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Doctors' Answers to "Frequently Asked Questions" - Depression
These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Lamictol for treating depression? [posted
Question: After approximately 1 1/2 years of suffering with refractory depression
my father was introduced to yet another drug. In November of 1997 he began taking Lamictol
for his depression. In less than a month the change in him was unbelievable. Prior to
taking the new drug I would ask him how he was feeling and always responded in the same
monotone voice: "Terrible". Then on Christmas Eve a miracle happened. I asked
him the same question I had for over a year and his response was different. He said I'm
feeling better today. He had actually taken a shower and changed his clothes and was ready
to celebrate Christmas with his family. He has been on a low dose of Lamictol since
November. In the past eight months the change in him has been so severe. Everyone who sees
him says he's better than he has ever been. Why is this working for him? This drug is an
anti-epileptic drug. Should we be concerned about side effects? Depression can be
hereditary, so should I be concerned for myself and my siblings?
Answer: I've never used this drug for depression. Check with his
doctor as to what he/she thinks they are treating. Is he having a seizure disorder petit
mal or frontal lobe, which looks like depression? Very strange.
Depression [posted 1/4/99]
Question: I have been on Prozac for the last 4 years. Whenever I t#>
o get off
Prozac, I feel fine for a month or two but then the depression symptoms come back again
and I start taking Prozac again. Are these the withdrawal symptoms or is it depression? I
want to become pregnant and that's the reason I am trying to get off Prozac. Is it safe
during pregnancy or are there any other safe alternatives.
Answer: It seems pretty safe with pregnancy as far as we can tell.
Long term studies on children have not been done.
Depression [posted 1/4/99]
Question: My wife has been diagnosed with depression and has been on several drug
therapies for the past two years. They seem to be working somewhat, but she is still
somewhat depressed sometimes. She has been on birth control for over ten years and she
also has low iron in her blood, which she tells me she has always had and that it's normal
for her. I recently heard Dr. Dean Edell on the radio say that recent research suggests
that a combination of iron deficiency and birth control may cause depression. Have you
heard anything about this and could you possibly provide more information?
Answer: No ask Dean.
Prednisone & Depression
Medications [posted 12/11/98]
Question: I'm taking prednisone for polymyositis 20mg every other day,started at
80mg. Plus I am in a depression as well, taking Anti-depressants 500mg/day of Depakote and
150mg of Effexor/day. My question: is dose prednisone prevent the anti-depressants or
interfere with their effectiveness for depression. Thank You.
Answer: No, but steroids do have mental status changes in about 10-20%
of patients unto themselves.
Depression Medications [posted
Question: I have been on anti-depressants for the past 10
years. For the past year I was taking Zoloft with great success. Suddenly it stopped
working and I became very depressed. It appeared as if I had became immune to Zoloft. My
Dr. has now prescribed Paxil 20mg. It has helped with the depression but I seem to be
experiencing two side effects. The first and most severe is night time dreaming. It feels
as if I dream all night and very rarely get a good nights sleep. My dreams consist of true
to life situations and not anything too unrealistic or wild. The second problem is
anxiety. This problem is not real bad, but noticeable. I have reduced the dose to 10mg and
still suffer the same effects. Any advise would greatly help.
Answer: Did you increase the dosage of Zoloft? Most people don't get
resistance;but, change in metabolism happens. A newer one called Celexa might be useful.
Depression & Visions of
Nonexistent Visitors [posted 12/01/98]
Question: My mother is being treated for depression. It started in Feb. '97 with a
sore throat. She didn't get better, so she was in the hospital 4 days and given a course
of antibiotics. Slowly she got better by the summer of '97. In Nov of 97 she got server
pains in the upper left quadrant, chest. After blood tests she was diagnosed as having
H-Pyloric infection, and treated for 2 months with antibiotics, then told she had severe
depression. She was given Amitriptiline, which was changed to Zoloft, and given
benziodiazopeans for anxiety. In March of '98, the chest pains were more severe. A stress
test and EKG found no problems. An internist prescribed Dyciclomine, which has mostly
gotten rid of the pain in the chest. Referred to an gastroenterologist, a colonoscopy
found no problems, was given Propulside for her sluggish bowel, because of years of
constipation. It hasn't helped much. She used stool softners, psyllium and occasional
laxitives, but still has to have enemas. She now has a fairly good appetite and eats a
decent diet. Her depression medicine has been changed from Zoloft to Paxil and Clonazapen
which seem to be working better. In September '98 she began experiencing alarming symptoms
---she would think there were people around who haven't been around for some time(phantom
visitors). She was put on Risperdal for this, with no results. She has one or two crying
spells per day, but also has a period each day when she is stronger and feels normal. Do
you have any suggestions for further treatment and/or a different mixture of drugs? Or
eliminate some of them.
