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What To Do Now? (anhedonia/dysthymia)

Posted by SFY on November 4, 2004, at 14:41:58

I have anhedonia/dysthymia/lack of motivation (though my energy is OK) with a lifelong history of SP (more anticipatory anxiety, avoidance, and brain lock than physical symptoms). Right now, my emotional range seems to be even more dampened than usual. I also have recurrent, chronic insomnia which manifests as early awakening.

I just tried Selegiline (5-10mg with DLPA) to no effect (except for the paradoxical side effect of killing my libido and causing sexual dysfunction). With my current pdoc, I've tried Wellbutrin, Effexor, Celexa, Lexapro, and Dextroamphetamine with no success.

In the past, Prozac was effective for treating my major depression (though causing insomnia and sexual dysfunction) but didn't do anything for my SP. Nardil (with Klonopin) did a decent (but not spectacular) job on my SP. I had to give it up though after it started causing chronic insomnia which persisted long after I went off the Nardil. I started Mirtazapine after that and have continued to take a small dose at bedtime for years to manage my insomnia. (I went off it now because of possible interaction with the Selegiline.)

I had a consultation a little while ago with an uber-pdoc whose first (and only) recommendation after our one-hour meeting was Parnate. He also suggested Risperdal to deal with any insomnia issues caused by the Parnate.

I've been putting off trying Parnate with my pdoc (hence the Selegiline trial). First, because of a vacation where the dietary restrictions would have been problematical. Mostly though because I'm concerned about the insomnia especially since Parnate is more activating than Nardil. When my insomnia kicks in for more than a few days, I become a complete useless zombie. I have have some concerns about the diet but I dealt with this issue successfully when I was on Nardil.

My pdoc said that since my insomnia is obviously depression-related, a successful trial of Parnate might help resolve it. But if not we can always try the recommended dose of Risperdal or some other AP. I'm a little wary of taking an AP just for sleep but even more so after reading posts here that APs have caused anhedonia in some people (which would defeat the purpose of taking the Parnate in the first place). So I'm having problems making a decision (which is a problem anyway because of my dysthymia) about trying Parnate or something else.

I just wanted to get other people's experiences, insights, recommendations on my course of action.

Thanks!


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poster:SFY thread:411757
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