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Please help me find a new medication or combo to treat my depression


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So it's been over a month on zoloft and pristiq and I'm still having depression. My depression manifests itself in suicidal ideation, social isolation, intrusive OCD thoughts, feelings of little worth. I don't hide in the bed. I am out in the world and doing things but deep down I feel like its all bullshit and that my life is a waste. On Thursday, I get an emergency meeting with a case worker and I want to propose a switch to my depression meds. As you can see from my signature, I have already been on a lot of meds so I'm hoping the knowledgeable membership on this site can give me ideas. Right now, I'm thinking about lexapro. I took it a long time ago but don't remember what happened. There is paxil and celexa but I've read that they are fairly weak so I doubt it would help me. I was interstead in rexulti but a lot of people report major weight gain and I already have an extreme weight issue because of clozapine. I'm not too keen on TCAs but if you can make a good case for one, I'll consider it. Also wondering if, I know depakote works for mania, but could it for bipolar depression? So take a look at my signature and let me know! Thanks in advance.    

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Just now, CeremonyNewOrder said:

Is Trintellix different than Brintellix? If so I've tried it. I've really wanted to try vraylar but my current pdoc refuses to take me off clozapine and she doesn't prescribe new meds. Unfortunately, right now I can't change pdocs. I really don't like my new pdoc.

sorry brintellix=trintellix i missed it in ur sig.

im sorry you dont like ur pdoc thats tough. 

luvox? celexa, paxil, zoloft, lexapro?

celexa didnt do it for me, lexapro was pretty good

paxil was good for me , some for depression, more on anxiety

fetzima SNRI

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The common knowledge on rexulti seems to be causes weight issues but I took it at significant doses with clozaril and didn't really gain anything. I'm not trying to prove everyone wrong...that would be stupid cuz I'm one person....just saying it could be worth a shot if you really need relief 

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I see you've tried Effexor, Wellbutrin and Adderall, but did you try them in combination with each other? That's what's keeping my head above water (just). Using Effexor as the uptake inhibitor and the Wellbutrin and/or Adderall (or Vyvanse) as a release agent helps you produce more of the neurotransmitter you need available, and keep it in your system longer.

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1 hour ago, Cerberus said:

I see you've tried Effexor, Wellbutrin and Adderall, but did you try them in combination with each other? That's what's keeping my head above water (just). Using Effexor as the uptake inhibitor and the Wellbutrin and/or Adderall (or Vyvanse) as a release agent helps you produce more of the neurotransmitter you need available, and keep it in your system longer.

Effexor worked great  for me but then it stopped working. I've tried Wellbutrin twice and it never did anything for me. Stimulants help with depression but the problem is I always grow a tolerance for them and have to switch to the next stimulant. Adderall worked for a year and then stopped working. About 4 months later, I tried taking it again because my pdoc said you have to take a medication vacation with stimulants sometimes but the Adderall still did nothing for me. I'm on dexedrine right now and having the same problem. 

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2 minutes ago, CeremonyNewOrder said:

Effexor worked great  for me but then it stopped working. I've tried Wellbutrin twice and it never did anything for me. Stimulants help with depression but the problem is I always grow a tolerance for them and have to switch to the next stimulant. Adderall worked for a year and then stopped working. About 4 months later, I tried taking it again because my pdoc said you have to take a medication vacation with stimulants sometimes but the Adderall still did nothing for me. I'm on dexedrine right now and having the same problem. 

And did methylphenadates not work either? Or Provigil/nuvigil? Sorry I'm on a phone can't see the sig 

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I would advocate trying a TCA even though you said you didn't want to take one. The secondary amines are actually not that bad--TCAs like desipramine (Norpramin), nortriptyline (Pamelor), and protriptyline (Vivactil). They tend to be stimulating and help people with low energy. Very little to almost negligible weight gain with these agents. I'm on desipramine now, and while I don't think it's causing weight gain, I think it might because me to have trouble losing weight. (That, and Abilify but anyway...) But anyway, despramine has been a lifesaver for me. My pdoc doesn't like prescribing the older meds, but I have to sort of trick her into prescribing them for me.

 

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@CeremonyNewOrder

A week ago or a tad bit more, I just started lexapro at a baby dose of 5 mg because my pdoc is worried about mania risk. Ugh. But so far so good. She doesn’t want to increase it yet or maybe never. Ridiculous. I may as well just not take it. In fact I asked her to just take me off of it if it’s a bad idea but she said too many changes at once is bad and lexapro could take weeks to work anyway. But no side effects for me yet.

I have similar symptoms to you but I do lay in bed listening to voices and the messages. So that is isolating. But that might not be a depression thing. I do get down in mood though about wasting my life in bed because of the damn things I hear or receive. So that is probably a mood thing. 

