Posted by SteelRat on November 21, 2002, at 0:02:02
Eeackk! First time posting to an iNet help group. Antecdote: I took one look a couple of years ago at alt.depression.medications or somesuch NG, and (figuratively) ran away screaming..
Okay, my history: I had several episodes of what was probably mild or moderate depression in high-school, and a generally socially-avoidant, intorvert, "analysis-type" termperment since as far as I can remember (One non-scientific Myers-Briggs test I found said INFP, if that test still had *any* validity at all).
I was diagnosed with depression after during the first year of college (late-teens, away from home) - symptoms of not eating, extreme pessimism. Went on Zoloft (25mg/d), which worked extrememly well (I seemed hypomanic/hyperthymic for about 3 months instead of what they say is the usual 2 week period)
The next year, things progressively went to hell - I think diminished concentration and some recurrance of the depression. At this point I was at 100mg.
I came back home, and after a horrible time trying to switch to St. John's Wart at my parent's insistence (there is no recognized family history of depression, though both my parents have what might be called introverted/"depressive" temperments), my pdoc switched me to Celexa (20mg/d). After about a year, it started to cause too much sleepiness, so I switched to Wellbutrin (300mg/d).
Also about this time I started taking Lorazepam (0.5mg/d) for performance axiety, and noticed that it helped with social inhibition as well. (My performance anxiety has manifested itself as a kind of over-awareness of my voice and feelings of physical dissociation) Recently (Sept 11 to be exact) I became aware of an increase in the social inhibition - although whether this was an actual "worsening" or just a recognition of a previously unrecognized state (a "Plato's Cave experience" so to speak), and went back to the pdoc.
I had always thought that my depression was central and any anxiety was secondary to it, but started to wonder if it wasn't the reverse. The pdoc perscribed a very low-dose add-on of Risperdal to the Wellbutrin for anti-anxiety effects. I ended up taking 1/16 mg of that for 4 days. The anti-anxiety effect was wonderful (I felt like "Atlas with the world lifted from his sholders" around women for the first time in years), but I stopped taking it because of some strange depressive effect and a memory-lapse. I later learned that Risperdal is metabolized through CYP2D6, which is a contraindication for Wellbutrin.
I'm currently just taking the Wellbutrin (150mg-300mg/d) and Lorazepam (1-2mg/d) and have another appointment in a couple of days. My pdoc wants to try Risperdal, which would be fine with me (it did have wonderful effects), except for what I read about TD and other such scary stuff..
My mother would prefer for me to avoid a combination therapy (SSRI+benzo), which to me makes absolutely no sense as benzos basically ONLY affect GABA, and thus don't interfere at all with 5HT, NE, or D circuits.
My reaction to Celexa now and Paxil (2 day trial) is a feeling of being "hyperaware" and a bit "inwardly jittery" (as opposed to physically jittery), though that may just be transitory. This leads me to hypothesize that the effect is related to 5HT, since Wellbutrin doesn't affect 5HT much (I'm told). I hypothesize that the powerful anti-anxiety effect of the Risperdal was teh result of D2 action, though it was much more powerful (quantitatively and qualitatively) than the Wellbutrin, and Wellbutrin also affects D (but which subtype - is that hypothesized to be important in anxiety/inhibition?)
At this point, I don't want to deal with the Risperdal AT ALL - at least not now, and not for longer than 2 weeks in any case. Partly because of a (perhaps somewhat irrational) fear of TD, partly because I just don't really want to change my personality/temperment that much (I've read Listening To Prozac and loved it..)
The Lorazepam works very well for anxiety at the level of 1-4mg (1-2 for normal situations like dating, 3-4 for giving a class presentation). This is higher than my initial response dose of 0.5mg, which worries me some (tolerance). I'm considering asking the pdoc if I could try switching back to a low-dose of Zoloft (10-15mg/d). Although I may have poop-out effect there..
One thing the pdoc did mention about the Risperdal is that it might afford the brain a chance to "reverse" some of the fear-conditioning that's supposedly at the bottom of the anxiety, whereas the benzodiazipine just blocks the effects of anxiety. I presume because of Risperdal's effects of dopamine. Does this make any sense? (Does *anyone* really understand how long-term-potentiation [again what I assume is behind fear-conditioning in people as well as rats..] works and how it is mediated?)
Sorry about the long-windedness, I figured more info is better..
poster:SteelRat
thread:128567
URL: http://www.dr-bob.org/babble/20021116/msgs/128567.html