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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by Ame Sans Vie on August 10, 2003, at 1:09:05
In reply to Re: SSRI'S SUCK » matthhhh, posted by galkeepinon on August 10, 2003, at 0:41:53
Posted by linkadge on August 10, 2003, at 3:09:01
In reply to Oh, other than that I agree 100%--SSRIs SUCK (nm), posted by Ame Sans Vie on August 10, 2003, at 1:09:05
Posted by SilmarilOne on August 10, 2003, at 3:14:56
In reply to For you they do, not others :) (nm), posted by linkadge on August 10, 2003, at 3:09:01
Is Effexor an SSRI? A Pdoc told me once it wasnt, and of course when I took it, I got EXACTLY the same sucky side effects and withdrawal syndrome I got with every SSRI.
hmph.
-thomas-
Posted by Ame Sans Vie on August 10, 2003, at 3:20:50
In reply to Re: ssris suck//Effexor?, posted by SilmarilOne on August 10, 2003, at 3:14:56
Effexor is an SNRI -- serotonin/norepinephrine reuptake inhibitor. Kind of a cross between a tricyclic's benefits and an SSRI's side effects, in my opinion.
Posted by crazychickuk on August 10, 2003, at 8:01:51
In reply to Re: SSRI'S SUCK, posted by Ame Sans Vie on August 10, 2003, at 1:07:34
Remeron doesnt decrease the amount of seritonin? where did you get that faulse information from?
Posted by PhilipCarey on August 10, 2003, at 10:50:02
In reply to SSRI'S SUCK, posted by matthhhh on August 9, 2003, at 14:21:44
Well, for the most part I agree. The only one I've ever been able to tolerate at a therapeutic dose is Remeron, and to a lesser degree Serzone (but even that one, I couldn't take a therapeutic dose every day).
Remeron doesn't feel like SSRIs. It could be worth a try. Couldn't hurt. I think if you're a person prone to anxiety with depressed states, it's definitely worth a short trial.
Posted by daizy on August 10, 2003, at 12:09:22
In reply to Re: SSRI'S SUCK, posted by Ame Sans Vie on August 10, 2003, at 1:07:34
Remeron
I think Im right in saying it isnt a TCA either!?
Posted by crazychickuk on August 10, 2003, at 12:18:34
In reply to Re: SSRI'S SUCK, posted by daizy on August 10, 2003, at 12:09:22
Posted by PhilipCarey on August 10, 2003, at 14:47:09
In reply to Re: SSRI'S SUCK, posted by daizy on August 10, 2003, at 12:09:22
> Remeron
>
> I think Im right in saying it isnt a TCA either!?Yea, you're right. I've never tried TCAs or MAOIs, though I've heard a lot of good things about Parnate and Nardil. For me Remeron effectively knocks out depression at only 15mgs. I take it at night, and it's great for sleep. Does not leave me sedated the next day. I think it'll remain part of my regimen. What it does not do is provide a real mood elevation. Dammit, I want these pills to do everything! I'm gonna try augmenting with Adrafinil. Recently tried Provigil, but found its action a little harsh. I hear Adrafinil, which is quite similar, is much milder in effect. I've also read that some that did not respond well to Provigil, do respond well to Adrafinil. We shall see. My order is in.
Here's the bio:
Remeron (Mirtazapine), approved in 1996, is the first in a new class of antidepressants known as “noradrenergic and specific serotonergic antidepressant’s (NaSSA’s). Mirtazapine works by increasing levels of norepinephrine and serotonin, two of the neurotransmitter chemicals that carry messages between brain nerve cells. Neurotransmitters are secreted by one cell and picked up by receptor proteins on the surface of another cell. Once the message has been delivered, a neurotransmitter is either destroyed or absorbed into the cell that made it. This process is known as re-uptake. When re-uptake is inhibited, the effect of the neurotransmitters is amplified. Neurotransmitters like norepinephrine and serotonin are involved in the regulation of pain, pleasure, anxiety, panic, arousal, and sleep behavior (the sleep-wake cycle).What makes Remeron etc. (Mirtazapine) somewhat unique, is that at the same time as it stimulates norepinephrine and serotonin, it also blocks two specific serotonin receptors (5-HT2 and 5-HT3). This ability to specifically target serotonin receptors theoretically minimizes common side-effects patients typically find undesirable with most other antidepressants, such as decreased sexual drive, nervousness and insomnia (ironically, Mirtazapine appears to be one of the more sedating antidepressants and is often used as a sleep aid). Mirtazapine shows a significantly earlier onset of action than SSRI antidepressants and appears to be at least as effective as Effexor (Venlafaxin), and the older tricyclic antidepressants. Weight gain appears to be the most commonly reported negative side-effect of Mirtazapine.
