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I had my pdoc appointment on Saturday. He told me all antidepressants that affect the same transmitter are pretty much the same other than side effects. He then showed me the list of symptoms for major depression and explained how some can be helped by medication, but others are because of the way we think or react to situations. He told me he didn't want to give me any more medication to try and that I need to stick with therapy. The only antidepressants we tried was Pristiq and Viibryd. I see a tdoc at the same place. I go weekly, but she is on vacation this week. 

 

I broke down balling to him (and am now writing this). He asked what he triggered and I said I didn't know. I don't really know. I guess I kind of felt like he was telling me I really don't have depression or it's my fault that I do. Or I felt like I will never get better or just mad that I have depression at all. I know antidepressants aren't a magic cure, but my depression is getting bad again and I was hoping for something that would help. I have been crying daily again and feel so hopeless. 

 

Is it true that if you try one antidepressant that's for, say serotonin, and it doesn't help then no other meds for serotonin will? I know there are so many kinds of antidepressants so I don't know why he is giving up on me. 

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8 minutes ago, taramisue said:

He told me all antidepressants that affect the same transmitter are pretty much the same other than side effects.

It sounds to me like your pdoc is really doesn't believe in meds when it comes to depression. What I quoted above is patently false in my case. I tried all the SSRIs except Luvox and some of the newer ones, and ONLY Celexa (and Lexapro) worked for me. I like the analogy that we have to find the right "key" (med) to unlock our particular brain chemistry.

Were I you I would get a second opinion. The sooner you start doing this, the sooner you will be seen by the new doctor because it sometimes takes months to get in to see one as a new patient.

I'm really sorry your doctor took away hope from you. I understand your frustration because I would really be hurt and frustrated if my doctor told me that. That just plain sucks.

BTW: It is true that meds don't solve everything. It still requires work. But meds often put our minds in a place where we have the strength and desire to do that extra work and makes therapy much more useful. The gold standard for treating depression is still MEDS + therapy the last time I looked.

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I have taken several different antidepressants over the years and this is the 3rd SSRI I have been on. I currently take prozac and it works well for me. The previous 2 SSRIs I have been on in the past were paroxetine and escitalopram.

I don't know why your pdoc has given up so easily/quickly on trying different antidepressants. There are many more you could try. 

Seems to me that your pdoc just wants to focus on therapy and has closed his mind to antidepressants

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2 hours ago, taramisue said:

He told me all antidepressants that affect the same transmitter are pretty much the same other than side effects. He then showed me the list of symptoms for major depression and explained how some can be helped by medication, but others are because of the way we think or react to situations. He told me he didn't want to give me any more medication to try and that I need to stick with therapy. The only antidepressants we tried was Pristiq and Viibryd. I see a tdoc at the same place. I go weekly, but she is on vacation this week. 

Is it true that if you try one antidepressant that's for, say serotonin, and it doesn't help then no other meds for serotonin will? I know there are so many kinds of antidepressants so I don't know why he is giving up on me. 

^^No, not all antidepressants are the same.  Everyone is different and reacts differently to meds.

1 hour ago, toast said:

Get rid of the quack. Modern science still doesn't have an explaination for why antidepressants work. They have theories, but that's it. It's a trial and error process.

Anyone who claims that your response to one medication will dictate how you respond to others is incompetent in my opinion.

Right ... any DR specializing in medication should know that how you react to one med in a group of the same med, doesn't mean other meds in that category don't work.

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2 hours ago, toast said:

Get rid of the quack. Modern science still doesn't have an explaination for why antidepressants work. They have theories, but that's it. It's a trial and error process.

Anyone who claims that your response to one medication will dictate how you respond to others is incompetent in my opinion.

I also agree with this. There is so much more that can be tried.

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4 minutes ago, wadjet said:

There is so much more that can be tried.

^^This is an understatement. Two antidepressants doesn't even scratch the surface of all the antidepressants out there. You haven't even tried all the classes of antidepressants. And when you have gone through the antidepressants there are the cocktails like I take. It just sounds silly what your pdoc said to you.

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I agree that it's ridiculous and support the suggestion for a second opinion.  As people have noted, lack of response to one doesn't mean you won't respond others within a class (like SNRIs), then there are other types of antidepressants (SSRIs, tricyclics, Wellbutrin, etc.).  I don't think that trying one in each class would make sense either, but at least in that circumstance he would be saying that you've attempted the various categories. And as CNO pointed out above me, the medications outside the antidepressant class also work better for some people--I'm one of them, in that although I somewhat responded to traditional antidepressants, it was Lamictal (anti-convulsant) that brought me completely out of the episode.  both times.

Viibryd and Pristiq are also two of the newer ones and I wouldn't be surprised if that contributes to them not working as well for some.  I have a friend who is concerned about Pristiq specifically because of concerns with the clinical trials that were done prior to approval (they didn't last long enough to match the amount of time you're supposed to take to respond to an SSRI).  I tried to see if I could find a citation for that and learned that it failed with respect to children and was no better than a placebo; additionally although you can take from 50mg to 400mg, there is no additional benefit from taking above 50mg and the risks of side effects are worse:

http://www.genengnews.com/gen-news-highlights/pfizer-s-pristiq-fails-phase-iii-trial-for-depression-in-children/81251382/

With respect to her concern that it was approved too quickly, apparently it was after four short-term (eight week) studies and usually we're told to give any drug in this class 6-8 weeks to take effect:

http://www.drugs.com/pro/pristiq.html

It also failed in one of the four, meaning only a 75% success rate after eight weeks.  The longer term studies were only conducted after its approval.  As far as why I'm throwing this information out there, I'm not trying to be a fearmonger--I support medication for depression and think it's beyond concerning that your pdoc doesn't.  And obviously you've tried it and are okay and plenty of other people take it regularly.  But if there's information that suggests it's not effective for a fair number of people and there's also information that other drugs are effective, I don't know why he wouldn't just conclude that this particular medication was not a good fit. 

 

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6 hours ago, CeremonyNewOrder said:

I'd try to see another pdoc if you can. I literally tried almost all the anti-depressants until I took Cymbalta, which has generally worked for me. There are also meds outside the anti-depressant category that can treat depression like lamictal or abilify.

Agreed.

 

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Thanks to all of you for replying. It really means a lot! I'm really frustrated because this is my first real pdoc other than while IP. I took the initiative to find a pdoc and to start therapy because my depression is getting bad again. I thought by seeing a pdoc he would be more aggressive in helping me find the right medication over my GP. I guess I need to look for a new one. It's hard when I work full time, and he has Saturday appointments, but I will see what I can do. Thanks again! I don't post a lot on here, but I read and follow you guys everyday. It's nice to know I'm not alone. :)

 

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Yeah, I'd look into finding a new pdoc as soon as possible. You were right and it is absolutely a reasonable expectation that a pdoc would be more aggressive in treating your depression than a gdoc.

I don't know what your line of work is, but I have found that many employers are generally cool with allowing you a couple of hours off if it is only once a month or so. You can just say that you've got a doctor's appointment which is the truth. The key is finding a good pdoc. That will make all the difference in the world.

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