times I just don't care. That's why I thought a stimulant might be useful in addition to the Wellbutrin I'm currently taking.
In doing some research yesterday, I also ran into another bid of info that may or may not be relevant. I've been taking Toprol XL for quite a long time and cannot discontinue it; however, some of the side effects of beta blockers can be fatigue and depression. I don't quite understand the mechanics of it, but apparently it blocks something that can cause levels of something else to drop which, in turn, can cause or contribute to depression. The solution, then, is to find the specific drug that will counter these effects. From what I read, bromocriptine could be one of them, but I have much more research to do.
Anyone heard this about beta blockers, the exact mechanism at work that may cause depression, and/or what drug might counter the specific negative effect?
Posted by Sherry on April 4, 2000, at 8:04:27
In reply to Re: Trazadone stimulating?!, posted by M on April 3, 2000, at 18:28:35
Even better, however, it:
>
> * increased motivation; I actually ENJOYED getting out and doing things. I was sociable. I wanted a life again and made steps toward that end (exercising, school, considering job options, etc.)
> * decreased anxiety; in fact, the worries and anxieties that sometimes controlled my life in the past just didn't seem very important to me anymore. Everything felt "controllable."
> * increased libido; I hadn't had much of a sex drive in years...literally. Not only did it reappear, it was fanf***ingtastic!
> * decreased brain fog; I felt smart and self-confident again. I could think clearly and not feel as though I was continually searching for words.
> * increased self-esteem; for the first time in years, I actually felt good about "me"
> * decreased sadness; yes, I had my moments of sadness, sometimes even tears, but not nearly as it had been previously.
>
> Most importantly, I felt joy again. I was happy. I laughed out loud. I wanted to live life. In short, I felt better than I had in a very, very long time. Obviously, the depression had lifted.
>
You mean there are medications that can actually make you feel that much better. I am having one helluva a time with the medication I'm currently taking because I think it is actually making my depression worse. I thought I was going to choke on the pain I was feeling this morning it was so intense. I cried, screamed, ranted and raved, and now I just feel completely numb. This is not like me as I just exist most of the time with no emotions. I am fast losing hope that I will ever find anything that will work for me. I so need to get well, if not for my sake, the sake of my children. I feel so guilty because I am not the nurturing mother they need and deserve. As I am writing this, another crying jag is coming on. I often wonder if they wouldn't just be better off without me. That way maybe my husband could find someone that could do all the things that need to be done and love my children. I am as about as worthless a human being as there is on the planet right now. I am sorry to vent this way in your thread, but I could not believe that anyone could have this kind of response to a medication. I hope you find yourself again.
Posted by M on April 4, 2000, at 9:52:57
In reply to Re: Trazadone stimulating?!, posted by Sherry on April 4, 2000, at 8:04:27
Absolutely, positively, there ARE meds out there that can make you feel much, much better. Others on this board, I am sure, can vouch for this as well. The key is finding the right drug or combination of drugs for YOU, and that can take a lot of time, patience, and tenacity.
You didn't mention which drug you're taking or how long you've been taking it but it seems to me that if you've given it sufficient time (6 weeks or so) and symptoms have only gotten worse, it's time to try something else.
What you're feeling right now is typical of major depression and very treatable with the proper care. I would strongly suggest that you call your doctor today and tell him exactly how you're feeling, just as clearly and honestly as you have here. I'm he/she would want to know and, in fact, NEEDS to know in order to help you through this.
As everyone here can attest, this is not an easy road, and there's no magical fix. It takes a lot of work on the part of both you and your doctor (a good support system helps, too.) What's important for you to remember, even if you don't really believe it,is that the desperation you're feeling now is NOT a forever thing...the hopelessness will disappear and your children will have their mommy back. Most importantly, however, you'll have your life back.
Oh, and Sherry...when you're feeling worthless, feeling guilty for not being the sort of wife and mother you feel you should be, and think your family might be better off without you, think about this instead: you are the only mother these children will ever have. No other person is capable of loving them as you do, just as they are not capable of ever loving another "mother" as they do you. If they live to be 100, they'll never understand why or how you could leave them and will shoulder the blame themselves. If you doubt it, talk to a few adults whose parents committed suicide, or a few widowers who have spent a lifetime trying to help the kids make sense of it all.
Believe me, I understand the desperation and hopelessness. Sometimes it even physically hurts. But somewhere deep inside there's always the teeniest glimmer of hope. Find it and cling to it.