Posted by Ame Sans Vie on August 10, 2003, at 15:27:04
In reply to Re: SSRI'S SUCK to ame sans vie, posted by crazychickuk on August 10, 2003, at 8:01:51
> Remeron doesnt decrease the amount of seritonin? where did you get that faulse information from?
If you'll reread my post, this is exactly what I said:
"It doesn't have any SSRI action at all -- in fact, it *decreases* the action of serotonin."
So, obviously I never said it doesn't decrease the amount of serotonin (I never said it *did* either, though). What I *did* say was that it decreases the *action* of serotonin through blockade of three specific serotonin receptor sites.
Posted by Ame Sans Vie on August 10, 2003, at 15:53:10
In reply to Re: SSRI'S SUCK to ame sans vie » crazychickuk, posted by Ame Sans Vie on August 10, 2003, at 15:27:04
The "class" Remeron is in (I put class in quotes because it's the only drug in it) is called either the NaSSB's (noradrenergic and specific serotonergic blockers) or the NaSSA's (noradrenergic and specific serotonergic antidepressants).
Serzone, along with Desyrel (trazodone), belongs to a class called the serotonin antagonistic reuptake inhibitors (SARIs).
As I mentioned above, Effexor is an SNRI, and I should also mention that Wellbutrin is an NDRI (noradrenergic/dopaminergic reuptake inhibitor). So that accounts for all the orthodox AD's that don't fall into the SSRI, MAOI, or TCA categories (though, IMO, Asendin shouldn't really fall into the TCA category, due to it's antipsychotic activity).
Although Prozac and Zoloft are often called SSRIs, I like to consider them "atypical" SSRIs, because Prozac achieves a bit of noradrenergic reuptake inhibition in addition to its action on serotonin, and Zoloft has an added effect on dopamine. Seems to me as if Prozac should be considered an SSNRI and Zoloft an SSDRI. Anyway, in my opinion, the only "true" SSRIs are Paxil, Luvox, Celexa, and Lexapro, though I usually go along with the crowd and lump Prozac and Zoloft in there too -- makes things easier.
Posted by McPac on August 11, 2003, at 14:18:03
In reply to Re: Followup, posted by Ame Sans Vie on August 10, 2003, at 15:53:10
Remeron doesn't give me the side effects that the ssri's did....but it doesn't LIFT my moods like the ssri's did either....would be nice to get a mood lift from something (that didn't induce anger and anxiety as well, like the ssri's).
Posted by PhilipCarey on August 11, 2003, at 18:54:33
In reply to Re: Followup, posted by McPac on August 11, 2003, at 14:18:03
>> Remeron doesn't give me the side effects that the ssri's did....but it doesn't LIFT my moods like the ssri's did either....would be nice to get a mood lift from something (that didn't induce anger and anxiety as well, like the ssri's).<< -- McPac
I'm with you exactly on this. Still, the fact that it knocks out the depression, without side effects is good in and of itself... that and allowing for great sleep. Any ideas on augmenting for mood lift?
Ames touched on something interesting too, about Zoloft effecting Dopamine.
I forgot to mention that it was the only one of the SSRIs that I could take at a therapeutic dose (seeing as I don't consider Remeron an SSRI). Zoloft gave me the best near euphoric feeling.
My problem with these meds (other than Remeron) is that I cycle through them on a daily basis really fast, meaning I take it, have a period of an hour to hour and a half when I have a benzo sort stoned feeling, then it really kicks in, and I feel great for about an hour and a half, then come down, and by say, 2 in the afternoon, I'm dragging. And I put up with that on Zoloft for nearly a year. Those mid day highs were really nice, but ultimately, that's no way to live.
