List AD that helped the most/longest..

OK..a zillion AD's out there.....please share the one/ones that helped you the most. <font color="purple"> </font>

Effexor XR. Been on it over 5 years, they will pry it out of my cold, dead hands to get me off it. ;-) Love the stuff.

Candy

designs - I finally found a combnation that worked; Effexor XR™ (venlafaxine) and Wellbutrin SR™ (bupropion). I found that the lethargy in the morning with the Effexor was close to being debilitating; adding the Wellbutrin helped .... for about 6 weeks. My doc added a bit of Dexedrine SR (dextroamphetamine) and that helped. I tried stopping the Wellbutrin, but found that it really did give that little extra mood elevation. It was kinda like the Wellbutrin "topped-up" the antidepressant effect of the Effexor.

I was kinda worried about being able to stop the Effexor and the Dexedrine; but decreasing the Effexor over 6 weeks I found that I was able to stop the Dexedrine at about week 4 and was completely off the Effexor by week 6. I didn't have much of a withdrawl effect from the Effexor, but did feel a bit uneasy or "spacey" a couple of times. It was only in retrospect that I related that "blah" feeling to decreasing the Effexor, but that is probably what it was.

I have been med-free since the end of last May. There are times that I wonder if I made the right decision, but so far no full-blown, lasting remission. I'd like to stay as far from the edge of that deep, dark pit as possible; if you know what I mean. Like my psychologist said, the meds can only do so much; the positive lifestyle changes that I am making (or, at least am trying to make ) really do seem to make a big difference on my overall emotion state. It ain't easy, but I'm am trying (my wife says "at times, very trying" )\

- Cam

Cam - I've heard this said and wondered if there is any validity, "If a drug is working for you, and you go off it, if you go back on, it will no longer be effective". It makes no logical sense....but it's one of those things you "hear" on the Internet.

Thanks, em

Emily4040 - There seems to be some validity in the phenomenon of when stopping an SSRI and then taking it again, the SSRI often doesn't work as well as an antidepressant as it did when it was first taken. I have seen this with all the SSRIs at least once, including Zoloft™ (sertraline), Paxil™ (paroxetine), Prozac™ (fluoxetine), Luvox™ (fluvoxamine) and Celexa™ (citalopram). I haven't "personally" seen it occur with Lexapro™ (escitalopram), but I do assume that it has happened.

This is not to say that an SSRI never works as well as on the second trial, just that sometimes it definitely does happen. I have seen it happen when someone has stopped an SSRI too soon (ie. before the body has had a chance to adjust from a depressive state to a euthymic state) and also when that SSRI had work for an initial deppressive, but when tried for a subsequent depressive episode (eg relapse of depression). This can be frustrating for both the person with depression and for the clinician.

There is no obvious reason for an antidepressant not to work a second time, but it does happen; and although it does not happen all of the time, it is not a rare occurance, but then again it does not happen every time.

When using an SSRI, I do suggest that, if the SSRI is controlling the depression (ie. helps to alleviate depressive symptoms), one should remain on that SSRI for at least 9 months after euthymia (ie. absence of depression) is acheived. This (hopefully) gives the body the time it needs to start producing enough serotonin on it's own. Since I do not know why this happens I always recommend staying on an SSRI, if it is working, for at least a year after attaining euthymia.

The old adage of "don't fix it if it ain't broken" definitely applies to SSRI. I have seen other psychiatric meds not work as well on retrial, with lithium being the classic medication that seems not to work second time around. Many clinicians (eg psychiatrists) do not believe that this is true. Many studies show that lithium works just as well the second time; many psych nurses that I know will disagree.

I have seen this effect wih other psychiatic medication like the atypical antipsychotics. (eg. Zyprexa™ - olanzapine and Risperdal™ -ripseridone) and even mood stabilizers like Tegretol™ (carbamazepine) and Epival™/Depakote™ (divalproex), but to nowhere near the extent that it happens with lithium and the SSRIs.

That said, I really do not have scientific proof of this happening, but I suspect that most clinicians have seen it at least once. Often a failure upon second trial has been explained away as noncompliance on the part of the patient, but I know that this is not true in a majority of cases.

