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which antidepressant should I try next?


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I'm not 100% sure I should ditch Lexapro, because it partially works, but I've been on the maximum dose for months now so I'm pretty sure I know the maximum benefit I can get from it. Lexapro is my first antidepressant. And I have tried adjuncting as much as 300mg of Wellbutrin which I stopped many months ago because I could not tell if it provided any benefit (it didn't seem to do harm either).

So, here are my symptoms: hypersomnia, appetite loss, feel old and creaky, feel scatterbrained/out of it/not like myself, feel like I'm getting the flu, free-floating anxiety (sometimes), don't want to do anything, social anxiety ramped up, suicidal thoughts and hopelessness/helplessness (sometimes), constant worrying about the future, frequent mood shifts.

When Lexapro was working it's best, here's how I felt: at peace with myself and the world, no unusual anxiety problems. Just blissfully normal as far as I know.

Here are the side effects I experience with Lexapro that I would like to avoid in my next med if possible: hypersomnia, dead libido.

I have the feeling I should try another SSRI next. I just have a good feeling about it. Zoloft in particular. Not totally sure why.

What do you think? (of course I know it's up to my doctor, I just want to get people's opinions)

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the only ones i've tried are lexapro and paxil. both only gave me loss of orgasminc ability (not loss of interest- it was cruel that way ;) ), so i'm not sure if there is an SSRI that will get you by without sexual side effects. they're so normal with that class of drugs. it is like the benefits outweighing the negatives kind of thing.

i really love what paxil did for me, except that i couldn't have orgasms for the first several months, and then it took a lot of work after that. that's one of the reasons i don't take it anymore- because wellbutrin does work for me.

it sounds like you do need an SSRI. perhaps zoloft would be a good choice. i'm not suer which ones have a reputation for a lower risk of side effects thant he others.

sorry i can't be of more help!

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I have double depression, too, and I was on lexapro for a while until it pooped out on me. prozac is doing good things for me now, I really like it. (it and the ativan I take for anxiety work really well for me.) I don't know much about the libido thing, because I don't have sex, but it's good for moods. I think prozac is also considered one of the better SSRIs for dealing with anxiety, so it might help with that, too.

a lot of times the SSRIs alone don't really help anxiety, though. they never have for me. so if anxiety is becoming a real problem you might also consider a benzo to take as needed. they're wonderful. ;)

but, yeah. prozac. :)

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zoloft is nice among the ssri's in the sense that it does have a slight dopamine affinity (i'm not sure how much, i've been meaning to start a thread asking that question on this board) maybe its a placebo effect, but for me it was the one ssri i've tried the past half year that does not make me feel numb, and surrounded by that serotonin feeling the second i started taking it. it actually seemed to lift me above the first rung of depression when i took 50 mg this summer. but as i tried to go up to 75 mg, my mood kinda went in funny directions. i would get set off on angry and dysphoric episodes some days - but i'm pretty sure that's because i combined it with caffeine. my mom takes zoloft and can down ice tea after ice tea, but for some reason (especially above 50 mg) it did not play nice with caffeine. which is pretty much the only reason i'm not taking it right now. or i'm considering taking it, but haven't started it yet. i think that may just be a personal thing. i don't think it will completely erase your sexual side effects - but i think it is a little apart from the rest of the ssri's in having some affinity for dopamine (read: you won't be completely numb?)

i don't know, i say go for it if lexapro has stopped working for you, but that's only persons opinion. i'm actually thinking of trying celexa instead of zoloft, cause i don't want to mess with the wacky coffee/dopamine interaction that seems affect me when i'm taking zoloft. i know that's probably a stupid reason, i could give up coffee and force myself to be disciplined and take zoloft - but i'm not that kinda person. i like my dopamine to win out over serotonin, screw peace of mind.

edited to add: oh yeah (i was reminded of this by checking out your other thread) make sure to check out to see if you're hypothyroid or not. getting your TSH, free T4 and T3 levels would not be a bad idea, because it sounds like you've got some of the symptoms of hypothyroidism. at least as far as the 'feeling old and creaky' part goes. how long have you been feeling sub-par [all the symptoms you mentioned] lexapro?

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SSRIs *do* help my anxiety, at least Lexapro does. Might be related to the type of anxiety. Mine is mainly anticipatory/ruminating/free floating.

Prozac--I'm a little scared of it. I took a few pills of it at a time when I was experiencing severe anxiety and insomnia and let's just say probably not the best time to be starting Prozac. I could swear I felt this chemical-y feeling throughout my body and my anxiety and insomnia became even worse, reaching panic levels. Of course, a lot of my anxiety at the time centered around the "meaning" of bodily sensations and phobia of drugs. Now that I am a semi-rational human being again I would try it.

What do you mean you don't have sex so your libido doesn't matter, vunja? There is a little thing that starts with m... But if I wasn't in a relationship I wouldn't give a crap about my libido either. Not only does it take away the desire, it takes away the desire to have desire...

It is the "atypical" aspect of Zoloft that is intriguing to me. Do you need caffeine for energy, s_p? Cuz it sounds like Z is good for you. Dude, peace of mind is seriously rad! You should give it a try, hehe. You could also try less caffeine maybe? I know that when I have too much I become *very* anxious. Anything more than a cup of coffee is seriously pushing it for me. A mocha, I start getting paranoid.

I was pretty obsessed with proving I was hypothyroid for a while there last year. But my doctors just weren't buying it. I even had them test the Free T4 and Free T3 like you said. I pulled out all the stops. My aunt is hypothyroid and her daughter has type 1 diabetes so maybe there's some autoimmune thing that runs in the family. And my antibodies were off-the-charts high. Apparently that doesn't mean anything though? I just gave up. If I am hypothyroid, it is a very subtle form.

