Posted by Racer on July 29, 2004, at 11:05:47
In reply to Help required. Very Confused. Kinda Urgent., posted by Daniel Woodfield on July 29, 2004, at 9:49:13
I'm not sure how helpful I can be about the medication issues, but I do have some very general suggestions for you. I hope they help.
First, though, I'll tell you something about my own experience on Paxil, since sometimes just hearing that I wasn't alone helps me. Years after coming off the Paxil, I was describing its effects to a new doctor, telling her that I was constipated, anorgasmic, lethargic, etc -- and that I felt unable to experience my emotions. She said, "So, you felt emotionally constipated?" I'd never have thought to put it that way, but as soon as she said it, it clicked into place. That's exactly what it felt like. I don't think that it's all that rare to experience something like that on Paxil. Of course, it did help my depression, and I know that it's very helpful for others. As we all like to say here, "Your Mileage May Vary".
If you have a very short time allotment with your doctor, I strongly recommend writing a list of topics and points to take with you. Just like any other outline for any other purpose, and it serves the same purpose. Write down all your concerns, all your ideas for exploration, and any medications you think might be worth discussing. In your case, I'd also suggest mentioning your unease with the diagnostic term "depression" rather than "dysthymia." (Think of the two as points on a spectrum, with the popular name of that spectrum being "Depression" -- does that help make his response any easier to accept?)
I'm assuming you're a young man, in which case what you're describing about the course of your illness really does fit with depression -- even if you're more aware of the anger and irritability than sadness per se. The lack of energy, feeling like a zombie, even the anxiety -- all can be part of depression for many people. (I have a little mood diary I made up for myself, but the "mood" section has separate columns for agitation, irritation, and despair, because I can't always see them in combination. I have to make a different notation for each in order to get at my overall mood. Together, they make up "depression" for me, even though I may not be aware of sadness all the time.) Besides, the diagnosis isn't what you want treated, is it? If your doctor diagnoses you as suffering JellyBaby Disorder, but treats your dysthimic anhedonic anxiety effectively, won't you still be satisfied with the outcome? Hard as it is, let go of any investment you may have in convincing him to recognize any specific disorder, and concentrate on what you really want: effective treatment of your most distressing symptoms.
There is an argument to be made for looking for a stimulating medication, but my experience has been that improving the depressed mood will generally increase energy without augmenting agents. That's only one person's experience, and it won't hold for everyone, but it goes along with another piece of advice: try one drug, and only add another if that first drug provides partial relief after an adequate trial at a therapeutic dose. (No, I'm not a scientist, but I could play one on TV...) Starting off with an SSRI or SNRI alone is fine, and some of them are known to be more stimulating than others. Prozac and Zoloft, as far as I know, are more stimulating than Paxil or Lexapro. Remeron is sedating, Wellbutrin activating. Effexor has as many peculiar effects on the up-taper as on the down-taper, but it can be very effective for many people. (It was a lifesaver for me, in combination with Prozac, although it did stop working for me eventually.)
Best luck to you. I hope something in here helped.
poster:Racer
thread:371983
URL: http://www.dr-bob.org/babble/20040724/msgs/372002.html