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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Mr.Scott on November 30, 2004, at 13:46:36
Any suggestions or sharing would be helpful to me.I have a chronic depressive/anxiety condition, a history that would suggest ADHD and LD or some odd form of non-classical bipolar disorder. The only reason I mention bipolar disorder is because when I report agitation or dysphoria to the docs from SSRIs, (which I think is akathisia) they tell me they suspect something bipolar. I have never in my life had anything that resembled a manic episode without it being chemically induced. And even then anything chemically induced never broke past a welcome hypomania. I had a conduct disordered youth, which eventually led to drug addiction (now in recovery).
I've been on the med merry go round for a long time trying to figure out what is wrong with me and how best to treat it. SSRIs were miraculous at first and a welcome change from Sinequan and Xanax. Over time I developed one hell of an intolerance to SSRIs which now cause me many side effects like muscle spasms and pain and akathisia. It's weird how the SSRIs are so effective for my general state of despair and yet they cause this agitation, restlessness, muscle stiffness, muscle spasms, muscle tension, and consequently pain. Zoloft also caused me to gain 35lbs and increased my cholesterol to 330. I have since reducing the dosage to 25mg lost all the weight and my cholesterol has returned to normal.
So now I have to piece together a cocktail of half measures in order to be functional yet I still remain impaired quite a bit. Any ideas folks?
I've experienced maybe 4 major depressive episodes in 15 years, but mostly have a chronic smoldering depression with lots of anxiety these days. Despite this I have managed to remain successful but with great effort.
So anyways I feel anxious, depressed, and HIGHLY OBSESSIVE, but I can't seem to benefit from the would be cure. I have that ever present feeling of always being on the verge of disater or catastrophy.
My current cocktail for today is:
.5mg clonazepam (more makes me dippy, less leaves me anxious)25mg Zoloft (not enough but doesn't give me terrible side effets)
25mg Lamictal (will try to go up, but it leaves me very tired)
10mg Straterra (just started)
All suggestions/comments are welcome. Thank You for trying to help!
Posted by ed_uk on November 30, 2004, at 15:17:57
In reply to Anyone wanna take a stab at my woes today?, posted by Mr.Scott on November 30, 2004, at 13:46:36
Hi,
Sounds like you're having extrapyramidal side effects from the Zoloft, perhaps adding an anticholinergic such as procyclidine would allow you to increase the dose of Zoloft without causing restlessness, muscle spasms etc. There would still be the problem of weight gain though.
Regards,
Ed.
Posted by Racer on November 30, 2004, at 18:01:31
In reply to Anyone wanna take a stab at my woes today?, posted by Mr.Scott on November 30, 2004, at 13:46:36
As well as meds, have you tried therapy? I know, this is a meds board, so I will get to meds, but therapy can help a lot, too.
Meds:
Give the Strattera a good shot. I'm pretty sure that, had it been the only drug I was on at the time, it would have helped me pretty well.
Be careful of the Lamictal. As usual, your mileage will vary, but some people do not do well on it, and my own experience was not optimal. (Spectacularly not optimal, in fact.)
How about Effexor or Cymbalta? Have you tried either of those?
Wellbutrin? It isn't a first line drug for anyone with anxiety, of course, but it might be worth trying as an augmenting agent.
How about trying a calcium channel blocker or beta blocker for anxiety? That made a huge difference for me, for what that's worth.
Therapy, to help you learn to address some of the issues that bring on the anxiety, without hitting the meds cabinet first thing?
Biofeedback or something like it? I haven't tried it, but it makes sense to me. It's on my list, for someday, once I get past some immediate stuff.
I hope this helps, at least in part.
Posted by Ritch on December 1, 2004, at 10:16:49
In reply to Anyone wanna take a stab at my woes today?, posted by Mr.Scott on November 30, 2004, at 13:46:36
>..Over time I developed one hell of an intolerance to SSRIs which now cause me many side effects like muscle spasms and pain and akathisia. It's weird how the SSRIs are so effective for my general state of despair and yet they cause this agitation, restlessness, muscle stiffness, muscle spasms, muscle tension, and consequently pain...
Scott, this is *exactly* the problem I'm running into. The conductance of pain and dystonia specifically. Even the tiniest doses of SSRI/Efx/Cymb. set off neck rigidity and joint pain. This is on top of the IBS problems that they have always greatly aggravated. I think I'm going to have to permanently ditch them, but what's the alternative? I've tried SJW and 5-HTP didn't seem to help. I really am beginning to think an MAOI would be the only substitute.
