![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Kerry on June 4, 2000, at 23:31:27
I've been diagnosed w/ Dysthymia and ADD. I'm currently taking Wellbutrin 450 mgs but am not too pleased with the results (I've been on it since January). Before the ADD diagnosis I was on (at different times) the following: Prozac, Paxil, Zoloft, and Effexor. What next? I'm not in therapy right now--am somewhat skeptical about cognitive therapy (hasn't worked in the past though I never was in it consistently). What about "interpersonal therapy--" is it different? I'm new to this board.
Posted by ChrisK on June 5, 2000, at 5:39:49
In reply to Chronic Depression/Dysthymia and ADD, posted by Kerry on June 4, 2000, at 23:31:27
Kerry,
Some people do well in therapy and others like me get nothing out of it. I tend to keep most of my problems bottled up inside, even with a therapist that I liked.
As far as the meds go you may want to try a TCA since you've gone through a bunch of SSRI's already. I reacted better to Nortriptyline than any of the SSRI's I tried plus Effexer and Remeron. The latter may also be a good option.
Hope this helps a little,
Chris
Posted by JohnL on June 5, 2000, at 5:46:42
In reply to Chronic Depression/Dysthymia and ADD, posted by Kerry on June 4, 2000, at 23:31:27
> I've been diagnosed w/ Dysthymia and ADD. I'm currently taking Wellbutrin 450 mgs but am not too pleased with the results (I've been on it since January). Before the ADD diagnosis I was on (at different times) the following: Prozac, Paxil, Zoloft, and Effexor. What next? I'm not in therapy right now--am somewhat skeptical about cognitive therapy (hasn't worked in the past though I never was in it consistently). What about "interpersonal therapy--" is it different? I'm new to this board.
Kerry,
Based just on what meds you've tried so far, I think it's fairly safe to gather the clues and conclude that your symptoms don't have much to do with serotonin. There's likely a different chemistry that needs some tweeking. Personally I don't think any kind of psychotherapy will be of major benefit. Been there, done that. It's helpful after you've found a drug that works. But overall it was less than satisfactory for me. Fixing whatever chemistry is screwed up is where the magic is.So where to go from here? Well, there are lots of choices. Wellbutrin has had a fair chance and could be discontinued. You might consider weening off it to compare other meds. Further exploration is warranted I think.
In the list of meds to try these come to mind:
Ritalin
Adderall
Desipramine
Modafinil
Adrafinil (international pharmacy)
ZyprexaMy personal favorite of the bunch is Adrafinil. But that's just me. I did not list these drugs in any priority. But I think you should give them all a short personal comparison, saving Desipramine for last; Zyprexa second to last. Give each one two weeks. These drugs do not require the long trials of antidepressants. Desipramine however is an antidepressant, and has more side effects that the others, and that's why I suggest saving it for last. Hopefully the magic will be found with one of the others. After comparing all of them, choose your favorite to continue for a longer trial.
Each one of these has the potential to correct common chemistries responsible for both dysthymia and ADD. Wellbutrin has had its day in the sun. Time to find a superior med. It's out there. And it wouldn't surprise me at all if it ended up being one of the ones listed above.
JohnL
Posted by Mia on June 5, 2000, at 8:48:09
In reply to Re: Chronic Depression/Dysthymia and ADD, posted by JohnL on June 5, 2000, at 5:46:42
For Chronic depression and ADD I have been on a combo of Prozac (20 mg) and Welbutrin (low dose- 150 mg a day)- and that has been the best combination. I have also tried Adderall, which is teriffic except it pronounces a slight tic I have with my right eye. Any amphet combo is not good for Tourette's.
I am curious why John said Wellbutrin has "had it's day in the sun?" I have been off all meds for three years to have two children, and am going back on this month. My doc just started up the Prozac-Welbutrin combo since that worked so well before for me-- has there been any developments lately that I should know about?
ps what's dysthymia?
thanks
Posted by JB on June 5, 2000, at 12:56:42
In reply to Re: Chronic Depression/Dysthymia and ADD, posted by Mia on June 5, 2000, at 8:48:09
I've had chronic depression for over 30 years and more recently I had a bout of major depression several years ago. I never knew that it was depression, I thought that I was just always negative and in a bad mood and looked at everything in the worst way and couldn't deal with stress and confrontation. Since the recurrance of the chronic depression I've tried Serzone, Trazodone, Remeron, Buspar, Celexa, and St John's Wort. The Serzone at 50-100 mg/day was initially effective at getting rid of the constant talking in my head and the constant negative thoughts but it also gave me too much anxiety and confusion as well as the sexual side effects. The Trazadone was great for sleep except for the tendancy for a priapism situation. The Remeron at 15 mg knocked me out and I felt that I didn't wake up for 2 days, no insomnia or anxiety but no energy or ability to think either. The Celexa at 10 mg/day made me feel like I was on speed and even though I only tried it for a week I was constantly wired and couldn't s
Posted by JohnL on June 6, 2000, at 2:57:14
In reply to Re: Chronic Depression/Dysthymia and ADD, posted by Mia on June 5, 2000, at 8:48:09
> I am curious why John said Wellbutrin has "had it's day in the sun?"
>
> ps what's dysthymia?