Please keep in touch and let us know how you're doing.
> You mean there are medications that can actually make you feel that much better. I am having one helluva a time with the medication I'm currently taking because I think it is actually making my depression worse. I thought I was going to choke on the pain I was feeling this morning it was so intense. I cried, screamed, ranted and raved, and now I just feel completely numb. This is not like me as I just exist most of the time with no emotions. I am fast losing hope that I will ever find anything that will work for me. I so need to get well, if not for my sake, the sake of my children. I feel so guilty because I am not the nurturing mother they need and deserve. As I am writing this, another crying jag is coming on. I often wonder if they wouldn't just be better off without me. That way maybe my husband could find someone that could do all the things that need to be done and love my children. I am as about as worthless a human being as there is on the planet right now. I am sorry to vent this way in your thread, but I could not believe that anyone could have this kind of response to a medication. I hope you find yourself again.
Posted by Sherry on April 4, 2000, at 13:20:27
In reply to Re: Trazadone stimulating?!, posted by M on April 4, 2000, at 9:52:57
I really didn't mean to unload on you, but it helps so much just to tell somebody. Most of the time I keep how I'm feeling bottled up inside until I feel as if I might explode. I am trying to hold on to hope. CAlled my pdoc, and he is supposed to get back to me. Thanks so much for your words of encouragement. They mean so much to me coming from someone that knows first hand what I'm dealing with.
> Absolutely, positively, there ARE meds out there that can make you feel much, much better. Others on this board, I am sure, can vouch for this as well. The key is finding the right drug or combination of drugs for YOU, and that can take a lot of time, patience, and tenacity.
>
> You didn't mention which drug you're taking or how long you've been taking it but it seems to me that if you've given it sufficient time (6 weeks or so) and symptoms have only gotten worse, it's time to try something else.
>
> What you're feeling right now is typical of major depression and very treatable with the proper care. I would strongly suggest that you call your doctor today and tell him exactly how you're feeling, just as clearly and honestly as you have here. I'm he/she would want to know and, in fact, NEEDS to know in order to help you through this.
>
> As everyone here can attest, this is not an easy road, and there's no magical fix. It takes a lot of work on the part of both you and your doctor (a good support system helps, too.) What's important for you to remember, even if you don't really believe it,is that the desperation you're feeling now is NOT a forever thing...the hopelessness will disappear and your children will have their mommy back. Most importantly, however, you'll have your life back.
>
> Oh, and Sherry...when you're feeling worthless, feeling guilty for not being the sort of wife and mother you feel you should be, and think your family might be better off without you, think about this instead: you are the only mother these children will ever have. No other person is capable of loving them as you do, just as they are not capable of ever loving another "mother" as they do you. If they live to be 100, they'll never understand why or how you could leave them and will shoulder the blame themselves. If you doubt it, talk to a few adults whose parents committed suicide, or a few widowers who have spent a lifetime trying to help the kids make sense of it all.
>
> Believe me, I understand the desperation and hopelessness. Sometimes it even physically hurts. But somewhere deep inside there's always the teeniest glimmer of hope. Find it and cling to it.
>
> Please keep in touch and let us know how you're doing.
>
>
>
>
> > You mean there are medications that can actually make you feel that much better. I am having one helluva a time with the medication I'm currently taking because I think it is actually making my depression worse. I thought I was going to choke on the pain I was feeling this morning it was so intense. I cried, screamed, ranted and raved, and now I just feel completely numb. This is not like me as I just exist most of the time with no emotions. I am fast losing hope that I will ever find anything that will work for me. I so need to get well, if not for my sake, the sake of my children. I feel so guilty because I am not the nurturing mother they need and deserve. As I am writing this, another crying jag is coming on. I often wonder if they wouldn't just be better off without me. That way maybe my husband could find someone that could do all the things that need to be done and love my children. I am as about as worthless a human being as there is on the planet right now. I am sorry to vent this way in your thread, but I could not believe that anyone could have this kind of response to a medication. I hope you find yourself again.
Posted by M on April 4, 2000, at 14:53:43
In reply to Re: Trazadone stimulating?!, posted by Sherry on April 4, 2000, at 13:20:27
We all need to unload from time to time. Been there myself a time or two(see "Wallowing" post.)
I'm glad to hear you called your pdoc and hope he returns your call soon. Perhaps once you've related everything you've said here, he will have a better understanding of what meds might be helpful to you.
