Posted by bob on January 3, 2002, at 2:38:51
In reply to Re: Almost finished. » bob, posted by jimmygold70 on January 2, 2002, at 3:07:41
Jimmy: THIS IS LONG.
I will try to put this in a nutshell, as any other attempt will end up being a novel. Even the nutshell is long though, and there are many things I had to leave out.
My original condition 11-12 years ago, was characterized by irritability, obsessive and ruminative irrational thoughts, and mild depression. I also had a severe case of something called avoidant paruresis, which in lay terms is known as "pee-shyness". I was worse at night than in the morning. I also slept too much -- often taking naps right after work. I was in excellent physical shape. Then anxiety, cycling unipolar depression, and significant anger and frustration set in. Then the medical odyssey started.
Prozac: eventual agitation, restlessness, and panic
Welbutrin: anxiety, agitation
Anafranil: Eventual control of some obsessive symptoms and some depression at the expense of my physical health: 45lb weight gain, dizzyness, sweating, total sexual dysfunction, jitteriness, etc... hard to tolerate.
Zoloft: controlled ruminations and anxiety at the expense of weight gain, sexual dysfunction, jitteriness, and diurnal variation.
Paxil: controlled ruminations and anxiety at the expense of me sleeping 18hrs per day.
Effexor: initial response was excellent in all respects! degraded into weight gain, oversleeping, anger, and severe diurnal variation. probably don't need to mention the ridiculous withdrawal other than to say i don't know if i was ever the same
Serzone: took for about 1.5 weeks and could not get past the dizzyness, nausea, and headaches
Depakote: took away anxiety, but did almost nothing for motivation of any sort. possibly helped a little with ruminations. this med was not acceptable without an energizing adjuct, as it caused intractable drowsiness -- thus, Welbutrin was always concurrently taken, and eventually Ritalin and Dexedrine were also tried on top of that, since Welbutrin was not doing enough. the stimulants i developed a rapid tolerance to and then i started getting physical fatigue from them. the effect was very short lived. Depakote also caused weight gain.
Celexa: by itself was not very effective -- it got rid of mental anxiety, but i was left with a general physical discomfort (something like muscle tightness) that Celexa didn't seem to address. This, as with all other heavily serotonergic drugs, caused severe diurnal variation. I played around with thyroid augmentation on this med and got some excellent results for about 1 week, after which the effect started to become unreliable and less intense. eventually I got mired in symptoms of hyperthyroidism and could not stand it any longer. My physical condition by this time was quite degraded -- the muscle tension/discomfort, and the weight gain were hard to deal with.
Lamicatal: showed promise in that I felt refreshed in the mornings for the first time ever since SSRIs. Developed a rash and my Pdoc told me to discontinue.
Topomax: I took a big chance here and transitioned to monotherapy with a drug from an entirely new class. Initially this drug showed promise as it gave me some hypomania and I was able to wake up in the morning somewhat refreshed. It also helped with ruminations. However, it came with a host of very nasty side effects, such as cognitive dysfuntion, cold and pain in my hands, rash, sore throat, cold body temp at times... the list goes on. I was willing to endure it because it was energizing and I felt so much better physically than I had on SSRIs. There was much less sexual effects, and I was losing weight also. It exploded into a nervous breakdown and coming off of it was the most harrowing experience (mentally of my life). I was never closer to suicide for a longer period. Klonopin was added to the mix here, and has never been removed.
Remeron: excellent sleep at night, didn't wake up in the morning, didn't seem to touch my depression.
Tegretol and Luvox: sweating, tired, added to muscle discomfort -- hard to tolerate
Trileptal and Luvox: similar to Tegretol - but induced agitation
Geodon and Luvox: induced agitation and akathisia within 2 days.
Luvox and Klonopin: what I'm currently on -- 50mg at bedtime. Klonopin .5mg qid. It has taken about 6 months since my near death experience with Topomax, but I have nearly returned to the typical response I used to get from SSRIs (I thought for awhile I had been rendered untreatable by Topomax). My anxiety is reasonably well controlled at the expense of oversleeping and severe dirurnal variation. I don't tend to overeat quite as much with the other SSRIs, but am noticing bingeing creeping back in. The antidepressant effect is not very robust. Sexual dysfunction is present as with all the other SSRIs. The therapeutic effects of the medecine don't seem to be very reliable anymore. I now experience things on a regular basis I couldn't have imagined 11 or 12 years ago: muscle tension/discomfort, horrific despondency, agitation, cold hands, alternating hot and cold body, sweating. These things all cycle in their own way.
I've also tried Lithium, trazodone, and buspar. The latter two seemed to do almost nothing. The former made me sick to my stomach, my hair started falling out, and of course there was the weight gain. I wasn't on it long enough to know if any true benefit would have been realized.
Now for some general comments:
Drugs with significant SRI action always seem to end up giving me the same predicament: the severe diurnal variation I referred to previously. By this I mean I eventually am so sedated in the morning, that I literally don't even hear my alarm clock. If am awoken by something, I hardly remember it. It's hard to live my life when I don't truly wake up until 2 in the afternoon. I'm not exaggerating here -- it's truly that extreme. My mood progressively lifts throught the remainder of the day and I stay up late into the night. Nothing... and I mean NOTHING I have ever done on any of the SRI meds has changed this response. It is the one thing that I can point to as an absolutely unacceptable side-effect. I can't hold down a job or live much of a life with that type of response. It happened on Paxil, Zoloft, Effexor, Celexa, Luvox, and Anafranil. Depakote I slept every chance I got, it seemed. There wasn't necessarily a diurnal variation, but it didn't matter.
I've also tried many supplements at times with little or no effect: Omega-3, 5-HTP, St. Johns Wort, to name a few.
MAOIs have been suggested to me, but I literally don't know if I'd survive the washout period without wacking myself. I am a dangerously unstable mess without meds now. I'd also probably have to deal with withdrawal effects from Luvox at this point.Maybe ECT with maintenance treatments? Medication trials are really getting to be too much at this point. There are obviously myriad combinations left to try, but I'm really not sure I'm up to it anymore. It takes too much out of me. I'm tired. Putting up with side effects and then finding out that 3 to 6 months down the road I can't live with the drug is becoming unacceptable at this point.
Anyway... sorry this is so long.
poster:bob
thread:88497
URL: http://www.dr-bob.org/babble/20011222/msgs/88599.html