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#1
Sep 07, 2015, 03:07 PM
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I have dysthymia. Yes, It was confirmed by a doctor. Lack of energy, motivation, desire to do anything. I am always bored. I have money, I have time, I can do whatever I want. But I have done everything already and I don't want to do anything anymore. I know, I know. Don't tell me there are an infinite number of new things I can do because my brain does not want to do anything. I am 41 and I am just tired and bored. Everything sounds like a lot of work for nothing.
Tried all SSRIs => prozac, lexapro and paxil. THEY DO NOT WORK FOR ME. They make things worse for me. I just get numb. It is like having a headache and fixing it by going to sleep. Not very practical. So my question is simple: WHAT TYPE OF ANTI-DEPRESSANT SHOULD I TRY NEXT? What type of medication is the second attempt to fight dythymia when SSRIs don't work? |
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#2
Sep 07, 2015, 06:26 PM
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Statistically speaking, antidepressants aren't actually better than placebo for depression (except possibly for severe depression). It's not surprising that they didn't work for you. Here is what I think is the best plan: http://forums.psychcentral.com/4262681-post105.html where the first step is checking for the many possible purely medical conditions that could be affecting you. These notes might help you understand how depression is working in your head and there is an easy thing you can do about it: http://egg.bu.edu/~youssef/SNAP_CLUB...0164151576.pdf This is an easy way to get started. There are many good things to try in the link above that have worked for others.  - vital
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#3
Sep 07, 2015, 06:53 PM
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Maybe mirtazapine and buproprion? There are also the SNRIs (Effexor, Cymbalta, Pristiq.) They often work well, but they have a severe withdrawal syndrome similar to that of a benzodiazepine.
I take Cymbalta and low-dose mirtazapine (Remeron, 7.5-15 mg). The mirtazapine is at a lower than typical dose because it helps more with sleep at that dosage. How's your sleep? Effexor is probably the antidepressant that's had the biggest effect in the area of helping me to feel happiness again. It usually causes sexual dysfunction and sometimes insomnia, too, though. Wellbutrin (buproprion) is supposed to fix the sexual dysfunction. Low-dose mirtazapine or Ambien will usually fix the insomnia. Mirtazapine has good antidepressant effects, too, but it tends to increase appetite. I gained around 8 pounds the first month I took it, but no more since then. Some people gain more. Speaking of food, I find that the types of food that I eat have a surprisingly powerful effect on my moods, but I'm not going to suggest that you adopt a "mood diet", because I am never able to do it unless my mood improves first from meds. My depression had been so much better for about six months, but during the last month I am starting to have more and more days where my mood is "slipping", so I'm getting worried. There have been specific events that have caused this, but I am not handling them as well I did 3-4 months ago. I hope that some other people will post and give you some more ideas. You've expressed where you are, mood-wise, very well. That kind of boredom and lack of interest in life is painful. If you try Effexor, I'd definitely go for the extended release type unless your doctor has a really good reason to do otherwise. I don't even understand why they still make the 3-times-a-day type. |
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#4
Sep 07, 2015, 07:46 PM
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hi chicagobuddy,
you're best bet would be an SNRI . im on Cymbalta after I was on Paxil . my therapist noticed it was ineffective for me cuz I couldn't sleep and I got into an accident nine months ago w my car. I would go with the SNRI along w an anti-anxiety med . im on Cymbalta and Vistaril together I take them at night to help me sleep. Diagnosis: Anxiety and depression meds: Cymbalta 60 mgs at night Vistaril 2 25 mgs daily for anxiety prn 50 mgs at night for insomnia
__________________
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#5
Sep 07, 2015, 09:21 PM
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"I stopped feeling desire to have sex. And when I can tease myself to have a good desire the orgasms are just tasteless. A little bit better than taking a pi. Not any erectile dysfunctions problems, but the orgasm itself is like eating pure rice with no sauce and no salt, just cooked rice." So I am inclined to try Wellbutrin for a second time. Yeah, I did try that, but I went from sleeping 8 hours per night to 4 hours at most, in the first week, so I gave up. Need to try again, maybe a lower dose (75mg). Must say that prozac and paxil were BETTER. I think Lexapro is the worst one when it comes to sexual side effects. So do you know anything about Effexor in terms of sexual side effects? Is it better than lexapro/prozac/paxil for mood/happiness/motivation/energy? |
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#6
Sep 07, 2015, 09:28 PM
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"Without paxil/lexapro/prozac I am upset be unhappy. For not living my life. For staying home all day doing nothing. My depressed condition concerns me. With paxil/lexapro/prozac I stopped concerning. So it wasn't a problem anymore. But I was still home doing nothing and without any desire to do anything." What is your opinion on Cymbalta sexual side effects? Does it cause insonmia as bad as Wellbutrin? |
