Med suggestions

[Ophelia12]

Hi all. *waves* I have GAD, OCD & Depression. I've just been seeing my pcp, but she's had to change my meds quite a lot due to not tolerating them (mostly ssri's) so I have an appointment with a psychiatrist on Monday. my doctor had recently switched me from Sertraline to a combo of Remeron & BusSpar. Since I'm seeing the psych very soon, I was just planning on waiting to see what she says.

My previous routine was Sertaline 25 mg, Xanax 0.25 mg prn, Temazepam 15 mg (for insomnia) . Also, anti-nausea meds from Sertraline side effects. The routine she just changed me to is supposed to be Remeron 15 mg, BusSpar 30 mg, Xanax prn still. I'm guessing I wouldn't need the Temazepam. A pharmacist also advised me to wait due to a drug interaction between Buspar and Remeron.

I'm looking for suggestions for possible meds/combos to discuss with the pdoc next week. I'm looking for something that will treat anxiety and depression (seperate meds is ok) without a lot of side effects. I've been taking additional meds just due to side effects and I don't much care for that. Even though I have insomnia, I don't so much want something that will make me feel sedated all the time. The Temazepam actually works great for helping me sleep at night. My pcp isn't crazy about me taking Xanax for very long. I don't know how this new doctor feels about benzos either.

I don't tolerate ssri's very well at all. I've tried Citalopram and Sertraline. I would be willing to try something less activating. I've also tried Trazadone. I also have IBS-D, so if its something that tends to cause diarrhea, it's probably not a good option for me.

[crtclms]

I think your question is too broad. We can't tell you what to take, and the possible combinations are many. There are a LOT of different cocktails, and you haven't really tried that many meds.

Plus, you cannot predict side effects based on what others have experienced, because everyone responds differently to each drug. For any given med, you will find people who couldn't remain on it, and people who think it is the best thing since sliced bread.

Do you have questions about specific meds you are thinking of trying?

[Ophelia12]

I think your question is too broad. We can't tell you what to take, and the possible combinations are many. There are a LOT of different cocktails, and you haven't really tried that many meds.

Plus, you cannot predict side effects based on what others have experienced, because everyone responds differently to each drug. For any given med, you will find people who couldn't remain on it, and people who think it is the best thing since sliced bread.

Do you have questions about specific meds you are thinking of trying?

I'm still doing some research, so I will get back to you on specific meds. I am wondering about which antidepressants are good to try for someone who can't tolerate SSRI's very well. Or if it's worth trying an SSRI that is less activating.

[tryp]

Remeron could actually be a very good option for you. The therapeutic window goes up to 45 mg, I believe, so you'd have a reasonable opportunity to increase your dose. It is good for anxiety and depression when it works, and very few people report agitation with it.

In some ways, I have had a similar problem. I was on sertraline and citalopram at various points, and the anxiety/agitation was just intolerable, so now SSRIs are on the list of medications that I cannot take safely. I also tried bupropion and had the same issue.

Remeron was quite good for me in that respect - I had quite severe anxiety at the time that I was put on it, and it really helped with that. It also helped with my depression for a time, but it stopped working for that, and depression is my predominant problem, so I moved on.

Personally I have had the most luck with Lamictal, which is used a lot in the BP crowd, but also in unipolars who can't tolerate or don't respond to straight antidepressants.

You have a lot of places to go with this - you haven't tried a lot of stuff yet. If I were you, I would go along with your doctor and let them fiddle around, since they're the ones with the medical training. Make sure that you are giving each medication you try a really good chance to work and time for the initial side effects to wear off (6-8 weeks), and that you are hitting a reasonable dose if possible. Obviously some side effects are so terrible that you just can't stay on it, but sometimes if you stick it out, things will improve. I was hellaciously nauseous and anxious when I started citalopram, but things did get better eventually and while as a whole, the med sort of sucked, I did get a good depression-free 6 months out of it before it started driving me batty again. Not a ringing endorsement, but anyway - it's important to give things a solid try because they just might work out in the end,

The only thing I might ask about is not starting the BuSpar and the Remeron at the same time. If you change too many things at once, you'll never know which one is working. Obviously if your doctor tells you to do that, you should do it, but it's something to ask about.

[Ophelia12]

Remeron could actually be a very good option for you. The therapeutic window goes up to 45 mg, I believe, so you'd have a reasonable opportunity to increase your dose. It is good for anxiety and depression when it works, and very few people report agitation with it.

In some ways, I have had a similar problem. I was on sertraline and citalopram at various points, and the anxiety/agitation was just intolerable, so now SSRIs are on the list of medications that I cannot take safely. I also tried bupropion and had the same issue.

Remeron was quite good for me in that respect - I had quite severe anxiety at the time that I was put on it, and it really helped with that. It also helped with my depression for a time, but it stopped working for that, and depression is my predominant problem, so I moved on.

Personally I have had the most luck with Lamictal, which is used a lot in the BP crowd, but also in unipolars who can't tolerate or don't respond to straight antidepressants.

You have a lot of places to go with this - you haven't tried a lot of stuff yet. If I were you, I would go along with your doctor and let them fiddle around, since they're the ones with the medical training. Make sure that you are giving each medication you try a really good chance to work and time for the initial side effects to wear off (6-8 weeks), and that you are hitting a reasonable dose if possible. Obviously some side effects are so terrible that you just can't stay on it, but sometimes if you stick it out, things will improve. I was hellaciously nauseous and anxious when I started citalopram, but things did get better eventually and while as a whole, the med sort of sucked, I did get a good depression-free 6 months out of it before it started driving me batty again. Not a ringing endorsement, but anyway - it's important to give things a solid try because they just might work out in the end,

The only thing I might ask about is not starting the BuSpar and the Remeron at the same time. If you change too many things at once, you'll never know which one is working. Obviously if your doctor tells you to do that, you should do it, but it's something to ask about.

I was thinking that, too. It's also a good option because it would help with the insomnia and I've heard it's good for people with IBS-D. So if I took Remeron and then with the Xanax prn, I would still need something that I could take daily for anxiety.

[tryp]

On Remeron, you might actually not need something else for anxiety - it is really quite good for anxiety on its own, for many people. That's actually the reason my pdoc chose it as my first antidepressant - because I had depression + anxiety and she wanted to try to control it with a single medication.

[sircuit]

Hi Ophelia. How have you gotten along with meds?

Maybe you could look at some of the first generation (older) antidepressants

.Some of them worked well and could do the same for you.

Parnate worked for me for years. May be worth a try.