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I'm BP2 and am very prone to AD's making me hypomanic. The only AD that has not only worked wonders for me, but doesn't have the hypo se's is 20 mg. of Prozac. Of course I also take 300 mg. Lamictal, 1.5 mg. of klonopin, 275 mg. of Seroquel. It seems to have been a good combo for me for months now. YMMV.

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Prozac--I'm a little scared of it. I took a few pills of it at a time when I was experiencing severe anxiety and insomnia and let's just say probably not the best time to be starting Prozac. I could swear I felt this chemical-y feeling throughout my body and my anxiety and insomnia became even worse, reaching panic levels. Of course, a lot of my anxiety at the time centered around the "meaning" of bodily sensations and phobia of drugs. Now that I am a semi-rational human being again I would try it.

What do you mean you don't have sex so your libido doesn't matter, vunja? There is a little thing that starts with m... But if I wasn't in a relationship I wouldn't give a crap about my libido either. Not only does it take away the desire, it takes away the desire to have desire...

mm, yeah. if it's been a while since you last tried it, though, maybe you could try it again, especially if you're overall more stable than you were. I swore off SSRIs a few months before I started prozac, but I'm glad someone convinced me to give them one last chance.

;) libido... haha, well... I might have some, but. I dunno. I'm very young and naive, don't know a lot about sex and stuff, so I'm really not much help there.

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yeah, i think i need caffeine for energy - but its probably more of a psychological addiction. its the only thing that brings me up in the morning, but i think it's the expectation that it will give my mood a boost that makes me so reluctant to give it up (and keep in mind i don't drink that much caffeine at all at begin with, like one cup in the morning, and maybe a soda or iced tea in the afternoon. maybe i should be drinking more ;) .) i just reached a point the past couple of days where i realized i can't go on much further without any kind of AD though. so the past two days i've taken my zoloft in the morning, and used all my willpower to stay away from caffeine. its still my suspicion that zoloft having a slight affinity for dopamine (and i don't even have confirmation on this, i just remembered it being mentioned on here a couple times) amplifies caffeines effect, and makes my brain go haywire. i still don't really know for sure though. and everybody's different apparently, i only had one person respond saying they couldn't drink caffeine on zoloft either when i posted it about it a couple of months ago.

i had a simliar thing happen with prozac last year. i started taking it last summer and for the first week or two i felt great. then i kind of slid into the SSRI start up funk, but by the eighth week - when i briefly flirted with going up to 40 mg - i felt real agitated and restless for a week until i finally just had to quit it. don't know what that was, but my pdoc said prozac was a pretty 'dirty' drug as far as the ssri's go anyway, because it also effects norepinephrine slightly, and maybe some other things. i'm really sensitive to an ssri's effects on other neurotransmitters

apparently.

i hope all this doesn't scare you away from trying any other ssri. i just tend to blather on about any topic if given the chance. which antibodies of yours were high when you tested btw? i don't really know anything about autoimmune hypothyroidism ( i believe its called hashimoto's disease, but there are probably other kinds too) but i would save all your lab work in any event. that's what i've gotten in the habit of doing. i have a nice and thick folder of my blood tests over the past two years. it definitely helps me keep track of things, and its useful for reference. it doesn't sound like hypothyroidism is your primary issue right now, but if you still feel sluggish then i wouldn't let it drop entirely either. endo's and other docs seem really conservative in what they consider 'hypothyroidism' and how aggressively they treat it, so sometimes you need to force the issue with them.

anyways i'll stop giving you unsolicited advice and general whining. good luck with whatever you try.

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I have the hypomania problem with AD's. They send me up for a while but then I end up more depressed than ever. Zoloft definitely did that to me, as well as I gained 30lbs in about a month. I haven't tried Prozac - maybe I should. I've been thinking about Symbyax - it's supposed to be really good for bipolar depression.

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Hi HF -

I remember from some other recent post that you'd gone to a GP while looking for a pdoc, and they suggested re-starting the Wellbutrin. Are you having any luck with it yet? WB seems to help my hypersomnia - I can't take SSRIs because they just increase the sleeping and eliminate my libido and any chance of the big O. Hope you find something that suits you.

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Hey Catnapper, I think the WB is helping. That stuff kicks in FAST. I swear you can feel an effect on the first day! I'm not sure if it helps mood as much as other things like energy and motivation and such. But I'm about ready to jump ship (slowly) on Lexapro. I'm sick of my genitals being useless lumps of flesh and I'm sure my hubby is too. Of course I will have to get up to therapeutic dose on WB first.

To the bipolars who talked about SSRI-induced hypomania--did my description of "normal" sound like hypomania or something? Just curious.

Oh I'm sorry, vunja, I didn't realize you were so young. I wouldn't have badgered you about the sex stuff.

Scream_phoenix, I hope you give the Zoloft a fair shot. Have you asked your doctors about what else you could do to give yourself more energy? If it works I would definitely choose it over the caffeine. BTW, I don't remember what the antibodies were.

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Hey Catnapper, I think the WB is helping. That stuff kicks in FAST. I swear you can feel an effect on the first day! I'm not sure if it helps mood as much as other things like energy and motivation and such. But I'm about ready to jump ship (slowly) on Lexapro. I'm sick of my genitals being useless lumps of flesh and I'm sure my hubby is too. Of course I will have to get up to therapeutic dose on WB first.

To the bipolars who talked about SSRI-induced hypomania--did my description of "normal" sound like hypomania or something? Just curious.

Oh I'm sorry, vunja, I didn't realize you were so young. I wouldn't have badgered you about the sex stuff.

Scream_phoenix, I hope you give the Zoloft a fair shot. Have you asked your doctors about what else you could do to give yourself more energy? If it works I would definitely choose it over the caffeine. BTW, I don't remember what the antibodies were.

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