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Bowdin: would appreciate advice

Posted by Peter on March 9, 2003, at 1:00:15

Hello Dr. Bowdin:
I feel like I've reached a dead end. Years of trying multiple mood-stabilizer (depakote, lithium, neurontin, lamictal), with no positive reponse and without there ever really having been any proof that I'm bipolar.
I'm 26 now. I smoked pot consistently and drank heavily since my mid-teens. I went right from there to heroin/cocaine addiction. And in 1997, I was prescribed Depakote-the day after I withdrew from heroin for the last time. Since then, it's been a rollercoaster of various anxieties-social phobia, general anxiety-and depressive episodes mixed in. My doctor who I'm still seeing (same one since '97) has placed me on all the above-mentioned MS's. But nothing works-everything leaves me with these constant depressive anxiety episodes. I've combined depakote and neurontin at different times with SSRI's (paxil, zoloft, celexa), Wellbutrin, Effexor, beta-blockers (inderol, tenormin), dopamine agonists (mirapex, etc.), stimulants (concerta, adderall, dexedrine spansules, adderall XR), and benzos (klonopin, temazepam).
The SSRI's helped me the most, but seemed to cause alcohol cravings and emotional blunting after a few months of being on them. This reaction to SSRI's seems to be the sole criteria by which my doctor has diagnosed me as falling somewhere within the 'bipolar spectrum.' He believes that a type of SSRI-induced hypomania causes my alcohol cravings & impulsivity. He's also diagnosed me with comorbid social anxiety and possible ADD. Other doctors I went to for consultations disagreed with him on the subject of my being bipolar.
As for the other meds, I couldn't tolerate effexor or wellbutrin. The adderall has helped me motivate and concentrate, and I have had no cravings for alcohol even when combining enough of it (@40mg) with an SSRI.
My doctor insisted a few months ago, when I was taking zoloft, adderall, depakote, klonopin, and temazepam, that I should start lamictal (I still had these depressive/anxious episodes). I've been on lamictal for 6 months, titrating slowly to 100mg. I haven't noticed any benefits; in fact, after coming off the zoloft, I've been experiencing more of these awful social phobia/derealization/depression episodes than ever before.
I am now taking 100mg lamictal, 40mg adderall, 2.75mg klonopin (2mg of which I take near bedtime with 15mg temazepam!), 10mg ambien. But because of my awful anxieties and recurrent depression, we decided to start me on another Anti-depressant. BTW, one of the many doctors I visited for second opinions said that I'm not bipolar but have 'depressive anxiety' and that a TCA might work fine for me since the SSRI's did only temporarily.
My doctor considered TCA's but said that, since he still believes I have some form of 'mild' bipolar disorder, TCA's aren't good because they'd push me into 'hypomanias' moreso than SSRI's. So we considered an MAOI but came to the conclusion that all the dietary/medication interactions render it not a good candidate for me, with my already-hypochondriacal, anxious demeanor. He also considered Straterra, but then ditched it saying a lot of his patients were reporting heightened irritability.
So, he decided to add Prozac, 1 of the only SSRI's I haven't tried, stating that it would have a good balance for me between activation and 'neuroleptic', calming properties, and it could directly help my anxieties. I just began it almost a week ago at only 5mg.
But I find that I've gotten terribly agitated and severely symptomatic; I can't leave my apartment, my body aches, I'm anxious and lethargic, and my mood swings drastically from one hour to the next. The only period of 'stability' I have is for 1 or 2 hours after each of my 20mg bid adderall doses-after that, I feel like I've been punched in the gut; I get so weak and my mood gets so rocky it's ridiculous. I have intense derealization, irritation, inability to face people. I know that adding a new agent to your system is bound to cause acute side-effects that abate as the drug's benefits kick in, but these don't seem like mere side-effects. Maybe a reaction to the SYNERGY of the different meds as a new one was introduced?
I told my doc and he said while the adderall might be exacerbating my mood swings, he wants to first see if reducing the lamictal might help. If it doesn't, I'd then go on to reduce the adderall-all while the prozac is beginning to 'work' (hopefully). He told me to drop the lamictal dose from 100mg to 50mg in a day, saying I won't experience withdrawal because it has such a long half-life. Well, I did that starting today, but all I can say is this is the worst I've felt in a long time.
I'm debilitated and can't function on any level. Hopefully the Prozac will kick in and work soon, but even if it does, wouldn't it just be like any other SSRI? OK for a few months and then horrible? I've become so self-absorbed and obssessed with meds, yet I haven't felt 'ok' in years. I don't see any other options on the horizon, especially since I've tried everything I know of for my symptoms, and all these doctors are disagreeing on my diagnosis! It seems that all these med regimes have 'created,' rather than alleviated, symptoms that are characteristic of entire mood disorders!
Also, I never know if adding meds are really for the reason of treating a biological desease or for trating the side-effects of another med I'm taking! I'm just constantly going around in circles, one med combination to the next. I'm very confused and FED UP!!!! Sorry for the length of this. I'd be very greatful for any advice you'd be willing to offer me.
Thanks very much,
Peter


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Psycho-Babble Medication | Framed

poster:Peter thread:207301
URL: http://www.dr-bob.org/babble/20030306/msgs/207301.html