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Re: Agitated depression; anxiety bad in morning

Posted by dannen on October 22, 2003, at 13:39:44

In reply to Re: Agitated depression; anxiety bad in morning » jrbecker, posted by zeugma on October 22, 2003, at 9:33:37

Jrbecker & Zeugma: Thanks so very much for your caring and advice.

I agree that it sounds like a classic melancholic depression re bad in the morning, better at night. But could my agitated depression be a mixed state form of bi-polar? I had thought that might be a reason I could not tolerate Prozac, Zoloft, Lexapro, or Paxil. (Wellbutrin was even worse. Lamictal also was too "activating"). Could my intolerance suggest BPII, where the agitation is hypomania? Just a thought. This whole "mixed state" thing is confusing/deceiving. I had some acupuncture the last few weeks; it killed the anxiety completely, but then the depression was terrible. So, it makes me think the anxiety is really the way the depression is manifesting itself, if that make sense.

I have thought about Effexor XR and a TCA, perhaps nortriptyline. Any advice on the TCA? I had heard the nortriptyline has a narrow therapeutic window, and I fear my psychiatrist is too unfamiliar with TCAs to be a reliable guide. It seems that since the SSRIs came out in the late 1980s, psychiatrists has lost touch with the TCAs--at least where I live.

My psychiatrist appears to feel most comfortable with Effexor XR and Lexapro. He mentioned titrating up on the Effexor XR very slowly--opening the capsule and taking only a few particles at a time. (Apparently, this was discussed at a recent seminar.) I want to avoid the benzos. I tried Xanax for about a month, and when I came off it the anxiety was absolutely horrendous.

Any further advice would be greatly appreciated. I have fought this anxiety without meds for over eight months, and I need some medical invention. I tried Neurontin for several months last year, but it caused a real brain fog and muscle jerks for large muscles (legs, stomach) and tics for smaller ones.

Again, thanks so very much. Dannen


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URL: http://www.dr-bob.org/babble/20031021/msgs/271924.html