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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Laney on December 16, 2009, at 11:00:18
Hi there. I'm new here. First post. I would like some help choosing an AD. I'm on 10mg. and really don't want to be on an SSRI. I'm depressed and have no motivation, lack of happiness in general, no passion, etc. I don't want the side effects of an SSRI or the W/D. Anyone have any good ideas? What about Wellbutrin? Have never taken anything except Paxil and have been on it for 13 years. Can't seem to get off of it and it pooped out on me a year ago. Need to get feeling better soon!!!
Thanks! Laney
Posted by West on December 16, 2009, at 11:41:49
In reply to Looking for a new AD, posted by Laney on December 16, 2009, at 11:00:18
Of what?
> Hi there. I'm new here. First post. I would like some help choosing an AD. I'm on 10mg. and really don't want to be on an SSRI. I'm depressed and have no motivation, lack of happiness in general, no passion, etc. I don't want the side effects of an SSRI or the W/D. Anyone have any good ideas? What about Wellbutrin? Have never taken anything except Paxil and have been on it for 13 years. Can't seem to get off of it and it pooped out on me a year ago. Need to get feeling better soon!!!
>
> Thanks! Laney
>
>
Posted by West on December 16, 2009, at 11:48:45
In reply to Re: Looking for a new AD, posted by West on December 16, 2009, at 11:41:49
Try an SNRI like Effexor. It's more lively for me than cipralex, and a better antidepressant than cymbalta (in clinical trials comparing efficacy). Sertraline is also good, all three have statistically superior rates for depression (severe melancholic).The only side effects that might lead to problems continuing effexor are insomnia and night sweats. W
Posted by inanimate peanut on December 16, 2009, at 12:24:51
In reply to Re: Looking for a new AD, posted by West on December 16, 2009, at 11:48:45
I really liked Wellbutrin, and it doesn't (or at least didn't for me) have the withdrawal effects of other SSRIs. It was good for the antidepressent effects and gave me energy, too, which was a nice bonus. It tends to have a lower side effect profile than many SSRIs. I know some people get irritable on Wellbutrin, though, so you won't know unless you try it for yourself.
Posted by Phillipa on December 16, 2009, at 13:07:30
In reply to Looking for a new AD, posted by Laney on December 16, 2009, at 11:00:18
Hi Laney welcome to babble. Wow that's good the l0 mg of paxil worked for that long. So your're seeing a doc? Is it a psychiatrist or regular doc? What suggestions has he/she made? How serious is your depression. Know the feeling of pooped out meds. Paxil l0mg took myself for two years and stopped it. Big mistake. Anyway good luck!!!! Hope you get lots of responses
Posted by willyeee on December 16, 2009, at 13:31:17
In reply to Looking for a new AD, posted by Laney on December 16, 2009, at 11:00:18
I agree if you have started the ssris already,and not happy with the overall picture then you at the least want to try a SNRI which will differ slighty,cymbalts and pritiq are two fairly new,or newest ones out and should add a punch to a common fee of ssris.
Also i dont know you personaly,so i can just guess,but perhaps either staying on paxil,or when and if you choose a common snri try adding low dose adhd medication mainly either low dose adderall or low dose dex,small small doses off these might add some additionals chemicals into play and create a synergy for you that might be helpful.
Again this would be if your doc was willing,if he were idf hope hed start you at a very low dose and titrate up,but again my choice of adhd med,would be aderall which can raise dopamine to a degree which might be what your seeking.
Posted by bleauberry on December 16, 2009, at 17:19:16
In reply to Looking for a new AD, posted by Laney on December 16, 2009, at 11:00:18
With respect to how long you have been on Paxil, I would suggest being in no hurry to get off it. Instead, add something else to it, with the idea of slowly weaning off Paxil over a few months while the new med is taking over. You will likely shock your whole system bigtime if you just wean off Paxil to start something else. It's been over a decade and your body is going to freak out without that molecule, despite that it pooped out. So basically I am saying stay with Paxil for now, in very slowly lowered doses, to avoid destabilizing things so bad you'll never catch up.
You may find that a new med added to Paxil is all that is needed, and that the two together will work as good or better than Paxil ever did on its own.
For starters, I would try adding Nortriptyline to it, starting at 10mg and slowly increasing as you feel it out.
This might sound weird since it is a new drug in the USA and a true SNRI, but Milnacipran in low doses seems to me like it would have very good potential added to Paxil. In other parts of the world it is commonly added to Luvox or Paxil (Japan for example, where it is one of their top drugs). In USA it is called Savella. Heavy on norepinephrine, modest of serotonin, but with some binding sites that are different than other antidepressants which makes it unique as well.
