Posted by purplesky on July 28, 2006, at 20:51:41
Hey everyone, I'm new here so I'll give you a little background. I apologize now, and thank those who read this, for this will be a really long post.
I'm a 24 yr old female college student with no health insurance and minimal coverage at my student health clinic. I'm diagnosed as BPII but I somewhat question that diagnosis (I think it's closer to mood-reactive atypical depression, though the difference between the two seems to be a bit of a scholarly debate according to Pubmed). I've been psychiatrically hospitalized twice following suicide attempts. I exist in a state of varying levels of depression, which is relieved temporarily when I'm around people and good things are happening, but the depression sets back in as quickly as people leave. I'm not an extrovert or a people-person by any means--I just perk up when I have friends around.
I am currently unmedicated, and have been for several months.
My main complaints are that I am tired and unmotivated. I find both physical and mental labor exhausting. I have withdrawn from my family and friends, choosing to stay alone instead. I am sleeping 10+ hours a day, and the hours I spend awake I spend essentially staring into space and doing nothing. I don't have the drive to do things that I used to enjoy. Even going to the kitchen to make a frozen dinner seems like a daunting task. I've completely lost my libido. I am not necessarily "sad" all the time; instead I feel more empty and apathetic. My memory is spotty, and I tend to drift off when I should be paying attention. I've been a highly motivated and goal-oriented person in the past, so these symptoms are really holding me back. I've lost my spark.
I've been on the following medications and would not consider them again:
Lamictal
Zyprexa
Remeron
Effexor
Paxil
LexaproI have been on the following medications and I would not object to taking them again for whatever intended purposes:
Xanax (PRN)
SeroquelI'm not sure what approach I should take now. My psychiatrist wants me to try Prozac with Seroquel, but the WORST medication experiences I've had have been with SSRIs, and while I'm not suicidal now, I wasn't before I went on Paxil and I quickly became suicidal after starting it.
My mother had bad cardiac and diabetic reactions to tricyclics, so I'm hesitant to take them.
I have a previous bulimia diagnosis so Wellbutrin is contraindicated, though I would be willing to try the SR version if my doctor were comfortable with that. (I am not currently engaging in eating disordered behaviors, and I am at a healthy BMI.) On that same note, I cannot guarantee my treatment compliance and lack of bulimic behaviors on any drug that will cause excessive weight gain or carbohydrate cravings. I know I have a weakness there, and I'd like to avoid that trigger if possible. I'm also uncertain if I could follow strict dietary restrictions for an MAOI, as deprivation leads to bingeing.
What are my options now? Does it seem like my problem is with Norepinephrine/Dopamine and not Serotonin? Do I have to go off-label now?
The various options I've come up with are:
Wellbutrin (maybe with an anticonvulsant?)
Strattera
Emsam
Provigil
Low-dose stimulants
Mirapex/Parkinson's medications
DLPA/L-tyrosine/DMAE/ginseng/ginko/etc.Of course, these would all be paired with a mood stabilizer if appropriate.
I can't switch doctors or ask for a second opinion as I don't have any money (the student clinic is free.) I'm especially worried because I usually feel better during the summer, and if I'm already feeling low then I won't be in good shape at all by the time winter comes around. Do any of you have an idea what I should do? Have any of you experienced symptoms like this and found relief from a certain medication? Is there anything that is particularly good at decreasing sleep while increasing drive and motivation?
I really appreciate any advice, anecdotes, or encouragement you can give me. Thanks!
poster:purplesky
thread:671576
URL: http://www.dr-bob.org/babble/20060724/msgs/671576.html