Another problem with SSRIs is the phenomenon of "poop-out". Someone taking an SSRI initially experiences some degree of remission of their depressive symptoms, but after 6 or 8 months the medication stops working, for seemingly no apparent reason. Like the above situation, this can be terribly frustrating, but, alas, it does happen. Again, I have no proven scientific explanation of why this happens. Raising the dose in both cases does not seem to fix the problem; Interestingly, a couple of times I have seen that a slight lowering in SSRI dose after poop-out did result in restored antidepressant activity. Alas, I have only seen this work a few times; most times lowering the dose did nothing.

Unfortunately, all I can say is that these phenomenon do apparently exist, and one must change medications. Sometimes changing from one SSRI to another fixes both poop-out and retrial failure, which is also puzzling.

Another thing that I should mention is that SSRIs to not "cure" depression. They are only a tool that resolves depressive symptoms enough so that one can "fix" the problems in their life that brought on the depression in the first place. In chronic depression, resulting in large part from genetic factors, one may have to stay on the SSRI for life, but a change of lifestyle to reduce stress does seem to help someone remain euthymic longer and also improve the quality of one's life.

I hope that this is sorta clear. - Cam

Zomig! I had been on Imitrex for a long time (for migraines) and didn't even know Zomig was there... and then I found out Zomig comes in disintegrating tablets so I don't have to wait to find water to take it or ask my T for a cup of water! It works faster on the migraines too...and that keeps them mostly from becoming the torrid ones. They also have a nasal spray that works fast too... I use this when I wake up already into a migraine in the middle of the night.

ok, i was having a blonde moment .... wasnt sure if AD meant advertisement or antidepressant, so heres a combination of both

http://www.geocities.com/cottoncandylocks/zoloftdie.jpg

and ya, the zoloft helped me the most... helped me into rapid cycling hypomania...

WARNING: cottoncandylocks is obnoxious and synical. all posts by this user should be approached with caution.

dont say i didnt warn you

Wow - GREAT info Cam, and highly readable. I love that about your posts. What about Effexor and going off and back on? Have any experience with that? I do know it's pretty famous for it's "poop out". I've been on it for 4 years. This year my depression came back full force, however there were also life nasty lisfe circumstances impacting me simultaneously. So, I'm not sure if effexor pooped, or life pooped...ya know? Anyhoooo, my pdoc added Lexapro, and I'm doing much better. Now, I'd love to get off Effexor, so I could get rid of some of the side effects....and because I don't think I'm getting any benefit from it. I'm just in the wondering stage now, since I AM feeling good and don't want to rock the boat. But if I got off Effexor, I could also stop taking Tamazepam for sleep, and perhaps enjoy better...um...ya know....fireworks displays this summer.

emmy

<font color="purple">Zoloft worked for me for 8 years.

Celexa didn't work for me.

Mirtazipine worked for 8 months, but made me gain weight.

I'm currently on Effexor XR and it works amazing, especially for my GAD.</font>

sheesh who makes up these stupid initial things? Ads are ads. Anti-depressants are anti depressants! While I'm at it, ED doesn't mean eating disorder!!! ED is ERECTILE DYSFUNCTION!!!! Criminy I hate having to think about what someone means.

Of course it's in the drug forum but I thought it was a clever topic and from a different angle... sorry, it's just another one.

This one leads in four categories.....best tolerated, most effective, least side-effects, longest lasting.... Hypericum perforatum, also known as St. John's wort.

Lar

I have what I believe to be a more genetic based depression...but who knows. I have been on many different meds over the years. I was your classic "bad" patient, I waited until I was suicidal...went to the Dr....took meds until I felt better, stopped...and then repeated the cycle..usually every year at least. No manic periods (darn) just plain old deep depression. I have now been on meds daily for about 8 years now. Zoloft lasted about 4 years and I am currently on effexor xr at 600 mgs. daily. I have loved it...but I am sure I have hit the top dose. I was also prescribed an anti-pyschotic over the years to combat the suicidality. I frankly hate the side effects..weight gain, fatique etc. so consequently I have cut back the dose of that med. I can feel myself rolling downhill again. I want to ask the Dr. for an additional anti-depressant..but am afraid he will get upset at the screwing around that I do with the other med consequently...I continue to roll and am picking up steam. My question is...do other meds, specifically the anti-psychotics "help" the anti-depressant work better (as I have heard is the case with say lithium), or are they their own animal and used to treat specific symptoms? I guess I am just looking for a rational to approach the Dr. about adding a new anti-depressant instead of upping the anti-psychotic. Thank you!

