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My newly acquired pdoc told me that he wanted to put me on an SSRI and an atypical anti-psychotic.  For OCD, anxiety, and most importantly, treatment-resistant depression.  I also have chronic daily migraines which we have not found a solution for; read my posts over at the Migraine board if you want to know more.  I don't want to bore you all.

I've read all the CrazyMeds pages about the drugs, I've gone to their individual sites (which is always useless), read the PI sheets, and a bunch of the threads here.  RemedyFind had almost no information, which is rare, and Drugs.com is the place to go if you want to be convinced not to take a new med out of sheer fear.

My pdoc told me to go research (he knows I do my own research), and find which ones I think might work best for me.  For the SSRI, I'm thinking Lexapro.  I have absolutely no idea on the AAP, and I'd like some advice if anyone can give it.  I know everyone obviously reacts differently to medicines, but there are some common effects, and hopefully someone here has been on this combo for depression.  I'm also on 300mg Wellbutrin XL.  Not doing a damn thing for any of my mental disorders or my migraines, but it's giving me more energy, taking away my appetite (which was pretty non-existent to begin with as I'm always nauseous), and wasn't causing bad side effects so I asked to stay on it.  First medicine EVER that did that.

The main things I'm looking for are:

Obviously, something that has been known to help with depression (a lot of people here mentioned Geodon

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I know how hard it can be to find something that seems right.

I don't have a lot of experience, but it does sound like Zyprexa is not for you -- it often makes people very tired. Risperdal is likely out for the same reason.

I've been happy with Seroquel. It does make people sleepy at low doses, but when you get far enough up, it no longer has that effect. I take 300mg during the without feeling sleepy from it.

As far as I can tell, it hasn't messed with my sex life (what sex life? other things nixed that long ago). I do have a severe recurrent depression, which is currently very well controlled with a combination of Lamictal, Seroquel, and Parnate. I've taken Seroquel through a wide assortment of anti-depressants and found that it has mixed well with them. It has continued to do its job.  The Seroquel controls my background anxiety, intrusive 'voices,' and things like that very well.

Fiona

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I'm going to suggest Risperdal with a beta blocker, Inderal. Risperdal is a great med. The only reason I don't take it is that it made me lactate (I'm female, so it wasn't as weird as if I were male). I've thought of going back to Risperdal, despite the boob milk, because it did so much for me. Yeah, I looked spaced out, but it helped.

Talk to your pdoc about Risperdal. Low sexual side effects, low zombie factor, won't mess with your sleep, will crack out any anxiety, and with the beta blocker will not mess with your EPS or anything like that. The beta blocker may be key.

BTW- you could use a mood stabilizer to help with those same symptoms. They aren't only for BP. They're far less scary then the atypicals. AAPs are very hard to take, hard on your body, at least for me. I'm kind of frail like that.

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Its an imporant decision to make.

From what my p-doc has told me :

- zyprexa is very sedating and a big weight gainer (around 80% of people gain significant weight)

- seroquel is sedating and around 25% of people gain significant weight

- abilify is somewhat stimulating and is weight neutral;

We went with seroquel for me, to treat Major Depressive Disorder, Obsessive Compulsive Disorder, Panic Disorder, and what is now agreed to be some psychosis as well. 

Its been pretty good for me.  I am on a crazy dose (1500mg/day) but it works really well. I have gained a fair bit of weight over the past year on it, but it has made me a happier person and has quietened down the voices that drove me insane.

I personally would like to try abilify - if its as good as people say it is, it would be nice to have the same therapeutic benefits without the weight gain.  That's if it is as good as people say it is. 

There are heaps of combo's available out there.  I was in initially (over a year ago) persuading my p-doc to go with prozac and abilify, but he persuaded me into paxil + seroquel.  Its probably a much better combo for my mind but I felt the other would be better for weight, undoubtably.

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I hope this isn't too late.

You mentioned taking a ssri as well as a aap. From memory lexapro can make migraines worse, though I may be thinking of celexa, which is like the baby brother of lex.

For your atypical I can recomend risperdal. It has some side effects to start with like weight gain, sedation and some sexual ones but they mostly wear off.

I was way underweight when I started taking it so the weight gain was good. The sedation didn't last long, only a few weeks really (though I still sleep a lot at night) and the sexual side effects only kicked in at higher doses which you aren't likely to reach with your dx.

Loon mentioned mood stabilisers as an alternative. I also take epilim (depacon) as an anti convulsant and I would recomend you try an aap first. I'm still adjusting to epilim but so far it's made me stupid and it's made me lactate(and I'm a bloke): which is better than having seizures all the time but it's worse than my risperdal side effects (other than when it made me impotent for a few months).

good luck!

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I love Seroquel and I'm a former ED psycho so I'm terrified to gain any weight.  I'm titrating up to 800mgs, it's only sedating at low doses so once I get over the hump I should be fine.  When I wake up, I feel calm and anxiety free....& so far "voices" free :-)

Don't be scared of any AAP.  If you try it and hate it, you can always change it..

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You don't want to do Geodon if you have a funky heart.  See this:

http://www.fda.gov/cder/consumerinfo/druginfo/geodon.htm

The two best SSRIs for OCD are generaly considered to be Luvox and Paxil. 

Seroquel has done more for my OCD and anxiety than any other med that I've been on. 

Pretty much any of the APs that are going to help with anxity and OCD are going to knock you out at least for a while after you take it.  That's just how it is.  If you take it at night and give yourself pleanty of time to sleep it shouldn't be too much of a problem though.  Just get used to the idea that you have to dedicate 8-10 hours to sleep each night.  With my anxiety treated I've found that I'm able to consume modest ammounts of caffine to counter any lingering sedation.

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Maybe Risperdal isn't RXed as much, but talk to your pdoc about it. It helped me a lot and only gave me lactation as a side effect. I was into it before I noticed my breasts were letting out milk. That is a rare side effect. Look into it! It is an AAP and a very valid option. Neutral on weight, non-sedating, and doens't mess with your brain too much. Great option for many people.

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