Psycho-Babble Medication | about biological treatments | Framed
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Kramer: the only combination I have not yet tried

Posted by Peter on April 1, 2002, at 2:02:33

Hi Dr. Kramer:
I've been working with the same psychopharmacologist for 7 years and he's put me on numerous medication regimes; over my years of seeing him, he formed my diagnosis, which he designated as mild BP characterized by subtle hypomania/SP/panic/possible ADD. After our first consultation back in '97, he placed me on depakote 750mg. Shortly afterwards, he added klonopin 1.5mg for SP and panic. These two drugs had been my 'foundation medications' for years, upon which my doctor added a variety of different combinations of meds to target my recurring symptoms of anxiety, social withdrawl, and depressive dips. Included over the years were SSRI's-paxil and celexa, other antidepressants-effexor, wellbutrin, and moclobemide, dopamine agonists-permax and mirapex, beta-blockers (inderal and tenormin), stimulants-adderall and concerta, and neurontin as another mood-stabilizer. It seemed that every combo he'd put me on would work for a bit but result in problems. So, I decided to get a second opinion; I went to a consultation with my pdoc's collegue, Donald F Klein in NYC, who stated his opinion that I simplify and try Lithium and a little depkote. My regular p-doc agreed that I try Lithium, but told me he never prescribed it to me over the years because it's better known for BP1, and I have mild, mixed moods, for which he said the anticonvulsants are better. He also never prescribed lithium to me because he understands the stigma of the drug and anticipated that I'd react with much apprehension and anxiety. But he assured me that it could work , that it's a good drug, and that it could target the depressive dips and resulting anxiety of my mood swings better than depakote or neurontin. So I decided to try it. I was at the time on 900mg neurontin, 30mg adderall, and 1.5mg klonopin. I began eskalith 300mg, and after 2 days my intensive anxiety about taking the drug kicked in; I became so obsessively worried about the need to always look out for dehydration and the necessary bloodtests, and so convinced that I am not a lithium candidate (neither I nor my parents nor my friends have ever seen any mania or even hypomania in my behaviour), that I stopped taking it. I asked my doctor if I could go back on depakote, since it was familiar, and though more sedating, I preferred the idea of it over lithium, if I had to choose between the two. But now I'm back on square one; I really want to settle on something, whether one drug or polypharmacy, that I won't have to keep on augmenting and altering for the rest of my life; the very process of always changing meds heightens my anxiety and worsens my mood, and I'd like to settle down and direct my energies and talents toward more productive things, like relationships and spirituality, instead of constantly figuring out what med works for what symptom. I think I've felt most stable and functional and most free from anxiety and social discomfort on an SSRI with my depakote&klonopin, but SSRI's usually, by increasing seratonin, created a dopamine-deficiency in me which caused me to crave and use alcohol/illicit drugs, so I'd always have to stop SSRI's after a short period. Adderall plus depakote&klonopin also worked for a bit in helping with my depressive/sp episodes, but after awhile it caused heightened self-consciousness, instability&anxiety. I'm wondering, since I really want to settle on something more permanent, how a combination of these two regimes would be for my symptoms-specifically depakote, klonopin, an SSRI AND a stimulant. Here is the reason this seems sensible to me: we always had to stop SSRI's because they induced emotional numbness and dopamine deficiency-the stimulant would surely make up for that deficiency. In turn, the SSRI could buffer any anxiety/agitation caused by the stimulant. This plan could thus possibly prolong SSRI treatment, and, essentially, help me with the various elements of my illness without my having to touch lithium, about which I'm apprehensive and really don't believe is a drug for me.
Sorry for such a long post, but I'd really like your input. Thanks.




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