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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by juanantoniod on July 16, 2007, at 0:36:03
Hello fellow Babblers,
I have a question for you all. I have gotten my depression under control thanks to VNS Therapy, and a couple of ADs, so this is about my partner. Although I should know the answer to this question, it has been so long that I cannot remember what I need to know.
He is currently experiencing a major depressive episode. He does not want to see “another [additional] doctor”, so our PCP is treating him, rather than my PDOC. The PCP tried him on Effexor XR, but he experiences a lot of somnolence on this medication. He has been on it for one month. It was working, and he thought he would become accustomed to the drug, so he did not want to DC it. However, the sleepiness persists and we must consider other options. I would like your recommendation of another AD to try that either has an activating effect, or at least, does not tend to cause somnolence. (Or weight gain!) This way I can go in to the PCP next time with a couple of “ideas” for “him” to consider prescribing.
His depression has an anxiety component, so he has been on Paxil in the past, and responded initially, but stopped taking it because it stopped working effectively. Wellbutrin is also out of the question because that is *too* stimulating.
Any ideas or suggestions? Your thoughts and comments are most appreciated.
Thanks for your help!
Antonio
Posted by shasling on July 16, 2007, at 6:26:34
In reply to Need recommendations of activating ADs, posted by juanantoniod on July 16, 2007, at 0:36:03
Cymbalta is activating for me, though if has an anxiety component he'd want to watch closely for problems with that. It does not cause me any amnxiety, rather makes me pro-social and kinda content feeling, but then I did not have anxiety to begin with.
Good luck,
Suzie
Posted by lymom3 on July 16, 2007, at 8:26:34
In reply to Re: Need recommendations of activating ADs, posted by shasling on July 16, 2007, at 6:26:34
Prozac? Emsam?
Posted by Phillipa on July 16, 2007, at 10:14:46
In reply to Re: Need recommendations of activating ADs, posted by lymom3 on July 16, 2007, at 8:26:34
Prozac or EMSAM are both activing but since I have severe anxiety most of them are for me. Good luck. Love Phillipa
Posted by spriggy on July 17, 2007, at 14:39:23
In reply to Re: Need recommendations of activating ADs, posted by Phillipa on July 16, 2007, at 10:14:46
From all I have read, Prozac tends to be the most activating SSRI for most people; followed by Zoloft (which I am on and at times in the day, can feel a bit of that- other times in the day I feel like a zombie).
Anyway, if an SSRI is what he needs, I'd say Prozac.
Also, my mother is on Effexor ( and has both depression and severe anxiety). It did take her about 8-10 weeks to really feel her energy return. Now she has more energy than ever so maybe he should give it another 2-4 weeks just in case?
I hope it gets worked out.
Posted by Oppycat on July 19, 2007, at 11:58:07
In reply to Need recommendations of activating ADs, posted by juanantoniod on July 16, 2007, at 0:36:03
> Hello fellow Babblers,
>
> I have a question for you all. I have gotten my depression under control thanks to VNS Therapy, and a couple of ADs, so this is about my partner. Although I should know the answer to this question, it has been so long that I cannot remember what I need to know.
>
> He is currently experiencing a major depressive episode. He does not want to see “another [additional] doctor”, so our PCP is treating him, rather than my PDOC. The PCP tried him on Effexor XR, but he experiences a lot of somnolence on this medication. He has been on it for one month. It was working, and he thought he would become accustomed to the drug, so he did not want to DC it. However, the sleepiness persists and we must consider other options. I would like your recommendation of another AD to try that either has an activating effect, or at least, does not tend to cause somnolence. (Or weight gain!) This way I can go in to the PCP next time with a couple of “ideas” for “him” to consider prescribing.
>
> His depression has an anxiety component, so he has been on Paxil in the past, and responded initially, but stopped taking it because it stopped working effectively. Wellbutrin is also out of the question because that is *too* stimulating.
>
> Any ideas or suggestions? Your thoughts and comments are most appreciated.
>
> Thanks for your help!
>
> Antonio
I've never taken Prozac so I can't comment on that. I recommend Parnate because it's activating and most people know if will help them within a couple of days. If he tries Parnate and it doesn't work, he can move to Prozac in 2 weeks at the longest. If he tries Prozac first and doesn't respond, he will have to wait 5 weeks before he can take Parnate.Another possible solution is try another AD and supplement it with a stimulant or Provigil to get rid of the daytime somnolence. I use Adderall with Remeron currently, and have used it with Parnate and other AD's in the past. I suppose one could also add it Effexor
Posted by juanantoniod on July 19, 2007, at 16:04:24
In reply to Re: Need recommendations of activating ADs » juanantoniod, posted by Oppycat on July 19, 2007, at 11:58:07
First, thanks to all of you for recommending the Prozac. That sounds like a good option. However, I think he would like to try increasing the dosage of the Effexor, and adding a stimulant, as also suggested, rather than switching medications, although we will do that if it is necessary.
Can you please tell me what would be the next dosage up after 75mg/daily, and what the maximum daily dosage is of Effexor XR?
Take good care everyone,
Antonio
Posted by spriggy on July 20, 2007, at 16:01:13
In reply to Re: Need recommendations of activating ADs, posted by juanantoniod on July 19, 2007, at 16:04:24
The next dosage would likely be to take another 75 mg's per day.
My mom is on it and that was her how progression went.
She got up to 300 mg's a day at one point.
This is the end of the thread.
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