My pdoc said it could make people drowsy or not. It could go either way. But she didn’t think I’d have that drowsiness because of the other heavy duty meds I’m on so she has me taking the lexapro in the morning. Ymmv.

Anyway, if you have any more questions about my experience with lexapro so far let me know. I’d be happy to help if I can!

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4 hours ago, mikl_pls said:

I would advocate trying a TCA even though you said you didn't want to take one. The secondary amines are actually not that bad--TCAs like desipramine (Norpramin), nortriptyline (Pamelor), and protriptyline (Vivactil). They tend to be stimulating and help people with low energy. Very little to almost negligible weight gain with these agents. I'm on desipramine now, and while I don't think it's causing weight gain, I think it might because me to have trouble losing weight. (That, and Abilify but anyway...) But anyway, despramine has been a lifesaver for me. My pdoc doesn't like prescribing the older meds, but I have to sort of trick her into prescribing them for me.

 

Thanks for the recommendation. I'll have to see if my pdoc would be willing to prescribe it. Yeah one of the reasons why I didn't want to do a tca is because I felt like I was in a sedated fog on clomipramine. . 

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3 hours ago, Wonderful.Cheese said:

@CeremonyNewOrder

A week ago or a tad bit more, I just started lexapro at a baby dose of 5 mg because my pdoc is worried about mania risk. Ugh. But so far so good. She doesn’t want to increase it yet or maybe never. Ridiculous. I may as well just not take it. In fact I asked her to just take me off of it if it’s a bad idea but she said too many changes at once is bad and lexapro could take weeks to work anyway. But no side effects for me yet.

I have similar symptoms to you but I do lay in bed listening to voices and the messages. So that is isolating. But that might not be a depression thing. I do get down in mood though about wasting my life in bed because of the damn things I hear or receive. So that is probably a mood thing. 

My pdoc said it could make people drowsy or not. It could go either way. But she didn’t think I’d have that drowsiness because of the other heavy duty meds I’m on so she has me taking the lexapro in the morning. Ymmv.

Anyway, if you have any more questions about my experience with lexapro so far let me know. I’d be happy to help if I can!

Yeah I think I'm leaning towards asking for lexapro. I've read that it is very strong and that's what I need. Because I'm on lithium and clozapine, I feel like I wouldn't go full blown manic. Let me know how the lexapro goes with you :) 

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2 minutes ago, CeremonyNewOrder said:

Thanks for the recommendation. I'll have to see if my pdoc would be willing to prescribe it. Yeah one of the reasons why I didn't want to do a tca is because I felt like I was in a sedated fog on clomipramine. . 

Yes, clomipramine is a chlorinated derivative of imipramine, a tertiary amine TCA (hence why it used to be called chlorimipramine), so clomipramine, too, is a tertiary amine. These tend to be sedating, and cause more weight gain than the secondary amines. It does however metabolize into a secondary amine, N-desmethylclomipramine, which is stimulating, hence why lower doses are sedating, and higher doses are theoretically supposed to be stimulating. I got up to 225 mg and I kinda just felt less sedated instead of stimulated.

The secondary amines are all primarily selective norepinephrine reuptake inhibitors (with some low degree of serotonin reuptake inhibition, low antihistaminergic and anticholinergic effects, and low α1 antagonism so no orthostatic hypotension).

  • Nortriptyline still has a bit of affinity for the H1 histamine receptor, so in low doses, it may be sedating (and hence why it is dosed at night), while higher doses begin to get more and more stimulating (the norepinephrine reuptake inhibition begins to really kick in). Blood monitoring must be done with this medicine to watch for therapeutic levels every now and then. If your blood levels are too low or too high, it won't work that well. It has a U-shaped dose response curve.
  • Protriptyline is said to be probably one of the most , if not the most, stimulating TCAs. It has the most anticholinergic properties next to amitriptyline (Elavil), and is the second most potent norepinephrine reuptake inhibitor. It's unlikely to cause weight gain due to its low affinity to the H1 receptor. It is uncommon compared to other TCAs wherein it is dosed 3-4 times a day instead of 1-2 times a day. It's very rarely prescribed today, so you may have a hard time finding a pharmacy that will be able to order it much less stock it.
  • Desipramine is said to be one of the most stimulating TCAs, on up there with protriptyline, though which one is more stimulating is up for debate. It is the most selective and most potent norepinephrine reuptake inhibitor, has minimal anticholinergic and antihistamine effects so minimal weight gain and dry mouth/constipation, etc., and has little antiadrenergic effects, so little to no orthostatic hypotension. Low doses may be somewhat sedating (10-25 mg), but 50 mg and above becomes more and more stimulating the higher you go.

If you do end up having brain fog on any of these meds, then I apologize for the recommendations. 

Nortriptyline would probably be a good one to start with first if you so chose to do so. 

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