Choosing the right Antidepressant

[Anon54]

Currently Im self medicating with cwe codeine & valium which costs me heaps. I cant continue doing this forever.

I already take Zyprexa but am concerned about weight gain & increased chance of diabetes. I take 5mg a night but I'll quit taking that if I can get confertable with an AD.

Im interested in trying mirtazepine or effexor maybe even lexapro.

im just wondering if anyone has had any experiences with these AD's. Im choosing these ones because i read a in a magazine they were voted the most successful ADs

 

[laCster]

why are you zyprexa? that shit will seriously fuck your head up man, i would stop taking that shit immediately! flush that shit down the drain

most AD's dont work that well to people, if iu have been taking hydrocodone and valium, i can tell you no AD will compare dude.

this is something u should talk to the doctor.

the only classical AD that works for me and my junkie friends is wellbutrin.

 

[i against i]

zyprexa is an antipsychotic, are you bipolar? because i don't think ssri's are good for that. i take lexapro, have done on and off for a few years no problems. but you should really discuss this with your psychiatrist.

 

[effie]

5mg is a low dose of Zyprexa, I imagine it is for sleep or anxiety? Are you happy taking that? There are side effects - movement disorders ("extra-pyramidal side effects") and metabolic effects (increased risk of diabetes, weight gain, cardiovascular problems) - but it's all about the risk:benefit balance.

Why are you particularly interested in mirtazepine, Effexor and Lexapro? They have quite different effects profiles. I appreciate you read in a magazine that they are the most popular, but that is not a good reason to choose a psychiatric medication. Here they are much less popular. I suspect it has a lot to do with marketing.. they are 3 of the more expensive meds.

Mirtazepine is a sedating antidepressant, although this action is less pronounced at higher doses. It also tends to stimulate appetite. Some find it lacks the sexual side effects of SSRIs/SNRIs. It is a good choice if you want a more sedating medication and if you have problems with your appetite.

Venlafaxine (Effexor) is a SNRI. It has a side effects profile similar to the SSRIs - it can cause sexual dysfunction, jitteriness, anorexia, insomnia, nausea - but many of these ease up within the first 2 weeks. It has a short half life and is prone to causing a discontinuation syndrome when stopped, but this is usually self-limiting. It is also licensed here for the treatment of anxiety, so it would be a good choice if you are prone to anxiety, or if you don't want a sedative drug.

Both of the above tend to be used second or third line here, as they are often effective when other antidepressants have failed.

Lexapro (escitalopram) is a SSRI - it is the S-isomer of citalopram and has one of the lowest side effects profiles amongst the SSRIs. Again, the side effects (if you get any) would tend to be sexual dysfunction, jitteriness/insomnia, reduced appetite etc. Over here it is reserved for treatment resistant depression, or for people who can't tolerate other medications.

SSRIs can increase the risk of suicide when you first start them, although this is probable relating to a lift in your energy with the improvement in your mood lagging somewhat - so suicidal thoughts that already exist can then be acted upon. This is not common, but it does happen so it is something to bear in mind. The risk appears to be greater in younger people.

Antidepressants can be very effective if you have moderate-severe depression, but the choice of which one is highly individual. Broadly speaking they are all reasonably equal in terms of efficacy, but what works for someone else may not work for you - you may need to try a few to find the right fit. It is worth giving them a good trial for several months before you switch, however, unless you can't tolerate them.

It is also very worthwhile considering some form of counselling or therapy.

Having said all that - this is a decision for you and your psychiatrist! You need a proper history to be taken, and an expert to help decide on the correct medication. We can't advise you - we don't know all the ins and outs, we're not experts and as I said before, what works/doesn't work for others can't be applied to you..

 

[Geaux Tigers!]

Effie knows the stuff very well; so do I. I can't be your PDOC but if you can give me a possible DX and some symptoms I could suggest something more specific.

 

[THC2LSD]

For me celexa which is basically lexapro sucked. It caused sexual dysfunction and insomnia, and made me manic. And it didn't work for depression, though some people benefit from it. Zyprexa didn't stop my psychosis and didn't work in me.

I like mirtazipine, helps me sleep and doesn't cause the sexual side effects. Higher doses of Mirtazipine are actually less sedating.Can give you the munches, not as bad as anti-psychotics. Only thing I hate is it blocks psychedelics.

