What anti-depressant should I take now?
December 19, 2010 10:19 PM   Subscribe

What anti-depressant should I take now?

I had been on Effexor XR for about a year and a half, and while I never really felt that it really "worked" for me, I realized after going off the medication (and the subsequent worsening of anxiety and depression) that it probably was somewhat of a help to me. So why did I go off the medication? My previous psychiatrist retired and upon switching to my new guy, we decided to try something else to see if it would work better. Also, I have high blood pressure, and was told by new psychiatrist that Effexor is not recommended for those with high blood pressure. So that puts Effexor out of the question for me.

Okay - so we started off with Wellbutrin and within a week I was feeling unbelievably anxious. After trying it for another week and a half we decided that it wasn't the right med for me. Moved to Lexapro, 10 mg, and tried that for 4 weeks. I didn't have the anxiety that I had with Wellbutrin, but no change in depression. Increased the dosage to 20 mg and have been on that for 4 weeks now. In total, 8 weeks of Lexapro and no change in depression. In the past I've tried Prozac, Celexa, and Paxil, all of which did nothing.

I see my psychiatrist this week, but I'm starting to lose hope about the efficacy of anti-depressants. The shrink has suggested trying Imipramine as a next step since the other anti-depressants haven't worked. I don't like what I've read about the drug, specifically its tendency to cause mania or hypomania in 25 percent of patients on it. Does anyone out there have any words of wisdom? Anyone been through similar trial and errors and ended up finding a drug that worked? Suggestions? Is there one with a similar chemical profile to Effexor XR that maybe would work better?

And yes, I know the drug is not the cure, I also see a regular therapist weekly, do yoga, exercise, socialize, etc. I'm aware that anti-depressants will not cure everything, but I do expect some improvement.
posted by Sal and Richard to Health & Fitness (20 answers total) 3 users marked this as a favorite
People's responses to antidepressants vary enormously, and there's no way to predict what the response will be.

None of us can give you any useful advice. Your therapist is trying to help you, and he should be your source here.
posted by Chocolate Pickle at 10:23 PM on December 19, 2010 [3 favorites]

Cymbalta is similar to Effexor because they are both SNRIs where many other antidepressants are SSRIs.
posted by needs more cowbell at 10:29 PM on December 19, 2010 [1 favorite]

Had Effexor actually worsened your high blood pressure? Mine has gone up a tad, but not that much. Again, I am not your doctor, but maybe it might be within the realm of possibility.

Your psychiatrist will be able to give you the best assistance. However, if for some reason you feel uncomfortable with the advice your new psychiatrist is giving you, feel free to look for another one. You're not doctor shopping; you're looking for the person who will give you the best advice and work well with both you and your therapist/other doctor(s).

I was in the situation you had with Effexor -- thought maybe I should try something else with fewer side effects and switched to Celexa. It was a big mistake, and I've been back on Effexor happily for about three years. But I'm only saying this to remind you that sometimes when you think something isn't working so well, it's doing its job in a more subtle way. Sounds like you know kind of how that goes, but I figured I'd add my experience.
posted by Madamina at 10:30 PM on December 19, 2010

I used imipramine for nearly 20 years and did well on it. The only side effect I had was dry mouth and dry sinuses, which was actually great for my allergies...

It's worth a try since you are being monitored by a doctor.
posted by a humble nudibranch at 10:32 PM on December 19, 2010

I was on Effexor, had borderline high blood pressure (dunno if it was related) and switched to Pristiq. It's a metabolite of Effexor, so it's very similar, but without as many side effects. My BP went down again. YMMV.
posted by saveyoursanity at 10:32 PM on December 19, 2010

Chocolate Pickle has it: everyone responds differently.

That being said, keep trying the drugs; one will work, eventually. Or perhaps a cocktail is required.
posted by LOLAttorney2009 at 10:37 PM on December 19, 2010

Madamina - when I was at a lower dose of Effexor (150 mg), the blood pressure didn't change. I eventually went up to 300 mg and pretty soon after the BP increased. It is back to normal now that I'm off Effexor.

A humble nudibranch - thanks for sharing that. For some reason, I'm very afraid of Imipramine, but maybe that's a lack of knowledge on my part.
posted by Sal and Richard at 10:37 PM on December 19, 2010

I had really good luck with Serzone (nefazodone) after trying other antidepressants and not being unhappy with their side effects. I was on it for about 7 years, and the only significant side effect was some hypomania when I was on a pretty high dose in the early stages, but it resolved quickly when we adjusted the dose down a notch.

That said, it's a controversial drug (there is a very remote risk of liver damage, which led to the brand name being pulled off the market), but my doctor monitored my liver function regularly so I was willing to stay on it. (I went off it a few years ago only because I no longer felt I needed an antidepressant in general, not for any reasons related to side effects.)
posted by scody at 10:55 PM on December 19, 2010

(er, that first sentence should be "...and not being unhappy with their side effects.")
posted by scody at 10:57 PM on December 19, 2010

Thanks scody - will do some research on that drug, never heard of it.

Chocolate Pickle - I am aware that everyone responds differently and that nobody will have the exact same experience. However, there are some commonalities and maybe someone here would have gone through a similar period of adjustment to medication that might be helpful for someone who is feeling like maybe this depression is as good as it gets for me.
posted by Sal and Richard at 11:08 PM on December 19, 2010

SaR - I can sympathize with your plight.

Over the past decade, I've tried nearly every anti-depressant out there, and the only one that even worked for me was Wellbutrin - and then only the name brand, and only on a very low dose (150 mg was the max I could take). All of the other ones either didn't touch my depression at all, made it worse, or had such horrible side effects that I had to stop taking them, even when they did work. But then, I felt towards the end that Wellbutrin only worked partially - I did notice a constant, low-level depression over my head, it barely touched my ADHD at all, and it did make me incredibly anxious. But I had taken it for such a long period that I have accepted those states as 'normal'.