Posted by Mr.Scott on December 1, 2004, at 20:20:50
In reply to Re: Anyone wanna take a stab at my woes today? » Mr.Scott, posted by Ritch on December 1, 2004, at 10:16:49
Mitch-
I can tell that these symptoms are dopaminergic. That is I believe from reading others research that the ssris put a squeeze on dopamine in the nigra striatal region of the brain and doing so causes these symptoms. By putting a squeeze on dopamine one might encouter systoms directly related to dopamine reduction such as lack of motivation, poor concentration, fatigue, flat affect. Also since dopamine inhibits acetycholine, the effect of reducing dopamine throws the acetylcholine system into overdrive and thats what I believe causes the restlessness, agitation, muscle twitching spasm, and tension. I have 50+ pages citing many articles/studies/etc. that indicate some folks will have EPS (akathisia/dystonia/myoclonus/muscle tension/rigidity/etc.) My doc has not believed me for years and pretty much had me convinced I was bipolar. I'm seeing a doc who is both a neurologist/psychiatrist in January and I'm hoping he will be able to shed some light on why this happens and how if at all possible I can get around it.
The poster above is correct about using an anticholinergic to help and indeed benztropine or even benadryl is helpul in alleviating it. Problem is that the anticholinergics have there own host of side effects, and I want to be reasonably sure that I won't develop Tardive Dyskinesia by simply covering up the problem with an anticholinergic drug.
Was that you who said you'd used nortriptyline with good results?
Scott
Posted by Ritch on December 2, 2004, at 1:25:59
In reply to Re: Anyone wanna take a stab at my woes today? » Ritch, posted by Mr.Scott on December 1, 2004, at 20:20:50
> Mitch-
>
> I can tell that these symptoms are dopaminergic. That is I believe from reading others research that the ssris put a squeeze on dopamine in the nigra striatal region of the brain and doing so causes these symptoms. By putting a squeeze on dopamine one might encouter systoms directly related to dopamine reduction such as lack of motivation, poor concentration, fatigue, flat affect. Also since dopamine inhibits acetycholine, the effect of reducing dopamine throws the acetylcholine system into overdrive and thats what I believe causes the restlessness, agitation, muscle twitching spasm, and tension. I have 50+ pages citing many articles/studies/etc. that indicate some folks will have EPS (akathisia/dystonia/myoclonus/muscle tension/rigidity/etc.) My doc has not believed me for years and pretty much had me convinced I was bipolar. I'm seeing a doc who is both a neurologist/psychiatrist in January and I'm hoping he will be able to shed some light on why this happens and how if at all possible I can get around it.
>
> The poster above is correct about using an anticholinergic to help and indeed benztropine or even benadryl is helpul in alleviating it. Problem is that the anticholinergics have there own host of side effects, and I want to be reasonably sure that I won't develop Tardive Dyskinesia by simply covering up the problem with an anticholinergic drug.
>
> Was that you who said you'd used nortriptyline with good results?
>
> Scott
Scott, I've been living with for real rapid-cycling bipolar for a long long time so I'm not disputing *my* dx. I know I need to take a mood stabilizer of some kind.. and anticonvulsants WORK the BEST as antimanic/anticylics in my case. I know that stims, WB, Strat, etc. WORK for the bipolar depression and the SRI's either don't work or tend to worsen everything. The trouble is the anxiolytic to use? Benzos are depressogenic, no doubt about it (for me), and SRI's work well, but set off worsening cycling. So I can effectively control mania and depression (for the most part) with an AC and a NE/DA AD or stim, but have cognitive flattening with the AC as a side effect or worsened anxiety with those ADs/stim. I am at the point where I feel I need to ditch the SRI's permanently because of the EPS issues and find alternatives for the anxiety. Nortriptyline yes did work well for anx. in the past. There was a time where I was taking Celexa+Wellbutrin midwinter and was getting a good AD response, but was very anxious, and adding nortiptyline to that (at just 10mg/day), caused a great reduction in anxiety.---Mitch
Posted by Mr.Scott on December 2, 2004, at 23:40:15
In reply to Re: Anyone wanna take a stab at my woes today? » Mr.Scott, posted by Ritch on December 2, 2004, at 1:25:59
I'm glad to know that I'm not unique in any way regarding my peculiar or less than spectacular response to meds.
I tend towards depression and anxiety. My experience with mania (if you can call it that!) is universally AD induced. It's really more like agitation or aggression and it's usually very ugly. Like being depressed and agitated instead of just being depressed! Once in a great while I might get a mild euphoria and feel that everything is great from a new AD I've never taken before. But that dissipates quickly...
50 mg of lamictal makes me feel exhausted so I always go back to 25mg. The benzos are clearly depressogenic for me but are helpful with anxiety. And the antidepressants are filled with side effects including EPS and agitation.
what a mess!
Oh well...
Scott
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