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Doctors' Answers to "Frequently Asked Questions" - Anti-Depressants

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Antidepressants [posted 1/13/99]
Question: I have been using clonazepam for about three months now for mild GAD and Panic Disorder. It has worked tremendously well. I take .5 twice daily. My understanding is that this is a very small dose and I should have no problems with it. Can this dosage be taken for long periods of time? Life is so much better with it than it was before! I cannot tolerate the SSRIs and Buspar did no good whatsoever. Also, I use St. John's Wort along with the clonazepam. Any problems there, and how long can one use the St. John's Wort safely?

Answer: Well, it is still potentially addicting even at this dosage if continued for a long period. However, that is not a specific reason to stop if it works well. There should be no problem combining St. Johns and any benzodiazepam. St. John's appears to be safe long term at this point.

Antidepressants and sexual dysfunction [posted 1/5/99]
Question: I would like to know what anti anxiety/depressants are on the market that do not affect individuals sexual desire. I have generalized anxiety disorder and periodically need anti anxiety medications. However, this affects my relationship with my husband greatly, and I would like to know if there are any drugs available that do not decrease sexual desire, but help with anxiety.

Answer: Try Serzone or Celexa. They tend to be the best.

SRI antidepressant [posted 1/4/99]
Question:What would be a good example or suggestion of an SRI antidepressant? What would a nerve biopsy show?

Answer: There are several good SRI drugs and I use them fairly interchangeably. Prozac, Paxil, Zoloft etc., are all fine. As to a nerve biopsy, you really don't know the pathologic cause of the problem. A nerve biopsy would be an attempt to come up with an answer.

What is the New Antidepressant from Parke-Davis [posted 11/6/98]
Question:What is the name of the new antidepressant to be marketed by Parke-Davis during 1998?

Answer: Could be several call them 800-223-0432. I suspect it is Celexa.

Longterm Antidepressant Use [posted 10/8/98]
Question:I have been on several different anti-depressants for nearly fifteen years. Each Time they seem to only be effective for a year or so. My question is is this common for these drugs to lose there effectiveness in long term use? And what is the normal time frame it is safe to use an antidepressant?

Answer: Depends on the drug, but, most do not lose their effectiveness as you describe.

Antidepressants [posted 10/6/98]
Question:I am wanting to get on an anti-depressant, and I have been doing a lot of reading on Paxil, Effexor, and Wellbutrin. There are all a little scare. But I have a friend that just went on Paxil and she lost 20lbs on the metabolife and is now down to one pill a day. Is it okay for her to be taking both pills

Answer: Shouldn't be a problem.

Antidepressants and Stuttering [posted 8/13/98]
Question: Do you have any information on antidepressants and their effect on stuttering? Are any known to work well with out acting on my speech? Do you have any information about antidepressants effect on speech? I am a 21 year old female battling endogenous chronic low level depression. I have been on prozac, wellbutrin, and zoloft - all of which made me stutter (a mild speech impediment I have had since childhood) worse.

Answer: I don't have any information on this. You might check with the company.

Anti-depressants and pregnancy
Question: After a 15 year struggle with bulimia, and many group counseling sessions, books read, etc., I finally visited a psychiatrist 4 years ago. I began treatment with Zoloft and weekly twice a month individual counseling, which was wonderful and helped tremendously. I did switch to Prozac for two years, stopped in May of 1996, and resumed with Zoloft in July of 1996. I feel much better on it than off. I am 7 weeks pregnant with my first doctors check-up next week. I cut back, then went off the Zoloft once I learned I was pregnant, but had headaches, felt queasy, felt lousy and would cry and the drop of a hat. Could this be from pregnancy or withdrawal? Anyway, I would like to remain on the Zoloft, but need to know if there are any success stories of healthy babies, and what the risks are, etc. I am 36 years old and this is my first child. I have a recovering alcoholic mother and her brother was a practicing alcoholic when he died. My father's father was deeply depressed and died in 1959 with now available treatment at that time. I'm afraid that my bulimia may be part of that chemical imbalance that surfaced by my turning to food rather than alcohol or succumbing to depression, so I would rather not go off zoloft.

Answer: I wish I could give you more concrete information, but there have not been controlled studies of zoloft or SRI in pregnancy. Studies performed in rats show an increase in liver adenomas in the offspring, but at extremely high doses. There has been no evidence of genetic deformity in rats offspring. There is no current data on drug levels in breast milk of mothers taking SRI drugs. There is no data on outcome of children conceived or nurses in the presence of SRI inhibitors.

Question: I took an anti-depressant a while ago and I believe that it has caused me a permanent sore throat. The anti-depressant was called something like Prothieden. I even snorted it through my nose. I have had the sore throat for many years now and I still believe it was this anti-depressant that I was taking that wasn't even prescribed to me. I have recently found that drinking water helps my throat a lot, so I thought maybe it has something to do with my stomach, or maybe this drug has affected the way my brain deals with fluids? Can you give me an answer to what you might think it is? I also took sleeping pills called temazeapam or something and I have ringing in my ears. It has been many years since I took these drugs.

Answer: I doubt this is the problem. Chronic sore throats are usually due to chronic post-nasal drip or acid reflux from your stomach. I would see an Internist or an ENT specialist for an evaluation if it has lasted this long.

Anti-Depressants - Paxil/Zoloft
Question: I was recently diagnosed as depressed and prescibed paxil; it was effective however I found I could not achieve orgasm. I stopped the paxil for three days and returned to a "normal" depressed state. I began taking the paxil again and the sexual disfunction returned however the efficacy of the drug decreased. I am interested in the new drugs in the ssri class which do not have as pronounced an effect on sexual libido.

Answer: The newer classes of anti-depressives are thought to act through the action of serotonin. The unfortunate effect among the initial entries in this class was a decrease in sexual drive. There are newer drugs in this class like Serzone which are more selective in their effect and have less libido loss as a consequence. These drugs have been available about 6-8 months. The patients I have switched from Paxil to this class of drugs report a marked improvement in sexual drive.

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