Posted by Mila S on May 30, 2004, at 4:21:20
In reply to Re: these days are med mixing testing grounds.... » SLS, posted by zeugma on May 22, 2004, at 13:01:40
Hey zeugma, judging from what you wrote below and what you have written in a few other posts I thought I'd ask you (or anyone else) for some advice:
I have problems similar to yourself. You mention "ADD, melancholic depression, social phobia and severe generalized anxiety, narcolepsy" I have all of these difficulties except the social phobia. Although I do lack confidence in social settings especially among intellectuals (my peers studying philosophy). Part of that is due to problems with my language abilities-I have noticed a decline which I think has to do with having been on various psychotropics over the past ten years. I have tried SSRI's, benzos, lithium, remeron+neurontin, effexor, zyprexa, risperdal, a cocktail of lamictal, adderal, and vivactil, and others. Nothing has helped. Recently my depression has spiralled into severity due to a breakup. I saw a new PDoc. I told him of my constant crying, my spending 18-24 hours in bed, my tendency to have panic-attack-like episodes two or more times a day in which I writhe on the floor, wail, rock back and forth, scream into a towel...etc. I told him I have been taking some old xanax pills I had and these have been the only thing helping me. He would not prescribe more xanax. He simply asked which of the drugs I have tried helped the most. I told him effexor seemed to help a little and so he has prescribed effexor at 75mg (I was taking 400mg when it *seemed* to help). He also prescribed trazadone to help me sleep. I get drowzy but I do not fall asleep on it. I Am completely nocturnal and am out of my bed only between 5-8PM to 1-3AM ususally. I am very dissapointed about the effexor prescription. That was three weeks ago, I have been taking the medications as he has directed me to, but I am in the same boat. The only things that have changed is that I am eating a bit more again. The xanax is the only thing keeping me from the ER (which I've been to several times in the past when the symptoms become unbearable and the screaming begins).
I am a grad student who is experiencing cognitive blunting, zero motivation (to the point where I shower once a week and stopped brushing my teeth for quite a while). I have a history of fatigue problems. I have been inclined toward a nocturnal schedule since I was a child. I have no longterm close friendships, nor is my family comforting to me despite their attempts to be supportive. I may have ADD as my last pdoc suggested for I cannot concentrate long enough to keep up with talks/lectures or even long conversations. I need something that will help my concentration and motivation, treat my fatigue/low energy, treat my severe anxiety and depression, and help me get on a normal sleep schedule (all wihtout cognitive dulling.
I'm going to run out of the xanax soon and I am scared to death. I really can't take the screaming sessions--the xanax has really helped with that. But I'll need something more for all my other problems. At the moment I am highly disfunctional and pretty much rotting away in bed (i spend many hours in bed just making repetitive movements with various parts of my body as I repeatedly count the edges of my room).
Furthermore, because of my condition, I could not fullfill my obligations to my dept. in full this past semester. I am at risk of losing funding and health insurance.
So I need to get functional fast. Even if I could work 2-3 days a week I would be incredibly better off. As things stand I feel hopeless and physically, because of all the time spent in bed, I am starting to experience throbbbing pain in my back and legs.
I know I need to force myself to get out and get some exercise, but I have not been able to do that. Getting out of bed seems to be impossible. I spent hours awake crying in bed, but I just will not get up. when I do get up, I cry more. finally when the xanax kicks in, I am calm but in despair. I eat a little and watch nonsense TV for in the wee ours of the morning hours and then return to bed. But I fall asleep around 7AM.
I've been trudging along with depression and semi-functional for over ten years. Lately when in public, which has been very rare, I become tearful and openly self-pitying. People look at me strange. It is humiliating. I have not been able to forge a social life because of this.
I have been therapist shopping and will start with one in two days. I will see my pdoc again in three days.
I would like for him to recognize the urgency of my condition. I told him what was happening when I saw him three weeks ago, yet he gave me nothing but the effexor at a low dose. So for the past three weeks I have been in practically the same condition. I don't understand how pdocs so easily send home people with acute symptoms without giving them any medication that can be of more immediate help.
Do you have any advice for me? Things have gone on like this too long. I am afraid of ending up in the hospital. Do you have any advice about medicationts that might help witht he symptoms I've described (meds that are less likely to slow down cognitive ability)? Also, any advice on how to assert myself to my doctor would also be appreciated.
Thanks,
Mila
> When things go bad, that's the time I query my doctor for reasons for his particular med choices. But the polypharmacy I have had for the past year and a half has been very much an empirical matter. On my first visit to him, he gave me samples of Buspar (I suppose the drug company was making a last-ditch attempt to promote this drug before it went off patent). I was finding nortriptyline unsatisfactory in the treatment of anxiety, and I decided i was going to try the samples regardless of what he said, unless there was a definite contraindication, which there wasn't. It did nothing for anxiety, but had an AD effect, so I got him to provide scripts for me without any problem. It was stictly my decision to try the Buspar.
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> Then I needed more help for my ADD, and he made the pharmacologically redundant choice of Strattera to add to the nortriptyline. It did work (Strattera is a much more powerful inhibitor of the NE transporter than nortriptyline and has no sedating effect, for me at least) so I was happy to use the two concurrently as I was getting relief from depression and ADD for about the 1st time in my life (the nortriptyline at that time had the depression in near-remission). As I've described elsewhere, I was able to convince his colleague to intercede for me to get a script for Klonopin after a disaster with CBT and a major change in life circumstances that would have made my previous level of social phobia an insurmountable obstacle. He had no desire to add the K even though I regularly complained of anxiety/social phobia. This is unfortunately standard practice for pdocs to think of SP as a 'minor' problem that can be handled with therapy.
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> My last visit, I had an episode of depression that was provoked by an exogeneous circumstance, and I was determined to get answers from him as to what med combos made sense and what didn't. We decided to slowly discontinue the nortriptyline, and I am going to ask him to let me try Provigil since it seems to work on noradrenergic systems in a synergistic (not redundant) way with Strattera. It will also target the symptoms of fatigue and desire for social isolation that may be consequent on fatigue in a more 'rational' way than anything that has been done so far with him. The truth is that I feel obligated as a patient to research as thoroughly as I can and listen to others' experiences as closely as possible so I can 'rationalize' my treatment. Unfortunately, no pdoc has had a global understanding of how the parts of my various disorders fit together (ADD, melancholic depression, social phobia and severe generalized anxiety, narcolepsy) and what i consider to be mere prejudices- against benzos, for example- also interfere with optimal treatment. It has been frustrating as h*ll, but then I am also functional to a degree I have never come to in my more than three and a half decades of life. So I trust him to help me, but many of the decisions seem to be mine. Maybe that's why i consider him to be the first pdoc who has helped me at all.
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poster:Mila S
thread:349631
URL: http://www.dr-bob.org/babble/20040527/msgs/352077.html