Psycho-Babble Medication Thread 14839

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Depressed again, meds, etc. (LONG)

Posted by Noa on November 8, 1999, at 19:29:58

I am attempting to be sensitive to the request not to bring forward archived threads, so I am starting a new one to continue the one I started yesterday just before the slate was cleared(my timing has always been lousy).

Janice, Racer, John, Cindy, Bob, Thanks for your comments.

As for meds--Effexor XR, 375 mg in the am
Ritalin, 10 mg, 3x/day
Synthroid 25 mcg, in the am
Cytomel, 12.5 mcg, in the am
Serzone, 150 mg, in the evening.

I have been on Prozac (worked well in the beginning, then began to poop out, increased doses caused headaches, rash, tinnitus ), Paxil (increasing poop out, increasing dose caused bad myoclonus, sleep problems, eventually pooped out big time), Wellbutrin (caused diarhea), Effexor (increasing poop out, increasing dose caused myoclonus, faintness, lots of sweating), Effexor XR (works better than reguar effexor, but increasing poop out, or more likely, I was underdosed for a long time. Increased doses cause sleep problems, fidgetiness. Less myoclonus than regular effexor. Sweating not a major problem. Both types of effexor cause some urinary problems). Ritalin added to combat extreme fatigue, which turned out to be caused by apnea, which is now treated by cpap machine. Also augments effexor. Thyroid meds added due to testing slightly hypothyroid, also to augment effexor. Trazodone, to help sleep (worked well for a while, pooped out, caused intense sedation) Serzone added recently to help with sleep and to augment effexor (makes me a bit drowsy, but not intensely so like trazodone did, although the effect lasts well into the morning from the evening before).

Do my meds work? Well I did start to feel a lot better after the worst depression in fifteen years. So, I thought it was working. Now, with stress, I feel depressed again. Would a different med help? I don't know.

My doc has talked about MAOIs, and I know there is support for the idea that they are effective for the kind of depression I have, but I have been reluctant because of the restrictions on decongestants. With obstructive sleep apnea, I am dependent on the nasal CPAP machine, and if I cannot breathe through my nose, sleep is totally impossible. If I sleep without the CPAP, I would have apnea, and that is worthless sleep. In any case, since getting used to real sleep again, I have now become conditioned to wake up immediately if I fall asleep without the CPAP, as soon as I start to snore.

He has also suggested an anticonvulsant or lithium, and I had an EKG and blood tests in anticipation of the possibility of starting lithium.

One change I do plan to make regardless of these questions is to switch from regular ritalin to SR. I get a rebound effect when it wears off, so the doc suggested trying Ritalin SR 2x/day.

I have been thinking about going for a consult with another pdoc, just to see if another doctor would take the same approach. Today, I decided to go ahead with that plan for two reasons, one being this whole med question. I generally think my doc is smart and capable and has done good work in terms of the psychopharm. But......the other reason I am probably going to get another consult is....

At the moment I am pissed at my pdoc, because his office called to cancel our Friday appointment and when I called back they said his first available appointment is December 1st!!! I said that is unacceptable. They had scheduled the appointment and later realized he would be out. This is the second time they have done this. I wish they would get their act together. They said they would have him call me about this. If he doesn't call tomorrow, I will page him. But I am annoyed. In general, he is very disorganized and very difficult to reach by phone. He tells me to contact him by pager, but I always feel wierd about that. This group practice is very disorganized and annoying--it has the atmpsphere of a pubic clinic. They want me to pay the full cost of a few months worth of sessions because the insurance turned down the claims--why? because the practice was very late in submitting the bills to the insurance company, which is contrary to the policy of their contract.

In any event, if I do end up going off any of my meds and switching to another, it will be hard. I am not sure I can do it without going into the hospital..Especially with what I hear about effexor withdrawal, but also just because of how depressed I will probably become (look how I get depressed even on all these meds).

 

Re: Depressed again, meds, etc. (LONG)

Posted by Racer on November 8, 1999, at 20:28:16

In reply to Depressed again, meds, etc. (LONG), posted by Noa on November 8, 1999, at 19:29:58

Ugh! What a great situation! It would be one thing if they forgot to bill you and then went after the insurance company...

As for the drugs, that's an awfully high dose of Effexor XR, isn't it? I thought that it only went up to 275? I wonder if you're being overmedicated, and if it might be better to back down some and try another combo?

