Posted by BarbaraCat on August 26, 2003, at 20:18:08
In reply to Re: BARB!, Naturopath visit results, please read, posted by McPac on August 26, 2003, at 17:21:16
Whew, baby! Alot here! I need to think about all this, but the fact you have OCD really does make it a hornet's nest. I don't know all that much about OCD but have heard that SSRI's are the meds of choice for it. One thing I can say before responding in more depth may interest you.
Remeron is a tricky med. I was on it for 6-8 months or so. At low doses (15-20mg) it acts mainly on serotonin and at a specific receptor site. It acts like a sleeping aid and makes people pretty groggy for hours in the morning (and let's not forget the pork-out syndrome). As you start raising it norepinephrine kicks in rather strongly. The magic number seems to be 45mg at which point it becomes much more activating. It sure did for me. I liked the extra motivation I got on it but was becoming anxious without really knowing why. Because anxiety causes depression everytime for me and I was getting more depressed, I raised it until I was hovering at 80mg. I felt great for a few weeks, then awful. I kept thinking that raising it would make me all effervescent, and activate me to raise my energy/exercise level for its AD and anti-porky effects. But I was having terrible anxiety, not so much irritability (that's more a BP thing for me and that's part of answers part II). I went on clonazapam to deal with the anxiety and it helped so very much. This was before lithium.
The most sedating and calming AD I've ever been on was Trazadone. It knocked me out at night which was a blessing, I could have easily stayed in bed til noon and had to force myself to get moving, but after a brisk shower was OK. It greatly helped my depression as well for many years. It is a lethargic med, which was mostly fine for me because my depressions are always characterized by too much anxiety. But sometimes the blobs were too strong and it was hard to motivate. I think that could have been helped if I motivated to exercise alot more, but back then I could get away with blobbing and still keep my girlish figure. ;-) I would consider it again if I ever needed an AD and if I started having bad insomnia, but would do so with caution because it causes weight gain and I've been working so hard at getting it off and also, lithium and lamictal are doing it for me so far. Another thing is that Trazodone is related to Remeron in it's 5H-3 (I think that's the one) receptor site target, but doesn't have any of the activating NE effects.
I quit Traz because Prozac broke onto the scene and everyone wanted some, including me. Tried Buspar briefly because of the anxiety I was getting with Zoloft and Wellbutrin combo (Gad, Zoloft made me apathetic and Wellbutrin made me speedy - can't win!) and it didn't do much except make me feel dizzy. Most pdocs don't think much of it. Didn't like Serzone one bit, even though it's very similar to Trazadone.
As I mentioned, Clonazapam helped me very very much in the anxiety department. Didn't dope me up, calmed me down and has some mood stabilizer qualities as well (says my pdoc). That's a good idea you have about benzos and/or lithium. Only way is to try, I guess, but don't stop the lithium until you know the benzo is working. Also, if Rem is working for you really really well, then bully! But it could be part of your problem, Mac. I recall reading something about Rem being indicated for OCD? Is that true? But they're all similar and all indicated for separate conditions. My suspicion is that it's a marketing ploy. If you follow the money, you'll find out that just about every mental health research project is funded by a pharmaceutical company somewhere along the money chain. Vested interest? Of course not! Pure altruism!
The other BP issues I'll get back to you on. But one thing to part with. I think the current revolving door 5 minute psych thing is an utter travesty and waste of time also and probably does more harm than not. All they can do is try yet another pill to put another temporary bandaid on our pain. They don't like the system either, but the current psych training is target the symptom pharmacology and most don't know there's anything else. Drug companies fund ALL aspects of physician education and research. I really hate managed care. ESPECIALLY since my insurance premiums have gone UP and not down, which was the whole point of the managed care mess we're in now.
poster:BarbaraCat
thread:9730
URL: http://www.dr-bob.org/babble/20030823/msgs/254484.html