I'm thinking I'll keep Remeron as part of the regimen, and maybe try to augment with some sort of Dopamine type med. I'm also gonna give Adrafinil a shot, and somewhere down the road, gonna take Zyprexa (I think there's a little dopamine action there) for a spin too.
Med classes I've never tried: mood stabilizers, anti-psychotics, MAOIs, TCAs.
I suppose it's good that there are still alot of untried options, but damn, the failed experiments suck!
Posted by Ame Sans Vie on August 11, 2003, at 20:03:17
In reply to Re: Followup, posted by PhilipCarey on August 11, 2003, at 18:54:33
Zyprexa does have a dopaminergic action, but likely not the kind you're looking for. It decreases the action of dopamine, as all anti-psychotics do. If it's an increase in dopaminergic activity you're looking for, then a dopamine agonist such as Mirapex or Requip would be your best bet, probably along with some sort of stimulant since they can cause sleep attacks. I personally had amazing results with Mirapex, but the narcoleptic-like side effects forced me to discontinue it; now I may start up again, but only because I just began taking dextroamphetamine.
Posted by PhilipCarey on August 11, 2003, at 20:16:06
In reply to Re: Followup » PhilipCarey, posted by Ame Sans Vie on August 11, 2003, at 20:03:17
Thanks for the tip on Mirapex Ame. I'll do some reading up on it.
A question for you; do you think that a person that has not responded well to SSRIs, and has a sort of anhedonic/dysthymic type of depression might instead respond better to a dopaminergic med?
I know, I know... you never know until you try. I'm fortunate to have a doc that is open to my suggestions. It's kinda funny actually... last time I saw him, he began by asking what I'd been researching on the internet?
I lucked into getting a great doctor.
Posted by crazychickuk on August 12, 2003, at 13:31:13
In reply to Re: Followup, posted by PhilipCarey on August 11, 2003, at 18:54:33
I suffer with, ocd, mild depression sever anxiety sever paranoia(ocd)mania (sometimes) and panick disorder... some times i hear voices as i am going to sleep (someone said it is normal as u r going to sleep cus it is so quiet and it is my mind talking), i have taken every ssri snri and trylics... dont get on with any.. i am currently taking 15mg remeron have been for 3-4 weeks, longest med i have been able to tolerate, it isnt doing anything for me at the moment only makes me tired and lazy the day after, dont knock me out, and i still wake in the middle of the night a few times, i will be raising the dose to 30 mg in 2 weeks, any suggestions?
Posted by Ame Sans Vie on August 12, 2003, at 18:28:16
In reply to Re: Followup Ame, posted by PhilipCarey on August 11, 2003, at 20:16:06
> A question for you; do you think that a person that has not responded well to SSRIs, and has a sort of anhedonic/dysthymic type of depression might instead respond better to a dopaminergic med?
Since you're asking what I *think*, I have to say absolutely. My depression never responded at all to SSRIs, and it was pretty much exactly as you described -- primarily characterized by anhedonia and dysthymia, with a complete lack of motivation as the icing on the cake. Due to social phobia, I also lacked confidence and assertiveness that I now know was related to dopaminergic dysfunction, since Mirapex rid me of all of these symptoms.
> I know, I know... you never know until you try. I'm fortunate to have a doc that is open to my suggestions. It's kinda funny actually... last time I saw him, he began by asking what I'd been researching on the internet?
>
> I lucked into getting a great doctor.Sounds like you and I have the same doctor -- are you in southeast Texas by any chance, lol? My doctor is always very open to my suggestions, and very grateful for them, as they give him treatment options for other patients he may not otherwise have considered. For example, he says that since I brought Mirapex and Ultram to his attention (for treatment of anhedonia/dysphoria and depression/OCD, respectively) he now has three other patients using these medications and responding wonderfully where dozens of other drugs have failed. He also asks me first thing at each appointment if I have any new internet research for him, lol!
Posted by Ame Sans Vie on August 12, 2003, at 18:45:15
In reply to Re: Followup any suggestions for me ??, posted by crazychickuk on August 12, 2003, at 13:31:13
There are so many medication possibilities for you, I'd need some more information... I know you said you've tried the SSRIs, SNRIs, TCAs, and Remeron, but what else have you tried?