Answer: Has she had a ct of the brain, been tested for syphilis, and
cerebritis? Look for other diagnosis if this has not been done, they are treatable,
psychois is treatable-but, difficult.
Depression & Claritin [posted
Question: My brother has shown all the signs of depression since his late teens. He
has extreme mood swings,has trouble sleeping at night, is obsessive about things and is
very unhappy most of the time. He has never seen a Physician or Psychologist about this
problem. Recently he was prescribed Claritin D (Loratadine) for his allergies. He told me
when he takes this pill he notices a complete change mentally, he feels happy and even
(describes the difference like night and day). Is it possible that this drug is acting as
some sort of anti-depressent and that maybe he has some sort of chemical inbalance? Who
should he consult on this? Thank you.
Answer: Well, the D part is pseudoephredine which can be a mood
elevator. You might try plain Claritin to see if he gets it with the D part or just the
claritin. If it works keep doing it.
Alternative to Vicodin for Patient
with Depression [posted 11/11/98]
Question: I was in a car accident today and the E.R. doc has prescribed 1-2 Vicodin
ES tabs, q4 hours p.r.n. for acute cervical strain. I take Depakote 500 mg, BID for
depression, mood swings and am wondering if these are compatible. I read that a side
effect of vicodin is mood swings, and that vicodin is a depressant. I can't afford
mentally to go that route since I just recently went off of Effexor and am fairly stable.
Any answers or suggestions?
Answer: Local heat, ice etc. Use tylenol with aspirin or equivalent. Excedrin is
a nice combo of acetaminophen,aspirin and caffeine and works pretty well.
Treating Depression [posted
Question: I had two severe cases of depression. In 1981 I had an enormous relief
with elavil. During 10 years I took one pill a day. In 1992, after many trials, the
treatment was sucsseful with nortriptilina, Pamelor. I've been taking it since them.
Recently,the doctor increased the amount to 150 mgs, since I started to had depression
again, not too hard, some days I have it, some days not, some hours. My doctor told me we
should try another kind of antidepressant. However, I have a lot of fear to stop taking
one antidepressant for some days while I wait to begin the other. My experience with that
is very hard. Before I started to take Pamelor, and a very few days later, I lost 17
pounds, and could barely stay on my on feet. It was cruel. My question is: is it possible
to start with another antidepressant without taking off Pamelor an do this during the
process of taking another one? In your opinion wich kind of antidepressant would be
better, a SRI etc? I have to work since I have two boys and I am the only person in the
family who has an income. I feel afraid of not being able to do it. What do you suggest? I
lived for 5 years in USA and I do believe in American doctors and drugs.
Answer: You can combine an SRI antidepressant with Pamelor, without problems in
most cases. We often use them together if neither is sufficient for control of the
Depression & Serotonin Deficiency
Question: I have been treated for depression caused by seratonin deficiency for
four years. The last blood test for seratonin came back at zero. I have been treated with
a variety of antidepressants and recently started taking nortriptoline instead of
efflexor. Are there any other recommended treatments? Any other type of medicine besides
anti-deppressants that I can take to raise the seratonin level? What does nortryptoline do
to raise seratonin levels? can a person not be able to work because of this? can you give
me examples of other cases? What kind of doctor should I be seeing? Would an
endocrinologist be of any assistance? why are psychiatrists most often recommended? What
are the consequences of long term seratonin deficiency?
Answer: I have a patient with the exact problem and the class of antidepressants
you are using is the best answer. I would check your serotonin level and try to increase
the medication to get low normal levels. This is currently the best medication to raise
Depression Medications [posted
Question: I have had major depression since 8/97. I have been hospitalized 3 times
due to suicidal tendencies and I have been treated with numerous medications. I also have
undergone ECT treatments earlier this year with no sign of improvement. I was started on
Welbutrin and Ritalin this Summer. I started feeling better but I was having panic attacks
several times a week. My doctor added Paxil to my mix of medications. I have noticed
little or no sexual desire since I started with the Paxil. Would an in.htmse in my
Welbutrin help? ( I currently take 300 mg. daily.)Or would Viagra be safe to take with the
above mentioned medications?
Answer: Try Serzone or Celexa in place of the Paxil. This will last as long as
you take the Paxil and little seems to help.
