Old-Style Anti-Depressant vs. Fancy SNRI

Disclaimer: not looking for DX, just informed (or uninformed) discussion.

I’ve been taking Pristiq, a supposedly cutting-edge SNRI, for about eight months and it has been kinda bleh as far as making very much of a difference. I’ve been through seven SSRI and SNRI drugs over the last ten years and they’ve all been minimally helpful (especially Prozac and Zoloft).

I have terrible insomnia and the doc prescribed Trazodone (Desyrel), an older anti-depressant that has a rep for aiding with sleep. I’ve been taking it for three weeks and feel REALLY good (depression much mitigated, sleeping well, etc).

Is it possible that such an old anti-dep could work so much better than the latest and greatest SNRI/SSRIs? I know so much depends on one’s chemical make-up, but the new generation RXs are promoted as being the best. Maybe I just don’t have any serotonin in my brain . . . :stuck_out_tongue:

It’s possible that you need both drugs, and maybe the trazodone is all you need.

I’m actually very surprised that Pristiq got on the market, because preliminary reports were not encouraging. Among other things, something like 25% of the people they tested it on had to discontinue it because of unpleasant side effects, most commonly nausea.

I didn’t know this about Pristiq. My side effects, besides it not being a great anti-dep, have been general sluggishness and weight gain**. I’m going to talk with my shrink about Trazo as a replacement or adjunct RX.

I also take Lamictal for epilepsy, so what drug is doing (or not doing) what is difficult to unravel

I’ve basically done all the common antidepressants, too.

Tricyclics–check, mild to moderate relief.
SSRI’s–check, ranged from no relief (Paxil, Zoloft) to mild relief (Celexa, Lexapro.)
SNRI’s–check, Effexor. Finally, relief!

Because the SNRI’s do tend to have that vivid dream/insomnia side effect (plus, they tend to make you thirstier, so you wind up waking up in the night to pee) I was also prescribed Trazadone as a sleep aid. Took it twice, and it caused zero drowsiness for me.

Anyway, Effexor is commonly called “Side-Effexor” on the internet, and it certainly does come with a few, particularly while adjusting to it. But that’s what works best on my brain chemistry, so it’s been nearly a miracle for me.

But in psychopharmacology, each patient is just different, and it is often a bunch of trial and error before you find what works for you.

(Full disclosure: I’ve got ‘double depression,’ or dysthymia + clinical depression, with a healthy dose of anxiety on the side.)

I tried Effexor (“Side-Effexor,” LOL) and it did nada for me. I’m just sick of years of trial 'n error (I also deal with dysthymia and clinical depression with a hearty side-dish of anxiety). I’m considering heroin next . . .:rolleyes:

No real helpful information here except to confirm that anti-depressants work differently depending on the person. For example, I took Lamictal and got a suspicious rash while not necessarily ‘the rash,’ it was enough for them to take me off of it. I also took 1/4 of one Trazodone one time and was still in a fog past noon the next day. You just never know what’s going to work for you.

ETA: I also tried effexor, too and it gave me Restless Leg Syndrome for life. Ugh.

(Bipolar person here.)

It is completely possible and even likely. The general understanding of why let alone how different psychiatric drugs affect different people can be called crude if you want to be charitable about it. Almost all of psychiatry is done through trial and error and there hardly any clinical tests that give clinicians the tools to pick one drug over another. It is mostly done through experience and self-reporting by the patient.

There aren’t ‘levels’ or generations of psychiatric drugs like there are which computers or cars. That is, the newer ones aren’t necessarily any better than the older ones for many patients and they may be much worse. All that means is that they have a specific profile of action that wasn’t available in older drugs. That may mean that it has a different side-effect profile than other drugs or it targets certain conditions in a more direct way but that doesn’t mean that it will work for everyone. The opposite may be true and the limited target of action may make the newer drugs completely ineffective for some people as opposed to older drugs that tend to have a wider behavioral neuroscience action profile.

Again, newer doesn’t equal better in psychiatry for everyone or even most people. It is a cookbook experimental art that requires trial and error for every individual case for both the drug(s) and dose. The most effective drug for a given individual may be one that has been around for 60 years or it could be another that has just been approved for widespread use. The reason they develop new classifications of drugs and even multiple drugs within that same class is because it gives a broader range of choices to work with. They aren’t developed in any specific order.

[quote=“Shagnasty, post:7, topic:681103”]

All that means is that they have a specific profile of action that wasn’t available in older drugs. That may mean that it has a different side-effect profile than other drugs or it targets certain conditions in a more direct way but that doesn’t mean that it will work for everyone. The opposite may be true and the limited target of action may make the newer drugs completely ineffective for some people as opposed to older drugs that tend to have a wider behavioral neuroscience action profile.


