![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Robert35 on February 11, 2006, at 7:56:52
Hi forummembers,
Till now I have read posts on this board with much interest; this is my first post.
At this opportunity I thank Dr. Bob and others helping him keeping up this site; it has been very informative to me !
I have been on different ad’s since 1992 (plus a short time in the 1980’s (to no avail)) and since I am a chronic pain patient as well I am now on prozac and tramadol; respectively 15 mg and 100 mg daily.
(I know about risks for serotonin syndrome btw but at least this combination I can stand and helps me to some extent and my above that doctors say it is ok to use this combo.)
In the past I have used luvox, paxil, prozac, zoloft (4 weeks), celexa (8 weeks), a snri (effexor), trazodon (Desyrel), Serzone, Remeron, two tca's (amytryptiline and one of the amytryptiline group (which name I should have to look up).Most of these I couldn’t stand; prozac, effexor and paxil I can tolerate though at a price: trouble concentrating on my job (I do a very simple job below my level), racing thoughts, tiredness, feeling “spacy” to the point of vertigo, difficulty learning, forgetfulness/bad memory (even watching movies) and in relationships trouble with sexuality.
I am sorry to be so outspoken about the sex issue: I don’t have much desire and have trouble climaxing.
Last week my paindoctor suggested other options for prozac: surmontil and anafranil (clomipramine).
He gave me a prescription for the latter; I should use this together with the tramadol.
Reading posts of many of you nortriptilene and lamictal (and St. Johnswort (of a dependable brand)) came up to my mind as well.
I suggested buprenorphine to him once but he doesn’t think it will improve me; he is afraid of the dizziness (and maybe afraid of opioids I don’t know).
Desipramine isn’t available anymore in the country where I live (the Netherlands).
To combat the sideeffects of ssri’s I have tried gingko biloba but that didn’t help with the libido .My question is: in comparison which ad would be recommendable ?
The last few years I have been at the point of stopping ad’s and tried that several times; putting through with this wasn’t possible.
Thank you in advance for any answers,
best to all of you,Robert35
Posted by SLS on February 11, 2006, at 9:46:54
In reply to First post/ which a.d ?, posted by Robert35 on February 11, 2006, at 7:56:52
Hi.
I think the most obvious alternative to what you have already tried is an MAOI. The two drugs that are most often chosen in the US are Parnate and Nardil. Both are known as being irreversible because once they disable the MAO enzyme, a new one must be synthesized to replace it. It will never function again once Parnate or Nardil adhere to it and disable it. One must adhere to a special diet that avoids a protein substance known as tyramine, the ingestion of which can produce a hypertensive crisis. Tyramine is often found in protein foods that are aged or smoked.
If you are uneasy trying one of these irreversible drugs, you could do a quick trial of moclobemide at 600-900mg per day. It is an MAOI, but is reversible and has a short half-life. One can safely ingest up to 50mg of tyramine in a given meal. If you respond to this drug at all - even if only for a week - you can then justify going for the irreversible MAOIs like Parnate and Nardil. I am not a big fan of moclobemide. It does not have a success rate equal to a drug like Prozac, but many people do profit from it. Nevertheless, the drug is attractive because it acts quickly - usually within the first week - and produces few side effects. It is usually devoid sexual side effects.
Since pain is a consideration, you could try either venlafaxine or duloxetine. You might glean both an antidepressant effect and some degree of an antinociceptive (analgesic) effect. Both drugs have a higher success rate than Prozac. This is because they inhibit the reuptake of both serotonin and norepinephrine. This is a property they have in common with clomipramine.
- Scott
Posted by Racer on February 11, 2006, at 12:23:37
In reply to Re: First post/ which a.d ? » Robert35, posted by SLS on February 11, 2006, at 9:46:54
I'd say Scott might be on to something with duloxetine, Cymbalta, which is being marketed here in the US for pain, as well as depression. One benefit is that, since you say you've been able to tolerate Effexor, you may be more likely to tolerate Cymbalta, too. They're both SNRIs, although they are different drugs. (I know -- that's obvious, why bother saying it? Because a lot of people -- including doctors -- are calling Cymbalta "Effexor Jr," and that might make people think they're similar in their effects. They are and they aren't, so if Effexor didn't work, it's still worth trying Cymbalta. It sounds as though Effexor might have been somewhat effective for you, but had too many side effects? Cymbalta has a very different side effect profile. It might be just fine for you.)
Otherwise, I defer to Scott's greater knowledge and experience with these drugs. Although I will say that nortiptyline was pretty helpful for me, twenty some years ago.
