Non SSRI Anti-Depressants

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I'm trying to be open minded about medication so I was wondering if anyone knows of any anti-depressants that aren't SSRI's. I had a bad experiance on prozac so there is that and also I do drink and apparently you're not supposed to drink on SSRI's. As much as I would like to boldly claim I could easily go without another drink for months or years that's a total lie so the drinking probably won't stop.

So I was wondering what sort of options there are, when it comes to anti-depressants, because I don't want something that makes things more difficult.

You can still drink with most anti-depressants. They say not to because the alcohol can have a different effect, such as increased drowsiness, when combined with anti-depressants. It's just the drug companies playing safe and covering their asses so they can't be sued. The FDA requires the warning.

Only MAOI's are dangerous to combine with alcohol, which is one reason they're hardly ever prescribed these days.

You might not want to get completely hammered right away though, especially if you're still adjusting to new medications. It can destabilize your mood in a bad way.

I loved, and still love, Desipramine ("Norpramin"). Unfortunately, my doctor took it away from me because his liability insurance won't allow him to prescribe it anymore (a few small kids died taking it over the span of ~20 years, and as a result they decided to extend a general warning about cardiotoxicity to everyone as a result). Basically, the mfr isn't really making money on it anymore & decided to protect itself from a future lawsuit by just throwing out a blanket warning instead of bothering to explore whether there was anything about young kids that made them more susceptible than adults (there was no specific evidence I'm aware of that it was cardiotoxic to adults).

Desipramine was awesome. No SSRI side effects (especially in the plumbing department), and it *massively* potentiates methylphenidate, so I was able to make it through most of the day with a single 54mg Concerta, augmented by 5mg IR in the evening. Once I quit taking desipramine, I had to start augmenting the Concerta with IR Focalin starting in the middle of the afternoon & continuing all evening to keep it from wearing off.

It also made methylphenidate itself tolerable. Here's an interesting story... back when I first started taking Ritalin, I absolutely *hated* it. It made me feel very "raw", and the crashes were horrible. I switched to Adderall for about a year, but still wasn't happy. My doctor suggested trying Ritalin SR (horrible) with desipramine, because it was widely-known and prescribed in the 90s to smooth out the worst of ritalin's ups & downs. It helped enough to keep me content for a few years, and once Concerta arrived around 1998 or 1999, I was totally happy & content with the combo.

Desipramine also worked miracles for my executive functioning (ability to work on the RIGHT thing) a lot. I've tried Strattera (yuck), Wellbutrin (made me stim like crazy), and Reboxetine (closest alternative I've found, but still no cigar), but nothing has ever come close to doing what Desipramine used to do for me. I think I had some dry mouth and constipation when I first started taking it, but both were ancient history ~10 years later (I took 50mg/day).

If you can find a doctor willing to let you try it, especially if you have ADD issues as well & take methylphenidate (I don't know what effect it has with amphetamines, but have a hunch it's similar), I recommend it enthusiastically. Just make sure you RADICALLY reduce your dose of mph/amp when you start taking it, until you get a feel for how much it's going to potentiate them for you. Remember, it takes about 3-4 days for a given dose of DMI to reach steady-state levels, and probably takes about a week to really stabilize... so if you reduce your dose of mph/amp on day 1 & it's not quite enough, that won't necessarily be true 2 or 3 days later. There's no hard risk to increasing subsequent doses in the same day if the first dose at the lower level just isn't cutting it for you, just go easy on it, and keep in mind that a lot can change overnight for days 2 through 5 whenever you're starting/increasing your DMI dosage.

For the record, Desipramine also is well-known for being one of the most potent antidepressants, period, for "lethargic" depression. It fell out of fashion with the arrival of SSRIs, and hasn't been actively marketed as Norpramin in years (partly because the patent expired about 20 years ago), but if you read about it, it packs a HELL of a punch. Unlike most tricyclics, it is absolutely NOT sedating. It also has an incredibly long, stable half-life, so after a few days, it's rock-solid and stable. There's no "roller coaster" whatsoever.

One caveat: if you have bipolar tendencies (I don't remember whether you mentioned it somewhere once), it might not be the best choice, because it's known to be VERY "activating" (read: if you have even the slightest bipolar tendencies, it's probably going to send you into manic-mode at the usual doses given for "depression" (~200mg/day), though it might be OK at the doses traditionally given for ADD (10, 25, or 50mg/day).

Wellbutrin and Cymbalta are two SNRIs that are commonly used. Seroquel and Abilify are two atypical anti-psychotics being used for SSRI/SNRI augmentation of unipolar depression. If you are bipolar II, Lamictal is a good medication for bipolar depression. As for alcohol consumption, it's really not a good idea to drink alcohol with ANY psychiatric medications, not just SSRIs. Yes, MAOIs are the only anti-depressant where it is extremely dangerous to use alcohol, but psychiatric medications' levels in the bloodstream are affected by lots of different substances and interactions. Definitely ask your doctor which anti-depressant would have the lowest risk associated wtih alcohol use.