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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by hansi555 on March 3, 2009, at 12:59:15
Hi
Is there any chance that a non-depressed (but somewhat stressed person) could get depressed from taking ADs?
If so, how big a chance/risk for this to occur?
Posted by NewQuestions on March 3, 2009, at 13:19:18
In reply to Depressed from ADs - how likely is it?, posted by hansi555 on March 3, 2009, at 12:59:15
ADs can cause depression. Sometimes it is a start-up effect, sometimes it will cause depression indefinitely. Just start with small doses and increase gradually.
Posted by hansi555 on March 3, 2009, at 14:09:21
In reply to Re: Depressed from ADs - how likely is it?, posted by NewQuestions on March 3, 2009, at 13:19:18
> ADs can cause depression. Sometimes it is a start-up effect, sometimes it will cause depression indefinitely. Just start with small doses and increase gradually.
Okay
I started out 14 months ago w. stress and TOTAL insomnia. Started out on 30 mg Remeron only to be able to sleep, I was NOT depressed (but exhausted)
After 2 weeks on Remeron, I suddenly started crying out of nothing, dosage was increased, it helped some, but not enough, so after some months my psychiatrist added Lexapro, but it never went to some constant relief, only 2-3 weeks at a time, then set-backs. Summer and autum was like this.
During october, Nortriptyline was gradually added and more or less all of the psysically symptoms went away (nausea, no appetite, dizzyness), but still mood swings. Since december Nortrip 85 mg has been my main drug, I have slowly stopped Lexapro and only take 15 mg Remeron at night time. The first 6 weeks of the year were rather good, I felt more or less cured as I tappered down Lexapro.
But I have had a set back during the last couple of weeks w. crying spells, depressed feeling etc. (but also good days in between).So I am puzzled; after 14 months of treatment:
50% of the time: feeling normal/good
25%: so-so, I get by
25%: depressed
????
Posted by NewQuestions on March 3, 2009, at 16:12:57
In reply to Re: Depressed from ADs - how likely is it?, posted by hansi555 on March 3, 2009, at 14:09:21
Need more information. What were your symptoms before medication? What is your diagnosis? How long did you experience them? What is the nature of the AD side effects? How are you depressed? What ADs are you on? Do you consider crying outbursts to be depression?
Posted by Phillipa on March 3, 2009, at 16:33:49
In reply to Re: Depressed from ADs - how likely is it?, posted by NewQuestions on March 3, 2009, at 16:12:57
What's your definiton of depression? Ask because wonder if just could be fluxuations of mood. Other than is your life happy or should it be? Phillipa
Posted by raisinb on March 3, 2009, at 20:44:03
In reply to Depressed from ADs - how likely is it?, posted by hansi555 on March 3, 2009, at 12:59:15
This is anecdotal only, but I know without a doubt that Remeron made me more depressed in exactly the way you describe--very weepy, feeling meaningless. I tapered off it quickly and went back on SSRIs, with good results.
Posted by polarbear206 on March 3, 2009, at 22:03:55
In reply to Re: Depressed from ADs - how likely is it?, posted by hansi555 on March 3, 2009, at 14:09:21
> > ADs can cause depression. Sometimes it is a start-up effect, sometimes it will cause depression indefinitely. Just start with small doses and increase gradually.
>
> Okay
>
> I started out 14 months ago w. stress and TOTAL insomnia. Started out on 30 mg Remeron only to be able to sleep, I was NOT depressed (but exhausted)
>
> After 2 weeks on Remeron, I suddenly started crying out of nothing, dosage was increased, it helped some, but not enough, so after some months my psychiatrist added Lexapro, but it never went to some constant relief, only 2-3 weeks at a time, then set-backs. Summer and autum was like this.
> During october, Nortriptyline was gradually added and more or less all of the psysically symptoms went away (nausea, no appetite, dizzyness), but still mood swings. Since december Nortrip 85 mg has been my main drug, I have slowly stopped Lexapro and only take 15 mg Remeron at night time. The first 6 weeks of the year were rather good, I felt more or less cured as I tappered down Lexapro.
> But I have had a set back during the last couple of weeks w. crying spells, depressed feeling etc. (but also good days in between).
>
> So I am puzzled; after 14 months of treatment:
> 50% of the time: feeling normal/good
> 25%: so-so, I get by
> 25%: depressed
> ????
>You may have some underlying cycling going on here. Antidepressants can exacerbate depression in these cases if a mood stablizer isn't on board. I went through a very similar situation. Adding a mood stablizer (lamictal) did the trick.
Posted by hansi555 on March 4, 2009, at 0:41:05
In reply to Re: Depressed from ADs - how likely is it?, posted by NewQuestions on March 3, 2009, at 16:12:57
> Need more information. What were your symptoms before medication? What is your diagnosis? How long did you experience them? What is the nature of the AD side effects? How are you depressed? What ADs are you on? Do you consider crying outbursts to be depression?
