[Paracelsus]

Vyvanse and Dexedrine worked great for my depression. I noticed that Vyvanse tried but failed at getting FDA approved for depression recently. But after 5 years these stimulants began to lose their magic. I became more anxious and started having panic attacks. I began taking benzodiazepines instead. They seem to help. But I’m looking for something else. I’m looking for an off label medication for depression. I want to feel alive again. Any suggestions would be appreciated. I’ve been terribly depressed and uninterested in life for years now. What meds works? (no SSRI MAOI or Trycyclics)

[BeyondtheRainbow]

Have you tried an MAOI? It's a big step but it was the best move medication wise that we have ever made for me in 19 years of psych meds. I am on Emsam which is a patch I change daily. Emsam has no dietary restrictions at the low dose, at the middle dose my pdoc allows me to have reasonable amounts of the foods that are not allowed (the man who created it told her that the restrictions are only there b/c the FDA insisted; nobody reacted during trials) and at the high dose I follow the restrictions carefully. The food restrictions aren't that bad (I miss cheese and Chinese food sometimes (soy)) but it passes and other things exist.

I had been on pretty much every AD out there and the one I'd been on for a few years was no longer working. So that left Emsam. I went on it in the hospital so that I could go immediately from the lowest dose of my imipramine taper onto the Emsam without a 2 week washout period. By 14 days in I was feeling different and by a month much, much better than I had felt in years. I even had a couple of months that my bipolar was "in remission" and that has never happened before or since. 6 years later I'm still on it. My pdoc says it rarely stops working for people. I've had a bad year with my bipolar and if an upcoming med change doesn't work I think they'll be taking me off Emsam and trying something else. I hope that doesn't happen; I like Emsam. We discussed other MAOIs but their dosing schedule would be hard for me so they aren't ideal although they'd be my first requests if I do have to come off Emsam.

Anyway very long story short (sory, no sleep and mood is a mess) MAOIs are good. Not all drs will prescribe them which is a problem but they work very well and are not as scary as they sound initially.

[Moogieotter]

Originally Posted by Paracelsus

Vyvanse and Dexedrine worked great for my depression. I noticed that Vyvanse tried but failed at getting FDA approved for depression recently. But after 5 years these stimulants began to lose their magic. I became more anxious and started having panic attacks. I began taking benzodiazepines instead. They seem to help. But I’m looking for something else. I’m looking for an off label medication for depression. I want to feel alive again. Any suggestions would be appreciated. I’ve been terribly depressed and uninterested in life for years now. What meds works? (no SSRI MAOI or Trycyclics)

Hello,

Sorry you are still suffering. I remember your other thread about Zoloft and your med fears. I would like to help, but I need to understand why controlled substances/scheduled drugs, which have been shown much more risky then SSRIs, are not triggering your fears - Vyvanse, Dexedrine, and benzos carry much greater risk of side effects and addiction.

Please explain this.

The other med classes that might help your depression are Mood Stabilizers like Lamictal and Atypical Anti Psychotics like Abilify. Especially in the AAP's case, there is much greater risk for side effects and long term issues than with SSRIs.

Best of luck and please keep posting.

moogs

As of Friday I'm on clozapine for depression.

[Paracelsus]

Originally Posted by Moogieotter

Hello,

Sorry you are still suffering. I remember your other thread about Zoloft and your med fears. I would like to help, but I need to understand why controlled substances/scheduled drugs, which have been shown much more risky then SSRIs, are not triggering your fears - Vyvanse, Dexedrine, and benzos carry much greater risk of side effects and addiction.

Please explain this.

The other med classes that might help your depression are Mood Stabilizers like Lamictal and Atypical Anti Psychotics like Abilify. Especially in the AAP's case, there is much greater risk for side effects and long term issues than with SSRIs.

Best of luck and please keep posting.

moogs

I’ll be happy to answer your question. To be frank I don’t care if it is a controlled substance or not. I take them responsibly. And you’re only assuming that SSRIs are safer. I’ve heard of countless people committing suicide on SSRIs. In fact I’ve lost a handful of friends that way. I almost lost my life that way.

The reason people kill themselves on SSRIs is because of the SIDE EFFECTS. That’s why it says WARNING THIS MEDICATION MAY INCREASE THE RISK OF SUICIDE. It’s not a safe medication at all. It’s not any safer than Xanax or Adderall.

Thanks for suggesting that I'm only after scheduled substances. Not true.

