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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by addinbc on April 14, 2008, at 20:06:24
Hi there;
Over the last 15 years, I have been on a myriad of antidepressants for anxiety/depression. These have maily only included the SSRI's (Zoloft, Luvox, Paxil, Celexa, low dose Effexor, etc...). Through all these trials, I have discovered that I am EXTREMELY sensitive to medications. (BTW - I can't tolerate Wellbutrin or Duloxetine, and Remeron made my mood worse - yuck!)
For me, these wretched SSRI drugs cause wretched side effects. They all cause extreme lethargy/fatigue ( i.e.; they make my body feel like lead - I am bedbound for the most part), major PAIN in my abdominal/diaphragm region, apathy, and they cut me off from 'myself'. After 15 years on these horrible drugs I am needless to say TIRED of living with these side effects. They basically make my life unlivable - I can't function while on them. Literally.
I've tried coming off them. After sorting through withdrawal effects, my anxiety/depression inevitably returns to such an extent that I have to go back on the drugs. Last time I tried to come off, I ended up in hospital for 6 weeks.
I feel SO trapped!! I cannot live with these drugs, but I can't seem to live without them either!!!
My doctor keeps saying to me that we are out of drugs to try. I assume he says that because he knows I'm sensitive to drugs and thinks that I likely would not be able to tolerate drugs in other classes (e.g. TCA's). Regardless, I find it very annoying!
I'm wondering if some people experience the TCA's as more tolerable than the SSRI's. I just can't stand these wretched drugs anymore!!
Any input would be most appreciated!
Thanks!
Posted by antiserial on April 15, 2008, at 0:41:39
In reply to SSRI's vs. TCA's, posted by addinbc on April 14, 2008, at 20:06:24
Was your anxiety/depression worse after quitting SSRIs than it was before you started on them? Was your condition relatively managable before?
Posted by Quintal on April 15, 2008, at 8:49:21
In reply to SSRI's vs. TCA's, posted by addinbc on April 14, 2008, at 20:06:24
I'm surprised you haven't taken any other class of antidepressant by now - you're certainly not out of meds. As far as tolerability goes, SSRIs aren't that great. It isn't really true that they have fewer side effects than older antidepressants, they're just different, and maybe less likely to end in fatality, but unless you're planning to OD that's not really an issue. Personally, I don't tolerate the SSRIs very well at all. The second antidepressant I ever tried was dothiepin (after I couldn't tolerate Paxil), and I felt so good that I came off it after a month or so. I went back to it and it worked well each time.
Ironically the antidepressant I responded best to - and had among the fewest side effects, was Parnate. It really depends on what side effects bother you most - for example I can't stand the anorgasmia and emotional numbness that SSRIs used to give me, but the dry mouth and urinary hesitancy of dothiepin didn't really bother me that much. It's been my experience that TCAs (with maybe the exception of clomipramine) don't cause emotional detachment like SSRIs. I'm considering adding lofepramine to my Lamictal shortly for exactly those reasons. I think desipramine, nortriptyline and lofepramine would be the most tolerable TCAs for most people.
Q
Posted by Phillipa on April 15, 2008, at 10:35:01
In reply to Re: SSRI's vs. TCA's » addinbc, posted by Quintal on April 15, 2008, at 8:49:21
Does your pdoc say why he says he's tried them all?I'm truly sorry for your pain. Maybe a second opinion? Phillipa
Posted by kaleidoscope on April 15, 2008, at 14:53:55
In reply to SSRI's vs. TCA's, posted by addinbc on April 14, 2008, at 20:06:24
SSRIs and tricyclics can be very different. If you were to take a non-sedating tricyclic such as desipramine, the risk of apathy would be much less than with SSRIs.
Staying on the SSRI merry-go-round is silly. The various SSRIs have ever such a lot in common - any differences between them are often greatly overexaggerated. You would be much better off trying a med from a completely different class.
Posted by kaleidoscope on April 15, 2008, at 14:56:38
In reply to SSRI's vs. TCA's, posted by addinbc on April 14, 2008, at 20:06:24
>Through all these trials, I have discovered that I am EXTREMELY sensitive to medications
You are not sensitive to 'medications' - you are sensitive to *certain types* of medications. This does not mean that you will be sensitive to drugs from a different class. Almost all the drugs you've listed are SSRIs ie. they have the same mechanism of action - which you are clearly sensitive to. Go with something different :)
Posted by cactus on April 15, 2008, at 16:14:56
In reply to Re: SSRI's vs. TCA's » addinbc, posted by kaleidoscope on April 15, 2008, at 14:56:38
Why not try something away from anti depressants like dopamine angonists or modafinil.
I too am very sensitive to some meds, SSRI's, SNRI's anti psychotics and some TCA's, but I must admit that the only class of AD's that elevated my mood were TCA's but the side effects were still too much, Tofranil and Prothiadine were the best for me.
I also had amazing results from ropinirole, in regards to major mood elevation, (Dopamine agonist) but it made me really sick which I put up with for a while because I felt so good. It became too much in the end (vomitorium central). Tirate up very slowly, I did, but I still got quite ill.