 

[Anon54]

I might consiter mirtazepine as i have trouble with anxiety & insomnia. mostly anxiety. I take zyprexa for treatment of anxiety it's prescribed off label. at 5mg it doesnt seem to have any side effects & i have no trouble sleeping now. i actually like it & wanna keep taking it but the increased chance of diabetes scares me & thats the only reason i wanna change.
It would be good if i had some statistics. i made another thread about this.
if it only increases the chance of diabetes by 30% of so it wouldnt bother me but if its like 500% than i wont wanna take it any more. Does anyone know what the increased chance of getting diabetes is with zyprexa?
is it generally the same with other APs like Seroquel because i didnt mind seroquel either. 100mg was a good dose for getting to sleep when i was really anxious & it didnt have any side effects.

ive tried mirtazepine before & it gave me weird dreams. I know its an antihistamine which is sedating but its also a stimulant. so it wake ya up & makes ya tired at the same time which is probably why it gives ya weird lucid dreams.

im also going to consiter wellbutrin. its an DNRI isnt it?
I quit smoking & i like the effects of the nicotine gum & wellbutrin ive read hits the same receptors as nicotine which is why here in australia u can get a script to help quit smoking called zyban.

Does mirtazepine raise blood suger levels like APs?
obviously it makes ya put on weight like APs do...

 

[THC2LSD]

Yes, mirtazapine can raise blood sugar. I haven't gotten high blood sugar but for a few months it did give crazy dreams. Zyprexa is supposedly more likely to cause weight gain and diabeties than other anti-psychotics. I'm not sure if it's the increase in hunger and weight gain that causes high blood sugar or the action of the drugs.

I haven't tried bupropion except one pill once. Didn't seem to do anything but make me crave tobacco less, though it may take 4 weeks for full anti-depressant effect to appear. I've heard of other people who like it.

 

[Allein]

Hey Anon54,

Whilst it makes interesting reading and its great that people share their experiences of different drugs and treatments it really won;t help much in finding a good treatment for you.

You need to find a good doctor who will help you ans support you in finding the correct drug for your specific problems and your body, ideally you would be assessed by a psychiatrist first to determine the profile of your problems and give a diagnosis. Here in the UK that only really happens if the doctor either thinks you are so ill it is required or has rub through all the options they have.

ADs have totally different effects on different people, more so than any other group of drugs I have ever come across, I went through at least 6 before settling on Venlafaxine (Effexor) which I suffer some side effects from but they are managable.

What your doing at the moment isn't going to be sustainable and could make things more difficult in the long run, self medication isn't a route I would advise at all for Depression, almost by definition you aren't the right person to decide what medication to take.

 

[Anon54]

^^i really dont have that much faith in drs. they can only go on what u tell them. & if i dont know exactly whats wrong with me how can i explain it to a dr.
most drs ive talked to know less than me about meds for anxiety & depression (ive learnt alot from BL over the years).
a few yrs ago a dr wanted to put me on xanax cuz she thought that valium was more addictive cuz it lasted longer.
they wanted to put me on beta-blockers when i went to an actual mental health team but didnt realize that ppl who have asthma cant take em.
i went to another dr who put me on seroquel. when i seen another dr again they said thats the wrong drug. each dr u see will have different opinions.
i ask on here because IN GENERAL how a drug effects one person is similar to how it effects another. so here im actually talking with ppl who have experienced the drug & suffer from similar symptoms to what I do & can give good suggestions on what works for them. Most drs will just type it in there data base. it comes up with take an AD & than they just take a guess. they cant determine which AD to give to ya just from talking to ya.
& they cant make a diagnoses on ya mood unless they've known ya for a long time because ppls moods change every day.

im still interested in the same ADs.
anyone know if mirtazepine increases ya chance of diabetes like APs do?
i might try that first & if i dont get weird dreams i'll use that instead if APs.
if it doesnt work i'll try effexor. if i find it to be uncomfortably stimulating I'll try lexapro.
i have tried pristiq b4, the metabolite of effexor & it was uncomfortably stimulating. im hoping effexor isnt as "strong"
ive tried lexapro too but stopped it before id given it enough time to fully kick in cuz of side effects but ive heard they some-what pass

anyways for now ive just taking 100mg of valium. so im atleasat gunna be ok for the time being

 

[effie]

^ I understand your lack of faith in doctors if you have had some bad experiences. There are good ones and bad ones. However - just because you don't know what is wrong with you, doesn't mean a (good) doctor won't - they have training and experience in diagnosing people and should, in theory, have a much better knowledge of psychiatric conditions than the average person. Some are better than others, of course. If you are not satisfied then you can always seek a second opinion.

The difficulty is a) we aren't a forum full of medics, b) even if we were a psychiatric interview can take over an hour and we don't know the ins and outs of your history, plus a discussion via forum posts =/= a face to face chat, and c) we can share our own experiences but antidepressants, more than most medical treatments, are highly individual and vary a lot from person to person, so there is limited value in this.

