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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 elbe on June 1, 2008, at 8:13:11
Help! I am a 51 year old woman and have been fighting depression for 20 years (that I know of) I was on Wellbutrin for years, but it supposidly took a toll on the adrenals. (PDoc had prescribed various SSRI's prior to the Wellbutrin) but they did not agree with me. Now I am suffering terribly again and am taking small dose of ativan at night for anxiety, but need an antidepressant. OD prescribed Lexapro, Zoloft - both in mini doses because I respond intensely. With each I only took it once and only took 1/2 of the lowest dosage available and was out of my mind for 3 days - awful depression!!!! I have also previously tried Celexa and others - all SSRIs?? What can I do? OD has let it go - doesn't have any suggestions. I have read threads and blogs and websites. Investigated 5HTP - but it seems that is the same type of drug, though herbal, as Lexapros and those. Everyone raves about those drugs - what's wrong with me?
Posted by bleauberry on June 1, 2008, at 19:28:24
In reply to Is there a good non SSRI AD - Rx, herbal, anything, posted by elbe on June 1, 2008, at 8:13:11
If you did well on wellbutrin, it should be possible to return to it to see if it works again. If it does, you would need a prescript for hydrocortisone to take the strain off the adrenals. 5mg to 20mg per day are physiological replacement doses for weak adrenals. They are not the risky high doses used for other conditions. Though this was fairly new a few years ago, there is a growing body of medical evidence supporting it. There are hundreds of people on low cortisol right now for hypoadrenalism, which is what it is for. If your doctor hesitates on the idea, he/she is not up to speed. Most integrative doctors do this routinely.
That said, sometimes a drug that once worked won't work again the second time. No way to know without trying.
There are plenty of options. Your doctor seems rather limited if the ssris and wellbutrin make up the universe of drugs at his/her disposal.
Here are some:
Modafinil
Nortriptyline
Desipramine
Overseas mailorder Milnacipran
Stimulants (Ritalin, Adderall)
Deprenyl
EnsamNaturals:
DL-phenylalanine
Tyrosine
(you are correct, 5htp is a lot like the ssris)
St Johns Wort is possible. Similar to ssris, but quite different also. Try a miniscule dose to test (75mg-150mg). A bad reaction should show up within hours and be gone in a day.And you are wrong on one count...that is, not everyone raves about the ssris. There are plenty of people just like you and me who get much worse on them very fast even at tiny doses. It means our mood disorders are probably related to a different neurotransmitter, not serotonin.
I am as sensitive as you are and I react the same way. I even did super bad with wellbutrin recently. There is one drug that has shown to be more effective than most, and amazingly I can tolerate it and it actually helps pretty fast even at tiny doses. (Milnacipran)
> Help! I am a 51 year old woman and have been fighting depression for 20 years (that I know of) I was on Wellbutrin for years, but it supposidly took a toll on the adrenals. (PDoc had prescribed various SSRI's prior to the Wellbutrin) but they did not agree with me. Now I am suffering terribly again and am taking small dose of ativan at night for anxiety, but need an antidepressant. OD prescribed Lexapro, Zoloft - both in mini doses because I respond intensely. With each I only took it once and only took 1/2 of the lowest dosage available and was out of my mind for 3 days - awful depression!!!! I have also previously tried Celexa and others - all SSRIs?? What can I do? OD has let it go - doesn't have any suggestions. I have read threads and blogs and websites. Investigated 5HTP - but it seems that is the same type of drug, though herbal, as Lexapros and those. Everyone raves about those drugs - what's wrong with me?
>
>
Posted by blueboy on June 2, 2008, at 11:19:40
In reply to Is there a good non SSRI AD - Rx, herbal, anything, posted by elbe on June 1, 2008, at 8:13:11
> Help! I am a 51 year old woman and have been fighting depression for 20 years (that I know of) I was on Wellbutrin for years, but it supposidly took a toll on the adrenals. (PDoc had prescribed various SSRI's prior to the Wellbutrin) but they did not agree with me. Now I am suffering terribly again and am taking small dose of ativan at night for anxiety, but need an antidepressant. OD prescribed Lexapro, Zoloft - both in mini doses because I respond intensely. With each I only took it once and only took 1/2 of the lowest dosage available and was out of my mind for 3 days - awful depression!!!! I have also previously tried Celexa and others - all SSRIs?? What can I do? OD has let it go - doesn't have any suggestions. I have read threads and blogs and websites. Investigated 5HTP - but it seems that is the same type of drug, though herbal, as Lexapros and those. Everyone raves about those drugs - what's wrong with me?
>
>The last thing first, i.e. "what's wrong with me?" Don't make the mistake I did. I sought help for depression for decades. Finally, two weeks ago, I forked over $400 for a very smart specialist who, aside from research, only does diagnosis.
He diagnosed me as definitely Bipolar II. Neither I nor any of the psychiatrists I have seen had even considered this. But in retrospect, it seems patently correct.
So, my first suggestion is to get a definitive diagnosis of exactly what condition is causing your problem. Spend the money for a really good clinic/research facility.
