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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 1/7/99]
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 12/08/98]
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 11/21/98]
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 11/5/98]
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.

Depression & Serotonin Deficiency [posted 11/4/98]
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 serotonin levels.

Depression Medications [posted 11/3/98]
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 10/30/98]
Question: I am trying to find some information on a new anti-depression drug called zelexa.

Answer: Celexa? A new antidepressant with more specific binding and less side effects(according to the company.)

Multiple Medications for Depression [posted 10/30/98]
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 10/13/98]
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 factors.

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 closely.

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 8/13/98]
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 7/17/98]
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 to.

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 family physician.

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, etc.

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.

Depression - Drug withdrawal and alternative drugs
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 drug.

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 their lifetime.

Overseas Medication
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 a prescription?

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.

Anxiety Disorder
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 inherited?

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.

Self Diagnosis
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 energy then?

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 doc?

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.

Alternative Medications
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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