Trazadone for Anxiety &
Depression [posted 11/3/98]
Question: Can you please tell me if 50 mg. of Trazadone in the evening will
alleviate anxiety attacks? Throughout the day and evening I have alot of shortness of
breath and nervousness and my doctor just put me on Trazadone (which I took in '93 without
success), I'm also taking 5 mg. of Ambien to sleep. Trazadone does not work to put me to
sleep and keep me there. I was on Paxil for 9 months and it worked so great that I didn't
feel I needed it anymore and I went off cold turkey. When I tried to go back on it 2 weeks
ago it was a nightmare I was a walking zombie. Then he put me on Effexor (37.5mg) and that
was even worse, I almost shook myself right out of my skin. So now I'm on the Trazadone
(50mg) and I'm not convinced it will help with the depression and all the symptoms that go
along with it. Thanks in advance for your response.
Answer: Why would it work not if not before? What problem did you have with the
Paxil? Would be very uncommon to have problems if you tolerated it before. Anyway, there
is a new antidepressant called Celexa that is touted as less side effects;but, similar
activity as Paxil. Worth a try.
New Anti-depression Medication [posted
Question: I am trying to find some information on a new anti-depression drug called
Answer: Celexa? A new antidepressant with more specific binding and less side
effects(according to the company.)
Multiple Medications for Depression [posted
Question: I am taking effexer for depression and to help me sleep at nite. I have
found out resently by my shrink that I am bipolar type 2. He wants to see how the meds
work out before putting me on wellbutrin. I was woundering if there is any side effects
with the combination of the 3 and if it is a good combination to take.
Amswer: Usually one would use lithium or other drugs in bipolar disease rather
than adding an additional antidepressant. There should be no major problem adding them
together other than somnulence [tendency to cause sleepiness].
Changing Medications for Depression [posted
Question: I have been taking 300 mgs. of Wellbutrin for 3 months. The Wellbutrin
has been wonderful for my depression and it also has helped me lose weight by decreasing
my appetite. Would it be okay to add 5HTP hydroxytrytophan to my supplements. I have heard
it can be beneficial to depression. Would it have any adverse effects with the Wellbutrin?
Answer: I wouldn't if you are achieving success, why screw with what works?
Halcion [posted 10/9/98]
Question: In 1990, my son was 16yrs. old, depressed, using drugs,and suicidal. A
pychatrist gave him Halcion, can you tell me if this was a good decision, can Halcion
enhance depression mixed with illegal drugs.
Answer: Halcion is usually classed as a depressant. Whether it was a good choice
would depend on his individual circumstances which I am not aware of.
Depression [posted 10/6/98]
Question: I am 21 years old male, heartbroken from a breakup with a girl at my
college, with whom I was in love with and had a physical relationship. I can not forget
her, and ofetn I am depressed, adn experience a lack of hunger (very inactive) and
sometimes I have incontrollable sexual urge. Consequently, I cannot concentrate and I am
performing very poorly in my exams even though I was very brilliant student in my school.
I didn't go to any doctor for the fear of my parents. I shed tears most of the time and
feel like committing suicide. I cannot tell this to anyone. I am very confused.This has
been going on for 1 year now. Please help me and guide me so that I don't spoil my life.
Answer: You need to see a physician-counseling and possibly medications. The way
to screw up your life is to continue to try to do it on your own. This can be a tremendous
growth experience-if you get some guidance and help.
Depression [posted 10/6/98]
Question: I have been taking Serzone for about a month - started at 50 mg/day, then
twice, now 100 mg twice/day. I have tried Zoloft, Wellbutrin and Paxil but had problems
with diarrhea. I actually started to feel better with Zoloft but the diarrhea was
impossible, then I was given Luvox which also worked for about six months then symptoms
appeared almost more severely than before. The dr. recommended doubling the dose when in
fact I thought he would take me off it - I turned into a walking zombie so I stopped it
after four days. Serzone started out feeling like it was going to be the answer, but now I
find I am wanting to sleep all the time, and I'm still quite depressed.
Answer: What was done to limit the diarrhea? Sounds like you need something to
keep the diarrhea away so you can funcion.
Depression [posted 10/6/98]
Question: My wife was recently diagnosed with depression related in part to
bi-polar tendancies. Currently she has the following drug Therapy: Spironolactone (25mg
3/day),Alprazolam (.5mg 3/day), Wellbutrin (150mg 2/day), Methylphenidate (20 mg am/noon).
I am concerned about possible long term effects, other drug interactions, and other health
Answer: Spironolactone is generally well tolerated. It does have a slight
estrogen like effect which enhances breast size in some women. Alprazolam is addictive
when taken long term, but, if she needs it to function so be it. Other effects are pretty
minimal. Should not be taken with alcohol or other sedatives. Wellbutrin has not been
around long enough to predict long term problems, so far none seen. Some patients
experience either weight gain or loss with this drug. Methyphenidate appears to be well
tolerated. Some patients experience withdrawal syndromes on stopping the drug-again not a
problem if medically supervised.