Mirtazepine doesn't increase your risk of diabetes like antidepressants, no, although it can increase your appetite which can lead to weight gain, and weight gain (especially abdominal fat) is a risk factor for diabetes. It has a better side effects profile than a lot of the others - no sexual side effects, for example.

if you found Pristiq stimulating you may not get on with venlafaxine itself, or you might. How long did you give it? I found venlafaxine uncomfortably stimulating for the first week or two, then it eased off and has now completely vanished.

 

[scramdor]

I'm currently on Effexor 225mg sr and didn't have any stimulant effects. It was quite the opposite. The first few days I was very tired, after a week or so the fatigue went away. Effexor has been shown to be very effective treating anxiety as well as depression. If you had problems with pristiq, Im not sure effexor is the way to go though. Effexor is known to have more pronounced effects than pristiq

Mirtazapine seems to be the most sensible option. It stands at the top of the list when it comes to antidepressants and there effectiveness. It also has a great profile for anxiety reduction as well as helping out a great bit with insomnia.

The biggest thing with AD's is patience. You don't know till you try it, and then you have to wait a few weeks to get the desired effects. In some cases you get undesired effects and you have to try a new one. I've been there many times. Ive kept my head up and take each new med with an optimistic outlook.

Im content with Effexor, I tried Prozac, Zoloft, Wellbutrin, a combo of Prozac and Wellbutrin, and they didn't seem to work. Then I tried Effexor and wallaahhh. I feel better.

Good luck

 

[CitioKid]

E'reybody is different, as Tila Tequila would say.

I've tried Lexapro (didn't help), mirtazepine (only for a week, not long enough to know if it worked) and Wellbutrin (helped the most of the three).

In general, Lexapro is said to be the most effective SSRI statistically.

SNRI's, like Effexor, seem to work better than the SSRI's for most people. Effexor, I've also heard, is the best AD at treating opiate PAWS - along with Wellbutrin. But the discontinuation syndrome from Effexor and the SNRI's are significantly worse than SSRI's, and are sometimes described as being as bad as coming off dope.

If I was you, or anyone, I'd try Wellbutrin first. Positive affects seem to start more quickly, and it doesn't have sexual side effects for most people. Give it three weeks before you make your final decision.

I would then try Mirtazapine for 5 weeks, perhaps along with the Wellbutrin.

If that fails, try Effexor, as by this point you will likely be jonesing for some relief and not in the mood to test out any SSRI's for a month.

If Effexor fails after 6 weeks, try Lexapro.

If Lexapro fails, just go on suboxone. It will make you feel better instantly, and its side effect profile is less than most AD's (still may get some sexual dysfunction and constipation from the suboxone.) Getting off suboxone is harder than all of the AD's, and will likely result in a prolonged period of fatigue and depression as with any other opioid.

But if you sober up off of everything else, get into the 12 steps or whatever program you prefer, and develop some healthy habits like good eating and frequent excercise, getting off the Suboxone is manageable with a long, slow taper.

Never worked for me, but I've never been good at following doctors orders as I want results NOW, and tend to cold turkey my subs in a desperate bid to get off of them, or switch to kratom to help my "detox". It always fails. Every time.

 

[scramdor]

Wellbutrin has a lot going for it. It has one of the most favorable side effect profiles of any antidepressant and is certainly good for increasing sex drive, and energy. The only problem I see with that is the op mentioned he struggles with anxiety and insomnia. Wellbutrin Is often successfull at treating depression but is known to worsen anxiety and insomnia. These side effects often diminish but for some they don't.

On the flip side, some people show improvements in the anxiety with it.

Just something to keep in mind. You could use it as an add on with an ssri. Create similar effects to that of Effexor without the worry of terrible withdrawals and sexual side effects.

 

[Anon54]

how long does it take for mirtazepine to fully work? doesnt it kick in faster than most other ADs?
I might try that one first. if i get crazy lucid dreams i'll try other. im not sure whether to try wullbutrin of effexor after the mirtazepine. who knows maybe it'll work.

for anyone who has tried both effexor & wellbutrin. which do u think works the best?

someone mentioned bupe before. a friend gave me some. didnt seem did have much of an effect at all. do u have to take it for a while? im sure the dr wont give me that anyway.
my friend has a heap of 8mg he doesnt want. what kind of dose would he helpful.
i could break it into quarters & take 2mg on the days i feel the worst.

u think a dr would REALLY prescribe bupe for anxiety/depression.
anyways i can go on a bupe maintenance program anyways if i want. I do actually do oxys & codeine.... w/d dont bother me. i used benzos at fairly high doses for months & i found it easy to quit with a taper of valium ofcourse

I think i mentioned earlier that i took tramadol for 4.5 months. wish i could get that again cuz it gave me alot of motivation. maybe i could claim that i suffer from migranes. they consider it a weak pain killer in australia. The drs dont know that the dose they presribe is actually the recreational dose. It's prescribed easier than panadeine forte (500mng apap/30mg codeine)

 

[effie]

Buprenorphine does have antidepressant properties but the opioid action makes it impractical as an antidepressant - you don't want an opioid addiction complicating matters..

edit: I see you could use it for maintenance too. If you do, think of it as primarily a maintenance med - any antidepressant action is a bonus..

