Dr. B's Predatory Rashy Medicine Show

[cleolinda]

Okay, I need some help from y'all. I went to the doctor today for a medicine check, and increasing my Zoloft has not worked. In fact, not only has it not worked, it has been very, very bad. Like, hour-long-crying-jags bad. And I knew that people have had some bad reactions to Zoloft, so I just said, "Look, I feel awful, but it'll pass. I'll ride it out; I'll let the side effects subside." Yeah... they weren't the kind of side effects that go away. Not being able to sleep, having hot flashes, having headaches--that, in the past as well as now, has gone away. "If you need me, I'll be in bed weeping" does not. And the sad part is, I felt really, really good for the first two weeks we increased my dosage. And then it just all went to hell. In fact, it got really bad last week, and I actually think saying, "You know, I have this story idea I've wanted to work on, let's do that," and banging out 20,000 words over about four days is pretty much the only thing that got me up and about.

(Yeah, this will probably come as a surprise to most of y'all, but I've found that many people suffering from depression tend to perk up a little when they're with people or are otherwise presenting a public face. Whether this is from pride, or social stimulus, or just plain not wanting to bother other people with their problems, I don't know. All I know is, I'm just not the kind of person who's going to wallow and wail on her livejournal.)

So I'm going to try to go back down to the next highest dosage we tried, 150, and try that for two weeks. Because I felt really, really good at 150 for two weeks, and I've been taking Zoloft for something like eight years, and it's largely a pretty good deal. But I can tell my doctor's getting kind of antsy to put me on something new. Well, actually, the first thing she did was ask me questions that were subtly, in an obvious kind of way, trying to divine if maybe I need to be rediagnosed as manic-depressive. Like, the bright spots I've had over the last couple of months, was I really... really... happy? "Uh... no. It was just like, 'I've gone out and seen a movie, that was nice,' or 'I just wrote a ton of stuff, that was really productive and I feel really good about that.'" Do I have trouble sleeping on my "good" days? "Uh... no. Usually it's the days I feel bad that I can't sleep, because I'm not active enough to be tired at night. I sleep pretty well on good days, because I've worked or done whatever until I'm tired." And so on, until finally I was just like, "Look, I'm not the doctor here, but I'm pretty sure I don't have any symptoms of any manic component whatsoever. I'm one of the most sedate people you'll ever meet. I live with a manic-depressive. I'm pretty sure I ain't."

So she wants to try one of two other antidepressants if Zoloft doesn't get its act together in the next two weeks--Effexor or Lamictal, and I can tell she's leaning towards Lamictal, which is an anti-seizure drug that apparently has shown some benefits for people who suffer from chronic, recurrent depression. Me, I think it sounds kind scary. Like, for some reason, it makes me think of a praying mantis. Look, I don't know. It's got the long Ls like legs on either end and this "ict" hunching in the middle. It sounds predatory. I'm also one of those people who sees colors for words and numbers, okay? DON'T JUDGE ME, OKAY?

Also, it can give you a giant rash.

So what I wanted to know from y'all was if you'd ever tried either Lamictal or Effexor, and if you'd had good or bad experiences with either one. I mean, yes, I can go read up on them, but you tend to get laundry lists of every good and bad side effect possible, mostly so the company can cover its ass, which isn't as helpful as someone saying, "Yeah, I couldn't sleep and I gained a lot of weight. Don't take that." Anyone?


ETA: I should add that I already take Wellbutrin as well, as a one-two combination. And that if you don't feel comfortable commenting publicly, you can always email me.

Comments

[celli]

I took Effexor for quite a while. Had a few side effects, most of them due to a medication reaction with another antidepressant I was on (Trazodone)--it gave me the jitters every once in a while, but other than being kind of startling, I didn't mind. :) And I thought it was pretty effective.

[sorchar.livejournal.com]

I've never tried either, but I have had to switch SSRIs a couple times. Now, I'm on Paxil and Lithium and it's working great. Good luck. *hugs*

[aliaspiral.livejournal.com]

Ive never taken anything but prozac, but ive had a few friends who took Effexor, and the thing that popped up several times was the really really bad withdrawel. like, even if you were an hour late taking it. But one guy I know swears by it. so...its hard to say. ask your doctor, do your research, etc. good luck.

[cleolinda.livejournal.com]

My sister said the same thing about Effexor, actually--and she's notoriously bad about taking her meds consistently, which was why she decided it wouldn't work for her after about a week.

[a-hollow-year.livejournal.com]

I was on Effexor. It worked really well, but I had those awful "sexual side effects" they talk about. I like my orgasms, thanks. >:( But then again, Zoloft did that to me, too, so it might not have that effect on you. It's worth a shot.

