Anxiety gone due to Xanax... but depression more severe

[Daniel E.]

the initial negative side-effects of antidepressants are most harsh when you first start taking the pill?

Generally, yes.

Regarding research, I remember reading there are attempts to correlate certain genes with successful outcomes from specific antidepressants but, to my knowledge, such genetic testing for people with depression is not worthwhile as of yet.

 

[Retired]

I wonder if the psychiatric researchers in the lab are coming up with ways to match a persons brain configuration with an antidepressant

A very pertinent question, BluMac.

Here is some insight, albeit technical, as it's quoted from a medical review
Source: Medscape

.......the inability to predict which patients are more or less likely to respond to particular therapies continues (is) an important limitation of current therapies. Patient care would of course be enhanced if the patients who were unlikely to benefit from an initial course of SSRI therapy could be prospectively identified and rapidly switched to alternate therapies.

Cook and colleagues[8] reported intriguing results using frontal quantitative electroencephalography (fq EEG) as a potential biomarker of SSRI response.

In this trial, changes in fqEEG after only 1 week of therapy with escitalopram (10 mg/day) were tested as a potential means to guide the decision to: remain on escitalopram (n = 73), switch to the norepinephrine dopamine reuptake inhibitor (NDRI) bupropion (300 mg/day; n = 73), or augment escitalopram with the NDRI (n = 73), all for 7 more weeks of therapy. Among those randomly assigned to remain on the SSRI, the fqEEG predictor accurately predicted subsequent favorable outcome (67% vs 28%). The converse pattern held for those switched to bupropion (28% vs 53%). Curiously, the pattern did not predict response to augmentation with the NDRI (33% vs 28%).

The search for other potential biomarkers of differential treatment response led Houston and colleagues[9] to study polymorphisms of the catecholamine metabolic enzyme (COMT) and the serotonin 2A receptor as potential moderators of response to the SNRI duloxetine.

They found a strong association for COMT polymorphisms and no association with the serotonin receptor. Remission rates for the 3 COMT (rs165599) genotypes were as follows: (AA) 61%, (AG) 46%, and (GG) 38%.

References:
8) Cook IA, Leuchter AF, Gilmer WS, et al. ATR-guided antidepressant selection may improve response and remission rates: Insights from the BRITE-MD Trial. Program and abstracts of the American Psychiatric Association 161st Annual Meeting; May 3-8, 2008; Washington, D.C. Abstract NR3-048.

9) Houston JP, Perlis RH, Sutton VK, et al. COMT variants associated with duloxetine response: a candidate gene association analysis of a randomized clinical treatment trial for major depression. Program and abstracts of the American Psychiatric Association 161st Annual Meeting; May 3-8, 2008; Washington, DC. Abstract NR3-057.

_________________________________________

So, yes, there appears to be ongoing research to identify methods of optimum response to certain therapies .

 

[Halo]

After 2 years on that I figured all the other SSRI's that I "didn't give a chance" work in the same way pretty much so there is no use in trying those any more.

I use to think that all the SSRI's would be the same so what was the point in trying them but I quickly realized after trying a few that they didn't all work the same nor did they all produce the same side effects. I also realized that with most of the meds that I had tried that the side effects although not pleasant at first did dissipate after about a week or so.

In all honesty in order to know whether a med is really going to help you at all I think giving it an honest try and sticking with it for at least a month is the best bet. And just because one type of med hasn't worked for you doesn't mean that another won't. As myself and others have said, it is a sort of trial and error when it comes to medication. Unfortunately, I do wish there was a more definite way to figure it out but for now that's what we have.

Take care

 

[BluMac81]

I just wanted to report a positive note on the use of Xanax.
I'm finding that of course using Xanax before social situations relieves all social anxiety, but for some social encounters I don't take Xanax... like yesturday when I got together with a bunch of strangers to play tennis (ya taking xanax before exercise is inadvisable, and I don't do it).

But I realized that hey, I didn't have social anxiety even without the xanax. Since I started on xanax I have been going out to social events with strangers and everything, stuff I normally don't do. I'm finding that the more experience in just doing this, the less nervous I get in future social encounters. So I don't even need it for the social anxiety aspect anymore really! CURED I'd say.

Now to deal with these bouts of depression...