I wish you the best of luck.> I really didn't mean to unload on you, but it helps so much just to tell somebody. Most of the time I keep how I'm feeling bottled up inside until I feel as if I might explode. I am trying to hold on to hope. CAlled my pdoc, and he is supposed to get back to me. Thanks so much for your words of encouragement. They mean so much to me coming from someone that knows first hand what I'm dealing with.
>
> > Absolutely, positively, there ARE meds out there that can make you feel much, much better. Others on this board, I am sure, can vouch for this as well. The key is finding the right drug or combination of drugs for YOU, and that can take a lot of time, patience, and tenacity.
> >
> > You didn't mention which drug you're taking or how long you've been taking it but it seems to me that if you've given it sufficient time (6 weeks or so) and symptoms have only gotten worse, it's time to try something else.
> >
> > What you're feeling right now is typical of major depression and very treatable with the proper care. I would strongly suggest that you call your doctor today and tell him exactly how you're feeling, just as clearly and honestly as you have here. I'm he/she would want to know and, in fact, NEEDS to know in order to help you through this.
> >
> > As everyone here can attest, this is not an easy road, and there's no magical fix. It takes a lot of work on the part of both you and your doctor (a good support system helps, too.) What's important for you to remember, even if you don't really believe it,is that the desperation you're feeling now is NOT a forever thing...the hopelessness will disappear and your children will have their mommy back. Most importantly, however, you'll have your life back.
> >
> > Oh, and Sherry...when you're feeling worthless, feeling guilty for not being the sort of wife and mother you feel you should be, and think your family might be better off without you, think about this instead: you are the only mother these children will ever have. No other person is capable of loving them as you do, just as they are not capable of ever loving another "mother" as they do you. If they live to be 100, they'll never understand why or how you could leave them and will shoulder the blame themselves. If you doubt it, talk to a few adults whose parents committed suicide, or a few widowers who have spent a lifetime trying to help the kids make sense of it all.
> >
> > Believe me, I understand the desperation and hopelessness. Sometimes it even physically hurts. But somewhere deep inside there's always the teeniest glimmer of hope. Find it and cling to it.
> >
> > Please keep in touch and let us know how you're doing.
> >
> >
> >
> >
> > > You mean there are medications that can actually make you feel that much better. I am having one helluva a time with the medication I'm currently taking because I think it is actually making my depression worse. I thought I was going to choke on the pain I was feeling this morning it was so intense. I cried, screamed, ranted and raved, and now I just feel completely numb. This is not like me as I just exist most of the time with no emotions. I am fast losing hope that I will ever find anything that will work for me. I so need to get well, if not for my sake, the sake of my children. I feel so guilty because I am not the nurturing mother they need and deserve. As I am writing this, another crying jag is coming on. I often wonder if they wouldn't just be better off without me. That way maybe my husband could find someone that could do all the things that need to be done and love my children. I am as about as worthless a human being as there is on the planet right now. I am sorry to vent this way in your thread, but I could not believe that anyone could have this kind of response to a medication. I hope you find yourself again.
Posted by One in Ten Thousand on March 10, 2001, at 16:53:27
In reply to Re: Trazadone stimulating?!, posted by M on April 3, 2000, at 18:28:35
> > M, are you saying that you found trazodone stimulating? If you are I wonder if you might be thinking of another drug. Trazodone is extremely sedating, and is often used to treat insomnia.
>
> You're quite right, trazodone was not stimulating. In fact, I always took it right before I went to bed for insomnia...within ten minutes I was sound asleep and stayed that way until 6:00 am or so. When I awake I felt refreshed and ready to start the day (not at all the norm for me.) Even better, however, it:
>
> * increased motivation; I actually ENJOYED getting out and doing things. I was sociable. I wanted a life again and made steps toward that end (exercising, school, considering job options, etc.)
> * decreased anxiety; in fact, the worries and anxieties that sometimes controlled my life in the past just didn't seem very important to me anymore. Everything felt "controllable."
> * increased libido; I hadn't had much of a sex drive in years...literally. Not only did it reappear, it was fanf***ingtastic!
> * decreased brain fog; I felt smart and self-confident again. I could think clearly and not feel as though I was continually searching for words.
> * increased self-esteem; for the first time in years, I actually felt good about "me"
> * decreased sadness; yes, I had my moments of sadness, sometimes even tears, but not nearly as it had been previously.