[Moogieotter]

Originally Posted by Paracelsus

I’ll be happy to answer your question. To be frank I don’t care if it is a controlled substance or not. I take them responsibly. And you’re only assuming that SSRIs are safer. I’ve heard of countless people committing suicide on SSRIs. In fact I’ve lost a handful of friends that way. I almost lost my life that way.

The reason people kill themselves on SSRIs is because of the SIDE EFFECTS. That’s why it says WARNING THIS MEDICATION MAY INCREASE THE RISK OF SUICIDE. It’s not a safe medication at all. It’s not any safer than Xanax or Adderall.

Thanks for suggesting that I'm only after scheduled substances. Not true.

I suggested two non-scheduled medications that meet your requirements of no SSRIs, TCAs or MAOIs. You should check em out, but there's risks with those too.

From my perspective, you have built a tolerance to amphetamines and are now using benzos to help with the symptoms. I am familiar with the effects of these meds from my personal experience, and I am sharing the idea that for me the negative impact on my quality of life is/was far greater from amphetamines and other controlled stimulants and most certainly benzos than any SSRIs or other med classes I have taken.

Go with the statistics, try what you like. Replacing speed and benzos will be very difficult without an SSRI, TCA, or MAOI. I'd be willing to bet that you have increased anxiety, irritability, and OCD from the amphetamines, as they complicate these symptoms more than help them.

I seriously am trying to save you a great deal of pain by suggesting to move away from controlled substances. Take it or leave it.

moogs

[BeyondtheRainbow]

Sorry about posting bout the MAOI. I didn't see that you weren't interested. I will say that they have the most common mechanisms of action to the drugs you prefer but without the risks of tolerance or dependence. When I first was on an MAOI I needed sedatives for the first few weeks just to cope with the increase in energy because they are very stimulating. They are also extremely well-tested drugs having been around for a very long time.

[Paracelsus]

@Moogieotter

I do not take Adderall and Xanax concurrently. I stopped taking Adderall last year. I only take 0.5 mg of Xanax daily. My psychiatrist and I are trying out medications to see which one works. So far Clomipramine and Zoloft have failed. That's why i'm asking everyone. I want ideas for when I go and see him.

[Moogieotter]

I see. But you were on Dexedrine for 5 years?

I think I remember that you tried one 25mg Zoloft and had a panic attack and stopped taking it? How was your experience w the TCA (Clomipramine)?

[BeyondtheRainbow]

I'm not trying to argue with you, I'm just curious, why are you eliminating so many meds after only trying 2? I understand that you feel SSRIs are not well proven to be safe but why not tricyclics? Imipramine is the AD that's been around the longest and is the gold standard used to compare other drugs when they are tested (or it was the last time I paid attention to AD testing which has been a long time). The meds in each class are so different even when related somewhat and just because one tricyclic failed doesn't mean anything about the others (unless you are talking about 2 that are more closely related but there are plenty that aren't.) Noritryptiline and amytriptyline both come to mind. I do not think that SNRIs would be good for you because they tend to be more side effecty when going on and you feel a lot of anxiety already. Remeron is a good clean drug without a ton of side effects. MAOIs probably aren't even an option your dr would consider if you've only been on 2 ADs so forget anything good I've said about them (although they are good ). They would also be hard with medication related anxiety.

If you are just on a little bit of Xanax then you are only really getting treatment for some anxiety and not the depression you are seeking help with. I'm sure you know this. I just think that you probably are eventually going to need to either take an AD or consider some type of mood stabilizer or antipsychotic and those are much more likely to have side effects than an SSRI or tricyclic. I've been on nearly all of them in all of these groups and side effect wise I'd go (eliminitating SSRIs because they didn't pley well with my bipolar at all)===tricyclics, Remeron, MAOI, SNRIs (have little experience with these so hard to place), mood stabilizers, antipsychotics. Benzos are out on their own because of dependence (and I do take benzos every night and have a 2nd PRN for sleep because it is all that works so I'm not anti-benzo) but if I hadn't tried everything else for anxiety/sleep I wouldn't take them and I am hoping to reduce my usage of them after a med change that is pending for me. I say that because a couple of months ago I was quite manic and also felt really sick one day. I thought I had a stomach virus and had all that goes with one. Then I went to take my pills and realized I'd completely forgotten meds the night before and thrown myself into withdrawl. I was good and sick and while some of that was from another med plenty of it was benzo related and that's just not good.But I've been on a fair amount for a very long time so I'll have some work to do to get off, when I can.

