Posted by Joe Schmoe on May 11, 2004, at 19:17:27
Well, I find myself in need of a medication change and I am seeing my pdoc about it this week, but I was hoping for a little input first from the gang.
I suffer from social phobia and dysthymia, and at times general anxiety. In the past I have taken Celexa, Klonopin and Wellbutrin as a combo. I still felt anxious even on 2 mg/day of Klonopin which amazed my pdoc. But I was fairly functional.
I discontinued the Celexa last fall (I think I was on 20 mg) since I didn't feel it was doing much and I was tired of having low libido. After a horrible two month withdrawal (and slow taper) I finally was over it but the libido never returned.
Looking back I can see that I became more emotionally fragile starting around December - more thin-skinned. I began to feel more and more anxious and eventually stopped the Wellbutrin and started taking Inderal as needed. This led to a deep depression this spring. I started the Wellbutrin again which got me out of the depression but the anxiety (and some social phobic episodes) has returned and become intolerable. I am also suffering testicular pain, which I have noticed in the past when taking Wellbutrin. Testicular swelling is listed as a side effect so I was not that surprised. It started to manifest around the time the depression lifted (after 3 weeks or so at 300 mg/day of Wellbutrin SR). I am taking Aleve several times a day because of it which obviously is not a good thing.
Due to a low carb diet I have lost over 30 pounds since January and am looking better (and have healthier blood chemistry) than I have in ten years.
Anyway, due to both the anxiety and the pain I do not want to continue the Wellbutrin at the therapeutic antidepressant dose (300 mg/day). I am thinking of taking another antidepressant instead and maybe taking 150 or 100 mg of Wellbutrin to supplement it for the inevitable sexual side effects. I really, really don't want to regain the weight I have lost, and for that and other reasons am not attracted to the idea of taking Nardil.
So, I am faced with two questions: first, have I become tolerant to the Klonopin, or did I just never reach the optimal dose in the first place? I suspect my pdoc will not like the idea of going above 2 mg/day of it after being on it for three years - she will probably assume I am developing tolerance, which is bad news if true, since it would mean increasing the dose is only a temporary solution.
Second, what AD should I take for my dysthymia? Celexa did not seem to do much one way or the other but then again maybe it was helping more than I realize. I have never tried Prozac, Zoloft or Effexor. Paxil I tried for three days and couldn't stand it. Serzone was pretty worthless and very sedating.
I am confused about the SSRIs because lately I have been reading about how social phobics have low dopamine, so in theory a dopamine boosting drug should help. However, drugs like Prozac and Wellbutrin, which do boost dopamine, have reputations for causing anxiety in social phobics, which makes no sense to me.
So, what do you say? As an AD to go along with Klonopin (I doubt anything could replace it, except maybe Nardil, which I don't want to take) what would you recommend? Prozac, Zoloft, Celexa, Effexor? I would be interested in your experiences. Thanks.
poster:Joe Schmoe
thread:345896
URL: http://www.dr-bob.org/babble/20040510/msgs/345896.html