>
> Most importantly, I felt joy again. I was happy. I laughed out loud. I wanted to live life. In short, I felt better than I had in a very, very long time. Obviously, the depression had lifted.
>
> That's the "me" I want back.
>
I was prescribed Trazodone in conjunction with Immovane to aid in sleep. It helped me get some sleep but increased my libido to the point that my every waking moment was obsessed with sex.
I had to discontinue after one month. I had no idea it was related to the drug and was fortunate that my doctor identified it as an extremely rare side effect (one in ten thousand women). I'm looking for feed-back from any other women who have had this problem. This is not a joke and I implore you to respond with respect and compassion.
Posted by willow on March 10, 2001, at 21:57:59
In reply to Re: Trazadone stimulating?!, posted by One in Ten Thousand on March 10, 2001, at 16:53:27
One in Ten
I had taken trazadone and didn't have this problem with it; however, when I started effexor it had this effect physically on me. The doctor who prescrided it explained that a side-effect is that it slows down my ability to reach a peak sexually, thus the increased sexual drive. It has settled down though now that I haven't needed to increase the dose in awhile. Each time the dosage was increased the side-effect returned.
Hope you have found an alternative!
Best Wishes
Willow
Posted by SLS on March 11, 2001, at 11:05:38
In reply to Re: Trazadone stimulating?!, posted by One in Ten Thousand on March 10, 2001, at 16:53:27
Dear One in Ten Thousand,
> I was prescribed Trazodone in conjunction with Immovane to aid in sleep. It helped me get some sleep but increased my libido to the point that my every waking moment was obsessed with sex.> I had to discontinue after one month. I had no idea it was related to the drug and was fortunate that my doctor identified it as an extremely rare side effect (one in ten thousand women). I'm looking for feed-back from any other women who have had this problem. This is not a joke and I implore you to respond with respect and compassion.
Two other antidepressants, Serzone (nefazodone) and Remeron (mirtazapine), are also used as sleep aids at dosages lower than those usually used to treat depression. It seems that Remeron is chosen more often, and is prescribed in a range of 7.5mg to 15mg. to be taken before bed. It is difficult to predict with certainty how any one person will respond to any given drug. Both drugs are worth a try.
Although I was able to find examples of your trazodone (Desyrel) experience elswhere, I haven't seen any explanations as to what drug mechanisms might be responsible for it. The way some of the abstracts are worded, one would think that the same trazodone mechanism is responsible for sex-specific phenomena: priapism in men and increased libido in women. I would guess that there is more of an overlap, however.
These unusual side effects may involve a chemical metabolite that is produced when the body breaks down trazodone. This is only a silly guess. The metabolite is known as mCPP (m-chlorophenylpiperazine). This is also a chemical product of the breakdown of Serzone (nefazodone), although I am not sure as to how the amounts produced compare. I think it is important to note that nefazodone is a structural analogue of trazodone. They do have some things in common, but they are still very different in the way they act clinically. Serzone does not appear on Medline as producing priapism.
It is also worth noting that Remeron, along with Serzone and trazodone, shares another serotonergic property, 5-HT2 receptor antagonism. This is thought to be the reason why Serzone and Remeron produce so few sexual side effects (lowered libido and anorgasmia), and why they are sometimes used successfully to reverse those produced by the other antidepressants. Perhaps all three drugs will produce the same side effect in you. That would probably make you one in a million. Lucky you. :-( I doubt it though. :-)
If you do react in a similar way to both Remeron and Serzone, and you want to continue searching for sedating antidepressants to treat insomnia, I would recommend looking at two tricyclic medications, Elavil and Sinequan. Both of these drugs have been used routinely in the past, and are dramatically different drugs than those mentioned above. As with trazodone, they differ from sleeping pills like Imovane (zopiclone) in that little or no tolerance develops to require escalating dosages, and that there is very little potential for abuse or severe withdrawal reactions.
I hope this has you helped you rather than confused you. I think you should act under the assumption that trazodone is uniquely the only drug capable of causing you the troubling side effects you have experienced. I recommend that you go on to try drugs in the order that your doctor suggests, even if Serzone is his first choice. You cannot be sure that any one drug will cause you problems just because it is superficially similar to one that did. All of the guessing and hypothesizing above might explain some things, but can only be evaluated through hindsight. Any association might be useful to you in the future.
Good luck.
- Scott
This is the end of the thread.
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