I eventually had to stop taking it, as my insurance company stopped paying for the name brand, and the generic made me agitated and angry all the time. Turned out to be a great move - thanks, Premera Blue Cross of $Texas!

So, currently I'm not on any anti-depressant at all. However, I did have my Vitamin D levels checked, and they are very low - so I'm taking 100,000 IU a week for the next three months, under a doctor's supervision. (And yes, I know the new Vitamin D research that came out - mine's still low even according to those standards). I'm also taking a very low dose of generic Dexedrine Spanules for the ADHD. Both of these are helping me tremendously - I can tell that the Vitamin D is helping the depression directly. And with the ADHD being tamed, I'm able to be more productive and organized, which does wonders for both my anxiety and depression.
posted by spinifex23 at 11:22 PM on December 19, 2010 [1 favorite]

I'm also looking into switching right now. Effexor RX and it hasn't been doing much for me. I've previously taken Zoloft, Wellbutrin (went off it quick, it made me feel 10x worse), and Celexa. I've been thinking of suggesting something like Modafinil. Ultimately, I'll do whatever my doctor thinks but it's been something I've heard about lately.
posted by autoclavicle at 3:29 AM on December 20, 2010

Depressed people are often not good at measuring their depression. Most family docs don't really deal with this. You need a way to rate your mood, energy, and other factors every day, so that you can adequately judge. Also, there's a book about fighting depression with out meds that has been recommended on ask.me. I have a copy on the way. I don't expect to get off anti-depressants right now, but I'm unable to tolerate the dose that would really help the most, and I hope to find useful strategies.
posted by theora55 at 6:53 AM on December 20, 2010

I'm sorry you're going through the chain. Has anyone brought up a cocktail approach? Maybe 2 drugs? Whatever the solution is, no one here can help since they work differently on all people.
posted by stormpooper at 7:31 AM on December 20, 2010

I had been on Effexor XR for about a year and a half, and while I never really felt that it really "worked" for me, I realized after going off the medication (and the subsequent worsening of anxiety and depression) that it probably was somewhat of a help to me.

I had a very similar experience, and later realized that what I thought was my mind returning to its normal state was in fact the symptoms of Effexor withdrawal itself. Withdrawal from Effexor for me caused severe anxiety and crying jags that lasted for over a month, as well as physical symptoms like nausea and dizziness. It was particularly severe for me because I went cold-turkey, instead of tapering down my dose, but people can have really intense reactions to Effexor even tapering.

In my experience, doctors are not informed enough about how extreme the withdrawal can be in some people, and it sounds like if your new psychiatrist just tried to put you on a different drug "to see if it would work better," he may be one of the less-aware. You might want to talk to him about the possibility that what you're feeling right now is not major depression exactly, but withdrawal, and how treatment can be tailored to lesson withdrawal.

For me, the withdrawal didn't get any better until I started on another SNRI, the very similar Cymbalta (duloxetine). I don't know if Cymbalta would be a good choice w/r/t blood pressure; you'll have to discuss that with your doctor. But be warned that Cymbalta withdrawal is no easier than Effexor withdrawal. I've been taking the drug now for years and am unable to get off of it (which I would like to, as it is expensive and the long-term effects of use haven't been researched sufficiently) because the withdrawal is so intense.
posted by bookish at 8:13 AM on December 20, 2010

It really is a very individual thing, and often a combination of drugs is necessary.

One data point: I took Celexa for about 6 months, and while it reduced my anxiety, it only took the edge off the worst of my depression. Then my shrink added Wellbutrin and now everything is great.

So, if Wellbutrin causes you anxiety but helps with your depression, maybe you need a few months on an anti-anxiety/depression drug like Celexa until it builds up in your bloodstrean, then add the Wellbutrin back in?
posted by Jacqueline at 8:49 AM on December 20, 2010 [1 favorite]

IANAD - I second the significant increased amount of Vitamin D along with an increase of niacin (B3).

I have two friends who both are clinically depressed and their doctors prescribed them high doses of Vitamin D and it has worked wonders for them.
posted by jillithd at 8:57 AM on December 20, 2010

Cymbalta worked really well for me, for about 2 years. I'm off it now, as it's not safe for pregnancy. Going on and off anti-depressants is one of the hardest things someone can do, and I wish you the very best in finding what works for you.

Also, I've been taking a prescribed Vitamin D supplement, as it was found I have a Vitamin D deficiency. Other things, like change in diet (going gluten or sugar free) have been found to help too.

Good luck!
posted by bethazon at 9:03 AM on December 20, 2010

I want to second the idea of possibly taking a cocktail of drugs. I currently take Celexa as well as Buspar to help with anxiety and Neurontin (a mood stabilizer). My first two weeks on Celexa were a roller coaster of anxiety, but my doc increased my dosage (of everything) and the anxiety improved significantly.

I'm not necessarily recommending Celexa as I'm not certain it helps with my depression, but some of the options (like Wellbutrin) may be aided by an anti-anxiety prescription as well.

My therapist also recomends that I keep a daily journal of my mood throughout the day so that I have something very exact to report when I see my doctor. Treating depression with meds is almost completely trial and error, so the more informed you are about your own moods, the more information your doctor can use to prescribe.

Good luck, I know how difficult and frusturating this process can be.
posted by thankyouforyourconsideration at 9:52 AM on December 20, 2010

I have a lot of friends who responded well to Zoloft.
posted by amycup at 10:49 AM on December 20, 2010

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