I'm not impressed with Wellbutrin. In some countries it works so poorly in their clinical approval trials that they don't even approve it for depression. It is instead found useful for smoking cessation more than depression. Once in a while we see someone get remarkable improvement with Wellbutrin, but I can't think of any case where it lasted for any respectable amount of time. More than anything it seems to be good for energy, when and if it works. Mileage varies of course.
Another option is low dose Ritalin or Adderall added to Paxil. Either one of those should work within 1 to 3 days if they are going to work.
Some doctors like to spice up an antidepressant with an antipsychotic. In that arena, Abilify is probably the best bet, though any in low doses could be helpful. Or not. Sometimes they worsen the exact symptoms you are complaining about. Sometimes they help them. Hard to tell.
I like the idea of adding another antidepressant with a norepinephrine/dopamine angle to it, which means either Nortriptyline, Savella, Ritalin, or Adderall. I would not consider Wellbutrin until those had been exhausted first.
My two cents.
Posted by Laney on December 16, 2009, at 17:50:01
In reply to Re: Looking for a new AD, posted by bleauberry on December 16, 2009, at 17:19:16
> With respect to how long you have been on Paxil, I would suggest being in no hurry to get off it. Instead, add something else to it, with the idea of slowly weaning off Paxil over a few months while the new med is taking over. You will likely shock your whole system bigtime if you just wean off Paxil to start something else. It's been over a decade and your body is going to freak out without that molecule, despite that it pooped out. So basically I am saying stay with Paxil for now, in very slowly lowered doses, to avoid destabilizing things so bad you'll never catch up.
>
> You may find that a new med added to Paxil is all that is needed, and that the two together will work as good or better than Paxil ever did on its own.
>
> For starters, I would try adding Nortriptyline to it, starting at 10mg and slowly increasing as you feel it out.
>
> This might sound weird since it is a new drug in the USA and a true SNRI, but Milnacipran in low doses seems to me like it would have very good potential added to Paxil. In other parts of the world it is commonly added to Luvox or Paxil (Japan for example, where it is one of their top drugs). In USA it is called Savella. Heavy on norepinephrine, modest of serotonin, but with some binding sites that are different than other antidepressants which makes it unique as well.
>
> I'm not impressed with Wellbutrin. In some countries it works so poorly in their clinical approval trials that they don't even approve it for depression. It is instead found useful for smoking cessation more than depression. Once in a while we see someone get remarkable improvement with Wellbutrin, but I can't think of any case where it lasted for any respectable amount of time. More than anything it seems to be good for energy, when and if it works. Mileage varies of course.
>
> Another option is low dose Ritalin or Adderall added to Paxil. Either one of those should work within 1 to 3 days if they are going to work.
>
> Some doctors like to spice up an antidepressant with an antipsychotic. In that arena, Abilify is probably the best bet, though any in low doses could be helpful. Or not. Sometimes they worsen the exact symptoms you are complaining about. Sometimes they help them. Hard to tell.
>
> I like the idea of adding another antidepressant with a norepinephrine/dopamine angle to it, which means either Nortriptyline, Savella, Ritalin, or Adderall. I would not consider Wellbutrin until those had been exhausted first.
>
> My two cents.I hope I'm doing this right. Replying at the bottom and not at the top of this. What kind of side effects does Nortrip have?
Thanks! Alayna
Posted by Laney on December 16, 2009, at 18:02:09
In reply to Re: Looking for a new AD, posted by bleauberry on December 16, 2009, at 17:19:16
Bleauberry,
How much Adderall if I added that?
Thanks! Alayna
Posted by X-ray on December 17, 2009, at 4:18:44
In reply to Looking for a new AD, posted by Laney on December 16, 2009, at 11:00:18
Hi,
I'm on Wellbutrin and Remeron since two months. I'm happy with this combo that has given me a lot of energy.
For sleep I augment Remeron with a low dose of Lyrica.
I'm also on a low dose of flupenthixol to handle the agitation and anxiety induced by Wellbutrin.
I have struggled with Elavil for 37 years, but now I have finally managed to come off this drug.
Best regards,
X-ray
Posted by bleauberry on December 17, 2009, at 17:56:13
In reply to Re: Looking for a new AD » bleauberry, posted by Laney on December 16, 2009, at 17:50:01
>
>
> I hope I'm doing this right. Replying at the bottom and not at the top of this. What kind of side effects does Nortrip have?
>
> Thanks! Alayna
>
>You can respond any way you like. Put your message at the top or the bottom or erase the previous message completely.
Nortriptyline at low doses primarily has the side effect of a little bit of a dry mouth, maybe a little bit of a decrease in appetite, probably improved sleep, maybe slight constipation, and that's about it. Benficial side effects include excellent pain relief (headaches, arthritis, Lyme disease, MS, etc), more daytime energy or endurance, and improved sleep. At higher doses there might be some hypotension (dizzy if stand up too fast), fuzzy vision, and a dryer mouth and constipation. Sexual side effects are uncommon.
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