The best mood brightner with literally no side effects for me has been modafinil, Which I'm currently taking now.
Good luck
Posted by bleauberry on April 15, 2008, at 19:06:58
In reply to SSRI's vs. TCA's, posted by addinbc on April 14, 2008, at 20:06:24
Some people do find TCAs more tolerable than SSRIs. But not usually.
Chemical sensitivity has mysterious causes, such as a sluggish liver or a hyper immune system.
You might consider taking the tiniest dose of the best overall ssri you've had (6-12.5mg zoloft as an example of tiny dose), but then explore other things that are used off label for depression that are not antidepressants. Things such as ritalin, abilify, lithium, lamictal, memantine, pramipexole, trivastal, and such. After 15 years it might be that you and me both are at a point where an ssri might always have to be in the mix, though we can probably do with the tiniest amount. I too am wicked sensitive.
Don't rule out Kira St Johns Wort.
Posted by Bob on April 15, 2008, at 19:40:13
In reply to Re: SSRI's vs. TCA's, posted by bleauberry on April 15, 2008, at 19:06:58
I am also sensitive. Ultra, super, wicked sensitive.
Posted by X-ray on April 16, 2008, at 9:32:09
In reply to SSRI's vs. TCA's, posted by addinbc on April 14, 2008, at 20:06:24
Hello addinbc,
I have been on Elavil for 36 years.
This is an effective drug for anxiety-related depression.
It's a very good sleeping aid.
I take 50 mg two hours before bedtime.Best of Luck,
X-rayP.S. I also take Buspar twice a day.
Posted by undopaminergic on April 17, 2008, at 21:26:14
In reply to SSRI's vs. TCA's, posted by addinbc on April 14, 2008, at 20:06:24
Small doses of amisulpride or sulpiride generally have few side effects, and they are more likely to stimulate than to induce lethargy. They are only slighly effective against anxiety, but for extra anxiolytic effect, benzodiazepines like alprazolam or diazepam could be added. Unfortunately, if you're in the US or Canada, you would have to order amisulpride and sulpiride over the Internet (they aren't FDA-approved).
Since you don't tolerate Wellbutrin, you may not tolerate modafinil, methylphenidate or amphetamine, but they may be worth trying. In particular, they almost certainly won't make you lethargic or fatigued, and they often have slight to moderate mood-elevating effects.
Selegiline and rasagiline are well tolerated, but they may not have sufficient antidepressive effects. They can at least sometimes potentiate sulpiride, amisulpride and methylphenidate. Also, they may render phenylalanine (an amino acid) effective as an anidepressant - in this case, some pyridoxine (vitamin B6) probably should be added.
The TCAs, except clomipramine, which is very SSRI-like, may always be worth trying. Their side effect profiles differ from that of SSRIs, and some people do tolerate them better.
Of course, MAOIs are often effective, but doctors usually don't like to prescribe them. In general, tranylcypromine is the least likely to cause intolerable lethargy and weight gain. Isocarboxazid seems to have fewer side-effects than phenelzine, but phenelzine is apparently effective in some cases where tranylcypromine fails. Also, you have to avoid certain foods and drugs that may cause life-threatening hypertensive effects when taken with MAOIs. Furthermore, all serotonergic agents should be avoided with MAOIs, as there is a serious risk of serotonin syndrome.
Posted by undopaminergic on April 17, 2008, at 21:32:59
In reply to Re: SSRI's vs. TCA's, posted by cactus on April 15, 2008, at 16:14:56
>
> I also had amazing results from ropinirole, in regards to major mood elevation, (Dopamine agonist) but it made me really sick which I put up with for a while because I felt so good. It became too much in the end (vomitorium central). Tirate up very slowly, I did, but I still got quite ill.
>You should have tried adding some amisulpride, sulpiride or perhaps even better, domperidone - a peripheral dopamine antagonist. All of these have the potential of largely eliminating such dopaminergic side effects as nausea and vomiting.
Personally, I did find pramipexole (a non-ergot dopamine agonist like ropinirole) to be highly mood-elevating, but that was very sporadic and unreliable, and after a couple or weeks or so, there were no positive effects at all.
Posted by SLS on April 18, 2008, at 5:37:12
In reply to Re: SSRI's vs. TCA's, posted by bleauberry on April 15, 2008, at 19:06:58
> You might consider taking the tiniest dose of the best overall ssri you've had (6-12.5mg zoloft as an example of tiny dose),
Are you saying that Adinbc should use the SSRI that has worked best for him/her, or are you of the opinion that Zoloft is the best drug among the SSRIs?
I think most psychiatrists are using Lexapro as their first-line treatment. I took Zoloft. Almost had it. It was better for me than Lexapro.
- Scott> but then explore other things that are used off label for depression that are not antidepressants. Things such as ritalin, abilify, lithium, lamictal, memantine, pramipexole, trivastal, and such.
Great list.
- Scott
This is the end of the thread.
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