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Depression

Alternative Drugs to Treat Depression

12/01/2008

Question:

I am a 60 year old single for the past 10 years, female. I have been taking anti-depressants, and over the past years have not found one that helps. I have taken, Paxil, Prozac, Effexor, high blood pressure and extreme dizzy spells. It took forever to gradually come off of it and then tried Lexapro, same problems, high blood pressure, panic attacks and dizziness. I used Celexa to wean myself off of everything (because of finances, it was available at generic cost). I have since stopped the Gabapentin as well to get my body back to a base level and begin again. I feel I need to be on something but have had so many adverse reactions. Cymbalta made me too sick to take, with immediate violent diadrhea ( side effect was listed as constipation and I thought this would help w/ my pre-existing problem of diarhea) My Dr said it couldn`t be the Cymbalta, so I waited a couple of weeks and tried again. I could never get past 3 doses. Does this extreme reaction to the Cymbalta tell me anything about the way my body reacts to this type of anti-depressant? The most successful combo to date was Prozac and nortriptroline (sp?) But all joy in my life is gone. I have no desire to do anything or go anywhere. I am slowly becoming house bound for fear of all things outside my own home. The anxiety is awful and the sadness is overwhelming. Where can I learn about different combinations of medications. My insurance does not have good mental health coverage. My rhuematologist feels I should be on an anti-depressant for my connective tissue/ auto-immune disorders but says this is not her field of expertise. How can a phyisician have expertise in Mybromyalgia and similar disorders and not anti-depressants, when the main component for its treatment is anti-depressants combined with other medications? Can you recommend where I can go to read up on anti-depressants combined with other medications for relief of depression and anxiety/panic attacks? I have been searchng the web and find only brief, vague references. The way the body reacts to one type of medication should indicate what it is doing to my body and what it contains to avoid in another. The meds that don`t have side effects leave me feeling like a numb zombie, like a slug moving in slow motion with no cares about anything and no purpose. The only thing they seemed to help was the panic attacks, but if you don`t care about anything , there is nothing to panic about...there has to be a way to feel something but not be so anxious and panicky about being able to feel.

Answer:

It certainly appears you have struggled for a long time and that sensitivity to treatments have been problematic for you. Without a  thorough review of your course I can make a few comments.
It certainly appears to me that Cymbalta (at least acutely at some starting dose) caused GI problems. This is not uncommon but it appears more severe with you than most individuals. It is good that a combination of fluoxetine and nortriptyline was of some help to you. If your cardiovascular status is good, this "type" of combination might work for you. I would recommend that you work with an academic center's Department of Psychiatry and if possible a mood disorders clinic, since it appears your difficulties require a specialist.

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Response by:

Nicholas A Votolato, RPh BCPP Nicholas A Votolato, RPh BCPP
Assistant Professor of Pharmacy
College of Pharmacy
Assistant Professor of Psychiatry, Emeritus
College of Medicine
The Ohio State University