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#7
Sep 07, 2015, 10:24 PM
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I have dysthymia. Dysthymia is a serious state of chronic depression and the scientific literature tells us that 90% (https://www.ncbi.nlm.nih.gov/pubmed/7755112f) of those people with the condition get major depressive episodes as well. This is referred to as double depression. I have had this condition for nearly 30 years and it runs in my family. If I were to rate my mood when in a major depression then it would be a 1/10 and during the more chronic dysthymia it would be around 3/10 so to me there was never much difference. Describing one as mild and the other as severe never reflected reality for me. I am going to make some points numerically. 1 It is a getting a bit old now but this has been discussed by the CEO of Psych Central Dr John Grohol Dysthymia Treatment | Psych Central 2 It is a lie to say that antidepressants do not beat placebo. This is often used by people that fit the description of 'anti-psychiatry'. They are philosophically opposed to the use of medication and even to the diagnosis of mental illness. Here is an article which thoroughly reviews what the scientific literature actually says. You can look up the studies yourself as well to check if that article is accurate and I strongly advise everyone to do just that. Do not take my word for it, have a look yourself. » The Antidepressant Wars, a Sequel: How the Media Distort Findings and Do Harm to Patients 3 Although the origins of the condition are diverse, there is strong evidence of structural abnormalities in the brain of people that have this condition and that genetics plays a very influential role http://www.biologicalpsychiatryjourn...436-1/abstract http://www.jad-journal.com/article/S...101-3/abstract Dysthymia: a review of pharmacological and behavioral factors 4 Antidepressant medication is an important strategy. Here is an article that reviews the condition https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719439/ And this compares psychotherapy to pharmacotherapy https://www.ncbi.nlm.nih.gov/pubmed/16263177/ The conclusion of the above (pharmaceutical treatment is superior to psychotherapy) was written 10 years ago. The evidence for anti depressant treatment has progressed since. 5 You asked what medication next. I found that the SSRI's worked very well initially and then started to rapidly fade and I found myself back in depression. I have used most of those as well as the SSNRI'S. I had more success with the SSRNI's although Cymbalta and Effexor gave me sexual dysfunction and I never felt like I had fully recovered. I am now on the tricyclic medication Nortryptline and it has been the most effective medication by far. Here is a comparison of the medications, https://www.ncbi.nlm.nih.gov/pubmed/15738743 This is about all I have time for. I might come back and post more studies later. Dysthymia is a legitimate medical condition. I found it relieving to find that it was not my fault and that my decisions were not responsible for my suffering; I had a real illness that could be treated. And while we need to get regular exercise, and pay extra attention to our diet and our lifestyle, these are in addition to the proper treatments that the worlds best minds advise us to pursue and are not a replacement for them. Last edited by lonely-and-sad; Sep 07, 2015 at 11:11 PM. |
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#8
Sep 08, 2015, 06:36 AM
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I would look into an SNRI + Remeron combo. That should get you some results. Good luck, moogs
__________________
Current Status: Stable/High Functioning/Clean and Sober Dx: Bipolar 2, GAD Current Meds: Prozac 30mg, Lamictal 150mg, Latuda 40mg, Wellbutrin 150 XL Previous meds I can share experiences from: AAPs - Risperdal, Abilify, Seroquel SSRIs - Lexapro, Paxil, Zoloft Mood Stabilizers - Tegretol, Depakote, Neurontin Other - Buspar, Xanax Add me as a friend and we can chat
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#9
Sep 08, 2015, 09:48 AM
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Home | Cochrane Library which does systematic reviews of medical practices. The Truth About Antidepressant Research: An Invitation to Dialogue - Mad In America This will be my last post to this thread. - vital |
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#10
Sep 08, 2015, 10:06 AM
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» The Antidepressant Wars, a Sequel: How the Media Distort Findings and Do Harm to Patients Also appreciate the link to mad in America. Unfortunately they are not taken seriously and neither should we take anyone seriously that spruiks for them. This is what the respected New England Journal of Medicine thinks http://www.nejm.org/doi/full/10.1056...00206273462620 Also the Treatment Advocacy Centre, which unlike some actually cares about people with mental health problems. Some have never even suffered. http://www.treatmentadvocacycenter.o...k=view&id=2085 MODS HOW MUCH LONGER? |
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#11
Sep 08, 2015, 10:49 AM
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I think SSRI is important for people with ANXIETY, PANIC and STRONG DEPRESSION. People that are in desperate need to be numbed.
