Antidepressant(s) for fatigue & anxiety- any input is appreciated!

[Lynn201]

Hi, I have been on several antidepressants and have yet to find the right one or combination.  What I am looking for is an anti-depressant that will give me energy and motivation and a desire to socialize again (instead of simply laying in bed all day).  However, a major problem I suffer from is high anxiety and have heard that many 'energizing' antidepressants can increase anxiety.  Therefore, I am also looking for something that will help with my anxiety but not make me feel tired all day.  An aside- I am also prescribed concerta for ADD but even that fails to keep me up with certain medications.

Medications I have tried in the past:
-effexor- did not find it to be particularly effective
-remeron- thought this helped my depression when I was at my lowest but it made me way too tired throughout the day
-brintellix- I felt like it was helping but I started to experience too many side effects with extreme itching and rashes
- wellbutrin- dr. prescribed this as an add-on with the brintellix- seems to work ok as an add-on but not alone
- cymbalta- started taking this (along with the wellbutrin) about 4 weeks ago (2 weeks at 20 mg, 2 weeks at 40 mg).  Initially I was really hopeful because I felt like it was helping with my anxiety but for the past week I have felt extremely exhausted  all day (even with the wellbutrin and concerta)

So does anyone have any suggestions?? I am starting to get really, really discouraged and would appreciate any input.  

Also, I am willing to start trying some TCAs so if anyone has had any positive results or suggestions about TCAs I would be interested to hear them.  

Thank you so much for any suggestions or input.  It is greatly appreciated.  

[Flash]

I have had good luck with doxepin, which is a TCA. All of the other ADs I've tried haven't worked at all (see my signature). It took a while before I saw any results, however. I got a little improvement at 200mg, and then a big boost at 250mg. I titrated up 50mg at a time, starting at 50mg, and am now at 300mg, which is the maximum recommended dose. My mood is great (balanced), but I have no energy. I don't know if that is a side effect from meds or lingering depression. I am going to ask for Provigil to see if that will give me an energy boost. As with any med, YMMV. Amyltriptiline (sp?) is another popular one, but I haven't tried it.

[jt07]

I have had a lot of luck with adding Abilify. It gives me an interest in life and gets me out of bed every day. It offsets the apathy caused by my SSRI. Of course, YMMV. There are some people who find Abilify sedating, but it seems most people find it activating.

[melissaw72]

What kind of Wellbutrin were you given?  I found that Wellbutrin SR did not work well for me, but the IR worked really well.

[Katzendame]

Prozac was the only antidepressant that got me out of bed. It made me eat heaps though

[Lynn201]

Thank you so much for all the suggestions- certainly a lot to consider. I saw my Dr. this week and we decided to try prozac (and get off the cymbalta), as some people find it helps with energy along with anxiety.  I've been on the prozac at 20 mg for 6 days and have not had any side effects and have had some slight mood improvement which I take to be good signs.... so fingers crossed.

melissaw72-  thanks for bringing up the issue of the type of wellbutrin, I hadn't considered that.  I was previously on wellbutrin xl, and decided to switch to the instant release to get a little extra boost in the morning.  I think it's been working great so far as I definitely notice more energy in the morning.  I might decide to take another dose in the afternoon, as that is when my energy is typically at its lowest (along with when my anxiety is highest ironically)

Flash & jt07- thanks for the ideas about other meds.  I'm definitely interested in trying abilify (but my Dr. would like to wait to try other changes first as it is an antipsychotic med).  I didn't know about provigil before and it definitely sounds like something that would help my energy levels but I read it is very expensive, do you know if that is still the case? Im assuming there is no generic 

For energy my Dr.'s preference is to first play around with other ADD meds to find one that will keep me awake, so I will most likely be changing from the concerta soon.  Unfortunately my anxiety remains an issue but I do not know how much is from all the med changes, so Ive had to resort to taking a small dose of klonopin which certainly isn't helping the energy/motivation.  I'm still concerned about these current meds addressing my anxiety, as I dont want to have to rely on klonopin on a daily basis, but I guess all I can do is wait and see if the prozac helps 

Thank you to those who provided info regarding TCAs but it seems my Dr. does not want to use them.

Thanks again for the comments & suggestions.  Any further input is much appreciated!

 

Edited September 13, 2015 by Lynn201

[Flash]

I believe Provigil is generic, but still expensive. My insurance company requires preauthorization.

[melissaw72]

I also think there is generic provigil, not sure of the price, but it is probably high.  My insurance covers 2, 200 mg pills a month.  Any more need a PA. Every insurance company has their own differences though, so I'd check with your insurance as to what is covered or not.

[Hopefully]

I suffer depression and anxiety disorders. I was also lethargic . My pdoc told me that modifinil/provigil, would be the only thing that I could take that wouldn't aggravate my GAD. I take 100 mg, daily. For a long time it gave me superwoman like powers. I'd accomplish more in 2 hours than I had in a week. But after a long time it has tapered down to just giving me enough energy to live, stay awake, and do the things I need to do. I tried going up to the 200 mg, but it made me shaky.  So I stayed at the 100 mg ( they come in 200mg tablets). It's a life changer for me. Now if I could just do something about my depression...

[melissaw72]

^^FWIW They also come in 100 mg tablets.

Edited September 14, 2015 by melissaw72