Depression [posted 8/13/98]
Question: I' ve been taking nortriptlina for 4 years.It is not working anymore,and
my doctor wants to take it off slowly and only I tke the last pill he will introduce a SRI
drug. I am desperate. I am afraid to have a hard depression without any antidepressive. Is
it possible to take off specific amounts of nortriptilina and at the same time introducing
slowly the new medication? Thank you for your help.
Answer: Yes, but, most physicians would follow a similar regimen to your
physician. The tri-cyclic antidepressants can be used with SRI class;but, must be followed
Depression [posted 8/13/98]
Question: Can a person suffer from depression and not realize it until the person
is over the symptoms?
Answer: This happens pretty often. I often treat people for depression and they
will tell me that they have been depressed for major parts of their life and were unaware
of it. When depression is present, people get used to it and assume that it is the normal
state. It is often after they are better that they recognize the problem.
HRTs and Depression [posted
Question: I had a complete hysterectomy 5 months ago. I have never wanted children,
so that is not an issue. I was being treated for clinical depression before that time, but
I seem to have gotten worse. My doctor swore I would be happy, so he gave me more hormonal
spiking, and he's correct in the latter, but I have not been happy for any amount of time
since the surgery. My Wellbutrin was upped to 400 mg, I've been given Klonopin for anxiety
attacks, and I'm taking 2.5 mg Estradiol and 100 mg. transdermal progesterone. Is there
any connection, i.e. estrogen dominance, too little estrogen, too much progesterone, not
enough progesterone, etc., to a bad depression getting worse?
Answer: It is clear that sexual steroids have a major role in mental health. The
best course with this problem is to vary the dosage of estrogen and progesterone to see
where you mentally feel the best. Since you have had a hysterectomy, there is little/no
reason for progesterone. I would cut this out first and then gradually increase the dosage
to see where you feel the best.
Depression and Zoloft [posted
Question: I had depression and was put on Zoloft, 50mg per day. My thyroid test
also showed a 4.3 rating and I was put on levothyroid medicine. A month later my thyroid
test showed normal. My Zoloft was increased to 100mg and then later to 150mg. It is now
March 1998 and frankly I don't believe the Zoloft has helped much, if any, unless of
course without it I could be worse off if that was possible. How long should I take the
Zoloft? Should I see about changing the Thyroid medicine to something else? I am not sad
or unhappy except about my condition.
Answer: I'd stay on the thyroid medication, although this level is close to
normal. Another alternative is to stop it and see what the level is. As to the Zoloft, if
it isn't working I'd switch to another medication. This dosage should work if it is going
Depression- Metabolism Pills
Question: My girlfriend has been rather depressed recently, and her mother takes
non-prescription pills that claim to raise your metabolism (at least that is what she
claims, I haven't seen the bottle). Well, you are only supposed to take one a day, and in
her self-destructive mood, she took eight in the morning, thinking it couldn't do anything
to her. Then tonight she became blotchy, like her whole body was blushing: her knees,
chest, face, neck, and she said she was hot and it felt like her head and brain were
burning. However, I could tell she wasn't feeling more than the slightest discomfort. I
assumed these things were related, and told her not to do it again, but she just shrugged
it off. I know any overdose of a drug is harmful, but I've found nothing on side effects
or dangers of taking metabolism pills. Is it that dangerous, and if so why.
Answer: It depends a lot on the actual medication. I'll need that to help you
with this one. However, I'd be more concerned with her depression and what is possibly a
suicide gesture. If her parents are not aware of this, I'd find a way to let them know
without violating your girlfriend's trust. This could be a serious mental problem.
Depression - Parnate/Prozac
Question: I was on Parnate for the last 10 years for the treatment of depression
and anxiety. It no longer is effective and I feel that I may have built up a tolerance to
the medication. I would like to try Prozac. One of my physicians said that after 5 days
off Parnate I could start Prozac. Another doctor said No. I agree. I have been off Parnate
for 7 days now and I am feeling terrible withdrawal symptoms. Is this normal? How long
will they last? The doctor who said to start taking Prozac is my psychiatrist, the other a
Answer: By now, I don't have to describe the withdrawal symptoms. These usually
abate after 1-2 weeks and about 40% of patients will experience some withdrawal symptoms
(not addiction type).
