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I'm looking for some advice. I've had a lot of experience with different antidepressants, and almost no success. I'm getting pretty tired of the whole trial-and-error process, and I'm not terribly confident in my doc's ability to prescribe the right thing, especially considering some special circumstances.

Here's my history. I have been diagnosed with social anxiety and dysthymia. I've had both as long as I can remember. My first experience with taking antidepressants was Paxil when I was 16. This actually seemed to work well, cleared the anxiety and depression right up. I eventually tapered off the Paxil without any major withdrawal symptoms, but due to a significant life change my anxiety and depression came back. I tried using Paxil again, but I did not get any better (due to tachyphylaxis, I suppose).

After that, I tried Celexa which made me feel irritable, like my muscles wouldn't stop tensing up, and like there was a gorilla sitting on my chest. After that I took Effexor, which all I can remember was the horrible withdrawal symptoms I had when I discontinued it. I was then put on Cymbalta, on which I felt very similar side effects to Celexa. Cymbalta had a hell of an awful withdrawal phase. I was also prescribed Buspirone and Wellbutrin with the Cymbalta, but neither had any effect. I later took Desipramine, which I do not remember feeling any better or worse under, and then a year later tried Lamictal, under which I again felt unbearable muscle tension, like a gorilla was on my chest, irritation etc.

There's one more added wrinkle. I have reason to believe that I'm still experiencing post-SSRI sexual dysfunction, as I am unable to feel any sensation in my genitals. This has been the case off and on since I started taking Paxil in my teens. I've been trying to find a cure for this ever since.

As you might suspect, I have a lot of reason to feel skeptical about taking any medication, but I worry that unless I try something I'll never get my anxiety and depression licked. My doctor has suggested Viibryd, but since it is an SSRI I am worried it will contribute to my sexual problems (I have heard it is without sexual side effects, but I've heard that before).

It seems to me that the remaining option is to take an MAOI, but I am hesitant because a) I don't want to waste a lot of money on another something that might not work, and b) I am still worried that another antidepressant will make my sexual dysfunction worse.

So, since my doc is willing to discuss options with me, I'm wondering if anyone here has any suggestions, i.e. if any of the stuff I've described throws up any red flags for something that might work, or if I should try the Viibryd, ask for an MAOI, or even push for ECT. I'm really considering any option at this moment. Even starting exercise.

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It kinda boggles my mind that you've been on that many AD's and are considering ECT when you haven't tried things like exercise. Exercise/diet/relaxation/therapy are really effective for dysthymia (not to mention sexual function) and for me, would be just as important as an AD. I've suffered with depression since I was eleven (of a bipolar nature) and meds are just a small part of what I do to maintain my wellness.

If you don't have all that stuff going on as well as an AD, I wonder how well an AD can do for you.

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I would agree with Titania - lifestyle changes, and especially focused psychotherapy, can be extremely effective in helping mental illness. Something like CBT could be useful in helping you manage your condition.

How long did you stay on those other medications for? Are you giving everything a full 2+ month trial at a therapeutic dose?

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I meant the exercise bit as a bit of a joke at the end. I am fairly fit, in the lower range of the "normal weight" for BMIs, so the motivation I have for exercise is almost purely as a means for improving my mental health. However, the social anxiety frequently conflicts with my desire to exercise (which I have tried in the past.)

I have definitely tried these medications for the alloted amount of time. My experiences with taking them has been over twelve years, not sure if that seemed compressed in the way that I wrote it. Some of them I've taken for over a year, and up to maximum dosage, even when side effects were extremely unpleasant. I'm afraid that I have not kept track of exact dosages.

I have been in therapy for most of this time.

Edited by littlepemo
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Well, Viibryd is probably worth a try - it is slightly different from an SSRI in its chemical mechanism.

When it comes to antidepressants, you could consider mirtazapine/Remeron - it doesn't seem to have sexual side effects at all, and it is known to be very good for anxiety and depression.

Otherwise, you could branch out to the atypical antipsychotics - I'm particularly thinking of Seroquel, which is often used for anxiety and depression.

Edited by tryp
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Oh, one other thing I forgot to mention. I have taken benzodiazepines, though they were given only for 'emergency' situations (I usually took them when the side effects from my other meds were at their worst). They did help me relax in a way, but it felt very artificial and wasn't really what I was looking for.

Thanks for the suggestions, tryp: I'll bring them up at my next appointment. I actually have a month's sample of Viibryd here, though I'm hesitant to start taking it as I'm not sure how much it will cost to continue it beyond a month due to (I think) no generic being available. Guess I'll try to navigate the world of my insurance company's help line, which is always fun with social phobia.

Edited by littlepemo
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littlepemo -

Has your pdoc suggested the possibility of using a central nervous system stimulant like Adderall as an adjunct to your antidepressant? My dx is refractive double depression (MDD + dysthymia) and while Effexor manages it mostly, I never got any real stability until my current pdoc added Adderall to help increase my dopamine release. Basically, while the Effexor prevents dopamine reuptake at the dosage I'm on, the Adderall also encourages increased dopamine release, in effect working at it from both directions. That's the idea, anyway, as far as the neurotransmitter part of the thinking goes, but of course there's more to it than that. Anyway, you might ask your pdoc about a stimulant. I find that that's what truly made the difference for me, and the only side effect has been a bit of jaw clenching at my upper dose.


Edited by Cerberus
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I want to second the vote for Remeron (mirtazapine). It doesn't give me sexual side effects. Another med that has almost been a miracle med for me is Abilify. I do not get sexual side effects from it, and it seems to offset the sexual side effects that I get from citalopram. It is indicated as an augmentation to an antidepressant and seems to really work, at least for me anyway.

As for MAOIs there is the Emsam patch which I don't believe requires you to follow a diet at the lower doses. I didn't have much luck with Marplan, but I've heard some people have really had success with Parnate and Nardil, but they require you to follow a diet.

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If you are looking for depression control alone, you have more options - Lithium and Lamictal should also be on your list. If you're looking for anxiety control as well, probably an AAP or mirtazapine will be your best bet.

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