Pretty much all antidepressants take a couple of weeks to kick in, although some people do feel effects a little quicker - where as others need at least a month. Mirtazepine does appear to have a quicker onset however, according to this paper.

Onset of improvement and response to mirtazapine in depression: a multicenter naturalistic study of 4771 patients
The purpose of this open multicenter study of 4771 patients with a DSM-IV diagnosis of Major Depressive Episode was to analyse the response to mirtazapine in general practice and primary care. Patients with a baseline score of at least 20 on the Montgomery-Asberg Depression Rating Scale (MADRS) were treated with mirtazapine for 6 weeks (30 mg/day) and clinically assessed by their psychiatrists at weekly intervals through the MADRS and Clinical Global Improvement (CGI) rating scales. The data analysis was carried out on an “intent-to-treat” basis to collect outcome information on all patients. Our results suggested that the efficacy of the antidepressant effect relates to a nonspecific process. Nearly all patients (95% ) showed at least slight improvement at the end of the observation period, while the response to treatment was independent of the clinical forms of depression. In particular, all measures of efficacy displayed the maximum change within the first 2 weeks of treatment, with further improvement occurring at much slower rates. Significant improvement within the first 2 weeks of treatment was highly predictive of the final response, and can serve as a guideline for clinicians when deciding about increased dosage, augmentation, or change of medication in unresponsive patients. Detailed analyses of individual MADRS items showed that mirtazapine’s pharmacological profile, unlike selective serotonin reuptake inhibitors, led relatively quickly to a significant reduction of suicidal thoughts, a fact of particular clinical relevance.

 

[scramdor]

I have tried both.

I went to Wellbutrin after unsuccessful outcomes with Zoloft and Prozac.
I used Wellbutrin 150mg twice daily for well over a year.

I also more recently have been put on Effexor and have been on it for 3 months.

There were pros and cons to both.

Wellbutrin began working after about 3 weeks. My energy level was heightened and there was a slight increase in my mood. I still felt down but not nearly as down as I did earlier. It helped me get motivated to hit the gym and spend more time doing social things. I don't suffer to bad from anxiety, I feel it from time to time and Wellbutrin had no effect on that.

Effexor began working in about 2 weeks. I felt quite tired the first few days but ever sense my energy level is normal. My doc started me at 75mg for a week, then 150 for a week then 225mg. After 5 weeks I felt really good. I was in a very stable happy mood. It didn't give me more energy like wellbutrin but it didn't sedate me either. I also felt any anxiety I did struggle with disapear. The negative.... Is my sex drive is shot.

For me Effexor has been significantly more effective at fighting my depression and the little anxiety I had. That being said, I think It would be wise to first off try Wellbutrin+ssri of choice. I think that could have been the missing key for me. If that fails then Effexor should be your next move.

 

[CitioKid]

Anon54 - Why would it be hard to get bupe? You said you are self medicating with opiates, so I'm guessing you are an addict and therefore a candidate.

If codeine and tramadol make you feel better, bupe will undoubtably work for you. Most consider it more euphoric than both codeine or tramadol.

Lower doses tend to have more sustainable euphoric effects, so when you are in light withdrawal try 2mg. That should work just fine.

But before you begin a bupe habit, give wellbutrin and effexor a try. Getting off bupe is a real bitch - MUCH harder than getting off codeine.

 

[scramdor]

I'm not sure Wellbutrin and Effexor is the best way to go. Effexor is considered by most the most potent anti-depressant. Wether it is or not is up for debate. Effexor alone has been shone to have stimulant effects and raise the resting heart rate by an average of 4bpm. It has also been shown to increase blood pressure.

Wellbutrin is known to increase both as well. Typically a psychiatrist will use Wellbutrin in combination with an ssri hoping to achieve the effectiveness of Effexor without the sexual side effects.

This is just my opinion. Ive read that there are some occasions where the two are combined, but rarely.

 

[ErgicMergic]

Benzos cause depression and make existing depression much worse. Try cutting that out with a taper first.

Depression and anxiety are at two different ends of the spectrum. SNRI's and SSRI's give you a stimulating "boost" out of depression, which some people find makes them more anxious. Benzos are the opposite: slow down your brain, slowing down your anxiety, but making you more depressed in the meanwhile.

Some people get great anxiolysis from SNRI's though, so I'm not totally discounting them for anxiety relief.