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Re: This combination may work. Elizabeth

Posted by svevo1922 on December 16, 2001, at 5:27:56

In reply to Re: This combination may work. svevo1922, posted by Elizabeth on December 15, 2001, at 23:09:53

Thanks for your detailed comments.

Re: MAOI's. In addition to the fear of weight gain, I knew I'd feel as if the sword of Damocles was hanging over me with the requirements of that diet. My pdoc has said that it isn't as stringent as it used to be but I don't want to give myself a great new reason for anxiety; I have plenty already. And food is one of the few reliable pleasures I have access to. Further, I really like ripe bananas, red wine, smoked meats and some aged cheeses. My roommates are fond of all of these too. I wouldn't want to be in a situation where I was too depressed to go out, hungry and looking at a smoked salami.

Other meds:

You asked about Zoloft, Celexa and the RIMA, Moclobemide, I believe it was called. They were not very effective. To the extent there wre mood changes they were too subtle to get excited about.

I've tried Paxil (which produced extremely unpleasant withdrawal symptoms, Serzone, Effexor, BuSpar, Desipramine, Tofranil, Mirtazapine, Lithium, Wellbutrin, klonopin, norpramin, Lamictal (developed a bad rash, fever and flu symptoms), ritalin, estazolam, Sonata and Ambien. I'm sure I've forgotten something.

I can't recall what dose of Remeron I was taking but I'm sure it was relatively low. I've heard that the weight gain problem lessens as the dose increases, too. But I wasn't going to wait to get that point. I've tried it twice. This year and last. In addition to weight gain, it causes edema. All my shoes were suddenly tight and it blew up my face, but so does clomipramine.

On being self-defeating: I don't really think I am, but that charge has been leveled by people who don't understand why I don't just get up and fix things. Sometimes it's hard not to wonder if these ignorant people aren't correct. Everyone has self-doubt.

A couple of years ago I saw a therapist to whom I was referred by my pdoc. (Over the past few years I have seen therapists only at the aggressive urging of my doctor -- I keep telling him that they have not helped me and now whenever I see new therapist I become extremely upset at the prospect of having to go over all this stuff again, except now there's more of it. I keep saying, You have no idea how painful this is.)

The psychologist I saw a couple of years agp, while generally kind and sympathetic, said once "Don't you realize that you can make yourself do things even if you don't want to?" I half-nodded in assent, but afterwards got very angry. When my mood has declined to
a certain level I can't force myself to do anything.

Change of mood: Actually it's the clomipramine that's chiefly responsible. I felt this way last year when I took a much higher dose. But the combination of drugs I was taking was making me feel groggy. The Dexedrine has given me energy. I told my doctor that I'd rather not have any side effects, but if I had to choose, I'd much rather be hyper than exhausted and hugging my bed. At least I feel alive.

Re free will: I agree with you. But I'm reacting to people who maintain that it's just a matter of chin up and charging forward. You can't convince them otherwise. They just think you're a defective weakling. Some of these people are idiots, but others are well educated and intelligent and to them even seeing a therapist is
an unforgivable sign of weakness. And forget about taking . . . drugs.

Re it's not helpful being told what to feel: Exactly right. And at least if I'm being told that I shouldn't worry about other people opinions and take risks (despite my many anecdotes in explanation of why I feel this way), I should at least be given concrete methods that will work for me. I don't think it's particularly fair to tell someone to stop leaving so many negative messages (about myself) without a little more guidance. I kept saying, of course I understand your point. But what exactly am I supposed to do when I can't think of anything else but these nasty thoughts about my life and have nothing sufficiently powerful to distract me? The only way I cd successfully not express negative comments wd be to place a piece duct tape over my mouth.

Re other purposes of therapy: I agree that therapists can be helpful in that respect. But I find a lot that they live rather cloistered lives and don't understand my field. I get tired of feeling I have to prove that what I'm experiencing is true. As Kissinger is reputed to have said: Even paranoids have enemies. But I don't feel the same urgency to be understood bec I feel better.

I told my pdoc: I don't think that you always understand me and the situations I'm in even now. If you never do, I'll be hurt, but now that I have a boost from these drugs, I can live with it. There is no perfect understanding between human beings.
You have to live in your own head and deal with it. But I still think it's ironic that I've received the same kinds of advice time and time again, about being optimistic, about not worrying about other people, some of whom I know for a fact are very judgmental, find myself unable to follow the advice and then find that it's fairly to follow these pretty basic suggestions when my mood has beem improved by an agency unrelated to the therapy. Since I've spent so much time trying to get something out of these relations but usually have remained unchanged, and actually, even more hopeless, the irony is not very amusing to me.

It seems to me that therapists ought to feel a little embarrassed about exhorting clients to adopt a perspective that they can sustain and build from unless they genuinely feel better and the feeling better does not come from the therapy.