I had been stressed for 1 year or so, so 20th nov 2007 I stayed home feeling dizzy, and confused. During december I went through different kinds of psysical symptoms like nausea, headaches, loss of appetite.
Then on the 25th of december I had a major nightmare so bad that within 5 days I went into total insomnia. Tried different normal sleeping meds but after fighting this f 3 weeks I gave up and begen the Remeron 30 mg, at this time also my appetite was pretty low. And had also been taking more depression tests, but I was not depressed at the time.
After starting Remeron, I could sleep again and eat for the first 2 weeks, everything seemd on track and back to normal.
Out of nothing I began crying and again I could not sleep wtihout sleeping pills and appetite was less again. After 2 weeks I went to 45 mg, now diagnosed w. depression. Over the next 2 months I went up to 60 mg but I was never in a good mood for more than 2-3 weeks, then I felt depressed again, had problems w. eating, nausea´, crying. In the meantime I had been able to stop taking the sleeping pills.
At around mid May my PD thought we should add Lexapro and cut a bit of the Remeron. During the next 5 months it was more or less the same, good/normal mood for 1-2 weeks, then a simlilar period of not-so-good 80-90% of normal.
In october I asked my PD if we could make a switch to something more powerful and I started Nortriptyline, first at a low dosage and since dec 85 mg/day. Since then ALL psysical symptoms has disappeared completely, it is only this mood thing troubeling me.I have now been on 85 mg Nortriptyline (and 15 mg Remeron at bed time) for the past 2½ months and I have had a fairly good time, I have felt more and more my old me, also been able to slowly increase my working time. Dont know if this is because of the nortrip or just because of the time passing along.
From the 20th of december and 7 weeks forward I have gone from 20 mg Lex to 0 mg as planned by my PD and I: We should go for the Nortrip only (and also remove the Remeron later on). I have had no real psysical withdrawel symptoms during this proces.
I have now been on NO Lexapro for 15 days but for the last 2-3 weeks the number of not-so-good days have become more and more again. Also my sleep has become more unstable, I wake up early, fall asleep again etc..
Again I have this feeling of just being 90% of normal happy. Also crying spells once a week or so when the feeling of-not-normal or depressed gets too much.
Is this type of setback typical when you stop taking a med like Lexapro - even when it has not been working very well / at all?
How long does it take for Lexapro to completely wash out of the system?
Should I go for more Nortrip or just "wait it out"?The blood screening of my Nortrip concentration has shown 292 (the therapeutic interval is 190 - 570), so there is room for a higher dose than my current 85 mg
I (and my PD) consider crying outburts and this 80-90% feeling symptoms of depression, dont know if this is correct.
Sorry for the rather long post.
Posted by bleauberry on March 4, 2009, at 18:11:46
In reply to Depressed from ADs - how likely is it?, posted by hansi555 on March 3, 2009, at 12:59:15
I've hunted deep through pubmed to find data on patients who get worse on ADs during trials. It is not mentioned hardly at all. Those people fell into the category of patients who dropped out of the trials and it is usually assumed that they dropped out because of intolerable side effects or lack of efficacy.
I did find a handful of studies that reported data on the patients who got worse or deteriorated from baseline after initiation of the drug. The general percentage varied from trial to trial ranging from a low of 5% to a high of 15%. As many as 15 people in 100 can deteriorate on ADs. An argument could be attempted that those patients coincidentally fell into a slump at the same time the med was started, except that they quickly returned to their previous baseline when the med was stopped.
Of curious note...in those clinical environments when patients deteriorated, they were quickly withdrawn from the offending drug. That is contrary to our own MDs who say to stick it out and give it more time. And then the patient is found dead of suicide. And then it is blamed on the disease and not the med. Never mind the patient wasn't suicidal before the med. Ya know? Weird. Sorry, off topic.
I've seen many people, hundreds at least, at pbabble get worse on meds than before they started. All kinds of meds, not just ADs. Just because a med is assumed to make someone feel better doesn't mean it will. Statistics do not support that they will. It is nearly a 50/50 bet at best.
I speak from personal experience too. Wellbutrin was the worst torture of all, felt like I was already in a coffin it was so dark. Lexapro had me on my knees crying and weeping in despair when I had been nowhere close to being like that before. And others, but I don't want to relive that here.
And we must not downplay the blackbox suicide warning on med labels. Even if most people don't get suicidal, I think it is logical enough to read between the lines at what is implied...some people will feel bad.
It is pretty simple actually. If you are on a med that is making things worse, get off it (with respectful weaning). Then do one or all of these three things: 1)Re-assess the diagnosis; 2)Try something else; 3)See another doctor for a second opinion.
This is the end of the thread.
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