Posted by JohnL on October 30, 2000, at 5:55:35
In reply to Note to JohnL, posted by CarolAnn on October 29, 2000, at 17:19:51
Hi CarolAnne,
You know, there are so many avenues to take it's so confusing, isn't it? I pretty much agree with you on dropping the Wellbutrin, as it would be no surprise if it is contributing to anxiety. And if it's not doing much anyway...The Celexa I'm a little more iffy about. In your shoes I might perhaps cut the dose in half, but I personally would not drop it completely at this point. But that's just me. You know what's best for you. The only reason I say that is because statistically a serotonin med has a high percentage of being at least helpful in anxiety and depression, either as monotherapy or in combinations. Only later if I found out something else definately worked better would I drop it competely.
With Wellbutrin, and maybe Doxepin, I worry there might be too much potentiation of norepinephrine which could result in headaches. Though Nortriptyline is different than Doxepin, they are both tricyclics. I combined Nortriptyline and Adrafinil once and got massive headaches. The NE potentiation was too much. I have no idea if Doxepin would be like that, but Wellbutrin sure could.
Hopefully Adrafinil will work out nicely for you. Whether it does or doesn't, here are statistics of what worked in what percentage of people suffering from anxiety. Notice that other choices you haven't tried yet might include a benzodiazapene, low dose Lithium, or low dose antipsychotic. If you are going to self direct your own care for a while, you can get just about anything mailorder except the benzos. If you wanted to get a hint of whether a benzo might be helpful or not, you could sample the herb valerian. Recent studies have shown it increases the release of, and inhibits the destruction of, GABA. It's normally for sleep. But it might provide some hint on how you might respond to a benzo. You'll feel better, you'll feel worse, or you'll feel nothing. Whatever. At least you'll get a hint. Anyway...
Serotonin antidepressants: Worked in 37% of anxiety patients
Other antidepressants: Worked in 11%
Benzos: 24%
Lithium: 22%
Stimulants: 14%
Antipsychotics: 13%
Depakote: 11%
Tegretol: 3%
Thyroid: 24%
Note: Combinations were used in 35% of patients, not reflected in the chart.
Note: Some of these, like Lithium for example, had no clinical justification in treating anxiety, but they worked anyway. Interesting.In a worst case scenario if you end up getting nowhere in the next month or two with the changes you make, you can make some new choices based on this chart. At least it will give you an idea of where to explore. Except for the benzos, you can easily get your hands on the rest. For a benzo you will need your doctor's involvement, as they are scheduled controlled substances.
But I have my fingers crossed for you! Hopefully the simple addition of Adrafinil, elimination of Wellbutrin, and reduction of Celexa, will do the trick.
John
poster:JohnL
thread:47708
URL: http://www.dr-bob.org/babble/20001022/msgs/47750.html