Posted by PhilipCarey on August 12, 2003, at 18:52:17
In reply to Re: Followup any suggestions for me ??, posted by crazychickuk on August 12, 2003, at 13:31:13
> I suffer with, ocd, mild depression sever anxiety sever paranoia(ocd)mania (sometimes) and panick disorder... some times i hear voices as i am going to sleep (someone said it is normal as u r going to sleep cus it is so quiet and it is my mind talking), i have taken every ssri snri and trylics... dont get on with any.. i am currently taking 15mg remeron have been for 3-4 weeks, longest med i have been able to tolerate, it isnt doing anything for me at the moment only makes me tired and lazy the day after, dont knock me out, and i still wake in the middle of the night a few times, i will be raising the dose to 30 mg in 2 weeks, any suggestions?<<
Well, it doesn't look encouraging for Remeron if you've taken it for three weeks with no benefits. Still, if as you say, you can tolerate it, many say the sedation goes away at 30mgs. I tried 30 for the better part of 2 months, and I felt more sedated at 30 than 15. You might get lucky. No harm in trying it I guess.
Have you tried mood stabilizers, or anti-psychoctics, or some kind of Dopamine agonist.
Seems you've tried the SSRIs etc. It might be time to try something a little outside the box.
Truth be told, I'm thinking I need to do likewise. I've ordered some Adrafinil, which should arrive within the next week or so. With so many med failures though, it's hard to get your hopes up too high for any particular one. The good thing is that there're a lot of them out there, so hopefully you and I will happen upon something that works. God, I hope so.
Posted by esokev on April 6, 2007, at 0:38:19
In reply to SSRI'S SUCK, posted by matthhhh on August 9, 2003, at 14:21:44
I agree... having taken the gamut off them... Improvement, but with a horrendous host of side-effects. I've never been so fat in my entire life.... I'm going to wean off this year. I'd rather be a benzo addict, because at least they know what benzos do in the longterm.
Posted by esokev on April 6, 2007, at 0:42:32
In reply to Re: ssris suck//Effexor?, posted by SilmarilOne on August 10, 2003, at 3:14:56
I think before someone takes effexor they should carefully outweigh the benefits and risks. It's a nasty little drug that can be killer to discontinue if it doesn't work... My brother quit taking it incorrectly, and was offered a bed in the psych ward... He'd never experienced anything so prolonged and so awful in his entire life... I've come to the conclusion that newer drug does not always equal better drug...
Posted by squeekyCat on April 6, 2007, at 10:03:41
In reply to SSRI'S SUCK, posted by matthhhh on August 9, 2003, at 14:21:44
I couldn't agree more. You need the benzos to abate the side effects of the SSRI/SNRIs. Scientists need to start working on pharmaceutical-grade crack.
Posted by pearlcat on April 7, 2007, at 22:52:52
In reply to Re: SSRI'S SUCK, posted by squeekyCat on April 6, 2007, at 10:03:41
I took effexor for 3 months and although It helped I had gained 25 or so lbs and 2 months later of being off of it I am still trying to stay sane. It is a horrible drug.
Posted by suebird on April 8, 2007, at 9:38:24
In reply to Re: SSRI'S SUCK, posted by 34 male on August 9, 2003, at 15:53:35
I have been on paxil and kolnopin for about 2yrs and when i first went on it i was anxious had no apptite but it has worked great for me and as far as the meds making you fat its not the meds its because your feeling better and so u can eat once again, thats what my p-doc had to make me realize and it is true because im on the meds and im loosing weight and still on the meds. thank you suebird
Posted by elanor roosevelt on April 9, 2007, at 22:32:59
In reply to Re: SSRI'S SUCK, posted by pearlcat on April 7, 2007, at 22:52:52
if you look around the site there will be explanations about the weight gain. I went from 120 to 180 and the extra weight blew out my knees. It was not from feeling good. I battled my way down to 150 and stayed there for 3 years by working out like mad at my gym at least 4 days a week. But then I went off ssri's and on Parnate felt horribly unhappy and lost weight quickly. I am still not back on ssri's and still losing weight slowly but surely.
If the ssri's worked well I would choose plump and upbeat. But they don't so I won't.
This is the end of the thread.
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