Psycho-Babble Medication | about biological treatments | Framed
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This combination may work.

Posted by svevo1922 on December 15, 2001, at 17:22:03

Although not without very unpleasant side effects, I began to feel a marked improvement in my mood this week. I can only hope that I will continue improving enough to start moving forward again instead of being at a standstill, or worse, slipping backwards.

About two months ago, I started to take clomipramine (anafranil) again. I had taken it at a higher dose (ultimately, 200 mg) for two or three months in the Spring of 2000 until the side effects, especially the weight gain, just got to be too much, and especially after my mother made one of her characteristically sensitive remarks when I started talking about being depressed about my life and my appearance because of clomipramine. "You mean you?re ____ years old and you haven't figured out yet that you aren't the prettiest girl on the block or the sharpest blade?" I haven't talked to her since then, although she doesn't seem to realize that I am extremely angry with her and am not planning to speak to or see her again until such time as I can deal with her, which may not occur in both our lifetimes. But enough of that.

The drugs I tried after clomipramine in July 2000 that didn't do much. I don't maintain records the way some people do (probably out of denial) but I think I tried Celexa, Lamictal and Zoloft between then and now. For the first time I considered taking an MAOI (I had earlier tried a RIMA, a form of MAOI that does not require the restricted diet), but decided I couldn't torture myself both with the diet and the weight gain that often occurs. I went on Remeron again briefly, but it didn't do anything and I started to gain weight and look and feel bloated and swollen. My pdoc was urging me to try clomipramine again, after all, it was the only thing that appeared ever to have made a dramatic difference and my mood was lower than ever . . . . The entire year as I tried one drug after another that still did nothing, or next to nothing, I'd say, this is bad, but I'm never going back on clomipramine ? that evil drug.

Last year, although my mood had improved on clomipramine, I began to feel almost like I was undergoing a "physical" lobotomy. I felt the medication was turning me into a doughy, formless extremely fatigued middle-aged person. I felt that the only thing I had going for me was a fairly youthful appearance. Now even that was being taken away. The clomipramine softened my criticism of my body to the point where for the first time in years I wore a short summer dress without stockings (I'd been convinced that some childhood scars could not be displayed). That was good change. But then one day I put on my glasses to take a good look at myself (I had been so depressed I didn't want to wear glasses despite terrible nearsightedness because I figured I was better off not seeing every little unpleasant detail of myself or my environment; I'd get too upset. Actually, even now I think it's not such a bad idea). What I saw with my glasses made me upset. The weight gain from the clomipramine was giving me slight saddle bags, and I could see small ripples of cellulite along them. I felt like mutton dressed like lamb.

Although I felt guilty about it, I went off the drug, saying sorry, it is helping, but not enough for me to start gaining weight like this ? it's really not just vanity ? but I still kept nagging myself, was I being resistant and self-defeating, or was this so unpleasant a drug it just wasn't worth it? Gwyneth Paltrow was recently interviewed about the movie in which she wears a fat suit to play an enormously overweight woman. She said that one day during the shooting of the film she went out for a walk in Soho or Tribeca and was amazed by the reaction she got from people, since she "was still the same person." Unfortunately that's not true. It's wrong to treat overweight people badly, but one's physical appearance does play a role in the expression of one's personality and how other people judge the appropriateness of the expression, just as an older person looks ridiculous using the gestures or the language that would be considered cute only if used by a teenager. Maybe in a different world that would not be the case, but this is the one we?re in.

This time around I'm taking a combination of drugs. About two months ago, I restarted the clomipramine at 25 mg a day for two weeks and then moved up to 50 mg, where I've stayed and hope to stay. I was taking 100 mg of Zoloft every day but persuaded my pdoc about three weeks ago to let me substitute fluoxetine (Prozac) for Zoloft (sertraline [?]) for the SSRI. No "wash out" period is required to switch from Zoloft to fluoxetine so I switched right away.

I was supposed to take 10 mg. of fluoxetine for a week and then move up to 20 mg the next week. The third day I lost the 10 mg bottle, so I started the 20 mg capsules, which I'm still taking. I continued to take .05 mg of lorazepam (ativan) twice a day.

I was also taking 10 to 20 mg. of Dexedrine spansules with the option to go up to 30 mg (I've been taking it on and off for two or three years). But I ran out of it and it was not until I started taking it again last week that I felt a real difference.

Up until last week, I had noticed a slight improvement in my mood. But I was still extremely tired all the time. I was, however, managing to get up and get a little stuff done at least.