The one that helped me the most and most concistently has been Adderall XR which of course isn't technically an antidepressant but it works for me. I have been lucky that I haven't developed a lot of tolerance for it and have responded to very small amounts -10 mg a day. I have taken it for several years.

Previously I have had pretty good results with Prozac at first but it eventually led to overwhelming apathy and I discontinued it. Effexor worked pretty well on my anxiety and somewhat on my depression but I discontinued it after it caused memory problems. St Johnswort worked really well for me for about a year. I discontinued it and the second time I tried it have not had the same good results.

I have had trials of many other drugs but those worked the best.

Daisy - Yes, the atypical antipsychotics, even in low dose, can help give that little extra "oomph" to antidepressants. Actually, they can help on the manic end for those who suffer from bipolar disorder and aren't totally relieved by the standard mood stabilizers. Zyprexa™ (olanzapine) has been approved for this indication.

I have seen small doses of Zyprexa (2.5mg to 5mg at bedtime) used to boost SSRI and Effexor XR™ (venlafaxine) effectiveness, the risk of weight gain and Type II diabetes makes me shy away from recommending this routinely as an antidepressant booster. I tend to like to see doctors start by adding a little Risperdal™ (risperidone) at doses of 0.25mg to 0.5mg at bedtime. I know of a few docs who do use this, but I do not believe that the practice is that widespread.

More commonly, I see docs use Seroquel™ (quetiapine) at doses of 25mg to 50mg at bedtime, but personally, I like the Risperdal. More often than not, I see doses of Seroquel being bumped from 100mg to 200mg. I am not saying that this happens all of the time, and for many people, the low dose of Seroquel is enough to help the antidepressant; I just have seen better results with the Risperdal. This is just a personal "feeling" of mine, with no scientific basis to back up this claim.

I find that the Seroquel and Zyprexa are especially used when there are problems with a person's sleep patterns with taking SSRIs. These medications do seem to take the edge off of the ruminations (the cycling thought patterns) that occur at bedtime and make it hard for one to fall asleep. I have found that low dose Risperdal also helps stop ruminations (no, I do not have shares in Janssen Pharmaceuticals - the maker of Risperdal ).

Another medication that I have seen used successfully in boosting SSRI efficacy is an older antidepressant called Desyrel™ (trazodone). This antidepressant was used by itself in doses of 450mg to 600mg a day, but it caused profound sedation and a significant "hangover" effect (excessive tiredness the next morning ) at these doses. Also, some men experienced priapism at these doses; which is prolonged, painful erections, that can cause permanent damage to "little Johnny" if not prompting treated. Many docs now use Desyrel (or it's generic equivalent) as a non-addictive sleeping pill in doses of 25mg to 100mg at bedtime. As a note guys, I have heard of any priapism at doses under 100mg a day, but theoretically there is a very small risk. Sometimes 25mg to 50mg at bedtime is enough to give an SSRI that little extra "oomph" they need to help achieve remission.

Talk to your doc about these options and see if he/she feels comfortable using one of them to augment your Effexor. It may be all you need, but then again ..... maybe not. It would be nice if this were an exact science.

I hope that this is of some help. - Cam

st john's wort is good, just might not want to take it with SSRI's .... i did and was overloaded with serotonin!

Thank you so much for the quick response. Actually Respridal is the one anti-psychotic I have not tried ....

I currently take clozaril (don't get worried) because of the positive results for people with a lot of suicidal ideation. It has worked up until now...although I am cutting back the dose a bit... I guess I need to tell the doctor that too.. What I really would like to do is add an anti-depressant as opposed to increasing the clozaril again....although it really helps me sleep !

I just feel I have probably topped out on the Effexor and am worried that the Dr. will think increasing the clozaril would be the way to go.....oh well..

By the way I love your posts....the animation and icons are great! Thank you again!