Smart stuff, Shagnasty. I’ve always thought that the newer RXs were wide-spectrum and the older stuff was really narrow. If Trazo does keep working so well I may be in need of an older and more comprehensive drug. Very interesting.

Congratulations on finding something that works! That’s really all that matters.

I took trazpdone for a week and it just made me angry, so I’m jealous. :smiley:

Well, diagnostic twin, I really hope that you do find something that gives you relief. After my divorce, I rocked along in a haze for about a year, taking the medicine I’d been on for years, before I realized that something had to give.

I spent about 6 months going to a really good therapist, and the CBT did help with a few of the things I could control–negative thoughts, the feeling that everyone is interested in your faults, mistakes, etc.

But that still wasn’t enough. After trying all the different medications over the years, and knowing that things were far worse than they’d ever been, I went to my PCP and said “lookit–the honest truth is that I need to feel better or I’m going to end up being a junkie.” I actually asked for a psych referral so that I could even try electroconvulsive therapy. It was worth the potential memory loss (which, since I teach college, could have meant losing my career.) The doc wanted to try one more thing first, which was the Effexor.

Best I can say is: keep trying. And bear in mind that, despite what the depression makes you think/feel, you most certainly aren’t alone.

Effexor is also dreadfully hard to wean off of if you’ve taken it for a while.

But the side effects and withdrawal are NOTHING compared to Cymbalta. I would never recommend that unless EVERYTHING else has failed, including ECT.

I cannot take trazodone, as it has a rather atypical effect on me. I’ll become extremely sleepy and tired but I will be unable to fall asleep because my mind will be racing. It’s happened every single time I’ve tried using it as a sleep aid, which is maybe 5-6 times altogether.

Since 1995 I have taken over 20 different medications for depression and they have all been meh.

I’m tired of the confusion, the headaches, the side effects and everything else related to depression. I don’t even know what it would feel like to NOT be depress. Right now I’m going thru the motion for my mothers sake. When that is no longer necessary, well then…

Sorry this hasn’t been very helpful. I’m glad that you and anyone else finds meds & therapy that works. I wish you the best.

basically happiness does not come out of a bottle. hang in all.

I’ve been there, Foggy, and held on for the same reason, my mom. There was a long period of time where I was unaware of what life without depression (or at least severe depression) would be like.

Nobody can talk you out of the “well then…” but let me just encourage you to go through every single option you can. I strongly considered inpatient treatment, and my therapist gave me the card for their program, which had a 24-hour number in case things got really bad at any time.

And, though I’d put it as a treatment of last resort, some sufferers have found relief from ECT. There is also a current study regarding folks with treatment-resistant depression being given low-dose Ketamine, which is showing cautiously optimistic results.

I feel for you, man.

Happiness is just a fleeting emotion. Even though I’d say I’m in remission for depression, I’m still not “happy.” At one point during therapy I said that, even from childhood, I can’t remember a single time I’ve ever felt elated. I’m not sure if I’m even capable of feeling what people call “joy” or “euphoria.” Well, ok, outside of opiates, which is why they scare the shit out of me. The feeling of “all is right with the world” is so good anyway…but for a person who never gets that any other way, I can see how folks get hooked.

I think most folks with severe depression or dysthymia are mainly not looking for happiness, but rather an elevation in their baseline mood to the place where “normal” people tend to reside. Even if there aren’t many/any swings above the ‘normal’ baseline, that’s still good enough, because you don’t spend every waking minute wanting to die. That was my goal, anyway…just going from “I hate life and wish I were dead” to “Meh.” Huge improvement.

Hi Sentrix: with respect to your opinion, I, like Blake, would be happy with just feeling “meh-ish” most of the time: “happiness” is a very rare state for me – just functioning enough to take care of my responsibilities is what I aim for.

I have a high-level professional position and my office doesn’t have a dark closet to curl up in :stuck_out_tongue:

KETAMINE? Ooooh, fun! I haven’t tried ECT, but have had a few grand mal seizures after which I felt great for several days – I suppose this was a natural form of electric zapppppping of the old brain.

I took Adderall for eight months as off-label for depression. It worked really well, but was not a long-term solution.

Wanna go to South America with me and try ayahuasco? :smiley:

The happiness deal is all wired wrong.

The same as the sex deal.

Sex could kill you. Do you know what the human body goes through when you have sex? Pupils dilate, arteries constrict, core temperature rises, heart races, blood pressure skyrockets, respiration becomes rapid and shallow, the brain fires bursts of electrical impulses from nowhere to nowhere, and secretions spit out of every gland, and the muscles tense and spasm like you’re lifting three times your body weight. It’s violent. It’s ugly. And it’s messy. And if God hadn’t made it unbelievably fun, the human race would have died out eons ago. Men are lucky they can only have one orgasm. You know that women can have an hour long orgasm?


Yes. Cameron.

For me I am not wired for sad. I emphasize. I don’t know only what i read.