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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by randermin on February 24, 2007, at 22:31:26
hello, I am not currently on anything, but I definately need to get back on the drug boat... the problem is my symptoms conflict with eachother's treatment options..
I need something to curb my depression, which is paralyzing nowadays, but also to help me with some OCD-type problems that have persisted for years now.
Effexor seemed to work well for the latter problem, but it really snuffed out my emotions, I wasn't very "down", but not up either, more like I was trapped in a kind of numb middle state, completely disconnected from my emotional self. also I had insomnia and sexual side effects on it.
Lamictal is being considered now. otherwise, either emsam or wellbutrin are the other considerations, but I can't take anything until I'm finished with a trip I'm taking out of state.
are either emsam or welbutrin good for anxiety or ocd? I know they are probably both bad when it comes to insomnia, but does anyone have an experience that favors one over the other?
I like the idea of dopamine, because it won't be as emotionally blunting as an ssri, and wont cause sexual side effects, plus I really need help getting motivated, but I know insomnia can be a problem.
so out of these four: lamictal, emsam, wellbutrin, or tianeptine (least likely). does anyone have any thoughts? basically I need to avoid insomnia, and mania or anxiety more than anything else.
thanks very much for any help!
Posted by Crazy Horse on February 25, 2007, at 9:59:00
In reply to which drug? please help! (dep, ocd, insomnia), posted by randermin on February 24, 2007, at 22:31:26
> so out of these four: lamictal, emsam, wellbutrin, or tianeptine (least likely). does anyone have any thoughts? basically I need to avoid insomnia, and mania or anxiety more than anything else.
These don't seem to be very good choices for someone with OCD, anxiety and insomnia. Especially the EMSAM and the Wellbutrin, which are both activating and may increase all 3 of the above mentioned problems. I'm thinking you need something a little more sedating like Luvox or Anafrinil, both approved for OCD, and both AD's so they should also help your depression and anxiety. Also, adding a benzo, i.e., Klonopin, Zanax, or one of the others could also help a lot and definitely help with your insomnia problem. Other's will give more advice..good luck in finding the right med. for you.-Monte
Posted by randermin on February 25, 2007, at 12:32:14
In reply to Re: which drug? please help! (dep, ocd, insomnia) » randermin, posted by Crazy Horse on February 25, 2007, at 9:59:00
> These don't seem to be very good choices for someone with OCD, anxiety and insomnia. Especially the EMSAM and the Wellbutrin, which are both activating and may increase all 3 of the above mentioned problems. I'm thinking you need something a little more sedating like Luvox or Anafrinil, both approved for OCD, and both AD's so they should also help your depression and anxiety. Also, adding a benzo, i.e., Klonopin, Zanax, or one of the others could also help a lot and definitely help with your insomnia problem. Other's will give more advice..good luck in finding the right med. for you.
>
> -Monte
I think I might have over stated the ocd element. I haven't actually been diagnosed with ocd, but I do have atypical elements to my depression that manifest themselves sometimes in a very compulsive or obsessive way. possibly all of that could be boiled down to anxiety or -I hate to use all of these diagnostic terms- even some kind of fast switching mixed-manic behaviour. but atypical depression seemes the safest term to use. Luvox was suggested to me, but by a sleep doctor, but I didn't consider him to be very qualified. plus, I'm hesistant to take another ssri because effexor made me feel very numb. I thought of those dopamine drugs because I know that activating drugs actually help with add in a paradoxical way, and since I have some of that too (add), I thought that my atypical, unfocused symptoms could be helped in the same way, but I could have been drawing false connections there. I thought that maybe a dopamine enhancing drug would take care of my depression, especially the self doubting, non motivated aspect, and leave my emotional self intact. also, I had kind of a vague impression that wellbutrin was found to be okay with bipolar or "suspected" bipolar spectrum types like myself, and that emsam was actua;;y helpful with anxiety despite its activating qualities. of course I'm prety clueless about all of this. thanks
Posted by Phillipa on February 25, 2007, at 12:37:08
In reply to Re: which drug? please help! (dep, ocd, insomnia), posted by randermin on February 25, 2007, at 12:32:14
I don't think EMSAM is known for helping anxiety the opposite. Lamictal would be a mood stabalizer that is know to be good for bipolar and has some boosting powers for ad's. I agree with Monte on the benzo. I'm sure others more knowledgeable than me will have more answers good luck. Phillipa
Posted by psychobot5000 on March 1, 2007, at 0:30:18
In reply to Re: which drug? please help! (dep, ocd, insomnia), posted by randermin on February 25, 2007, at 12:32:14
>
> I think I might have over stated the ocd element. I haven't actually been diagnosed with ocd, but I do have atypical elements to my depression that manifest themselves sometimes in a very compulsive or obsessive way.
