What's the best/most effective antidepressant?

Discussions in depression - new perspectives on depression. Get help if you are suffering, and discuss approaches if you are a therapist.

Postby Bentheman » Tue Jul 22, 2008 1:44 pm

I've had mixed results from antidepressants. A couple years ago I was on Escitalopram (Lexapro) which worked well. I went off it, and then one year ago I went back on Lexapro, but it didn't work, so my doctor quickly switched me to venlafaxine (Effexor), and that didn't help either. I'm going to the doctor tomorrow, what do you think is the best/strongest antidepressant besides those I've tried?
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Postby Midlands » Tue Jul 22, 2008 2:18 pm

Hi,

I think different things suit different people but I'll let you know what I've tried.

I found fluxotine and Citralipram (40 mg I was on) to be pretty similar. They worked quite well for anxiety but didn't lift the mood at all really. They just numbed me really. Exeffor was the same until the dose hit the 225mg mark and it really did improve my mood. I wasn't doing star jumps in the morning or anything but there was definately an improvement. I know you say you tried this but what was the dose?
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Postby *Nihilistic One* » Tue Jul 22, 2008 5:13 pm

No answer exists.

For different types of depression you can apply educated guess work though.

Example: Old school MAO inhibitors are more effective for people with atypical treatment resistant depression accompanied by social phobia. But 'treatment resistant' is the operative phrase.

TCA's are generally more useful for depression with a pain condition, and SSRIs are good for a long range of conditions.

Modern dual reuptake inhibitors have advantages and drawbacks.

Trial and error.

And yes - it sucks, but if you choose the AD route there is not much you can do about it save applying some rules of thumb.
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Postby Bentheman » Tue Jul 22, 2008 7:13 pm

I lied guys, I actually started a new antidepressant today, went to the doctor yesterday. It's called budeprion. Anyone ever tried it? Was it good or bad?
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Postby scampo » Tue Jul 22, 2008 8:08 pm

Look bupropion up on Wikipedia and you'll get the low down on it. It's not an SSRI so it's worth trying. Have you tried CBT yet? It's also very much worth giving a go.
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Postby *Nihilistic One* » Wed Jul 23, 2008 4:30 am

Well, you should manage to avoid the nasty sexual side effects like delayed orgasm and anorgasmia.

Pretty good AD if ever there was one.
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Postby Bentheman » Wed Jul 23, 2008 3:57 pm

Thanks for the advice guys. Midlands, I don't remember what the dosage was, but right now I'm taking 150. And do you guys have any good lifestyle tips to help get the most out of this antidepressant? Get full nights sleep, exercise sometimes, eat right, anything else?
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Postby elbow grease » Wed Jul 23, 2008 10:33 pm

hi there people

I've been on Prozac (did nothing), Venlafaxine (did nothing) Mirtazapine (Remeron) which I've been on for 7 or 8 years, Along with Citalopram for the last 4 years or so. Apparently this is the max dose of anti-depressants prescribable, at least for me; I also take anti-psychotics and a raft of other stuff too, so it's hard to say definitively how each med has helped, just that Mirtazapine's kept me alive, I'm sure the citalopram helped too. But there are side effects! Sleeping is impossible if you miss a dose, staying up late is difficult if you do, and you get the crazy munchies, especially in combination with other meds. I won't try and tell you anything I don't know, so will leave it there, but check out the crazymeds website/forum for a balanced (by the unbalanced) view.

I'm far from qualified to give any lifestyle tips! But I am a student nurse with a stack of pharmacy textbooks to refer to if anyone has something they need looking up.
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Postby jurplesman » Thu Jul 24, 2008 4:43 am

Bentheman wrote:I've had mixed results from antidepressants. A couple years ago I was on Escitalopram (Lexapro) which worked well. I went off it, and then one year ago I went back on Lexapro, but it didn't work, so my doctor quickly switched me to venlafaxine (Effexor), and that didn't help either. I'm going to the doctor tomorrow, what do you think is the best/strongest antidepressant besides those I've tried?


There is no "best/strongest" antidepressant drugs on the market and ALL have side effects (because of toxicity) and most, if not all, do not treat the underlying causes of depression and are mere palliative putting you on the road of drugs and drugs. There is no easy drug-fix for depression and they make you sicker and sicker, but you help to enrich investors of pharmaceutical companies.

Depression is a Nutritional Disorder

and ask the doctor to be referred to a Nutritional Doctor, a Clinical Nutritionist or a Nutritional Psychologist.
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Postby k1 » Thu Jul 24, 2008 1:19 pm

Jurplesman please take a holiday and give up spreading the nutritional word, it gets tedious. I wouldn't mind if it wasnt such rubbish.
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Postby scampo » Thu Jul 24, 2008 1:38 pm

I doubt there's any chance of a respite as Mr. Plesman believes fervently in promoting benefits of what he likes to call "nutritional therapy".

