Posted by zeugma on October 22, 2003, at 20:23:49
In reply to Re: Agitated depression; anxiety bad in morning, posted by dannen on October 22, 2003, at 13:39:44
> Jrbecker & Zeugma: Thanks so very much for your caring and advice.
>
> I agree that it sounds like a classic melancholic depression re bad in the morning, better at night. But could my agitated depression be a mixed state form of bi-polar? I had thought that might be a reason I could not tolerate Prozac, Zoloft, Lexapro, or Paxil. (Wellbutrin was even worse. Lamictal also was too "activating"). Could my intolerance suggest BPII, where the agitation is hypomania? Just a thought. This whole "mixed state" thing is confusing/deceiving. I had some acupuncture the last few weeks; it killed the anxiety completely, but then the depression was terrible. So, it makes me think the anxiety is really the way the depression is manifesting itself, if that make sense.
>FRom what I know, BPII would be on the "mood-reactive" side of depression. Agitated depression in itself is more or less what I experience; very anxious, pacing, restless (but fatigued) and insomnia. Terrible mornings, evening slight recovery (melancholic depresssion). I have relatively low mood reactivity, but lots of anxiety.
> I have thought about Effexor XR and a TCA, perhaps nortriptyline. Any advice on the TCA? I had heard the nortriptyline has a narrow therapeutic window, and I fear my psychiatrist is too unfamiliar with TCAs to be a reliable guide. It seems that since the SSRIs came out in the late 1980s, psychiatrists has lost touch with the TCAs--at least where I live.
Psychiatrists have completely lost touch with TCA's! Last year I walked into a pdoc's office and was determined to get a TCA at all costs as the only period of near-remission in my life was after I'd spent a year on nortriptyline in my early twenties. Lots of other treatments after that, lots of disasters. Luckily my pdoc knew what TCA's could do because he is an ADD specialist (another of my many diagnoses). Nortriptyline has gotten me out of a truly terrible place, and really has no more side effects than SSRI's or Effexor. The new drugs were always compared with the tertiary amine tricyclics like amitriptyline as the basis for their suopposedly superior side effect profiles. Somehow all TCA's got lumped in with them as drugs with terrible S/E profiles. Meanwhile the newer drugs cause more sexual dysfunction than any TCA and often this side effect doesn't go away, while tolerance develops to most of the TCA side effects.
>
> My psychiatrist appears to feel most comfortable with Effexor XR and Lexapro. He mentioned titrating up on the Effexor XR very slowly--opening the capsule and taking only a few particles at a time. (Apparently, this was discussed at a recent seminar.) I want to avoid the benzos. I tried Xanax for about a month, and when I came off it the anxiety was absolutely horrendous.I have been considering a benzo for the past few months. I don't know if my pdoc would prescribe it. I will ask him about the pluses and minuses because I do have bad anxiety sometimes, but I also don't want to add another med, and also I'm crossing my fingers that the last week has been truly indicative of progress and the anxiety IS dissipating.
Nortriptlyine is an extremely effective med for melancholia. This is one of the best-documented facts in psychopharmacology. It has a relatively narrow therapeutic window but the upside is that your pdoc can use it to determine whether the problem is dose-related or just that you're not having the desired response to the med and it might be wiser to drop it. That's a big advantage if you ask me.
>
> Any further advice would be greatly appreciated. I have fought this anxiety without meds for over eight months, and I need some medical invention. I tried Neurontin for several months last year, but it caused a real brain fog and muscle jerks for large muscles (legs, stomach) and tics for smaller ones.
>
> Again, thanks so very much. Dannen
poster:zeugma
thread:271647
URL: http://www.dr-bob.org/babble/20031021/msgs/272054.html