Post Partum Depression
Question: My daughter acquired post partum depression after receiving the Depro
Provera Shot. She is on the anti-depressant Paroxetine. She still is not able to drive,
Answer: She can't drive by doctor's suggestion or because she's psycho-motor
inhibited? The drug won't limit her driving per se. There is a suggestion in the insert
about this, but no one follows it. Legal boilerplate by the company I think. However, if
she is sluggish, and physically limited, she needs more aggressive treatment of her
Depression - Drug withdrawal and
Question: Taken off Prozac instantly, what side effects should I watch for and how
long can these side effects last? Also, is there an alternative to Ativan, Xanax, etc.,
for anxiety attacks that pose no health problems.
Answer: According to the drug company, there is not a withdrawal syndrome with
stopping Prozac immediately. However, some of my patients experience headache, nausea and
occasional diarrhea. Hard to tell if it is related to stopping the drug or not, but it
seems to be. This lasts 5-7 days depending on the dosage you are taking. Secondly, any
drug has a risk depending on the individual and the dosage. There is no free lunch. Are
you stopping the Prozac due to lack of effect or side effects? Other drugs such as Serzone
and Wellbutrin can help, but all have different side effects. I have seen no study of
hypericum(St. John's Wort) in anxiety attacks, but it does seem to have similar effects as
Prozac with less side effects. This might be worth a try. Unfortunately, I have no data.
Depression - Wellbutrin/Zoloft
Question: I have a 16 year old son who suffers from depression, which I believe is
inherited, since my father and I also suffer from it. My father was never treated for it
and was miserable most of his life. I have been on 50 mg of zoloft for 2 years and it has
made a tremendous difference in my life. I feel like I am leading a normal life for the
first time in many years and I have had no side effects. The doctor started my son on 50
mg zoloft about 6 months ago. The 50 mg didn't seem to do much, so we increased the dosage
to 100 mg. It seemed to help for about 4 weeks, then his entire personality completely
changed. He didn't care about anything. He even became suicidal. He is now on 150 mg of
wellbutrin. I have tried to find info on wellbutrin, but have not been able to find much.
Is it a new drug? The info I have found seems to suggest that the side effects are much
worse than the zoloft. What should I be looking for? Also, since zoloft had such horrible
side effects on him, is it probable that wellbutrin will do the same thing? He is also
taking 10 mg of Zyrtec for allergies, and is getting ready to start accutane for acne.
Answer: Wellbutrin is a relatively new antidepressant that is a class of its
own. Current mode of action is not known, but appears to be related to the serotonin
system. It is not an SRI however, Side effects are agitation, insomnia, occasional
psychosis, weight gain(or loss), dizziness, headaches, sweating, and tremors. These
symptoms are in the 20% range with numerous minor complaints. For the patients that can
tolerate it, it works well. There is no long term research in children.
Question: My father was diagnosed but not treated for manic depression. His father
had delusions of grandeur. I have twins that are 4 years old and I am 40. After my C
section my menses changed gradually, stop and start, sporadic clotting. My doctor said it
was my thyroid. So, I was put on synthroid 0.15 until last month. I am now on
Levothyroxine 0.175 and my doctor wants to up the dose when my prescription runs out. I
was also on Prozac and then Zoloft for about a year. Now I've been switched again to 20 mg
Paroxetine for the past week. I feel drowsy, fat (over 200 lbs.) and am crying without
being able to stop by myself. I can't make decisions without feeling doomed. All I want to
do is sleep and dream of being rescued. Herbs, exercise, breathing, balanced diet, and
baby-sitters are not working. I have to wait weeks for my medications to work, or not. I'm
scared. Is all this drug taking just a hit or miss, trial and error? I just want to not
feel like I'm in a hole and can't get out. I finally got an appointment with a
Psychiatrist for next week. How can I be objective, feeling so unstable, living day to day
avoiding everything that causes me anxiety?
Answer: It sounds like you have been dealing with very difficult symptoms, and
have been going though an extremely trying time. The vast majority of your symptoms are
highly suggestive of depression, although more information would be necessary for
confirming this diagnosis. Paroxetine is in the same general category of antidepressant
medications as Zoloft and Prozac, but many patients respond better to one of these over
the others. It sounds like the first two did not provide you with much benefit, and that
your physician is trying another to see if it improves your symptoms. It does usually take
about 3-4 weeks before the effects of this medication are apparent. The family history of
manic depression also makes the diagnosis of depression more likely, as these conditions
can run in families. On occasion depression is caused by other conditions, such as thyroid
disease, adrenal gland problems, and chronic illness of any kind. It appears that you are
on thyroid supplementation, as well. Realize that like any other "physical"
illness, depression, although not as well understood, is no less a real and physical
illness, with real symptoms, and real impact on quality of life. An appointment with a
specialist sounds like a good first step. With proper help from your physician, and
medication therapy, your symptoms will hopefully improve, and things will start to look
better for you.
