Posted by saturn on November 27, 2006, at 16:10:07
I feel kinda selfish with this post but I really trust and respect the quality and helpfullness of advice from babblers. So I'm just gonna lay it all out there and ask a some questions. Here are my problems in order of severity. I apologize for those who've heard my story a million times--please just ignore. I'll probably regret writing this later, but here it goes:
1. Dysthymia w/ bouts of MDD (double depression)
2. ADHD (inattentive--at least moderately severe)
3. insomnia (reasonably treated w/ phototherapy, strict sleep hygiene and lunesta).
4. SP
5. I'm just gonna call this anxiety NOS. Sometimes non-existent, sometimes may manifest as ocd/eating disorder.The sxs of all the rest wax and wane in severity and probably interrelate to some degree (ie ADHD causing anxiety leading to depression and insomnia. Or dysthmia worsening ADHD. etc). Anxiety comes and goes, but dysthymia is always present at least to some degree (by definition)--though sometimes I reach a normal to near-normal mood.
I absolutely can't tolerate stimulants. Also, had a horrible reaction to Zoloft (as in *severe* chest pain). I can't take a TCA. The conversion of selegeline into meth/amphetamine shuns me away from EMSAM and an MAOI would be last line. I think Wellbutrin would be too stimulating from a cardiovascular perspective. Didn't do well w/ Remeron though admittedly didn't give it a fair trial. Though I can't tolerate stimulants they virtually eliminate my ADHD and dysthymia. But they're out of the question--even with a beta blocker. I realize I may be unreasonably dismissive.
Light therapy and fish oil don't appreciably help depression/anxiety (light does help sleep pattern a little). Regular exercise mildly beneficial at best. I continue to stick with them, though.
Sudafed and coffee mildly alleviate depression and ADHD. If I have a stressful social situation such as an interview/speech I do alright with ativan and atenolol prn (on top of the sudafed and caffeine). Sudafed often poops out and is only moderately efficacious, but when it works it does help.
So here's what I'm thinking:
1. Provigil (for ADHD and major depression---I know its unproven and inferior to stimulants)
2. low dose klonopin--for SP, sleep and any Provigil induced anxiety.
3. atenolol if needed for provigil stimulation if any.Knocks out all problems w/ 2-3meds? I know this is all very theoretical and probably overly-idealistic, but I've gotta start somewhere.
I dunno. I'm brainstorming. I've been resistant to new meds for a while due to frightening experiences with Zoloft and stims (going to the hospital with tachycardia and chest pain--and I'm not one to exaggerate symptoms or somatasize anxiety).
Blueberry made a very insightful point recently that if a med isn't helping at all after 2 weeks, move on. I'm sure there's a place for T in my treatment, but I'm focusing here on meds.
I know any p-doc would say start with SSRI. Zoloft gave me horrible chest pain and akathisia. I would consider giving another SSRI a trial (with a start up benzo and beta blocker) if I truly thought it would be beneficial and not worsen my ADHD (or insomnia) and not poop-out. I know--I'm asking for the world, but please indulge me. I'm striving for reasonable mood, attention and functionality (aren't we all?)...not perfection and no side effects.
I think that perhaps my case may not even be that difficult, but I want first and foremost for A. my situation not to worsen from what it already is and B. to get "there" in the most efficient manner.
Perhaps my biggest obstacle is that I'm scared to death after having crushing chest pain from Zoloft. My doc says my heart is fine, but if I can't handle Zoloft I'm very scared of even swallowing a Provigil or Wellbutrin. I kinda also don't want to get on the med "merry-go-round", but am willing to cautiously move forward with a reasonable and systematic plan--not just med after med etc...
I've wondered if Neurontin might have any place in my tx (ie vs a benzo or something).
I know I've covered a lot and this post is a bit fragmented, but I would certainly appreciate any thoughts or feedback, and thank you for just taking the time to read. Peace...Saturn.
poster:saturn
thread:707924
URL: http://www.dr-bob.org/babble/20061123/msgs/707924.html