severe depression and medication questions

[jen 2]

I am 20 y/o and in college.  I become depressed in high sch. Fatigue, no motivation,irritability severe hopelesness and suididal thoughts. I also have suffered from lots of anxiety and have bitten my nails to the quick for past 8 yearI worry alot irrationally that others will be upset with me which couldn't be farther from reality since I work hard and am overly responsible if anything.Comes from growing up as only child in household where mother was always angry with passive father.Had 2+ years of good cognitive counseling. Helped me to get through the days of High school, but not happily. A year ago, I went on 20mg prozac. Huge difference almost immediately. No longer tired all day, feeling happiness for the first time in 6 or 7 years, lost the 35 extra pounds I had put on in High Sc due to using food to comfort and what felt like a true craving for chocolate.I'd have candy by the bags. After 3 months of feeling great, I stopped taking prozac cold turkey.Big mistake. I hated the idea of being on a drug.  Had no withdrawl symtoms nightmares stopped in a week,but depression returned after 4 weeks or so. Went back on prozac 2 weeks later, and was immediately more tired than ever.  Previous positive response did not happen at all. This continued to worsen, so I upped to 40 mg.  Sleepiness and fatigue continued.  I stayed on the 40 mg of prozac for the next 5 month (tried 60mg for the last3 weeks of it) Switched to celexa 20 mg the day after taking last prozac.  I did taper down prozac to 40 then 20 within one week while going off.  Have been on celexa for 9 days and still feel LOTS of sedation. For last two days am taking 40 mg celexa per MD.Still tired. Called in sick to work one day last week which I have never done(although I have fallen asleep at work) It is very hard for me to turn off the negative filter when I am in this funk.And I do work at it as well as not generalizing and the rest of it. My pattern is that I have a good day(able to function) and then have a day when it is almost impossible to get out of bed.  It is like a roller coaster but I have never felt or been anywhere near manic. Should I 1: stick out the celexa maybe going back to 20 mg to see if sleepiness goes away, 2:augment with wellbutrin or 3: get off celexa since SSri's now seem to sedate me, and just try wellbutrin. Have you had experience or anyone, with some ssris sedating you heavily but others not?  Also could buspar or something else for anxiety be helpful adjunct.  When I feel good I do triathalonsand feel like excercising and some days can push myself to bike or swim, so I'm leary of xanax,valium ect. but think something for anxiety would help.I am wondering if this type of sedation is common and then goes away or if I need to augment or change meds altogether.  I truly feel better for 5 minutes after eating chocolate, and have always been able since very young to eat all kinds and to the point where others will feel sick. Am going to check bloodwork also THANKS

[Roger Gould, M.D.]

ssri's frequently cause sedation but it almost always goes away when you reduce dose so I would suggest trying that first. You might also benefit from therapy at the same time because the combination of therapy and medications is the best medicine.  You can get some immediate help online at www.masteringstress.com.

[Try_to_be_social]

For my depression I took fluvoxamine 50mg, mianserin 60mg and clonazepam 2mg before sleep for 10 years, after failing single drug therapy. I found Prozac, Citalopram, Sertaline, Paroxetine, Venlafaxine, Mirtazapine, and Monclobemide could not replace Fluvoxamine. It indicates that different SSRIs has different effect on a particular individual. I deny failing prozac and Celexa means the rest of the SSRIs is contraindicated. Amitriptyline, imipramine, clomipramine, nortriptline, dothiepin, doxepin, Maprotiline could not replace mianserin. Diazepam, lorazepam, chlordiazepoxide, Buspirone, Alprazolam, Bromazepam, and Pinazepam could not replace clonazepam. I think your tiredness may be part and partial of your recurred depression rather than side effect of your SSRIs. I found by trial and error, if allowed, one could find a suitable drug for a particular individual. Of course Wellbutrin which belongs to a different class is worth a try. You can always try Sertaline, Paroxetine, Venlafaxine in case Wellbutrin does not work. Now I have successfully weaned off Fluvoxamine because I have been taking antidepressant for an adequate period of time. I think you should take antidepressant for a longer period before quitting it very slowly, while looking for the earliest signs of recurrence. I think you should go on with your cognitive therapy to get rid of irrational believes. you can try insight therapy too. I wish you every success in the adjustment of your medicine and thoughts.

[clarion]

I hope you have a very good doctor who can work with you, because proper dosing is half the battle to finding a drug that works well for you.  As was noted in other responses, severe fatigue could be a symptom of the depression or could be overdosing.  When I started medication, my dr. started me on very low doses and then inched me up every few days until I got a good response without sedation.

I responded to Effexor but got high blood pressure from it; also lost sexual response.  Switched to Wellbutrin -- had no discontinuation response to Effexor probably because I was simultaneously starting on Wellbutrin.  Everyone's different; you really need to experiment with the support of a good doctor.

One thing I wanted to comment on:  that "up-down" response (feel good one day, then crashing) sounds like cycling, even if you are not manic.  I had that response to antidepressants at first.  I had amazingly good response, and then I would be back in the throes of deep depression very suddenly.  Cycling is characteristic of some atypical depressions.  For me what worked was adding a stabilizer (I used lithium), which did the trick.  After about a year with the stabilizer, I was able to discontinue that and only keep with the antidepressant.

You may have an unrealistic expectation about going off the drugs.  Research is indicating that people need much longer on antidepressants to avoid a relapse--at least 6 months to a year, and maybe as much as two years. With your history, you may not be able to go off easily.  Anyone with two or more major depressions is very much at risk of relapse without the medication.  I am in this boat myself, and although there are times I really hate having to be on medication, I am so grateful for the benefits, I get over the impulses to go off. Certainly, if you do decide to go off after a period of time, you need to taper the drugs with the support of a doctor.

Finally, to reinforce what was said above:  find a good therapist who can help you in conjunction with the medicine.  At the very least--work through your feelings about being on medication!!  Really, therapy can make you feel stronger and more free.

Best wishes.