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Advice Needed - Depression/Anxiety Treatment

Posted by SFY_Redux on July 15, 2018, at 11:02:42

Looking for some advice for my upcoming pdoc visit.

I have a history of Major Depressive Disorder, Social Anxiety Disorders and Anhedonia/Dysthymia as well as Early Morning Awakening Insomnia.

Had some success in the past with Prozac for the MDD, Nardil for the SAD, and Mirtazapine for the insomnia. Had to go off the Nardil because of very bad insomnia and the Mirtazapine no longer seems to do much (except cause unwanted weight gain). CBT has helped with the SAD as well but I seem to hit a plateau that I cant get beyond.

Im currently struggling with recurrent mild depression (flat affect, amotivation, depressed mood), a flare-up of my SAD (which never really goes away), and the reemergence of my early morning awakening insomnia. There also seems to be some diurnal variation in my depression as I feel much worse in the morning which is exacerbated by the insomnia.

Right now, weve been trying to manage the insomnia to no great effect - doxepin, temazepam, melatonin with no improvement. Due to another condition, I need to avoid anything that acts as a strong antihistamine effect.

With the more recent flare ups in my depression, I think we need to revisit antidepressant treatments with something that may impact the insomnia. Bupropion and Trintellix (which I didnt react well to) have both been tried.

Right now, Im stuck in the weeds looking at meds and wondering if anyone had some thoughts that might be helpful.


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poster:SFY_Redux thread:1099604
URL: http://www.dr-bob.org/babble/20180521/msgs/1099604.html