Not my case. I don't need to be numbed. I need to regain desire to do things. That's more like a dopamine problem I would think. Cocaine would solve this problem for a couple of hours (never did and will never do it), but everybody knows the dangers and terrible consequences of this drug long-term. I will try Wellbutrin, even if I can't sleep. Science has to take cocaine and make it better. Can you imagine the potential for humanity? Biggest than the penicillin! |
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#12
Sep 08, 2015, 02:11 PM
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Have you ever looked in to Brintellix? I believe it is an SSRI but it is a new'ish one and evidently works differently than most SSRI's. Just a thought....
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#13
Sep 08, 2015, 03:56 PM
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Autoimmune disorders often have a "waxing and waning" pattern, as does depression (unless you're really unlucky). When I was younger, I would end up in a pattern of trying to date/start a new relationship when my health was somewhat better, and then when my health got worse again, the relationship would almost always end. My limited experience with the sexual side effects of Effexor and Cymbalta are that both drugs can cause decreased libido. Both also caused delayed orgasm for me. These effects seemed to decrease with time and also seemed to be less severe if I had a regular sex partner. I'm not sure of the reason for that. It was almost like my brain was "rewiring" itself to get rid of the sexual side effects. I never tried taking Wellbutrin for sexual side effects, because the one time I did take it in the late 1990s, I had severe jitteriness and anxiety and stomach problems. I think I was taking 225 mg non-sustained-release form then. That's a pretty high dose, so I probably just got put off the drug because of that experience. I think Effexor was more energizing for me and helped my motivation more, but it also caused insomnia. I should say that I was taking a dose of 375 mg/day because I also have fibromyalgia, and that's the dose you need to get significant pain relieving effect from Effexor, so my conclusion that it was more energizing may just be because of the dose I took. This article contains a table that lists the "estimated selectivity ratios" of 5-HT (serotonin) to NE (norepinephrine) for the four SNRI antidepressant drugs (Effexor, Cymbalta, Fetzima, & Pristiq.) It's 1:30 for Effexor and 1:9 for Cymbalta. Now that I've told you this, I've forgotten what 5-HT is associated with and what NE is associated with, aside from that NE is associated with fibromyalgia pain relief, and I doubt that that's useful info to you. With Cymbalta, the same dose works for pain relief as is used most commonly for depression (60 mg.) For the first 3 years or so that I took it, Cymbalta was sedating for me and I took it at bedtime for that reason. I think people more often find it to be not sedating and take it in the morning. I have no idea why people experience that difference with it. Moogie's suggestion of an SNRI + Remeron is what I'm taking now. If you do a search for drugs recommended for treatment-resistant depression, that's one of the combos that will come up. My doctor only prescribed 7.5-15 mg Remeron for me, because he said that it works better for insomnia at lower doses. I think that 30-45 mg is a more typical dose for treatment of depression. Remeron/mirtazapine is an interesting medication. It affects serotonin and norepinephrine, but not in the same manner as other drugs. Read this for details if that kind of stuff makes sense to you. The Remeron has also helped my motivation, or maybe it's helping the Cymbalta to work again. (I've been taking Cymbalta for around five years now. I took Effexor for six. I've ended up on those drugs for so long because of needing them to treat fibromyalgia. There's not much available that helps fibromyalgia pain for me as much as the SNRI antidepressants.) If you end up taking Remeron/mirtazapine, I'd recommend starting off at 7.5 mg for 3 days or so. In my experience, doctors tend to start patients off at 15 or even 30 mg and it will knock you on your ***. Literally, in some cases. Some other posters mentioned tricyclic drugs. I took nortriptyline a very long time ago and found it to be effective but didn't like the side effects. Ditto for Parnate, an MAO inhibitor. I think you have to find a very knowledgeable prescriber (or a very old one) before they usually want to try tricyclics or MAOIs. Anyway, there are still plenty of drugs that you haven't tried. (Yay!) Last edited by Anonymous200325; Sep 08, 2015 at 03:59 PM. Reason: typo |
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#14
Sep 08, 2015, 05:18 PM
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I'm not sure how questioning the efficacy of SSRI's or of any other anti-depressants makes one "anti-psychiatry". Anti-pharmacological perhaps, but still not unequivocally. Considering how many in the scientific community do so, one has to ask, why? There's no relative money to be had in opposing big pharma, just as there's little money to be made being an advocate of more regulations in the banking industry.