On the other hand, I WILL say that going off Effexor was absolutely horrible. I don't even remember much about that week before they put me on Xanax for a few days to get me to calm the fuck down, but I remember that I cried constantly. Like, "OMG the light just turned red WHY IS MY LIFE SO EMPTY??" type of things.

[a-hollow-year.livejournal.com]

Also seconding what someone above me said - withdrawal symptoms set in within twenty four hours. Mine were basically very brief dizzy spells clearly designed to be a friendly reminder. XP They weren't that bad as long as you took your dose as soon as you could.

[fennin.livejournal.com]

i'm suffering from un-medicated ... something or other, so i sympathize and hope you feel better on the increased dosage. those crying fit-thingies are /no fun/. it's hard swinging back and forth and really not feeling worth your druthers ... dumb brain chemical cocktails.

good luck -- i've only been on zoloft for a month and that was a nice, nice change for me, so i don't know if any of those others work at all... i hope it goes well, whatever happens. take care!

[palmetto.livejournal.com]

Effexor, in addition to making me drowsy, gave me the most incredibly fucked up dreams. Like, vivid, nigh-lucid nightmares most nights, and what dreams weren't nightmares were surreal to say the very least. Then coming down off of it gave me worse withdrawal than quitting smoking.

[saridout.livejournal.com]

i had the same symptoms. i've never had dreams so vivid before. and the withdrawl would send me into screaming, hysterical crying fits.

[viggofest.livejournal.com]

You know, I wrote out an answer, but then I decided maybe I'll just send it to you in an email. But know that I relate to a lot of what you're saying, and I'm in favor of new drugs over 8 year old drugs. a) I think your body, metabolism, whatever, builds up an immunity, and b) newer drugs are generally more refined, able to target specific receptors better.
Whatever you do, I wish you a lot of luck. You're braver than I am to discuss it outside of your head.

[cleolinda.livejournal.com]

You know, I should have mentioned that emailing me privately was an option, because I can totally understand that people might not want to talk about their situations here. And thanks. : )

[casirafics.livejournal.com]

One for the worrying end of the scale (http://seattletimes.nwsource.com/html/nationworld/2003180227_depress07.html), re: Effexor (and others) -- or more to the point, getting off it. Something to keep in mind.

[leila82.livejournal.com]

I haven't tried either of those two, but I'm on Wellbutrin right now, and it's actually working pretty well. It's one of the few that makes you lose weight rather than gain (I'm almost never hungry, but since I gained a TON of weight to begin with, that's not so much a problem as a welcome side-effect). My biggest problem with it is that I'm not sleeping so much, since I increased my dosage (I was sleeping all the time pretty much, before I started taking it, and a lot even at the lowest dose).

Hopefully that is...somewhat helpful? I'm not really sure how useful it is with recurrent depression; I've only been on it for three months now.

[a-hollow-year.livejournal.com]

:) I've been on Wellbutrin for six years now and it's still working just fine for me. I get my depressive bouts, but they're "normal" blue periods, not crippling any more. When do you take your medication? My doctor told me to do it first thing in the morning so it wakes you up for the day and you can sleep better at night.

Which I should be doing right now. XD

[wildcatlizzie.livejournal.com]

I'm actually on both and I have been for several years now.

The rash that comes with the Lamictal is completely avoidable. Your doctor shouldn't start you on a dose higher than 25 or 50 mg. The dose gradually increases to prevent the rash. If you were to jump feet first into a 200 mg dose, then, yeah, you're going to get the rash. Lamictal is also one of those psychotropic drugs that's a multi-tasker. It can help prevent seizures and it's a mood stabilizer. I'm not epileptic at all, and I've had no problems with the Lamictal.

I've also never had a problem with the Effexor.

Both of my parents are pharmacists and my mother has also been diagnosed with depression. My mom likes both drugs on a professional and personal level.

I hope that helps some.

[cleolinda.livejournal.com]

Yeah, that does--she did say that I'd build up to a full dose of Lamictal over eight weeks to avoid the rash, and so on--I think she did say something about starting at 25 mg.

[saridout.livejournal.com]

yeah, i've gone the way of effexor, and i can't really say a single good thing about it. didn't really help my symptoms, made me have a terribly short fuse, and getting off of it was the worst hell i've been through. well, getting off of lexapro was about as bad.

but then, i had good results with zoloft until i developed a tolerance. i maxed out my dosage and had to try something else. so who knows; effexor might work great for you. that's the problem with these drugs: the effects on different people are SO different, it's hard to make reccomendations. one never can tell which drug will work for them, darnit.

Slightly more than tuppence...

[lovefromgirl.livejournal.com]

Your doc is on crack, and not the good kind, because you're together enough that you don't need to go down the road she's suggesting just yet.

My first recommendation: go read crazymeds.org all the way through, because it's by the users, for the users. The contributors have, no shit, been on most of the drugs they're describing or know someone who has.

