Posted by Ritch on February 8, 2002, at 10:09:20
In reply to prozac/general meds query, posted by kreedi on February 7, 2002, at 1:11:54
> I've been on and off Prozac (three or four times) since 1995. First time I took it for eight months or so; the next couple of times, only for a few months, discontinued after I felt better (largely because of the sexual side-effects). Haven't really tried any other drug -- though my psychopharmacologist in the States had me on, briefly, at different times, lithium, valproic acid, lamictal (the idea being, I guess, to prevent a manic episode, smooth out mood "irregularities"). Never more than a few weeks on any. I even tried Ritalin for a while. I guess I'm one of those people who has trouble sticking to any one thing, even medication.
>
> I started taking Prozac again recently -- third week now, first week 10mg, 20mg after that. But I still feel terrible; losing weight also (which makes me feel worse). No motivation to do the things I need to do. Self-esteem low. Hopelessness, bleakness.
>
> Not sure what to do. Sertraline (Zoloft) made me virtually impotent last year -- I took it for only ten days. Luckily, last January's (2001) episode lifted
> pretty quickly.
>
> Around July last year, felt the awfulness of depression returning. Wellbutrin for a couple of weeks, 150 mg SR, but lots of weight loss, insomnia. Then Remeron -- at 7.5 mg it made be unbearably groggy for a full 24 hours. I knew that a higher dose might not cause oversedation, but I was too scared to try -- what if 30mg meant I wouldn't wake up for three days?
>
> Now, I've been feeling depressed again for the last couple of months. And Prozac doesn't seem to be working yet.
>
> Also in long-term psychoanalysis -- over three years now. It helps me gain a lot of insight, and I've ceased a lot of self-destructine behavior because of it, but doesn't help through a depressive episode. I sometimes wonder, in fact, if the analysis is indirectly contributing to the greater frequency of depressive episodes, by making me confront a lot of my own crazy assumptions about life.
>
> My questions are: (1) Should I stick with the Prozac? Lower the dose to 10mg (lowering the dose seems to help some people, right?) or increase to 30mg?
>
> (2) Should I/Can I combine Wellbutrin and Remeron? Do they work well together for depression? And, as for the side-effects, will the weight-loss and insomnia that bupropion causes "cancel out" the sedation and weight gain that mirtazapine causes?
>
> (3) Try the tricyclics or even MAOIs? Mood stabilizers? (Some of the newer drugs aren't available where I live yet.)
>
> (4) ANY feedback welcome.
>
> Thanks, K.
Kreedi,I need to combine low-dose SSRI with either a TCA, Wellbutrin, or a pstim to get a proper antidepressant response. You might try dropping the Prozac down to 10mg (reduce the SSRI tiredness) and adding on some nortiptyline or desipramine (TCA), Wellbutrin, or a low-dose pstim. If you add on a TCA (esp.), you will have to wait out 2 full weeks before much of anything will happen, though.
Mitch
poster:Ritch
thread:93157
URL: http://www.dr-bob.org/babble/20020208/msgs/93303.html