Question: I am doing a biology project on neuro-medicine. At one point in my life,
I was placed on each of these medications mostly to ameliorate my depressed state and
possibly an obsessive-compulsive disorder. I need to find information about the
biochemistry of these medications. I would like to know whether the medicine acts as a
neurotransmitter, an inhibitor, etc., as well as the family of medications it is in. The
following are the medications: Prozac (which I currently take)--SSRI, Anafranil
(clomipramine)--tricyclic antidepressant Asendin Navane--neuroleptic Cogentin (to
counteract negative side effects of Navane such as spasms and dilated pupils) and Benadryl
(for sleeping). If you are not aware, or do not have the time to answer these
specifically, I would greatly appreciate it if you could direct me to a source(s) which
contains this information.
Answer: I would refer you to Goodman and Gilman's The Pharmacological Basis of
Therapeutics(Hardman, Molinoff, Gilman ed.). This is the standard textbook for medical
students and is very readable if you understand basic medical vocabulary. This text is
available in any medical library and most larger libraries.
Question: Are you aware of whether a drug called tandospirone is available yet? It
has been in advanced development by Pfizer. If it is not approved for general consumer
use, is there a way to participate in trials. I was a participant 6 or so years ago for
this drug and it worked wonders. The trial ended, and I have been unable to find any other
drug that is effective.
Answer: I am not familiar with this drug and it is not currently listed in the
PDR. You can contact Pfizer at 201-887-2100 and check on its current research into this
Question: My wife has been on Prozac for about 2 years now. She has had some
improvement from the initial prescription, but her depression seems to come back every few
months. She has recently been put on Lithium as well. I have heard from a few different
people that taking both drugs at the same time will have bad results, as the drugs are
combating each other. Is it true that Lithium and Prozac should not be taken together? It
also seems like every time my wife starts feeling depressed, the doctors either increase
the amount of her medication or decrease her medication, which is really starting to
bother me. She won't let me go with her to her doctor's appointments because she believes
I will make a scene. After 2 years of giving them my time and money, I expect better
results from them. she was also seeing a therapist for a while. I was even going with her
and participated in her sessions. Is there any advice you can give me?
Answer: It is fairly common to combine an anti-depressant with lithium. For
patients with bi-polar disorder (manic/depressive) this is essential. That is, the
anti-depressant is for the depression and the lithium is for the mania. However, it has
become clearer that some patients with only depression benefit greatly from lithium.
Lithium is tricky and its levels must be controlled within tight limits. Regular blood
tests for levels, sodium, and thyroid are necessary. Consequently, the physician desires
to keep the depression under control while avoiding toxicity. A more pressing question is
your reaction to your wife's depression. It is perfectly normal to be frustrated with the
events going on in your life. However, trying to influence them will not aid your
frustration. There is probably little you can do to help her. I'd try to freely express
your feelings, possibly with your own counselor, to help you deal with a difficult time.
Medication & Nursing
Question: I have been dealing with depression for over 6 years and I just had my
third child. I been taking medication until we found out we were expecting the third baby.
I have nursed my first until 12 mos. unknowing that I had a problem with depression until
PPD set in. My second child I nursed until 8 mos. but the depression was too much and I
had to go back on medication. Because of the adverse reactions and really being unsure I
decided not to nurse. Now with my third child the depression and obsession has really
overtaken me. So what I need to know is there a medication that I could take that would
not harm the baby in no shape or fashion?
Answer:No data ever done here and probably won't be. I'd stop nursing on the
theory that depression will affect your child more than the advantages of breast feeding
and the effects of the antidepressant on the child are not predictable-especially over
Question: I have been taking the anti-depressant drug, Paxi for the past 2 1/2
years. Next year I will be studying at a University in the UK. Are the same
anti-depressant drugs available in England that are in the US? Will I have trouble getting
Answer: These drugs are available in England -under different brand names. Most
of my patients who go overseas for 6 months to one year will purchase the drugs here and
have them mailed by family or take them through customs with a doctor's note.
Question: Every once in a while, but frequent enough for me to come to dread it - I
have an overwhelming sense of doom. My mother suffers from an anxiety disorder although
not like I describe. I get afraid of being inactive at night when I feel like this...it
feels like there is no hope, like something bad is going to happen, it feels like I don't
belong anywhere. I wondered if it was depression or some form of anxiety disorder
Answer: Depression clearly runs in families, research on the exact mechanism is
underway. This appears "inherited" more in women than men; but, not perfectly
clear here either. I'd see your doctor and discuss your symptoms; but, I'd probably start
you on an antidepressant like a SRI inhibitor.