Lamictal is primarily used for seizure disorders. Unipolar depression is an off-off-label use. Seriously, unless you've run out of SSRIs to use, don't try it. It's meant for manic depressives, not plain-ol' depressives, and you are not manic. Perhaps she does not believe you on this, in which case you will want to smack her with a cold fish.

Effexor's a multi-inhibitor, not just an SSRI like Zoloft. It's another one of those "holy crap, unless she gets this she's going to kill herself" kind of drugs. The only person I know that needed this was in such a low funk that she seriously could not continue to live her life without it.

You have so many more options than those two drugs, and I suggest you read up on them, because going into a psychiatrist's office completely unarmed is like vacationing in Beirut while Israel's shelling it.

I'm on Celexa right now and it's treating me okay; I need a higher dose, says my doc, but that's because I'm also the poster child for panic disorder. That's how I've spent my summer. You can go back and read the archives in my LJ if you have the time. I was on Lexapro, its cousin, which didn't do anything for me, probably for the aforementioned reason. I'm on Ativan and Klonopin for the anxiety as well; again, not something you seem to need. My doc IS tossing around the idea of a mood stabilizer for me -- because I'm showing signs of manic depression and PTSD. You are about the least likely candidate for that.

I'm glad you came to LJ and asked here first. We may not have degrees in the subject, but some of us have been schooled by life.

100% in your corner here --

Cat/Havoc

Re: Slightly more than tuppence...

[cleolinda.livejournal.com]

Heh, thanks. I just know that a surprising number of people always chime in with their meds experiences whenever I mention what I'm on, so I figured I had a pretty good pool of anecdotal evidence to work with.

[sparkythehamstr.livejournal.com]

I was on Effexor for a little over a year, and while it seemed to work well for the first few months, it kinda... didn't... after that. Even when they upped my dosage to the maximum. I didn't have any noticeable side effects from Effexor (except for the first couple of weeks when I was getting used to it) unless I forgot to take it, in which case I had a tendency to get dizzy and get that "whoosh" sound in my head. YMMV.

[sparkythehamstr.livejournal.com]

Also, as someone mentioned above, I had very little appetite while I was on Effexor, and it can make you really irritable.

[caitlen.livejournal.com]

Hey Cleo

My Dad is on Effexor and has been since 1999. I can't speak for 'personal' experience, but they've worked very well for him and he's never been on anything else. He's also varied his levels of medication over the years, and it's also worked fine.
He's got PTSD and I can now get along with my Dad fine, where as before it was really touch and go. He's much more level now. Saying that however, he has his bad days and good days.

[caitlen.livejournal.com]

I should point out that he has absolutely no intention of ever coming off them and can't ever see a time when he will, and wont talk about it either.

[bikutoria.livejournal.com]

I haven't been on Lamictal or Effexor, and I was only on Zoloft for a month about a decade ago. I just had to comment on your saying your seeing colors for words and numbers - I totally see gender for numbers. Always have.

[cleolinda.livejournal.com]

Well, naturally. Two is very female, I find. But 27 is definitely male.

[newsong.livejournal.com]

Ah, a fellow synesthete!

[reynardine.livejournal.com]

I took lamictal (prescribed for mania, actually) and had to get off of it very quickly because it made my tongue break out in a rash. Those who can tolerate it (ie, don't get rashes) say it's great, but that's for the manic side of things. I have no idea how it does with unipolar depression.

Effexor is one of the worst drugs to come off of. Bad, evil! But that was just my experience, YMMV. Everyone handles pysch meds differently.

I've had luck with Wellbutrin, with a bit of Lexapro on the side. But I have bi-polar disorder and have to handle my anti-depressants with a bit of caution (ie, they tend to make me manic if I don't watch it).

Might want to check out CrazyMeds (http://www.crazymeds.org/). Lots of info written in layman's terms. Also, Ask A Patient (http://www.askapatient.com/index.asp) has people rate their experiences with various meds.

Good luck. Getting meds right can be a challenge sometimes.

[adinkra.livejournal.com]

My first medication when I was diagonsed with clinical depression was Zoloft. 50 mg made me feel happy. 100 mg sent me into a manic episode.

I later took Lamictal, but only lasted about 5 days on it. I suffered from migraine headaches infrequently, but the lowest dosage of Lamictal caused almost 3 days straight of the most crushing migraines I have ever suffered. First time I ever called a doctor when I was actually crying with pain.

http://www.crazymeds.org/lamictal.html is a good resource for describing the risks of The Rash (when to worry, and when not to) and the headaches.

