[ComicWisdom]

I'm going to see my PCP this week and I want to bring some ideas.

I'm on Paxil (Paroxetine) for my depression and Budeprion (Bupropion) for Anxiety. It seems the Paxil isn’t working as well as it used to.

Have any of you switched from Paxil to something else? What do you recommend?

Has anyone tried Phentermine? If you tried it, what were the results? I know it's mentioned as a 'Success Story' elsewhere on the forum.

Thanks for your feedback.

[still_crazy]

hi. Paxil is very potent on serotonin receptors. tapering is sometimes kinda rough ((not trying to scare you, just thought I'd mention it)). Bupropion is a more stimulating drug for depression, and it can help reduce some adverse effects from the SSRI drugs, such as Paxil.

Paxil is often used in anxiety, depression, and OCD. Bupropion is useful for some forms of depression. It can also help reduce some symptoms of ADD/ADHD.

What are you looking to improve? Phentermine is approved for use in weight reduction. I've taken it, and its OK. I personally found the more popular psychiatric stimulants (Ritalin, Adderall) to be better for my set of problems, at that time. For my weight loss, I was switched to Phendimetrazine (Bontril), and I found it easier to tolerate than phentermine, and also a good bit more effective.

Some psychiatrists are using modafanil and NuVigil in some cases of depression, fatigue, etc. I've never tried it, but it does help some people, and you can get refills on it (Adderall, Focalin, Ritalin, are Schedule II substances, so you need a new written prescription for every fill. Kind of a hassle if you're not close to your prescriber...).

High doses of wellbutrin are sometimes used to help curb appetite and help with weight management. I don't know how well that works. I was on 400mgs/wellbutrin. It lifted my mood a bit, but I dropped it because I felt a bit too on edge and nervous on the higher dose.

Mixing stimulants with SSRI, SNRI, and some TCA drugs increases the risk of serotonin syndrome. Serotonin syndrome is not very common, but the risk is not 0. Wellbutrin can make stimulants somewhat less effective, because it inhibits the reuptake of norepinephrine and (I think...) dopamine.

Anyway, the choose of drug(s) really depends on your problems. If you're fatigued and such, something stimulating might be a good idea. If its more anxiety, then maybe an SSRI, SNRI. If you're feeling apathetic, you might want to avoid SSRI, SNRI, and probably most TCA drugs.

I hope this helps.

[ComicWisdom]

Thanks Still Crazy. Yes, this does help. I'll need to reeducate myself on the alphabet soup. Weight loss was not my specific goal, but it wouldn't hurt - my BMI is 32.

I was looking for something to help pull me out of this malaise I’m in. Apathetic? Yes. I used to be a workaholic. I looked for projects to keep me busy. Now, I hardly have the desire to get out of bed, much less complete a task. My productivity at work has decreased.

In my opinion, depression can be contagious. Meaning a couple can bring each other down if both are depressed. My wife has fibromyalgia, migraines, and other pain related issues. She is on disability and stays home talking to cats most of the time.

I need to find a way to pull myself out of thus rut so I can help her AND keep my job.

NOTES:
Selective serotonin reuptake inhibitors (SSRI)

• Celexa
• Lexapro
• Prozac
• Paroxetine
• Zoloft

Serotonin and norepinephrine reuptake inhibitors (SNRI)

• Savella
• Cymbalta
• Effexor

Tricyclic and tetracyclic antidepressants (TCA)

• Amitriptyline
• Amoxapine
• Desipramine
• Doxepin
• Imipramine
• Nortriptyline
• Protriptyline
• Trimipramine

[Skeezyks]

I don't really know much about psych med's in general, although I've been on a few in years past (not anymore.) Paxil is one of the antidepressants I was on... also Prozac & some others. None of them really did anything for me as I recall. Of course everyone is different & what works for one person may not work for someone else. The only antidepressant I ever took that I thought was worth the bother was Cymbalta (& later on its generic equivalent.)

[still_crazy]

hi. me again. If apathy is a problem, you might want to talk to your doctor about something outside of the ssri or snri groups. That's just been my experience...I now avoid SSRI and SNRI drugs because they work on anxiety and tension and such, but after a while...I feel like a zombie. not worth it over the long haul, for me at least.

I will warn you that drugs for depression are not all that great. In big studies, the antidepressants seem to have an advantage over placebo in more severe depressive states, and some critics have argued that even then the advantage isn't much. Having said that, some people respond very well to standard antidepressants, often for a long time.

There are other drugs, too. Lamictal is an anti-seizure drug that is approved to prevent depression in Bipolar I. Its used in other mood disorders, too. In big studies, using lamictal reduced the frequency (and I think severity, too) of depression in those studied. Most people seem to tolerate Lamictal well, although there can be very, very serious adverse effects. I just mention Lamictal because it seems to be gaining popularity as an additional drug in treating all kinds of mood problems, from Bipolar I to unipolar depression that keeps coming back.

A lot of doctors prescribe the newer, "atypical" antipsychotics with antidepressants for depression. Some of the "atypicals" are approved for this use, some are not. Although this approach sometimes helps, I'd personally steer clear, if you can. I say this as someone who takes an "atypical" every.single.day for a severe mood disorder. I think they're better than the older drugs for severe problems, but still not exactly ideal drugs. If you --can-- avoid any major tranquilizer, old or new, I think you'd be wise to do so.

Buspirone is also used as an add-on. Its generic and should be cheap(ish). It sometimes helps improve response to antidepressants. Some people find that it helps anxiety.

Other than that, I don't have a lot of info for you, lol. I know it sounds terrible and jaded of me, but do try to keep your expectations fairly low when it comes to psych drugs. With mine, I'm one of the maybe 1% of America that needs psych drugs daily to keep serious problems (that, thankfully, respond to psych drugs) at bay. I'm just saying this because it makes me sad to see people become --less-- able to function because of psych "treatment" that goes overboard.

I hope things work out well for you and your wife.

[*Laurie*]

In my experience, SSRI's don't cause apathy. Zoloft is especially known to be a more energizing SSRI.

[popuri88]

SSRIs make me hypomaniac. hahahaha

[ComicWisdom]

Thank you for your comments.