That would be fair enough, I suppose, even if it gets tedious to read the same message time and time again. Now though, we have the pernicious and frightening suggestion that seeking the help of a qualified medical practitioner is actually causing us serious harm. That's not what I would call a useful or acceptable message to give to the many, many folk who read these message boards.

As for the claim that we are lining the pockets of the rich pharmaceutical companies, well, I can only say that I am thankful to the research scientists who work to help ease this blight on our lives. Of course those companies are profitable but that, like it or not, is the way capitalism works. Out of those profits they must fund massively costly research and, as there's no alternative, I remain, even if guardedly, very grateful. Sadly, that's even though none of their drugs has worked for me - but then neither has the plethora of "alternative" therapies I've tried.

The plain fact is, of course, that multitudes of people the world over owe their daily lives or quality of life to the tablets they have to take on a daily basis.
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Postby k1 » Thu Jul 24, 2008 2:03 pm

Thanks, scampo, from backing me up. I am not one for causing trouble and arguments and I have no problem with people having alternative views. But i think this is somewhat different.

I myself am a research scientist with the added understanding that comes from being ill with depression and anxiety, and on the 'receiving end' of treatment.
Now I know full well, that like any other company, pharmaceuticals are in the business of making money. I am not naive. But I can also say that the effort and research that goes into making drugs is monumental and also genuine. Remember that people that work for these companies are human, the vast majority being ethical and caring. Myself being one of them. Add to this the fact that pharmaceuticals probably the most tightly regulated business that esixts.
And beleive me Jurplesman, if the health services thought there was a decent way of treating mental illness that didn't involve spending a fortune on drugs - they'd be offering it.
Oh and another thing, I have seen many different doctors in the course of trying to get better, and not one has pushed me into taking medication.
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Postby antimony » Thu Jul 24, 2008 2:06 pm

Scampo, I've always wondered - is your name the singular of scampi? And if so... er... why?

Adding my own two penn'orth, I would say that it would actually be a lot more expensive for me to follow an Alternative depression regime than taking prescription drugs, and that very very few products or services designed to relieve depression, whether mainstream or alternative, are provided free to the user. Those that are have to be funded or subsidised in other ways. Very few people will undertake to relieve your suffering out of the goodness of their hearts, unless I missed all those flyers for pro bono nutritional psychologists touring the country. There are lots of different ways to make money out of depression, and the big pharmaceutical companies are only one.

I have had very mixed results from medication (not great benefit but not bad side effects either), but I consider myself to be an informed user and I am glad that they are available. They should never be presumed to be the whole solution, and I wish talking therapy was more readily available, but medication can provide the breathing space needed to engage with therapy.

I would also say that anyone who weighs in too heavily with their solutions, whatever they are, even ones that worked miraculously for them, tend to make me feel worse about myself and diminish my hope even more. Maybe because there seems an implication of blame to the sufferer unless they accept and engage with this technique instantly.
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Postby heatherbell » Thu Jul 24, 2008 3:09 pm

Hi Bentheman

The simple answer to your question is there isn't a best or most effective antidepressant-it's simply horses for courses.

And to Scampo, K1 and Antimony-I couldn't have put it any better, you have my 100% agreement on all that you're saying. I'm glad to have the support of modern medication or people I care about would be dead by now. Rock on guys! [gals? Or is that too Jimmy Saville?????]


Cheers
Heather
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Postby scampo » Thu Jul 24, 2008 3:16 pm

Scampo? (-;

I hadn't thought of scampi! But it's nothing to do with that. It's my first initial plus a part of my surname with a final "o" to make it sound like a word. I suppose I could have stayed with "Scamp" but that's so unlike me as to be laughable...

As a matter of fact, I'm no lover of what are, really, silly logon names. I'd much rather use my proper name but I can see that that's not a particularly good idea on public email forums. I have to say that in many ways I dislike the whole system of forum emailing because of its anonymity and the ease with which people can say just about whatever they like and yet with no responsibility. Good relationships rely entirely on authenticity, sincerity and compassion; forum emails, on this basis, are a double-edged sword and in some ways a severely retrograde step. Btw, I have to say I like the word "Antimony" as it was one of those mysterious sounding chemical elements that I had such a passion for as a kid besotted with chemistry!

You make excellent points throughout your post but most particularly in your final paragraph.

K1, you couldn't have put it better. I have worked for many years in pharmaceutical companies until more recently becoming an English teacher. They are very far from perfect in what they do but as you say, the scientists they employ are human beings with all that that means.

It's so easy to criticise thoughtlessly but I don't believe that's what is being done here. JP's criticism is very thoughtful. I'd say it is rhetoric of a base quality. It's one of the retrograde features of forums such as this, I suppose!
Last edited by scampo on Thu Jul 24, 2008 3:28 pm, edited 3 times in total.
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