>...I hate to use all of these diagnostic terms...but atypical depression seemes the safest term to use.
>>
>>I have a mess of symptoms too--hard to decide how to describe myself sometimes--anxiety, atypical depression, OCD, insomnia...it's all an interrelated jumble for me, and hard to decide how to treat.
So, not that I'm an expert on theory or anything--because I'm not--but here's what I can suggest. I think CrazyHorse's suggestion of Anafranil is probably a good idea. You've tried the SSRI/Effexor class, if I remember right, and I think you're right to look for something else. Anafranil/clomipramine has a long track record for OCD, and is sometimes considered the -most effective- tricyclic for depression. That's saying something, too.
But I, personally, think you're ideas on seeking dopaminergic drugs are sensible--though it seems to me important to remember that all these meds have individual effects for everyone, and you'll likely have to find the one that's best for you. Trial and error.
It should be noted that, for atypical depression, MAO inhibitors are theoretically considered the proper treatments, based on some substantial evidence. So EMSAM would be the one to go for based on that.
So let's see: tianeptine, EMSAM, lamictal, wellbutrin...I've have experience with these. They're all effective drugs, except (probably) Lamictal. Lamictal has been pushed fairly hard by its manufacturer, but just recently a bunch of studies have come to light (seven studies) on its mood benefits, that did not show efficacy. So the new word on lamictal is that it's not very useful for mood disorders. It tends to make people feel rapidly better for a few days, then return to baseline (or worse), leaving a burden of side-effects.
As for tianeptine, it is the only medication that helps me substantially, without unacceptable side-effects (such as sleep problems). It helps modestly with my anxiety, OCD, and low mood, and some other people seem to have the same experienc. However, some others don't. And for some it troubles sleep.
Wellbutrin can be bad for anxiety, or it might help your mood a lot. ...It's really more of a noradrenergic drug, though, because it's dopaminergic effects are rather contradictory. ...It does have a short half-life, though, so some people get away with taking it early enough in the day that it doesn't bother their sleep. It seems a good drug to try, but I might go with others first, for your symptoms.
If you can afford EMSAM, or your insurance covers it, it seems to me that it might be the best choice. Some people find it bad for anxiety, and for some it seems to help, from what I hear. ...If you were willing to do the MAO inhibitor dietary restrictions, though, Nardil might have the best chance to be an effective drug. Like EMSAM, but possibly more powerful, and better for anxiety. It indirectly increases the anxiety-relieveing neurotransmitter GABA, as well as acting more powerfully on serotonin through MAO-a, so theoretically, it might be more powerful at relieving anxiety, OCD, and depression. Sleep could be a serious problem on EMSAM or Nardil, though.
Hope that helps some...others no doubt will know more.
P-bot
Posted by randermin on March 1, 2007, at 13:02:38
In reply to My take on this... » randermin, posted by psychobot5000 on March 1, 2007, at 0:30:18
thanks alot for your thoughts. I guess I can rule out wellbutrin now, I was really sensitive to the noradrenaline coming from effexor, so I'll just steer clear of that. Im sure my doc wonthave muchto say about tianeptine, but it sounds like it could help in theraputic way, since I still feel kind of mentally damaged from the effexor.
This is the end of the thread.
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