If you want to get to the bottom of any situation that seems on the surface inexplicable ask yourself the simple question ‘who profits?’Anti-depressants were never meant for long-term maintenance, which makes it tricky for dysthymics. There's an excellent research paper here that details many important considerations: http://www.researchgate.net/profile/...73161bab06.pdfPersonally, I wish I'd never taken even one, including SSRIs, SNRIs, and even the tricyclics, as their complications to my overall mental health have far outweighed any glimmers of slightly elevated mood I may have experienced on occasion. Change of scenery, when it's available, can be a nice shot in the arm.. not a whole solution, but I don't think there's any one answer like that.. takes efforts on multiple fronts. Best of luck to you. 
__________________
“We use our minds not to discover facts but to hide them. One of things the screen hides most effectively is the body, our own body, by which I mean, the ins and outs of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes from the mind the inner states of the body, those that constitute the flow of life as it wanders in the journey of each day.” — Antonio R. Damasio, “The Feeling of What Happens: Body and Emotion in the Making of Consciousness” (p.28) |
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#15
Sep 08, 2015, 06:23 PM
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#16
Sep 08, 2015, 07:20 PM
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jo_thorne, you help others a great deal. I admire this!
moogs
__________________
Current Status: Stable/High Functioning/Clean and Sober Dx: Bipolar 2, GAD Current Meds: Prozac 30mg, Lamictal 150mg, Latuda 40mg, Wellbutrin 150 XL Previous meds I can share experiences from: AAPs - Risperdal, Abilify, Seroquel SSRIs - Lexapro, Paxil, Zoloft Mood Stabilizers - Tegretol, Depakote, Neurontin Other - Buspar, Xanax Add me as a friend and we can chat
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#17
Sep 08, 2015, 08:56 PM
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As to why. Well profit isn't the only motive, there is also belief. But I would challenge the view there is no money in advocating a certain position. What about book sales? Or sales of tickets to conferences. And then there are those that sell supplements. Just to name a few off the top of my head. When you look at wars often there isn't that much spoils to be had and it costs more to run the war than what they can take off their enemies. Wars are usually out of belief, in this case hate. So I strongly challenge your assertion. I always feel sorry for those that can't get relief from anti depressant medication but just because one person can't get help doesn't mean there isn't another three out there that do. These medications save people's lives and I will be forever grateful that I found some relief. I do see some alternative views around such as the medical community collectively schemed to drug entire nations. And that myself and many others have only been tricked by placebo. The pharma conspiracy theory and views that I am responding to placebo should be seen for what they are: totally ridiculous. I do have one question. Where did you get the information that antidepressants were designed for any length of time? Short, medium or long. Who designed that? And when was it designed that way? Oh and the oppositional tolerance theory and your link, yes I have read that before and yes there is something in it but it is far from settled science. But I appreciate your response regardless. Last edited by lonely-and-sad; Sep 08, 2015 at 09:24 PM. |
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#18
Sep 08, 2015, 09:54 PM
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You're welcome. You now know more about my sex life than my last boyfriend.
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#19
Sep 08, 2015, 10:08 PM
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In the interest of full disclosure, I've personally suffered permanent injuries as the result of erroneously applied healthcare in multiple fields, so it may indeed slant my attitude towards what *I'm* willing to accept as settled science. Guess I'm just unlucky! Be well.
__________________
“We use our minds not to discover facts but to hide them. One of things the screen hides most effectively is the body, our own body, by which I mean, the ins and outs of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes from the mind the inner states of the body, those that constitute the flow of life as it wanders in the journey of each day.” — Antonio R. Damasio, “The Feeling of What Happens: Body and Emotion in the Making of Consciousness” (p.28) |
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#20
Sep 08, 2015, 10:16 PM
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Semantics aside (meant versus designed ) lol
Um well the cost of bringing a medicine to say a suicidal patient by looking at them for years well I don't have to finish the sentence ... There are in fact longitudinal studies so I am afraid that is incorrect anyway. I will be happy to post some later. David and Goliath? Lol Not everyone can become a pharmaceutical company or can they? Maybe goliath and david or maybe none of the above. Its easier to sit there and criticize pharmaceuitical companies and psychiatry in general. Pop psychology wins every time just as Mcdonald's outsells fine dining Edit: http://www.ncbi.nlm.nih.gov/pubmed/12668362 some negatives will undoubtedly emerge: http://www.ncbi.nlm.nih.gov/pubmed/20843507 and more http://www.ncbi.nlm.nih.gov/pubmed/20843507 But the question is how many lives does it save? I will keep digging as I love the topic and if we can arrive at some kind of 'truth' that is better than just assuming a position and looking for something, anything in fact, to support it. Last edited by lonely-and-sad; Sep 08, 2015 at 10:41 PM. |
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This is an old thread. You probably should not post your reply to it, as the original poster is unlikely to see it.|
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