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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Atmlady on November 29, 2015, at 18:17:07
so I'm really depressed. After 5+ years on 60 mg Prozac and 450mg Wellbutrin (working ok the depression but causing sleep problems and sexual dysfunction, not to mention attention issues) I weaned off both (under dr's supervision) and started 6 mg Emsam patch a month ago.
This really sucks. I'm voraciously hungry, am sleepy all day, yet sleep at night is terrible, and just want to stab myself, and everyone else I see, in the eye, but I'm too tired to actually do so.
What next? I like my pdoc but feel like I need to do my research and give him suggestions. I don't want to go back to my old meds, since they weren't perfect, but what's the alternative?
Thanks for listening to my bitching, I know there's no magic med or solution, but if there's any hope I know you guys and gals are on top of it.
Posted by Hugh on November 30, 2015, at 18:14:39
In reply to EMSAM - meh. So what next?, posted by Atmlady on November 29, 2015, at 18:17:07
Have you considered trying ketamine? Intravenous ketamine and ketamine injections are very expensive, but Deahoidar recently posted that intranasal ketamine is helping him, and he's only paying $70 for a three-month supply.
http://www.dr-bob.org/babble/20150929/msgs/1083998.html
The muscle relaxant baclofen (I was taking it for muscle spasms in my lower back) eliminated my depression and anxiety, and increased my libido. Unfortunately, after I'd been on it a week, it started to cause terrible insomnia, so I discontinued it. I suspect the reason that baclofen elevated my mood so much and increased my libido is because it increases striatal dopamine levels. This is probably also why it started to cause insomnia. I'm extremely sensitive to stimulants. Being that you were able to tolerate Wellbutrin, you might be able to handle baclofen better than I did.
I found neurofeedback helpful, especially for anxiety and irritability.
A study was recently published showing that light therapy can be an effective treatment for nonseasonal depression. Here's a thread I started about it:
http://www.dr-bob.org/babble/alter/20150301/msgs/1084052.html
Posted by rjlockhart37 on November 30, 2015, at 20:33:43
In reply to EMSAM - meh. So what next?, posted by Atmlady on November 29, 2015, at 18:17:07
the main thing you could add are provigil, or deplin, there's also stablon you can order online along with adrafinil, just google those two things and put sale after and you can buy them online,
but i was on 60mg prozac and 300mg wellbutrin from 09-2010 it worked semi well "wellzac"
but if your hungry alot and sleepy, that could mean something in the blood system is not working right, thyproid or low blood sugar, even though depression causes you to feel slaggish, it could also have a psychical symptom with something in the blood stream not working right, ask to get test done to see if those are options to treat ....Provigil or Nuvigil is a kick starter in the morning, its not like adderall or dexedrine but it gets you awake, adderall makes you speedy and can cause imbalance after it wears off
but Ensam is seligine and is actually methamphetamine levo isomer, so it give a small effect of an amphtamine stimulant but not the active form, maybe ask about increasing it, and maybe moving to Parnate, or Marplan. Those are vary effective antidepressants that are used when others have failed, there kinda like the last resort but they are very effective
Posted by europerep on December 1, 2015, at 18:01:06
In reply to EMSAM - meh. So what next?, posted by Atmlady on November 29, 2015, at 18:17:07
Hi there...
I don't have a lot of time right now, but I just wanted to quickly reply with a few points.
First, Emsam 6mg is the lowest dose, right? If you've only been on it for a month, you might still notice improvement in the weeks to come.
But, more generally, I'd say that if an SSRI + bupropion worked for you, I personally would look for a solution closer to your previous combo. One option would be the new vortioxetine (Brintellix), if you have an insurance that covers it. If not, you could try one of the "regular" SSRIs, if necessary also with bupropion or maybe methylphenidate (if indicated, since you mentioned attention issues). Adding SAMe to SSRIs has also been shown to increase effectiveness. Venlafaxine may also be an option, but since you described sexual dysfunction on your previous combo, this may not be best option to go with right now.
That's what I can think of right now...
ER
Posted by former poster on December 2, 2015, at 8:24:27
In reply to Re: EMSAM - meh. So what next? » Atmlady, posted by europerep on December 1, 2015, at 18:01:06
Is it safe to add Sam-e to an SSRI?
Posted by Hugh on December 3, 2015, at 12:00:55
In reply to EMSAM - meh. So what next?, posted by Atmlady on November 29, 2015, at 18:17:07
Deep TMS penetrates 6 or 7 cm into the brain, compared to 1.5 cm with standard TMS. JohnLA wrote this detailed thread about his experiences with Deep TMS. His insurer covered the treatment.
Posted by europerep on December 3, 2015, at 15:52:28
In reply to Re: EMSAM - meh. So what next? » europerep, posted by former poster on December 2, 2015, at 8:24:27
> Is it safe to add Sam-e to an SSRI?
I'm not aware of it being not safe, but that doesn't necessarily mean anything.
There were one or two serious studies done just a few years ago (at Harvard I think) about adding SAMe to treatment-resistant patients on an SSRI, and it showed some statistically significant positive effect.
But I've been off SSRIs/SNRIs for a while now, so I'm not actively following augmentation strategies for those drugs, so it's always possible that something has changed in the meantime.
This is the end of the thread.
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