![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by ronser2000 on March 6, 2005, at 11:03:24
hello, i am 25 yr old male,i suffer with mild to moderate depression and GAD-i think its gad,when i am not on any medication i worry excessively about my health thinking i have cancer heart problems etc and worry about things like the nature of life and my inevitable death and these things real trouble me,one week i spent a lot of time worrying about the possiblility that an asteroid/meteorite could strike the earth at any time. my depression is mainly a low mood social withdrawal low self esteem negative thinking pessimism.
i have always been an anxious person with low self esteem but my problems really started when i was 19 and experimented with ecstacy in university,i suffered panic attacks a week after having a paranoid reaction to the ecstacy after initially feeling as good as i ever had for about an hour.
i have been treated with the following
paroxetine-improved mood and reduced anxiety but made me very tired during day and other side effects
effexor-made me feel terrible -didnt leave my home for months
fluoxetine-very good for mood and anxiety but brain fog and fatigue during the day means its not suitable as i want to start a career also it made me feel more depressed at times.
impramine-good for mood concentration and anxiety but also has side effects which makes it unsuitable for working
lexapro-made me feel bad-stopped after one month
reboxetine-made me feel
bad,tachycardia,constipation etc stopped after two weeks
cognitive therapy-had this for several months a few years ago.helped me banish panic attacks and helped with mood somewhat.given this info does anyone have any ideas of any medication that may help me? ssri's seem to improve my mood and reduce anxiety but they also give me brain fog fatigue during the day and sometimes make me feel more depressed during the day, imipramine was probably one of the best meds i've taken and i may go back to it,effexor and reboxetime were the worst.
any thoughs welcomed
regards
ron.
Posted by ed_uk on March 6, 2005, at 11:13:43
In reply to help me find the right medication!, posted by ronser2000 on March 6, 2005, at 11:03:24
Hi,
Please could you describe the side effects and benefits that you had from imipramine. Another tricyclic antidepressant might be suitable. What dose of imipramine did you take?
Also, what doses of paroxetine and fluoxetine did you try?
What side effects did you have from Effexor and Lexapro?
Ed.
Posted by ronser2000 on March 6, 2005, at 12:20:10
In reply to Re: help me find the right medication! » ronser2000, posted by ed_uk on March 6, 2005, at 11:13:43
imipramine 150mg a day
side effects-all usual tricyclic-blurred vision dizziness dry mouth
plus at times feeling of detachment from reality/depersonalisation
also daytime fatigue,trouble concentrating,spaced out at times
benefits- mood generally elevated happier motivated ,little negative thinkingparoxetine-highest dose 50mg a day
fluoxetine-80mg a day but best response at 20mg a day but still side effectslexapro failed to work within 4 weeks-headaches fatigue spaced out
effexor-similar to lexapro but worse,more depressed dizziness nausea,totally spaced out
Posted by ed_uk on March 6, 2005, at 12:39:53
In reply to Re: help me find the right medication!, posted by ronser2000 on March 6, 2005, at 12:20:10
Hi,
I think you would like desipramine for your depression, it is generally easier to tolerate than imipramine. It might not be adequate for your anxiety though.
>blurred vision dizziness dry mouth, daytime fatigue, trouble concentrating, spaced out at times.
These side effects are milder with desipramine compared to imipramine. Imipramine is probably more effective for anxiety though.
>paroxetine-highest dose 50mg a day
fluoxetine-80mg a day but best response at 20mg a day but still side effectsDid paroxetine work at a low dose eg. 10-20mg/day? Did you stay on the low dose for 2-3 months before increasing, to see if the low dose was adequate. People often have a lot more side effects at high doses. Higher doses aren't generally much more effective, unless you have obsessive-compulsive disorder in which case high doses are usually needed.
Since you did best on the lowest dose of fluoxetine, did you ever try a lower dose eg. 5-10mg/day? Why did you increase the dose if you were doing well at 20mg?
In one clinical trial of 5mg fluoxetine in depression, 5mg was effective. In fact, there was a trend towards patients given 5mg doing slightly better than those given 20mg. After 6 weeks, patients given 5mg did just as well as patients treated with 40mg!
Ed.
Posted by ronser2000 on March 6, 2005, at 12:53:41
In reply to Re: help me find the right medication!, posted by ed_uk on March 6, 2005, at 12:39:53
my former psychiatrist upped the dosage too quick on paroxetine so didnt stay at low dose for long, he also upped the dosage of fluoxetine too quick i ended up stoping it in 2000 but went back on low dose in 2003 and it worked well at that dose except for some side effects
Posted by ed_uk on March 6, 2005, at 13:15:43
In reply to Re: help me find the right medication!, posted by ronser2000 on March 6, 2005, at 12:53:41
Hi,
I think it's worth trying fluoxetine or paroxetine again, but at a lower dose. You could try 5mg fluoxetine or 10mg paroxetine. Don't increase to quickly- or you'll end up on an excessive dose with too many side effects.