In the past, therapists generally suggest things I've already thought of or tried without success because of my mood. If my mood is better it's not that hard to follow through. I also get irritated because I think I've probably at times acted far more boldly and independently than some of my therapists have in their live and yet they're criticizing me for not being able to shrug off problems that nobody I know would be able to shrug off. Since it's such an emblematically unilateral relationship, I can't say to them, have you ever been in this situation? How many times has that happened to you? How would you feel about facing it again?

I also think it's very unfortunate that most psychologists and psychiatrists are not required to go into therapy themselves. Were they to experience the personal vulnerability and the financial burden that many people experience in therapy, they might understand better how sometimes what they're asking is unreasonable, if not impossible.

Lorazepam: I am prescribed it for anxiety. It helps somewhat. If I'm really terrified about something, I can feel an undercurrent of the fear even though I'm taking the medicine. I've tried taking 1 mg during the day if I'm particularly anxious, but I think it may cause some short term memory loss or word finding difficulties.

Your point about Prozac is interesting and I'll talk to my doc about it. I wanted to switch to Prozac because it was the only SSRI that I dramatically helped my mood. I took it years ago, but had to stop because of the side effects.

When I talk about wt gain, I'm exaggerating a little. I'm far from clinically overweight, but I don't like the way this weight looks on me. I've fallen into the habit of raising the alarm early before I got to a weight that actually was really too heavy.

Re the dry mouth: I chew gum alot when I can although not all situations are appropriate to do that. I drink lots of water and swish it around my mouth before swallowing it. I like the ice because the chewing causes salivation and the cold
deadens the pain a bit. I was thinking of getting some Ambesol and trying that. I had some Carmol lip balm around and I've smeared that over my lips and even over my gums a little since it's supposed to be good for cold sores. Another web site suggested a teaspoon of light vegetable oil at night. Another said to use oil of cloves with a cotton swab. (I think Dorothy Comingore's character has just come from the drugstore after buying oil of cloves for a toothache. I've never had a cavity so I'd be pretty unhappy to suddenly have to get my teeth drilled because of this side effect.

I've tried the increased doze of benzo. Doesn't always quell the RLS, unfortunately.

For th4e gastrointestinal problem which is not constipation, I've been told to take a stool softener. I do whenever I remember, whidh has been twice in two months. I am definitely resistant to feeling like an old person at this age having to take things like that.

Dexedrine: My doctor told me I could take all my spansules at the same time when it became clear that I couldn't comply with a schedule where I had to remember to take drugs at times other than upon rising and at bed time. Again, part of it is the resistance issue. That's one reason why they came out with Prozac Weekly, I was reading recently. A lot of people dislike being reminded every day that they have these problems. I could live with that knowledge, it's the S.E.s I'm tired of. I have decided to consider this cocktail as a mild from of chemotherapy. That's the only way I can consistently justify it. And as I sd earlier, adhering to this mixture in the face of the s.e.'s is where willpower really comes in.

Re: "Happy Pills." I was being facetious and alluding to the uninformed dolts who think taking these medications is an illegitimate, unearned ticket to Nirvana or whatever they think. And I hate those idiotic debates about what if the entire world took a happy pill? As if the human race is not always going to have more than sufficient reserves of misery, malice and violence. I want to choke those glib writers who without knowing anything about these drugs have dummed it down to a junior high school debate issue.

Onward. Thanks again for the comments and suggestions.

