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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Tried numerous mess since Prozac pooped out Feb 2014

Customer Question

Tried numerous mess since Prozac pooped out Feb 2014 for my depression anxiety and agoraphobia. Currently on Restoring for sleep, 10mg Lexapro and 300 Neurontin. Been on Lexapro 7 weeks now and a few days neurontin. Still having dark thoughts plus I'm in counseling. Doc said dark thoughts will pass. Very unsure this will work.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.
*This website DOES NOT constitute treatment and only provides information and advice. For treatment (therapy and/or medications) you must go to a licensed professional in your area.
Hello, I am very sorry that you are having these “dark thoughts” I can understand how distressing this can be for you. By 7 weeks the Lexapro should have reached it maximum effectiveness so if you are still having these “dark thoughts” and possibly other symptoms of depression and anxiety, than your dose of the Lexapro should be increased. 10mg/day is only considered a moderate dose, so it would be best to increase the dose to the maximum at 20mg/day (maximum dose) which will provide a greater level of benefit for you. After 2-3 weeks on the increased dose of the Lexapro should start to be noticing less incidence of “dark thoughts,” and other symptoms of depression/anxiety, but if you still do than your doctor will have to add an augment to your regimen. An augment is meant to attach to your current antidepressant to boost its effectiveness. There are three possible augments for your regimen that you should discuss with your doctor. The first is Aripiprazole (Abilify), which your doctor can provide to you at a low dose. Studies have shown that using Abilify with a SSRI/SNRI antidepressant can significantly increase the effectiveness of the antidepressant due to its mood stabilizing properties. The second possible augment would be a low dose of Mirtazapine (Remeron), which is an atypical serotonin based antidepressant. Remeron can significantly less anxiety and depressive symptoms, and also has a sedative effect to help you sleep better at night as well. Remeron has proven itself as a stand-alone antidepressant, but when used as an augment it can truly help your overall regimen. The third option would be to add Lamotrigine (Lamictal) to your regimen. Lamictal is a mood stabilizer that has excellent properties for treating depressive symptoms, and due to its glutamate regulation function it can lessen anxiety as well.
I hope this answers your questions and gives you some guidance on this issue. I would recommend discussing these options with your doctor and I hope that your symptoms of depression and these “dark thoughts,” lessen very soon. Please let me know if you have any questions or concerns as I am happy to assist and support you regarding this issue.
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Customer: replied 1 year ago.
I have tried upping my Lexapro to 20mg per doc and got worse, paradoxical effect he called it. Ability revs me up too much and bad for anxiety that's why he put me on Neuron tin for anxiety
Expert:  Dr. Z replied 1 year ago.
If you got worse while increasing the dose to the Lexapro and this current dose is not lessening your "dark thoughts," than it is time to change to a different primary medication for your depression. You can look at the Remeron or Lamictal as your primary medications to lessen depression and possibly anxiety as well even though depression is your chief complaint right now. I am not sure what other medications you have tried, but Viibryd, Effexor, Paxil, and Brintellix can all lessen depressive symptoms as well and may be effective for you.
If you feel that you have tried too many medications without beneficial results than you may have something called Treatment Resistant Depression and this would require a more intensive type of treatment. I would recommend Transcranial Magnetic Stimulation (TMS) which uses magnetic waves to help stimulate neurotransmitters in your mind. TMS has been approved by the FDA to treat Depression since 2007. The good news is that this is very effective for lessening depressive symptoms (70-80 percent success rate) and also has a very low rate of side effects (the most common side effects are headaches and scalp irritation for a few days). Here are some articles on TMS if you want to look into it more.
http://www.mayoclinic.com/health/transcranial-magnetic-stimulation/MY00185
http://depression.wustl.edu/O'Reardon%20Pivital%20trial.pdf
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Customer: replied 1 year ago.
I've tried Brintellix, horrible and Vibriid no results. SNRIS increase my blood pressure and my anxiety. I'm looking into TMS and hopefully will get approved for that. Will ask doc about Remeron. Also tried Lamictal in the past, no luck.
Customer: replied 1 year ago.
The only two meds that ever helped in the past were Serzone and Prozac before they pooped out. Are these still options?
Expert:  Dr. Z replied 1 year ago.
Outside of Lamictal, you can consider Lurasidone (Latuda) as this has some strong mood stabilizing properties to lessen depressive symptoms. But because Latuda is an atypical antipsychotic medication, the chance of side effects is high unfortunately and given your sensitivity to medications it may not be the best option for you. Given that you have tried so many different medications it would appear you qualify for TMS or possibly IV Ketamine, which is another treatment option for resistant cases of Depression. IV Ketamine has shown great results to lower depression within hours of the first treatment session, but there must be subsequent treatment for long-term results. There are a few clinics throughout the country that use Ketamine to treat patients with Depression, here is a good list of them (this list also includes pain clinics which you want to avoid)
http://www.ketamineadvocacynetwork.org/provider-directory/
Prozac is not an option for you as have already developed a tolerance and Serzone has been discontinued in the U.S. for over 10 years so that is not an option either. At this point you can keep trying different medications, even going to the older antidepressants like the TCA antidepressants or the MAOI antidepressants (greatest chance of side effects and food restrictions with this). Or you should attempt to look into the new treatments for resistant cases of depression like TMS and IV Ketamine.
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Customer: replied 1 year ago.
Serzone now nefazadone is still available in U.S.
Expert:  Dr. Z replied 1 year ago.
Yes there are generic versions of the medication available, but with mixed results and a rarity of it being prescribed. The formula had to be tweaked a bit to prevent the hepatoxicity issues that was notorious with the original Serzone, which is why these are not true generic versions of the original medication and why it provides mixed results at best. Also most doctors do not prescribe this medication in its generic form due to the notoriety and also the increase risk of suicidal thoughts while on Nefazodone too.
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Customer: replied 1 year ago.
Thank you.
Expert:  Dr. Z replied 1 year ago.
You are most welcome and I truly wish you all the best with your continued treatment. I hope that your symptoms of depression and these "dark thoughts" will lessen very soon for you
*****If you are satisfied with my answer, I would truly appreciate it if you can take the time and provide me with a POSITIVE rating so that I can receive credit for helping you. Thank you