Zoloft vs. Paxil
Question: I suffer from chronic depression and anxiety. I tried Prozac and felt
like a zombie. I took Paxil for about 6 months during a stressf ivorce, but could
barely stay awake the first month or so. I stopped taking it because I felt much better
but now I'm getting worse again. I think I need medication again and hesitate to suffer
through the debilitating sleepiness or loss of libido. I will discuss Zoloft with my
doctor, but after reading some comments here, it sounds like another version of Paxil. Is
Zoloft less stupefying than Paxil?
Answer: I suspect that all the SRI class will give you the sleepiness and loss
of libido. Serzone might be an alternative and also Effexor or Wellbutrin might be
effective treatment without the SRI side effects. I'd probably use them in that order to
find an effective treatment with acceptable side effects.
Prozac vs. Redux
Question: I have been on Prozac for about a year now. Recently I went to see my
doctor about going on Redux. He prescribed it for me, after taking me off of Prozac for 1
month. Now I find, one month after taking Redux, that I am needing to go back on Prozac as
my mood swings are out of control. Is it safe to take both medications. I am on 25 mg. Of
Prozac/once/day, and the Redux is 15 mg./twice/day.
Answer: There is a specific warning in Redux literature to not take the drugs
with SRI class of antidepressants. Having said that some physicians have done it; but, I
would be very leery of this combination.
Paxil & Lamisil
Question: I have been taking Paxil (20mg) daily for 9 months for depression and
anxiety. It has helped my moods greatly, and all my symptoms have gone away. I have also
been taking Lamisil (250mg) daily for a toenail fungus. It has not improved the fungus at
all. I have 2 questions: 1)Is the Paxil interacting with the Lamisil, so that my toenails
won't improve? 2) Do these drugs interact to make me tired all the time? I sleep well at
night, but I'm always sleepy, and could sleep an extra 4-6 hours a day if I have the
opportunity for a nap! I will be finished my 3-month dose of Lamisil soon, and my doctor
says I can go off the Paxil at the end of August. Will I have more energy then?
Answer: Treatment of toenail fungal infections takes a while. In general, it
takes about six months for toe nails to completely grow out-about three months for
fingernails. You will need 6 months minimum on Lamisil before you'll be aware of any
improvement. In patients that I have treated, this drug has about 25% success rate in
terms of success and patients who will endure 6-12 months of treatment. I am not aware of
any interaction between Paxil and Lamisil. Also, I'm not a big fan of treating fungal
infections of the toenails. These infections are ugly; but, do not spread and have no risk
for the rest of your body. Lamisil does have a risk of liver toxicity and you should be
testing your liver functions periodically.
Question: I have done a lot of research on the Internet regarding depression
(besides studying psychology in college) and have pretty much figured out that I have been
depressed for the last six months. At this time, I have no health coverage at all and am
considering self-medicating with 20 mg. of Prozac to see if that alleviates the symptoms.
I know this probably isn't the best solution, in a perfect world, I could afford to see a
doctor, but really need to get some relief. It's starting to affect my ability to function
in my career and life in general. Is this a feasible plan at all? I know it takes 4-5
weeks for the medication to adjust and for me to know if it's working or not. I just need
to know if there are any dangers of doing this. I also have asthma, but it is fairly mild.
I only use a Ventolin inhaler as needed. 2) Do these drugs interact to make me tired all
the time? I sleep well at night, but I'm always sleepy, and could sleep an extra 4-6 hours
a day if I have the opportunity for a nap! I will be finished my 3-month dose of Lamisil
soon, and my doctor says I can go off the Paxil at the end of August. Will I have more
Answer: Where are you going to get the drug? It will take usually 1-3 weeks
before you see any problems. In reality, you shouldn't have too many problems except dry
mouth and constipation. If you don't take any other drugs, there are few
contraindications. Some patients use St. John's Wort for depression available in health
food stores. You might try this as well.
Anxiety/Panic & Depression
Question: I take 40 mg of parnate and 2 mg of klonopin per day for aggitated
depression. I have anxiety/panic disorder along with low grade depression. I have
fibromyalgia as well as degenerative disk disease. Two years ago I was hit by a car and
have had 4 surgeries--two more within 6 months. My mother died a year ago and very close
friend 6 weeks later. I am recovering from total thr revision at present. Have been more
depressed and now anxiety is hovering around too. I have no luck with anti-depressants or
ssri's. Been to therapy--depression and anxiety run in family. Want to end this
cycling--didn't for several years. Any ideas or possibilities I can discuss with psych
Answer: Has anyone tried you on SRI class of antidepressants? This includes
prozac, paxil, etc. They can be very helpful in anxiety disorders. Also, occasionally
lithium carbonate treatment along with treatment of depression is helpful. Last, but not
least, some patients get a lot of improvement on St. John's Wort(hypericum). This is
anecdotal currently,but, research is in progress. Good luck.