Your idea of a second opinion is a GREAT one. I'm glad you're doing it. Another doctor won't necessarily change anything, but at least may tell you what changes might help. Remember that doctors are leary of patients 'shopping' around, they don't know you and don't know if you're going to try to get 'fun' drugs or are maybe chronically unhappy with anything.

Still, from your posts, we know that you're smart and articulate, so that'll help you in talking to the new doctor. Good luck, and here's a little more support {{{{hug}}}}

 

Re: Depressed again, meds, etc.

Posted by Noa on November 8, 1999, at 20:53:21

In reply to Re: Depressed again, meds, etc. (LONG), posted by Racer on November 8, 1999, at 20:28:16


> As for the drugs, that's an awfully high dose of Effexor XR, isn't it? I thought that it only went up to 275?

I was on 225 for a long time, and just went up to 375 a few months ago. Noticed definite improvement with the increase. I don't think people only go up to 275. I think I read in the med info online that up to 375 was tested. some docs probably have people on even higher doses.
I guess when I think about it, I would like to be at a state where all this stress can upset me, but not make me start spiraling downward, thinking and feeling hopelessness and having suicidal thoughts, even if vague and remote. I would like not to get so incredible overwhelmed and withdrawn. Is there a med combo that could do this for me?

 

Re: Depressed again, meds, etc. (LONG)

Posted by Phil on November 8, 1999, at 21:54:33

In reply to Depressed again, meds, etc. (LONG), posted by Noa on November 8, 1999, at 19:29:58

> Noa,

Try John L.'s post on 10/9. Not sure if that's the one you were thinking of but it's a good start.

Phil

 

Re: Depressed again, meds, etc.

Posted by Racer on November 9, 1999, at 1:02:14

In reply to Re: Depressed again, meds, etc. , posted by Noa on November 8, 1999, at 20:53:21

Maybe instead of going higher on the drugs you're on now, your doctor could experiment with adding a drug to work on a specific neurotransmitter? Like mine: the Effexor works on the three biggies, then the Prozac ups the seratonin a bit. Voila! Fewer side effects and a better response than either drug alone.

While I'm not your twin separated before conception, I do send best hopes of your feeling better soon.

 

Re: Depressed again, meds, etc. (LONG)

Posted by JohnL on November 9, 1999, at 3:33:44

In reply to Depressed again, meds, etc. (LONG), posted by Noa on November 8, 1999, at 19:29:58


Hi again Noa. You're not on as many ADs as I thought. The whole mix looks OK to me except the Serzone. I don't know why, but I would question having Serzone in the mix with Effexor. Just a gut feeling. Of all the things that could be combined with Effexor, it seems to me there are much better choices than Serzone.

There is no history of TCAs with you. There's something special about those old dirty messy TCAs. They can work magic when the newer stuff doesn't. Either alone or with something else. I agree with you it would be scary and hard to get off the Effexor. I would think it's better to keep working with it.

With that in mind, here are some suggestions. Some heavy hitting pdocs view Effexor+Remeron as 'big guns'. Remeron is also much better for sleep than Serzone. And it won't drug you out in the day like Serzone does. Another possibility I like is adding a TCA. Nortriptyline I like. Desipramine is also a good one. Both have the fewest side effects of TCAs and will aid in sleep. For a more sedating TCA, with wider action to it (less specific) Amitriptyline or Imipramine. TCAs plus SSRIs or Effexor often work real good.

Probably a top choice in a survey of pdocs though is what your pdoc has already mentioned...Lithium. It is probably the first choice option for turning a partial response into a full response. It's dirt cheap and works fairly fast.

So I would talk to your pdoc about two things: 1)Ditch the Serzone and replace with either Remeron or a TCA, 2)Go ahead and add the Lithium, probably in the 600mg range. I have a gut feeling both of those changes will make a world of difference. Hope this helps! :)

 

the (evil baby factory) twin chimes in

Posted by Bob on November 10, 1999, at 5:28:48

In reply to Re: Depressed again, meds, etc. (LONG), posted by JohnL on November 9, 1999, at 3:33:44

JohnL, are you accepting new patients? ;^)

The less zoloft I have in my system, the more my hunch that over the last 8 months it was the nortriptyline I was taking and not the big Z that was keeping me sane. I don't know squat about TCAs being "dirty" ... before trying a TCA I was on a med merry-go-round. Seems like the others were a lot dirtier to my system than nortrip. Sounds like something in your mix is downright filthy.