> Hi there. I hope that the cocktail you're trying now is helpful for you. If it doesn't prove to be the right thing, though, I have a couple of thoughts that might be relevant to your situation.
> First of all, there are some MAOIs that don't cause weight gain much (if at all), and these might be helpful to you without the side effects that clomipramine has caused. The two drugs I am thinking of are Parnate (tranylcypromine) and selegiline (also known as deprenyl or l-deprenyl in some places). The latter is used mainly for Parkinson's disease; the dose required for depression will be quite a bit higher than what you would take for PD. They do have side effects (insomnia is very common with both) but can be very helpful for people with problems such as yours.
> Another thought I have is: what happened with the Zoloft, the Celexa, and the RIMA that you tried? And have you tried any of the other SSRIs (Paxil, Luvox) or Effexor (a serotonin/norepinephrine reuptake inhibitor)?
> There are also other new-generation antidepressants that might help you. Wellbutrin in particular comes to mind. It may be used alone, and it also can be added to other antidepressants to augment them and reduce weight gain if that is a problem. So adding Wellbutrin to clomipramine might be worth a try, since clomipramine worked so well for you.
> You said you tried Remeron but stopped because of weight gain. What dose were you taking? For some people, the weight gain goes away at higher doses.
> I don't think you're being "self-defeating" or "resistant." A lot of people feel unattractive as a result of depression, and if antidepressants make you look significantly worse just as you're getting your self-esteem back, that's a problem. (FWIW, I have a similar experience: I feel as if I am very unattractive when I am depressed, and effective antidepressants allow me to look in the mirror and feel pleased with my appearance -- I can see that I'm an attractive young person, not just a collection of flaws.)
> > I continued to take .05 mg of lorazepam (ativan) twice a day.
> Does that help you, and if so in what way?
> The Dexedrine sounds like it's doing you some good. I have problems with energy too (I think most depressed people do!) and I'd like to try a stimulant too. Dexedrine may very well help you manage your weight too (it's not supposed to be used for this purpose, but it can be a nice bonus effect).
> > 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 think that's probably the Dexedrine. Stimulants help a lot with anergia -- lack of energy and motivation. This is a big problem for me and is the main reason I want to try a stimulant.
> > 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.
> I believe there's such a thing as free will, but it's not absolute -- we all have limitations on what we can force ourselves to do, and that's not a reason to be ashamed or disappointed in ourselves.
> > 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.
> Yes, it is not very helpful for people to tell you what to feel. You feel however you're going to feel! Will power has little effect (if any) over our emotions. It's not as though you don't *want* to relax, or to let yourself do what you'd like without feeling judged -- but it's not as simple as 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?
> I think that depression can cause a lot of secondary changes and do a lot of damage to your life. In addition to medication, I need help getting my life back together, figuring out what I want to do and what I'm capable of doing, etc. That's stuff that talk therapy could help me figure out.
> > 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.
> I think that people who advocate talk therapy as a "cure" don't understand that. It may be that they've never had the problem of simply not feeling well enough to benefit from talk therapy.
> (BTW: This board isn't really where the "therapist's lobby" types hang out -- if you're looking for them (for some reason), go to Psycho-Social-Babble.)
> > 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.
> Adding Wellbutrin might prove helpful if the Dexedrine isn't enough. It's also possible that a different AD which wouldn't cause weight gain would help you as much as clomipramine does.
> You should know that the Prozac is probably causing the clomipramine to be metabolized more slowly, leading to higher levels of clomipramine. (Prozac has this effect on all the tricyclics, I believe.) So you may have as much clomipramine in your body as if you were taking quite a bit more. Ask your doctor about it -- he might want you to get a serum level drawn to make sure the level is not too high. If the dry mouth is much worse than it was on the higher dose of clomipramine, you might be better off going down to 25 mg.
> > 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.
> Although weight gain isn't so much of a problem for me, I understand what you mean. I'm not overweight, but I am out of shape, and getting back in shape is something I'd really like to do, but I just don't have the motivation, the drive, to get out and exercise.
> > I have excruciating dry mouth, and nothing, not sugarless gum, not water, not tray after tray of ice cubes all day long, is helping.
> Dry mouth is a problem for me too (buprenorphine causes very bad dry mouth for me), although I usually find that chewing gum or candy helps me to salivate. There is a medication called bethanechol that can help control it, but that's very short-acting. Aricept, a cholinesterase inhibitor used for Alzheimer's disease, might help more, but there's also the risk of increased depression (on the other hand, Aricept could help with concentration -- not everybody will become more depressed on it, and some might even benefit). I found that lithium made me drool more, and lithium might also increase the antidepressant effects. The dry mouth might also get better with time (it has for me). If nothing else helps, it might be good to keep a bottle of cold water with you and take sips from it regularly. Use Blistex or other medicated chap stick on your lips. It's important to try to do what you can to reduce the dry mouth, because in addition to causing sores in your mouth, dryness can also increase your risk of dental problems such as cavities and gingivitis.
> > There are nasty gastrointestinal effects and bad restless leg syndrome, although not the worst I've ever had.
> An increased dose of a benzodiazepine (such as Ativan) at bedtime might help with the RLS. GI problems from tricyclics are very hard to control; if constipation is the problem (it's a very common one), you might try regular Metamucil. This is also a side effect that Aricept might help with.
> > 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.
> Dexedrine Spansules are usually taken twice a day, I think. I took a stimulant called Cylert in college, and it was really nice because in addition to giving me energy and motivation during the day, it also helped me sleep better and more regularly. It was long-acting so I just took one in the morning, and then I would start getting tired right around bedtime when it started to wear off. Maintaining a regular sleep-wake cycle has been a problem for me all my life (my mother even remembers me having troubles with this as an infant), so this was a really nice surprise.
> > Some "happy pill" collection, huh?
> Hey, if it gives you the chance to be happy (which everyone deserves), nobody should fault you for taking it. I just hope you can get the side effects under control. It would be great if the Prozac turned out to work as well as the clomipramine, because that would probably be much more tolerable. (Right now it's hard to tell because you're taking what is effectively a full dose of clomipramine because of the metabolic inhibition from the Prozac.)
> > But it is at least a start and for that I am grateful.
> Congratulations. :-) I hope that things keep improving for you. Welcome to Psycho-Babble!
> best,
> -elizabeth




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