Good luck.
Posted by Phillipa on February 11, 2006, at 22:31:42
In reply to Re: First post/ which a.d ?, posted by Racer on February 11, 2006, at 12:23:37
Yes cymbalta is good for peripheral neuropathy. But it also gets rid of other aches and pains. Unfortunately I couldn't tolerate it muscle twiching, sweating, feeling like my head would explode. Fondly, Phillipa
Posted by Robert35 on February 12, 2006, at 10:37:27
In reply to First post/ which a.d ?, posted by Robert35 on February 11, 2006, at 7:56:52
Hi Scott, Racer and Philippa,
Thank you for your replies; I really appreciate it !
I mentioned MAOI’s to my paindoc last week but he didn’t think it would be a good idea (even after me explaining to him that the list of “what not to eat” for each different MAOI has been revised some years ago).
(Maybe it has more to do with the fact that in the Netherlands physicians are really reluctant to prescribe them, although I have heard that some (hospitalized) people get them.)
He also doesn’t believe St. Johnswort is very effective at all (I could buy the German formulation “P160” of Lichtwer (the name of the company which sells it here)).Moclobemide I have tried after weaning off venlafaxine but it didn’t do much (although I was in very bad mental shape after discontinuing Effexor and was in big need for an a.d.).
Interesting that you mention duloxetine and venlafaxine (my paindoc suggested the second one as well); I still might try duloxetine (thanks … I didn’t even know about this newer a.d.).
The side effects of Effexor were bad for me (worse than fluoxetine) but duloxetine might be different like Racer says.Do you perhaps know how clomipramine compares to ssri’s/snri’s regarding side effects ?
(I know that I have a hard time coping with “soporific-making” medication like remeron, serzone and even citalopram.)
Philippa mentioned muscle twisting of duloxetine; I hope it wouldn’t be too bad for me (but “everyone is different” and prozac (which I use now) can also cause that) because the pain I have is unfortunately caused by muscle twiching.
(I have tried baclofen and neurontin for that; still tramadol was better).
Maybe I should have a try with the clomipramine and when not succesfull ask for duloxetine (or nortryptiline, trimipramine, or maybe even lamictal (still have to do some reading about this one)).
Have a nice sunday, best regards,Robert35
Posted by Emily Elizabeth on February 12, 2006, at 14:21:04
In reply to Re: First post/ which a.d ?, posted by Robert35 on February 12, 2006, at 10:37:27
Have you ever tried lithium? I don't know anything abt pain issues, but I do know that Li can be a good med for (unipolar) folks who don't respond adequately to other AD's. It has helped me lots.
Best,
EE
Posted by Phillipa on February 12, 2006, at 18:50:40
In reply to Re: First post/ which a.d ?, posted by Robert35 on February 12, 2006, at 10:37:27
Hey I'm been to the Netherlands twice. My second husband was from there. I met him in the US. The best guy I ever met. He was from Wessener[sp?}. And we traveled all over Europe. His mother, sister lived in Switzerland. Boy for those days. And I remember the little village little houses down the street from his neice can't remember the name of the town. Did also go to Amsterdam. And the town between the little village I ran on a beach to Wassener. So it wasn't far away horses on the beach too. His name was Robin Nauta do you know of him . I would love to find him again. Fondly, Phillipa
Posted by Robert35 on February 14, 2006, at 15:16:43
In reply to Re: First post/ which a.d ?, posted by Emily Elizabeth on February 12, 2006, at 14:21:04
Hi Emily,
Thanks for the suggestion!
One of my friends is on lithium since his teens (but he is bp and I am not) and I will ask what he thinks of it.
He said prozac (the other med he uses) was a big help for him.
A few weeks ago he said I should up the dose of prozac; I have done so in the past (using up to 2 tablets (much for me)) and I couldn't bear it.
I experience tiredness, apathy, loss of feeling and memory problems; that's really why I want a change.
Otoh I want to stay stable and hope I can find a good moment to start clomipramine (or else ... I am pondering and want to read and ask).
Have a nice day, best regards,Robert35
Posted by Dr. Bob on February 15, 2006, at 6:48:52
In reply to Re: First post/ which a.d ? » Robert35, posted by Phillipa on February 12, 2006, at 18:50:40
> Hey I'm been to the Netherlands twice...
Sorry to interrupt, but I'd like to redirect follow-ups regarding being to the Netherlands to Psycho-Babble Social. Here's a link:
http://www.dr-bob.org/babble/social/20060212/msgs/609725.html
Thanks,
Bob
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.