If depression is your main problems at the moment, rather than anxiety, give desipramine a try.
Are you on any medication at the moment? Take care not to take anything which might interact.
Ed.
Posted by ed_uk on March 6, 2005, at 13:24:30
In reply to Re: help me find the right medication!, posted by ed_uk on March 6, 2005, at 13:15:43
Lol, if your pdoc doesn't believe that 5mg fluoxetine can ever be effective. Visit.....
http://medicines.mhra.gov.uk/ourwork/monitorsafequalmed/safetymessages/SSRIfinal.pdf
and go to Table 9.4 for the results of fluoxetine clinical trials.
They decided to make 20mg the official starting dose because there was more data on 20mg, even though 5mg appeared to be effective. I think it's worth a try.
Ed.
Posted by ronser2000 on March 7, 2005, at 9:31:29
In reply to Re: help me find the right medication!, posted by ed_uk on March 6, 2005, at 13:24:30
thanks ed,gonna try go without meds for a while(tried nortryptiline and reboxetine in the last two months and had to give up both within 2 weeks), gonna try st johns wort, exercise,more psychotherpy and getting a job to get structure in my life(havent worked in 5 yrs,graduated from university 2 yrs ago).if i dont feel good in 6 months i'll give 5mg dose fluoxetine or 100mg of imipramine.
i feel pretty alrite at moment -this usually happens when i stop an antidepressant but within a few months my thinking gets very negative again and i get low mood social withdrawl etc.
being agnostic i constantly worrying about ceasing to exist when i die(very disturbing).
its weird that i feel better during the day when off antidepressants but i have more anxious thoughts and dont feel like socialising and just feel apathethic all the time,no happiness but maybe my brain just needs time to return to normal after 5 yrs of antidepressants.
regards
ron
Posted by ed_uk on March 7, 2005, at 10:00:58
In reply to Re: help me find the right medication!, posted by ronser2000 on March 7, 2005, at 9:31:29
Hi,
Why did you give up on nortriptyline, what dose did you take?
>thanks ed,gonna try go without meds for a while
OK, best of luck. Some people say St John's Wort feels a bit like an SSRI!
All the best,
Ed.
Posted by ronser2000 on March 7, 2005, at 12:21:41
In reply to Re: help me find the right medication! » ronser2000, posted by ed_uk on March 7, 2005, at 10:00:58
was only on 20mg nortriptyline a day but i think there was some fluoxetine left in my system that reacted with it but i felt it didnt agree with my chemistry.
Posted by ixus on March 9, 2005, at 1:54:16
In reply to help me find the right medication!, posted by ronser2000 on March 6, 2005, at 11:03:24
> hello, i am 25 yr old male,i suffer with mild to moderate depression and GAD-i think its gad,when i am not on any medication i worry excessively about my health thinking i have cancer heart problems etc and worry about things like the nature of life and my inevitable death and these things real trouble me,one week i spent a lot of time worrying about the possiblility that an asteroid/meteorite could strike the earth at any time. my depression is mainly a low mood social withdrawal low self esteem negative thinking pessimism.
> i have always been an anxious person with low self esteem but my problems really started when i was 19 and experimented with ecstacy in university,i suffered panic attacks a week after having a paranoid reaction to the ecstacy after initially feeling as good as i ever had for about an hour.
> i have been treated with the following
> paroxetine-improved mood and reduced anxiety but made me very tired during day and other side effects
> effexor-made me feel terrible -didnt leave my home for months
> fluoxetine-very good for mood and anxiety but brain fog and fatigue during the day means its not suitable as i want to start a career also it made me feel more depressed at times.
> impramine-good for mood concentration and anxiety but also has side effects which makes it unsuitable for working
> lexapro-made me feel bad-stopped after one month
> reboxetine-made me feel
> bad,tachycardia,constipation etc stopped after two weeks
> cognitive therapy-had this for several months a few years ago.helped me banish panic attacks and helped with mood somewhat.
>
> given this info does anyone have any ideas of any medication that may help me? ssri's seem to improve my mood and reduce anxiety but they also give me brain fog fatigue during the day and sometimes make me feel more depressed during the day, imipramine was probably one of the best meds i've taken and i may go back to it,effexor and reboxetime were the worst.
> any thoughs welcomed
> regards
> ron.
Hi Ron,
I have also had relatively good response to fluoxetine. Nothing else worked, just worsened my conditions. It turned out that the only drugs working for me are MAOI. Now I am doing pretty well on tranylcypromine. It may be that phenelzine would be even better. Maybe this helps.
/ixus
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.