Posted by Toby on September 3, 1998, at 9:13:22
In reply to Toby, can you help?, posted by DL on September 2, 1998, at 22:25:46
Were you going through menopause during these last two years when all the medications were first tried? Sometimes the SSRI's can mimic or increase the symptoms of menopause (hot flashes, etc). If not, then SSRI's may just not be for you, especially with anxiety being a strong component here (some anxious people are very sensitive to the increase in serotonin in their blood).
Women who get severe postpartum depression sometimes turn out to have bipolar disorder. Given your tendency to not sleep and feel exceedingly racy with medications and caffeine (in chocolate, tea and coffee), this may be the case even though you may never have had a full blown manic episode. You may be getting what's called a mixed episode of mania and depression. If so, one of three medications may be helpful for both the mood symptoms and the anxiety you feel: Depakote (an anticonvulsant that works on the GABA system much like the Klonopin does), Verapamil (a calcium channel blocker typically used for blood pressure that calms the irritability of the neurons in the brain), or Tegretol (also an anticonvulsant that I find helpful for anxious, depressed folks). I encourage you to see if you can get at least one longer session with your psychiatrist so he can reevaluate for bipolar tendencies. Even if he decides that you are not bipolar in any sense, I have found Depakote and Verapamil helpful for simple anxiety.
If no bipolar tendencies are present, explore the following with your doctor: Were you an anxious person before you ever had an episode of depression? Have there been times when the depression lifted almost completely but the anxiety stayed? Do you worry about most everything in addition to the physical feelings of anxiety? Do you have trouble going to places like the mall or when you are there do you feel more anxious if you meet a friend than if you have to talk to a stranger? If you answer yes to more than 2 of the above, the depression you've been having, in the last few years at least, may be secondary to the anxiety. Perhaps Buspar would be helpful in that case. It works on the same GABA system as the Klonopin for the anxiety and can also be a booster for depression.
Again, a different scenario: Once you get a fresh evaluation from your doctor, if the situation really is primarily depression with anxious features, one of the following may be helpful without giving you the racy, jumping out of your skin feeling that the SSRI's gave you. 1. Remeron (this drug works backwards: the lower the dose, the more sleepy it makes you. When you get up to a good therapeutic dose of 45 mg at bedtime, you sleep well but are alert during the day.) is incredibly good for anxious depression. 2. Serzone (some people respond to a very low dose, so you may not need to go up to the usual dose of 300-400 mg per day; it can be taken all at night to help with sleep and reduce sleepiness during the day). 3. Nardil or one of the other MAOI's are very good for anxious depression, but I put them last because you have to follow a particular diet with them.
Ask the doctor to review with you the responses you had to the previous meds you tried and see if he doesn't think that you may have had some switching into hypomania and to consider your history of postpartum depression as a possible indication of bipolar disorder.
Also keep in mind that if you do start some new trials of medication that you will probably have to stop most of the herbal remedies that you are taking since there is no good research on what interactions may occur (and some have turned out to be dangerous). Good luck.
poster:Toby
thread:511
URL: http://www.dr-bob.org/babble/19980901/msgs/517.html