 

[Into The Light]

fantastic, blumac!! :yahoo: this is what happens, over time as you practice you get used to it and then the problem isn't much of a problem any more

 

[Halo]

That's great to hear Blumac :yahoo:

 

[BluMac81]

Well bright and early I will be seeing my psychiatrist tommorow, and I've prepared a list (with the kind aid of you all) of possible antidepressants I can try to get started on, tell me what ya think, gonna show it to him:

Acceptable possible antidepressants:

Wellbutrin/Bupropion
insomnia

Prozac/Fluoxetine
insomnia (19% vs 10% for placebo)
somnolence (12% vs 5% for placebo)

Risperdal/Risperidone
insomnia

Geodon/Ziprasidone/Zeldox
Insomnia
somnolence

Abilify/Aripiprazole
Insomnia
somnolence

Tofranil/Imipramine
Mood Swings

Lamotrigine
insomnia
labido

Lithium

Goal: To reduce depression & cyclothymia swings

Must Not have possible side effects:
Insomnia
somnolence
Depression
Libido Hinderance
Mood Swings



Odd how I see that most antidepressants here have insomnia as a side effect. I currently have and am being treated for insomnia, thus I've gotta avoid those that'll make it worse.

Lithium by the way, i heard is a weird drug to be on, maybe some can clarify on this. Apparently if you're on lithium you have to go in to get your blood checked like every week or something. Plus the info I got (from wikipedia) on lithium showed no side effects so, but I"m sure there has to be some.... Any one here have experience or knowledge on lithium? And of course comments on my drug listing there would be great

Thanks again all for the help.
-Matt

 

[Retired]

The reason some antidepressants can cause insomnia in some people is their peripheral effect on adrenergic receptors and acts as a stimulant sometimes causing vivid dreams. Although SSRI's are selective for serotonin, they do have some peripheral effects on other brain neurotransmitters (such as adrenergic, muscarinic and dopaminergic receptors) in some people, resulting in the side effects experienced.

Many of these side effects go away with time (a few weeks) as the brain chemistry becomes acclimated to the medication.

Lithium is a compound not found in the human body and its mode of action is not fully understood. However it has been found to be effective as a mood stabilizer. Lithium levels need to be monitored on a regular basis as ordered by the physician to ensure the does is high enough to be within its therapeutic range, but not too high to be toxic.

Lithium Dosages

Supervision of the lithium blood level is extremely important. If the level is too low, the symptoms will not be controlled. If it is too high, the resulting toxic condition can be very dangerous.

The correct dosage of lithium is partly determined by the weight of the patient. An average beginning dose is about 300 milligrams 2 to 4 times a day. Blood measuring should be done twice weekly for the first 2 weeks, once a week for the next 3 or 4 weeks, at 2 week intervals for the next 2 months, then monthly. The best time to draw the blood is 12 hours after the patient has taken his last dose.

The desired blood level is usually between .6 & 1.2mEQ/L. A level higher than 1.5 mEq/L may be unsafe. Levels below .5 to .6 mEq/L should be considered adequate only for some elderly persons or those who can't tolerate more. For patients who object to having blood drawn, there is a way of checking the lithium via saliva.
If a patient who has been taking lithium stops, they may experience anxiety, tension, palpitation, nausea, diarrhea, restlessness, & headaches

.

Source

 

[BluMac81]

Thanks Steve, well went to the psychiatrist appt. today, he does think I have some mild cyclothymia going on here, with manic states usually hitting around bedtime (hence the sleep disorders).

Anyway yeah we both agreed its best to treat the depression since the manic episodes are mild (and well... i get a lot done in them).

So after handing him the list (I posted above), we decided on going with Desipramine, which apparrently is the broken down version of Tofranil (fewer side effects). And its a tricyclic antidepressant so.... who knows maybe trcyclics work better for my individual chemistry than SSRI's do. Will give it a try!

 

[Halo]

Blumac,

I am glad that your appointment went well and that you talked to your doctor about medication. I hope that it works out well for you. Keep us posted.

Take care

 

[Cat Dancer]

I hope the Tofranil/Desipramine will work out for you.

 

[Retired]

Blumac,

It's not unusual that a psychiatrist might start with an initial course of a tricyclic antidepressant to observe its effects.

Most specialists have a protocol they follow based on their clinical experience.

At this point, I would propose you keep a record of how you respond to the medication, as well as any adverse effects you might esperience, so you can report these to your doctor.

Did your doctor advise you of what you might expect in the next few weeks of your therapy with Desipramine, and what do do if you want to report any developments with your new medication?

 

[BluMac81]

Nah he just told me what side effects I might experience