I've been treatment resistant from the first med I took so I've been on many, many meds. I am just suggesting that you try to give them more of a try and not judge a whole class of drugs by one bad experience. I've never been able to do that because if I did I would have been out of drugs very quickly and it has paid off as I've found meds that have worked after trial and error through all the different categories. Being open to trying has probably saved my life more than once and I hate to see you restrict yourself so much after only trying 2 meds. It can and will work out eventually. I know it is scary and hard but with time and trust in your pdoc it is possible to feel good and do well on meds that are safer and easier on your body.

[Paracelsus]

Originally Posted by Moogieotter

I see. But you were on Dexedrine for 5 years?

I think I remember that you tried one 25mg Zoloft and had a panic attack and stopped taking it? How was your experience w the TCA (Clomipramine)?

I was on Dexedrine for about 6 months. I was on vyvanse for about 3.5 years and Adderall for 1 year. I tried one 50 mg Zoloft and had more than just a panic attack reaction. It was 3 days of heart palpitations and rapid heart rate, 1 day of nausea, 2 days of diarrhea, 1 day of internal restlessness, 1 day of headache. It impaired my thinking and made me feel more anxious and more depressed and more irrational and impulsive than I have ever been before. Zoloft basically made everything 100x worse.

Clomipramine made my muscles rigidly and gave my extreme nausea and panic attack. Clomipramine 50 mg was actually not as bad as the sertraline but still intolerable.

In the past I have taken SSRIs SNRIs and many other medications and tolerated the side effects well. But things have changed this last year. My body has changed. I’m hyper sensitive to my bodily sensations and it sends me into panic.

I have been on mood stabilizers, antipsychotics, antidepressants and others over the past 9 years of my life. It’s only been the last year I’ve been medication free.

[BeyondtheRainbow]

Have you tried seeing a psychopharmocologist? (took me 5 minutes to spell that). Sometimes they have surprising techniques for helping when lots of meds don't work out. My pdoc is both a pharmacist and a pdoc so is a psychopharmaologist without calling that her specialty and she's done some things for me that sounded weird but worked. You might have to go to a big teaching hospital in a city but that can be worth the bother (assuming it is a bother). I drive 2.5 hours each way for my pdoc and it is worth it.

The other thing is have you tried the genetic testing? I know that a lot of insurance is paying for it now and that people generally seem pretty happy with it. I'm doing it through a clinical trial so I've done it once without getting results and will do it again when they have enough baseline patients and that time will get results, hopefully fairly soon. I read that sometimes a vitamin deficiency or something will show up that when treated makes meds work better. I truly don't know a lot but I know that there are a lot of people on here who've had it done and do know about it so asking might be worth it (especially on the depression or bipolar forums).

[Paracelsus]

@Breadfish
clozapine huh? I read that it has a 5% chance of giving permanent movement disorder. Also you have to have your blood regularly monitered for white blood cell count. Maybe it’ll work for you. Good luck. I’m probably not going to try that one anytime soon.

[Paracelsus]

@BeyondtheRainbow
An Emsam patch huh? Is that anything like selegiline? I haven’t tried emsam or selegiline. They are on my list of possible options though. Thanks for the suggestion.

Psychopharmecologist is a hard one to say. I drive an hour each way to see my psychiatrist. He’s alight. I’ll ask him about genetic testing. I’m also asking him about PTSD and panic disorder service dogs.

[BeyondtheRainbow]

Emsam is selegiline. It has worked very well for me for 6 years now. You are at a good place to try it b/c you aren't on another AD that would have to be weaned off before starting it.

I have had few side effects on it. It is stimulating and I've had to adjust the dose with cycling sometimes. The first almost year it kept me from being very hungry and I only ate some really specific things most of the time. But I got past that and started eating more normally after I was used to the change in my body. I did need some meds at first to help control the over-stimulation while I got used to it but that was just for a few weeks. There was some skin sensitivity at first so that I had to keep a log of my patch sites and keep as much time between uses as possible. But they changed the adhesive and I've never broken out since; the adhesive was an issue for a lot of people when the drug was newer. Those are the only things I can think of ever happening with it. It's an easy drug once you learn what foods you can and can't have and that you have to be really insistent that even the dentist check for interactions before numbing you (whatever my dentist uses is safe but he can only use so much. I tend to not stay numb long and so we had one cavity that he had used all but one injection. He put it in and said "now we're going FAST" and minutes later he had the painful part done. Usually there are plenty of shots left if needed so it's no big deal. I've had surgery 3 times on it and it wasn't a big deal, they just had to be careful and my pdoc educated the surgeons on safety and they used specially trained anesthesiologists who had a safe way of giving anesthesia. I like it.