The Dexedrine prescription was delivered around 9 at night. I was so hoping that it would check the weight gain I'd had that I took 30 mg. instead of 10 mg., at 9: 30 p.m. It was so unlike me to take a larger dose than prescribed that I couldn?t even get upset with myself. I stayed up all night, largely at my computer, although I felt that I could have slept if I'd wanted to. In point of fact, I was just happy to have some energy.

I was hyper all day on Thursday, although I hadn't had any sleep and didn't take any Dexedrine that day. I made an appointment with my pdoc because I was excited about the change and wanted to make sure to know what to do to maintain it, especially since he would be going away towards the end of the month. I told him that my mood had definitely improved and that I was not manic, a question that I knew he would ask me since he asks that whenever I talk about feeling unusually animated. ( I have never been diagnosed with bi-polar disorder and am a little too fond of making the sick comment that I'd do anything for a day of mania just for a change.) Although he agreed with me that I'm probably not manic, he wanted me to come back the following week to check. I think he expected me to resist. But I don?t mind coming if I think it's going to make a difference. It's all the appointments when I've dragged myself in, almost always late, to report that I felt exactly the same way -- lousy -- that I dreaded.

Maybe in another post I'll describe in more detail how the new combination has changed my mood and thought patterns. Briefly, everything is a lot easier. I'm still working to do what I can about the side effects and to discipline myself to work productively. Before, I felt terribly overwhelmed almost all the time.

I told my pdoc that I felt relieved but also somewhat sad because this development now has completely put the lie to the concept that willpower alone suffices or even makes a big difference. This is a point I've pressed with him periodically and with every therapist he's suggested I see. The therapists, especially, don't seem to understand, no matter how many times I say it.

In addition to drug therapy, I've tried many other methods to get my depression under control. A therapist I've been seeing recently has, for example, told me to relax, to take risks, and not to care whether I think other people are judging me. I told my pdoc that I tried that and could have recited those things to myself till kingdom come with virtually no change.

Guess what? It's not so hard to take risks if you already feel better, but the medication, not this therapy, or any therapy, is responsible for that. I'm not arguing that therapy is totally worthless, but just what is the point of therapy that only works when you've already experienced a sea change in mood? It reminds me of something a coworker once said to me, describing the company's health insurance plan: It's a great plan so long as you don't get too sick on it.

At the risk of receiving threats from the therapist's lobby, if you feel just good enough and are already motivated, nearly any therapy works and almost any psychobabble convinces. And I don't just mean conventional therapy; I mean any: Tony Robbins, O Magazine, astrology, Tarot, the people who market those horrible affirmation tapes. I can't help being somewhat irritated by this realization.

In my own case, I know that I didn't expect medicine to be a magic bullet, nor, having some puritanical qualities, did I particularly want it to. But none of the many things I did made any difference. I had no bootstraps to pull myself up with. You get frustrated after awhile, in my case, a long while, and stop trying. When I think of willpower in the future, I will try to remember that I am demonstrating it by sticking with the various trials of these medications and coping with their awful side effects. That's the only role for willpower, as far as I'm concerned. The rest is just so much verbal BS.

But lest we forget: the side effects. I have gained about eight pounds, which I'm not happy about, but I?m hoping that the Dexedrine will help control it. Note:
in the past I've taken it as a stimulant for depression, not as an appetite suppression device, although, there have been months when I've said that I didn't know if it was helping my mood except for the benefit of making me not worry about becoming a big fat pig.

Although the jury is out on whether exercise and diet make any difference, before taking the stimulant I was too tired and overwhelmed to exercise and too dispirited to make an effort to watch what I ate, which I usually do.

I have excruciating dry mouth, and nothing, not sugarless gum, not water, not tray after tray of ice cubes all day long, is helping. I am aware of it all day and all night. If I feel addicted to anything right now, it's to ice: I crave it all day long. The dryness has caused many sore spots in my mouth and on my tongue, and if I eat something acidic such as a tangerine, it hurts. My lips also are very dry. They're either cracked and red or bloated, tight and sensitive. When I eat, my gums feel irritated.

There are nasty gastrointestinal effects and bad restless leg syndrome, although not the worst I've ever had. I think I bruise more easily than usual and my vision is probably more blurry than normal. I'm trying to figure out the right amount and time to take Dexedrine so that I'm awake and calm, neither wired nor tired, and able to get the sleep I need when I go to bed. I took an additional .05 mg tablet of Lorazepam last night which helped some.

Some "happy pill" collection, huh?

But it is at least a start and for that I am grateful.




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Psycho-Babble Medication | Framed

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