![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Dr. Bob on May 4, 2001, at 19:01:40
> Hello:
> I am a newbie. I was diagnosed with Dysthymia in 1998 and was managed with the drugs, Wellbutrin and Serzone, Cognitive Group and one-on-one Psychologist sessions. I self-discontinued my medications in July 2000 and find myself recently prescribed the drug, Celexa and a 4 day stress management course.
> I think the worst is over, I had hit rock bottom approximately 6 days ago with S. ideation but thank God I am still in the fight. Does anybody have any suggestions regarding strategies to manage the Dysthymia bear?
> respectfully,
> Warrior
Posted by JohnL on May 5, 2001, at 5:06:05
In reply to Redirected: Dysthymia and antidepressants, posted by Dr. Bob on May 4, 2001, at 19:01:40
> > Hello:
> > I am a newbie. I was diagnosed with Dysthymia in 1998 and was managed with the drugs, Wellbutrin and Serzone, Cognitive Group and one-on-one Psychologist sessions. I self-discontinued my medications in July 2000 and find myself recently prescribed the drug, Celexa and a 4 day stress management course.
> > I think the worst is over, I had hit rock bottom approximately 6 days ago with S. ideation but thank God I am still in the fight. Does anybody have any suggestions regarding strategies to manage the Dysthymia bear?
> > respectfully,
> > WarriorI think dopamine and or norepinephrine type drugs work best for dysthymia. This is purely opinion, but is based on my own personal experiences and on observing what works for other people here over the years. Often it seems the serotonin drugs are not helpful for dysthymia, and can actually make it worse through a numbing effect.
At the top of my priority list would be Zyprexa added to your ongoing Celexa. Prozac could be a better choice than Celexa, because it is more activating and less numbing generally. Prozac also happens to go real well with Zyprexa.
If it were a straight forward bout of depression I would have a different opinion. But for dysthymia, successful treatment is often different than what would be expected for treating a bout of depression.
Other possible drugs to keep in mind would be Ritalin, Adderall, Risperdal, Adrafinil, Amisulpride, Desipramine, Nortriptyline. My favorites in this bunch are Adrafinil and Amisulpride for dysthymia.
No matter what you do though, I think having a serotonin drug as the foundation of your treatment is a good idea. I would keep the serotonin drug dose at the minimum however, to try to avoid any numbing effects that might be too much for other drugs to overcome. Even if the drug is not all that good by itself, it can become very good with the addition of a second agent. The second agent should be one of a totally different mechanism working on different chemistries, including any of the ones I mentioned.
My biased personal opinion favors Prozac+Zyprexa+Adrafinil for dysthymia. Amisulpride too is real good. Any combination of these. Stimulants can be helpful too, but sometimes become treacherous. Tricyclic antidepressants can be good, but often come with more side effects than you bargained for.
John
Posted by Mr.Scott on May 5, 2001, at 20:27:08
In reply to Re: Redirected: Dysthymia and antidepressants, posted by JohnL on May 5, 2001, at 5:06:05
"Stimulants can be helpful too, but sometimes become treacherous."
Hi John,
Can you elaborate on this? Particularly the treacherous part?
mr.scott
Posted by JohnL on May 6, 2001, at 5:03:12
In reply to JohnL, posted by Mr.Scott on May 5, 2001, at 20:27:08
> "Stimulants can be helpful too, but sometimes become treacherous."
>
> Hi John,
>
> Can you elaborate on this? Particularly the treacherous part?
>
> mr. scottWhat I meant by treacherous was that sometimes stimulants can become addicting and at the same time become less effective, requiring higher and higher doses over time. Psychosis, paranoia, anxiety, and tolerance are real life possibilities. For some people stimulants are perfect and they do not develop tolerance or any negative side effects. Stimulants are a good chemical/molecular match for them. For others though they can be trouble. Of course, mileage varies with any medication, and side effects can be gruesome with any medication, but stimulants in particular pose some additional possible problems not shared by most other psych meds. They are, after all, controlled substances for a reason.
John
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.