Paxil & St. John's Wort
Question: I am currently taking 10mgs per day of Paxil and would like to alternate
taking St. John's Wort every other day - is there an adverse reaction between these two?
Answer: No way of knowing since the research on St. John's Wort is in the early
phases. I really would avoid being a guinea pig-try one or the other.
Mom Won't Take Medication
Question: My mother is 77. Dad died 2 months ago at age 79 of illnesses related to
Alzheimer's Disease. Mom kept him at home and the last 8 years he was partially paralyzed,
bed-ridden, had to be fed, bathed and cared for every daily moment. Needless to say in the
summer of 1995 Mom was suffering from depression. She actually was suicidal. After several
tries with tricyclics which did not seem to work, she had some good luck with Prozac and
therapy. The doctor adjusted her dosage and added Buspar to take along with her Prozac.
The day of my father's funeral -- 2 months ago -- Mom decided to stop taking both drugs.
Because she "was feeling good." Within a month I noticed a major change in Mom.
She is agitated, scattered, cranky, begins many projects and never completes one. For the
first time in her life the weeds in her garden grew to my waist. She always took pride in
her flowers even up until 2 months ago. I finally asked her if she was on her medication
and this is when I found out that she had quit both "cold". I have been
encouraging her to contact her physician. She does not seem to know she is behaving
abnormally and it is quite evident to me. Her doctor is now out of town. I had begged her,
got information on depression and prozac off the internet and finally yesterday when she
found the doctor was out of town she began to take her Prozac again (but not the
Buspar).Naturally I worried knowing she went off the medications cold turkey -- but I am
equally worried about her going back on (dosage, health, and only one drug) without the
advice and permission of her physician. Should I take her to emergency? She is not
herself. I am afraid when she takes he morning mile walk that she may be so preoccupied
that she will walk in front of a car. She drove her car for the 2 years while she was on
the medication, but I was and am more worried of her state of mind, driving the car with
no medication, or now beginning to take Prozac with out her doctor knowing what she has
been doing in the last month. I also know she is grieving on top of this, even though Dad
was dying for years, he is actually gone now. As she put it, the day he dies we all
"lost our jobs" as being primary and secondary "care-givers". She has
more time yet does less now as she is so unorganized. Should I get her into a mental ward,
an ER ward, to see a different physician?
Answer: Stopping the prozac "cold turkey" is no problem. The
subsequent behavior is. Restarting the prozac would be the most important drug, Buspar is
mainly a second line anti-anxiety drug and would tend to sedate her some. Has she had a CT
of her head, thyroids and electrolytes checked? Some of her behavior doesn't sound
completely like depression, although it certainly could be. It sounds like she war heerforming adequately on the medications and I suspect the physician has made the right
diagnosis. However, small events -like a urinary infection-on top of depression will make
a major difference.
Question: My name is Michelle and I am 25 years old. I have been suffering from
severe panic attacks, depression, I get scared to go anywhere because it's almost like I
am scared to be around people, I cry for days at a time, and I am often suicidal. I have
been diagnosed as Manic/Depressive (Bipolar disorder) and I have been institutionalized
once for anorexia and once for severe drug addiction. I have been feeling like this for as
long as I can remember. I have been on several medications such as Paxil, Tofranil,
Depekote, Hydroxizine, Serzone, and Zoloft. None of these medications have actually
helped. In fact, most of them seemed to enhance the anxiety and depression. I have bought
valium off of the streets (from friends) and I have been taking 2 in the morning and that
seems to last all day and I can actually feel again. However, I am a recovering addict who
simply does not want to be addicted again. I had also been smoking pot to ease the anxiety
prior to the Valium (Roche 10) so you see the pattern here. I have heard a lot about
Buspar and it's ability to work for people with anxiety disorders. I would like to know if
this drug would work for me.
Answer: It's worth a try;but, I haven't been impressed with its efficacy(except
for minor anxiety). You might try something like St. John's Wort,some of my patients have
had major improvement(some not). One thing for sure, take more Valium and you will be
addicted. Other possibilities to explore, regular exercise, martial arts, Tai Chi,
yoga-all can be very helpful. Exercise can be the key.
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