In my case, all the SSRI's and tricyclics and everything else I had been prescribed were not appropriate for my condition.
Second (assuming you have some sort of unipolar major depression) there are several groups of drugs other than SSRI's that have been used successfully to treat the condition. Tricyclics and MAOI's are the major ones that I know about.
St. John's Wort seemed, subjectively to me, to be similar to Prozac but milder (and less effective).
Posted by elbe on June 2, 2008, at 18:04:15
In reply to Re: Is there a good non SSRI AD - Rx, herbal, anything, posted by bleauberry on June 1, 2008, at 19:28:24
> If you did well on wellbutrin, it should be possible to return to it to see if it works again. If it does, you would need a prescript for hydrocortisone to take the strain off the adrenals. 5mg to 20mg per day are physiological replacement doses for weak adrenals. They are not the risky high doses used for other conditions. Though this was fairly new a few years ago, there is a growing body of medical evidence supporting it. There are hundreds of people on low cortisol right now for hypoadrenalism, which is what it is for. If your doctor hesitates on the idea, he/she is not up to speed. Most integrative doctors do this routinely.
>
> That said, sometimes a drug that once worked won't work again the second time. No way to know without trying.
>
> There are plenty of options. Your doctor seems rather limited if the ssris and wellbutrin make up the universe of drugs at his/her disposal.
>
> Here are some:
> Modafinil
> Nortriptyline
> Desipramine
> Overseas mailorder Milnacipran
> Stimulants (Ritalin, Adderall)
> Deprenyl
> Ensam
>
> Naturals:
> DL-phenylalanine
> Tyrosine
> (you are correct, 5htp is a lot like the ssris)
> St Johns Wort is possible. Similar to ssris, but quite different also. Try a miniscule dose to test (75mg-150mg). A bad reaction should show up within hours and be gone in a day.
>
> And you are wrong on one count...that is, not everyone raves about the ssris. There are plenty of people just like you and me who get much worse on them very fast even at tiny doses. It means our mood disorders are probably related to a different neurotransmitter, not serotonin.
>
> I am as sensitive as you are and I react the same way. I even did super bad with wellbutrin recently. There is one drug that has shown to be more effective than most, and amazingly I can tolerate it and it actually helps pretty fast even at tiny doses. (Milnacipran)
>
>
>
> > Help! I am a 51 year old woman and have been fighting depression for 20 years (that I know of) I was on Wellbutrin for years, but it supposidly took a toll on the adrenals. (PDoc had prescribed various SSRI's prior to the Wellbutrin) but they did not agree with me. Now I am suffering terribly again and am taking small dose of ativan at night for anxiety, but need an antidepressant. OD prescribed Lexapro, Zoloft - both in mini doses because I respond intensely. With each I only took it once and only took 1/2 of the lowest dosage available and was out of my mind for 3 days - awful depression!!!! I have also previously tried Celexa and others - all SSRIs?? What can I do? OD has let it go - doesn't have any suggestions. I have read threads and blogs and websites. Investigated 5HTP - but it seems that is the same type of drug, though herbal, as Lexapros and those. Everyone raves about those drugs - what's wrong with me?
> >
> >
>
>
Thanks for the info - very informative. What a relief to know I'm not at a dead end!
Posted by elbe on June 2, 2008, at 18:08:42
In reply to Re: Is there a good non SSRI AD - Rx, herbal, anyt, posted by blueboy on June 2, 2008, at 11:19:40
> > Help! I am a 51 year old woman and have been fighting depression for 20 years (that I know of) I was on Wellbutrin for years, but it supposidly took a toll on the adrenals. (PDoc had prescribed various SSRI's prior to the Wellbutrin) but they did not agree with me. Now I am suffering terribly again and am taking small dose of ativan at night for anxiety, but need an antidepressant. OD prescribed Lexapro, Zoloft - both in mini doses because I respond intensely. With each I only took it once and only took 1/2 of the lowest dosage available and was out of my mind for 3 days - awful depression!!!! I have also previously tried Celexa and others - all SSRIs?? What can I do? OD has let it go - doesn't have any suggestions. I have read threads and blogs and websites. Investigated 5HTP - but it seems that is the same type of drug, though herbal, as Lexapros and those. Everyone raves about those drugs - what's wrong with me?
> >
> >
>
> The last thing first, i.e. "what's wrong with me?" Don't make the mistake I did. I sought help for depression for decades. Finally, two weeks ago, I forked over $400 for a very smart specialist who, aside from research, only does diagnosis.
>
> He diagnosed me as definitely Bipolar II. Neither I nor any of the psychiatrists I have seen had even considered this. But in retrospect, it seems patently correct.
>
> So, my first suggestion is to get a definitive diagnosis of exactly what condition is causing your problem. Spend the money for a really good clinic/research facility.
>
> In my case, all the SSRI's and tricyclics and everything else I had been prescribed were not appropriate for my condition.
>
> Second (assuming you have some sort of unipolar major depression) there are several groups of drugs other than SSRI's that have been used successfully to treat the condition. Tricyclics and MAOI's are the major ones that I know about.