[navillusarat.livejournal.com]

I was on Lamictal for about six months. It evened out my mood and pretty much stopped the panic attacks I'd been having for years, but it totally killed my desire to write, and when I would actually sit down and try to produce something, I struggled to form sentences. From January to June of this year, I barely used my journal. Articulating was difficult. I had problems with my memory, mostly remembering stuff like phone numbers and birthdays, which had never been a problem for me. Oh, and I gained ten pounds which I didn't expect to happen. My doctor said the weight gain wouldn't be an issue, but it totally was for me. It probably had a lot to do with the fact that I had no motivation or engery, which ultimately was the reason I took myself off the meds.

Even after being off Lamictal for two months, I still feel like it's affecting my writing and fogging my memory. I'm not sure how long it takes someone to detox, but hopefully it's almost completely out of my system.

I've met several people who are on Lamictal and love it, so I don't know. It guess it just depends on the person. Hope this helps... Good luck!

[jekylls-bast.livejournal.com]

I'm currently on Effexor XR, at the 112.5 dose so I've been on it for a couple of months now. I've actually lost some weight and was told that, like Lamictal, it too was used for seizures in young children.

So far I've had no bad exsperiances with it. No headaches or pain, no loss of sleep. I can actually tell when I've forgotten to take it because I'll feel down in the dumps and not want to do anything.

I'm like you though, I get talkative and beyond happy when I've been out and about or have talked on the phone with friends or have been very productive. I'm also not manic-depressive.

This is the first time I've ever taken anti-depressants, I'm generally a happy-go-lucky kind of gal, but some things that have happened to me recently has put me in a depressive state and I sought out help because I do NOT like being depressed. So Effexor XR is the only thing I've taken.

Hope this helps a bit. :)

[the-wanlorn.livejournal.com]

For the most part, I've heard good things about Effexor. The only bad thing is that, if you go off it, withdrawal is fucking nuts.

[conejita-diabla.livejournal.com]

Judging from the experience of a few friends, I have to say I *hate* that the response to manic depression seems to be to level it out by taking away that happy. That's just messed up. Everyone I know who got diagnosed w/ that got put on lithium, and they hated it, because they were way less happy! *shakes head*

[emerybored.livejournal.com]

As someone with bipolar, I have to say I'm sorry about your friends. They had bad doctors who didn't work with them to find the right combination of medications. You're right. They shouldn't be drugged into a stupor and have their happiness taken away. But they shouldn't be having manic or hypomanic episodes. It's possible to be happy and not be manic. It just takes the right medications. For me it takes five different ones - three anti-seizure, one antipsychotic (for sleep), and one antidepressant - and it took my psychiatrist two and a half years to finally come up with the right mix of meds at the right dosages. I've stayed at the same doses and with the same stable mood for the past six months and feel really good. My lows aren't low and I'm really able to enjoy everything, but without tipping over into hyperactivity. I hope this helps. Tell your friends to hang in there with their psychiatrists and keep trying new medications until they find the right combination of medications that work for them.

[particle-person.livejournal.com]

Well, actually, the first thing she did was ask me questions that were subtly, in an obvious kind of way, trying to divine if maybe I need to be rediagnosed as manic-depressive.

In a nutshell, that is why I don't like psychiatrists. The times I've visited them, they've always been like that. They get an idea for a diagnosis and nothing short of a hand grenade will jog it loose. After a while, you want to bring a hand grenade to the office. They don't evaluate the evidence and come to a conclusion, they conclude first and then hunt for evidence to shore it up. I'm told not every psych is like that, but I definitely haven't had good experiences.

[cleolinda.livejournal.com]

Well, the only other time she did that to me was the initial diagnosis eight years ago, also with the "Are you manic?" thing, but I understand why: you do not want to put someone with bipolar depression on unipolar depression drugs, because the mania side will be completely overloaded. If nothing else, she needed to make sure I wasn't before she looked into trying a new medication.

[gglass.livejournal.com]

I was on Effexor for five months, and I can honestly say it was the worst five months of my life. Going on it, I was prepared for side effects for the adjustment period, and decided to wait out the hallucinations, insomnia, and worsened depression. After the adjustment period, I kept waiting. I was entirely unable to focus on my classwork, had no energy, and my social life diminished to one or two people who didn't expect me to do much other than sit and watch movies with them. My depression continued to get worse, until I decided to give up on Effexor.

With that in mind, I also have a friend who has been on various medications for depression for over twenty years, and Effexor was the most effective one for him.

[lafemmezilla.livejournal.com]

I took Zoloft, then Paxil, then Effexor over a period of 10 to 7 years ago. They all were the same for me... I'd be good at first, then build up a tolerance, up the dosage, and then I'd switch to the next thing. I believe they're all in the same family of meds, as it were.

I went unmedicated for quite a while after that... then I had to deal with girly problems so they put me back on birth control which made verything tailspin again, plus I quit smoking, so now I'm on Wellbutrin. Which I love! I haven't had any side effects except *slightly* reduced appetite. The side effects ran the gamut on the other three.

Good luck, whatever you end up doing!