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Author Topic: Alternative to SSRI's?  (Read 226 times)

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Offline Calikime

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Alternative to SSRI's?
« on: May 12, 2014, 10:25:55 AM »
Hi,
I don't know if this is common, but when I have tried SSRI's and most recently an SNRI (Wellbutrin) I get extreme diarrhea and have to stop.  I happen to have Collagenous Colitis so I am sure that makes me more sensitive.  Has anyone had success with any other classes of antidepressants?  I have GAD/PTSD and moderate depression.  My GP is out of options and is trying to get me a referral to a psychiatrist who knows more about medications.  I was on another forum and a few mentioned having success with Mirtazapine.  I mentioned that to my GP and she said she only prescribes that for older people, for instance in a care home that tend to "wander" and it helps with keeping them down.  I guess my take away on that one is that I wouldn't have much energy.  I know it is good for sleep so maybe it makes you tired the rest of the time also.  Since the referral to a psychiatrist is going to take awhile, I started taking Tryptophan to help increase my serotonin, hoping that would help.  I take it with niacin, B6, etc to help cross the blood brain barrier, but I don't know if it will work, but I need to be doing something while I wait.  Any suggestions would be very welcome!  Thank You. 
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Offline Myocdragon

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Re: Alternative to SSRI's?
« Reply #1 on: May 12, 2014, 11:19:04 AM »
I can't answer your question directly, unfortunately, but have you tried asking it on those "ask a psychiatrist" type sites? Like http://www.healthcaremagic.com/ask-a-psychiatrist-online/35?utm_source=google&utm_campaign=Search%20Campaign%20Specialist%20US&utm_term=ask%20a%20psychiatrist&gclid=CIv5-K_Xpr4CFcVffgodPj8AlA
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I'm not crazy, I've just lost my mind

Offline BusuB

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Re: Alternative to SSRI's?
« Reply #2 on: May 12, 2014, 01:02:38 PM »
If diarrhea is an issue, you might want to ask about a TCA medication like amitriptyline or imipramine.  That class of medication has strong anti-cholinergic side effects (dry mouth, constipation, etc).

FYI, Wellbutrin is not an SNRI, it's an NDRI.  Your typical SNRI's are Effexor, Pristiq, Cymbalta, Savella and recently available Fetzima.  Most preparations of SNRI's are time released due to their short half lives, so I'm unsure if your colitis issue affects it's absorption (something to discuss with your physician of course).  The only immediate release option is Effexor which requires dosing at least twice a day (most get prescribed the extended release version).

Please keep in mind that I'm not a doctor. Please make sure any decisions are made under advisement of a medical professional.
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Offline insights

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Re: Alternative to SSRI's?
« Reply #3 on: May 12, 2014, 06:23:07 PM »
Has anyone had success with any other classes of antidepressants?  I have GAD/PTSD and moderate depression.

I have been on tricyclic antidepressants (TCAs) for over 27 years. They are highly effective meds which have been eclipsed by SSRIs not because they are less effective, arguable they are more so, especially for depression, but because they have more ongoing side-effects such as constipation, which may be an advantage in your case. 

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I was on another forum and a few mentioned having success with Mirtazapine.  I mentioned that to my GP and she said she only prescribes that for older people, for instance in a care home that tend to "wander" and it helps with keeping them down.

Mirtazapine is actually one of the two (with Effexor (venlafaxine)) most effective antidepressants for very severe depression. However, it is also the antidepressant most likely to stop working, often within only a few months.

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I guess my take away on that one is that I wouldn't have much energy.  I know it is good for sleep so maybe it makes you tired the rest of the time also.

Mirtazapine is a very sedating antidepressant and there can be some hangover during the day.

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started taking Tryptophan to help increase my serotonin, hoping that would help.

NO!!!!!!!!!!!!!!!!!!!!!! Snake oil. Potentially very dangerous snake oil. See: Serotonin: The 'chemical imbalance' myth

Adding vitamin B6 doesn't increase the ability of L-Tryptophan to cross the blood-brain-barrier. All you're doing is producing more expensive urine, and maybe upsetting your gut in the process. Most of the serotonin produced in the body is synthesized and used by the enteric nervous system, the mini brain that controls the gut. Around 95% compared to less than 2% by the brain.

Antidepressants do not work because they change the levels of a neurotransmitter in either the synapses, or the brain generally. While they may do so, this seems to be an consequence of the therapeutic effect, not its cause. They work by stimulating the growth of new brain cells in the hippocampal areas of the brain and increasing the strength of connections between cells and brain regions.

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but I need to be doing something while I wait.  Any suggestions would be very welcome


Both exercise and Omega-3 fatty acids/fish oil have been shown to increase hippocampal neurogenesis and can be effective treatments for mild anxiety, or depression. A 30 minute walk 4-5 times a week, and/or 4-6 x 1,000mg fish oil capsules (start with 1 and up by 1 very 3-4 days to avoid diarrhea) are going to do much more good than any amount of L-Tryptophan.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Calikime

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Re: Alternative to SSRI's?
« Reply #4 on: May 13, 2014, 10:06:45 AM »
Thanks to everyone who responded to my question!  I feel I have a lot more information now moving forward and glad to know that there are alternatives to what has not worked for me.  Two of the psychiatrist's that I contacted that were recommended to me are not taking new patients and oddly did not have another name to recommend.  So I am back at square one.  I printed off a list of available psychiatrists that are on our insurance.  The closest one is an hour away.  If you have any advice as to what questions I should ask to try and find the best one please let me know. Again, thank you so much for your responses.
Calikime
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