>
> thanksHi Mia,
The reason I said it's had it's day is because it has been tried since January at 450mg. And I'm speaking only for this particular patient, not Wellbutrin in general. 450mg at 5+ months is a plenty sufficient trial. Wellbutrin is a miracle for some patients, but not in this particular case.Dysthymia is a chronic depression. It is like a low grade depression that is always there. Sometimes it is interrupted by a severe depressive bout, in which case it is then called double depression.
Posted by AndrewB on June 9, 2000, at 8:58:52
In reply to Chronic Depression/Dysthymia and ADD, posted by Kerry on June 4, 2000, at 23:31:27
I have dysthymia also (along with social anxiety and some kind of chronic fatigue like condition). I didn't respond very well to wellbutrin. My response to serzone sounds exactly like yours JB. I have taken amisulpride for almost a year and it has been very effective in dealing with my dysthymia. A long list of studies have been done on amisulpride showing it to be effective for dysthymia. I don't know if it should be the first drug tried if a person has dysthymia, but my impression is that it definately should be tried after SSRIs, if they have failed. It normally has few if any side effects and it takes effect quickly (it works in 4 days for me).
The problem with amisulpride is that it isn't sold in the United States. If you want to try it you have two options; order from overseas without a prescription or bring to your psychiatrist informatin on amisulpride so he can decide whether or not to write you a prescription for it (this is what I did). I have an information piece that will give you the information you need for either of these options. If you would like me to email it to you, contact me at andrewb@seanet.com.
Best wishes,
AndrewB
Posted by SLS on June 9, 2000, at 10:01:24
In reply to Re: Chronic Depression/Dysthymia and ADD, posted by JB on June 5, 2000, at 12:56:42
> I've had chronic depression for over 30 years and more recently I had a bout of major depression several years ago. I never knew that it was depression, I thought that I was just always negative and in a bad mood and looked at everything in the worst way and couldn't deal with stress and confrontation. Since the recurrance of the chronic depression I've tried Serzone, Trazodone, Remeron, Buspar, Celexa, and St John's Wort. The Serzone at 50-100 mg/day was initially effective at getting rid of the constant talking in my head and the constant negative thoughts but it also gave me too much anxiety and confusion as well as the sexual side effects. The Trazadone was great for sleep except for the tendancy for a priapism situation. The Remeron at 15 mg knocked me out and I felt that I didn't wake up for 2 days, no insomnia or anxiety but no energy or ability to think either. The Celexa at 10 mg/day made me feel like I was on speed and even though I only tried it for a week I was constantly wired and couldn't s
As you describe it, your depression sounds like it would respond to a tricyclic antidepressant. Have you ever tried one?If sleep or anxiety is a problem, perhaps Sinequan is worth a try.
As you have seen, the insomnia and anxiety can disappear when the depression improves. It almost doesn't matter which drug you use if you respond to it.
- Scott
Posted by Lynne on June 9, 2000, at 10:46:53
In reply to Re: Chronic Depression/Dysthymia and ADD, posted by JohnL on June 5, 2000, at 5:46:42
John L,
Could you tell me the dosage of Adrafinil that you are taking? I have some that I ordered but I only tried 1 tablet a day and did not notice any help. Did it help with social phobia? How long did it take you to notice the effect of the Adrafinil? Any side effects? Your posts has helped me alot, I read all of your posts.
Thank you,
Lynne
Posted by JohnL on June 10, 2000, at 3:49:22
In reply to Re: Chronic Depression/Dysthymia and ADD John L ??, posted by Lynne on June 9, 2000, at 10:46:53
> John L,
>
> Could you tell me the dosage of Adrafinil that you are taking? I have some that I ordered but I only tried 1 tablet a day and did not notice any help. Did it help with social phobia? How long did it take you to notice the effect of the Adrafinil? Any side effects? Your posts has helped me alot, I read all of your posts.
>
> Thank you,
>
> Lynne
Hi Lynne. Nice to hear from you. Here's my experience with Adrafinil.I felt an immediate boost the first day which then quickly faded. For a while Adrafinil didn't seem any different than candy. No effect. But then at about 1 1/2 to 2 weeks I all of a sudden realized I was energetic, motivated, and interested in doing things. It snuck up on me. I started off at 900mg a day, but then dropped it down to 600mg after a few days, and then settled at 300mg. I'm pretty sure 300mg every other day would be just fine too, with me.
I've tried challenging the Adrafinil by stopping it to see what happens. I start getting my anhedonic depression again a little bit by the end of day 2 and then full force on day 3. When re-starting, I notice improve on day 2 and then major recovery by day 3 and total recovery by day 4.
It does seem like a smooth subtle drug. I mean, I can't feel each dose. It comes on so gradually. The literature suggests it takes several weeks of use to feel any benefits. With me, it was around 2 weeks.
The main side effect for me is a slight dizziness. Not bad, but enough to notice on a daily basis. If I turn my head real quickly I feel disoriented for a split second. That's about it.
Social phobia...definitely helpful. Adrafinil has a way of making passive people become active, and quiet people become more talkative. I feel comfortable in any social setting now.
But, temporarily probably, I have stopped Adrafinil to try a close substitute...Modafinil. I just took my first dose yesterday and I have to admit I wasn't too encouraged with it. While Adrafinil is smooth and subtle, Modafinil seemed rather powerful, like Adderall or Ritalin. Kind of an uneasy feeling. But that was just the first day. We'll see how it goes. I have a gut feeling I'll be returning to Adrafinil pretty soon. Of everything I've ever tried, there's just nothing like it. But I think I need to give Modafinil a fair chance before making any decisions.
JohnL
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.