I hope the second opinion goes well, bud. You know how I feel about irresponsible doctors (grrrrrrrr). Sounds like something new is in order.

be well,
bob

 

Re: Depressed

Posted by Noa on November 11, 1999, at 12:40:15

In reply to the (evil baby factory) twin chimes in, posted by Bob on November 10, 1999, at 5:28:48

Sorry I have been fading into the woodwork the past few days. I am feeling much better. The legal stuff has calmed a bit--I made the decision I needed to make, and although I have little control over what will happen next, I doubt anything will happen fast, so there is time to not have to think about it so much. At work, I cried to two colleagues and got support about how overwhelmed I am, and that helped a lot. I then stayed late last night and cleaned and organized my office--filed papers, threw papers out, caught up on notes, prioritized some stuff. It felt really good to have that done. My therapist offered an extra session on Tuesday which was "just what the doctor ordered". Recovering this quickly from that mood I was in makes me realize my medications are working at least somewhat.

What scares me is how quickly I transition from my dysthymic baseline to a more severe depression. One would think I would have to pass through a moderate zone, but it is as though my brain has paved its own short-cuts, superhighways that go directly to despair. Like neural HOV lanes that can bypass traffic and interchanges. The encouraging thing right now about the medication is that it seems to help me use support to turn the car around and head away from the dreaded destination. In the summer, when I first added the serzone and then increased the effexor, the turn around was painstakingly slow. More like a multiple point turn in severe ice and snow than a u-turn. I am surprised and, of course, very pleased that I am able to feel this much better after being so incredibly depressed just a few days ago. An indication to me that maybe the meds are on the right track.

 

Re: Depressed

Posted by Noa on November 11, 1999, at 12:46:36

In reply to Re: Depressed, posted by Noa on November 11, 1999, at 12:40:15

Oh, yeah about the doc.

His office called back and gave me an appointment for this afternoon. I feel good that my assertiveness ("that is unacceptable") seems to have worked.

You can teach an old dog new tricks. :>

As for the consult, I feel less pressure to do it now, but I am still thinking I might anyway, and maybe it will be even more useful as a "just checking" consult than one done in a state of frustration.

 

Yippee!!! Hey, Noa!

Posted by Racer on November 11, 1999, at 18:39:48

In reply to Re: Depressed, posted by Noa on November 11, 1999, at 12:46:36

Here's a cheer that you're seeing the light at the end of the tunnel! And, catch! Here's a little flashlight to help, too.

Could be that the drugs are working, but what lead to you recent bad times had less to do with depression in the biochemical sense, and more to do with the habits you've learned over the years that led to your depression in the first place.

And in the 'Everyone's Different' department, here's an example of what I mean:

My depression has led me into a pattern of taking on too much without saying anything to anyone as it starts to reach critical mass. Then, when I'm overwhelmed, I withdraw completely, rather than taking care of anything at all. This is the pattern, and it goes along with major depression of a biochemical sort. The two things are linked, but they are not the same. They may be cause and effect, but they are not one and the same. The depression may be triggered by feeling overwhelmed, or the feeling of being overwhelmed may come from the depression, but they are not the same. Does that make sense? So, I recently experienced a period of major stress. My reaction? You got it, I felt overwhelmed and I withdrew. I felt bad, all the way around, and like a loser and a f**k up, but I was not depressed in the sense of a recurrance of all my usual symptoms. Just feeling really bad.

Recognising the difference has helped me, and today I realized how far I've come: I had a quarrel with the person who was causing most of my stress, and I didn't back down, and I didn't fold up with guilt over what he was saying, I stuck to my points, and didn't let him take me off onto tangents. I'm still furious, but I also have that good feeling that comes from knowing that I didn't escalate this, I didn't back down inappropriately, and I didn't say anything I didn't mean.

So, maybe some of that is what's happening to you? You certainly did a lot of things that have helped you recover your equalibrium, which is a very good sign, and maybe you're feeling better because you associate the stress with depression? Now that you've dealt with the stress, you realize that the depression isn't there?

Whatever it is, I hope you continue to fee lbetter!


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