>
> St. John's Wort seemed, subjectively to me, to be similar to Prozac but milder (and less effective).
>Thank you! I do not want to have to go for years more - now that I know from the great feedback - I will be more optimistic that I can get good help.
Posted by Molybdenum on June 2, 2008, at 21:54:45
In reply to Is there a good non SSRI AD - Rx, herbal, anything, posted by elbe on June 1, 2008, at 8:13:11
Hi elbe,
sorry to hear about your pain. Depression is a horrid state indeed.
I have a few offerings:
1. As the anti-depressants take some weeks or months to have the intended effect, might it not be possible for you to have another try at them and at the same time, seek some sort of supportive & temporary drug treatment to address the unpleasant start-up feelings? I just know that I dismissed many ADs within the first 2 weeks because I did not see results. I'm sure that they probably would have helped me if I'd known what I know now & had some help with the side-effects. So if you feel this approach might be worth reconsidering, try to find a doc or clinic that will give you a holistic approach, not just a script & a bill...!
2. As bleauberry said, there's so many other meds for you to try. I find modafinil very uplifting, albeit in a gentle way. I find the Ritalin too harsh but the modafinil is in an entirely different class of compounds. If you're in the US, I believe you must have a script to legally import one of the cheap generics from an online pharmacy. That's what I do (albeit I'm NOT in the US) and it works out at about 1/5 the "name brand". MSG me if you want to know my experience with such things.
3. I agree with blueboy too. Go to a different "family doc" or GP to find out where to get EXPERT diagnostic help. A scientific approach to working out which ADs to try and in what order based on your experiences can be of great help. Given the long lag-time for these drugs to have the desired effect, you could easily waste years on the wrong treatment - while still suffering of course. So go find yourself an expert..! A good family doc will know who is a respected expert in the field.
Take Care & let us know how you're doing.
- Molybdenum.
Posted by Molybdenum on June 9, 2008, at 22:51:33
In reply to Is there a good non SSRI AD - Rx, herbal, anything, posted by elbe on June 1, 2008, at 8:13:11
Hey elbe,
another anti-depressant approach is the judicious use of opiates. I kid you not. In fact another babbler has been using them for acute pain & has noticed his depression lift too.
It's not mainstream because the opiates have been so commonly abused, but it depends what country you're in too.
If you're interested, here's an article: http://www.opioids.com/antidepressant/opiate.html that claims to be from the American Journal of Psychiatry.
Maybe print it out for your doc..??? Just say you'd like to "trial it". Might allay his/her fears a bit :)
Good Luck
M.
Posted by elbe on June 10, 2008, at 17:52:37
In reply to Re: Is there a good non SSRI AD - Rx, herbal, anything » elbe, posted by Molybdenum on June 2, 2008, at 21:54:45
> Hi elbe,
>
> sorry to hear about your pain. Depression is a horrid state indeed.
>
> I have a few offerings:
>
> 1. As the anti-depressants take some weeks or months to have the intended effect, might it not be possible for you to have another try at them and at the same time, seek some sort of supportive & temporary drug treatment to address the unpleasant start-up feelings? I just know that I dismissed many ADs within the first 2 weeks because I did not see results. I'm sure that they probably would have helped me if I'd known what I know now & had some help with the side-effects. So if you feel this approach might be worth reconsidering, try to find a doc or clinic that will give you a holistic approach, not just a script & a bill...!
>
> 2. As bleauberry said, there's so many other meds for you to try. I find modafinil very uplifting, albeit in a gentle way. I find the Ritalin too harsh but the modafinil is in an entirely different class of compounds. If you're in the US, I believe you must have a script to legally import one of the cheap generics from an online pharmacy. That's what I do (albeit I'm NOT in the US) and it works out at about 1/5 the "name brand". MSG me if you want to know my experience with such things.
>
> 3. I agree with blueboy too. Go to a different "family doc" or GP to find out where to get EXPERT diagnostic help. A scientific approach to working out which ADs to try and in what order based on your experiences can be of great help. Given the long lag-time for these drugs to have the desired effect, you could easily waste years on the wrong treatment - while still suffering of course. So go find yourself an expert..! A good family doc will know who is a respected expert in the field.
>
> Take Care & let us know how you're doing.
>
> - Molybdenum.Molybdenum,
Thanks for both of your responses. The SRI reaction was suicidal depression for 3 days following one, 1/4 tab dose of the lowest dosage of the Lexapro and the week before 1/2 tab of lowest dosage Zoloft (not suicidal, but definitely seriously worsened depression for 2 or 3 days) - unbelievable! I don't know that I could manage the severity of the emotional side effects until they "wore off". BUT, the alternatives you suggest sound interesting and definitely worthy of sharing with the Doc. He has been consulting with "an expert" and for now has put me back on Wellbutrin. We'll see - it's been 2 days and I know it's a while before effects kick in. I feel if I can stabalize then I will have a better frame of mind and not be so desperate and then seriously delve into some alternatives. So, thank you again as I will most definitely be referring back to you suggestions. I am in the US.
elbe
This is the end of the thread.
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