Posted by qbsbrown on April 11, 2006, at 19:51:03
In reply to Re: I guess I got a different reading on this ?Racer, posted by Phillipa on April 11, 2006, at 18:40:45
Great news! She came through with flying colors. I could not be more satisfied with her email. Thanks for your support. Enjoy reading.
"First of all, this is not a fight of egos. Not at all. I acknowledge the amount of information you have regarding mental health and medication effects/side effects. And yes, it is true that every person is an individual, meaning we are not supposed to generalize.
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But, in your case, I believed it was best to follow the "guidelines" to treat your anxiety and OCD. You have tried almost everything, with different timing and combinations; and your feelings, sometimes not only affected by the chemicals, are too subjective to be reliable. Please, understand me, I do not mean you are making up anything. I truly believe what you tell me is exactly how you felt. But I am somewhat skeptical due to the way your psyche works. That is why I preferred to follow the guidelines.
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SSRI is the first line treatment for anxiety, depression and OCD. After that, almost everything else is considered adjunctive treatment, working together with SSRI. (another treatment could be another antidepressant, such as the old tricyclic ones with many many side effects). My plan is using the paroxetine for as long as needed, 20 to 40 mg, initially together with benzodiacepines, for 3 to 4 weeks and then decrease and eventually stop benzodiacepine.
An hypnotic such as Ambion could do the trick to help you sleep better. And I do believe sleeping well is important for a good recovery.But continuing with the guideline:
1. SSRI for 4-5 weeks with benzo and then decrease/stop benzo,
2. increase SSRI,
3. change SSRI or add adjuvant treatment such as (I prefer the last, if not it is a waste of time)?
?. another antidepressant
?. antipsychotic
? mood stabilizer
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I decided to wear you off Trileptal because you were already complaining about its side effects (mostly those terrible headaches) and in order not to interfere with a "proper" treatment. Trileptal was not really bothering me, it was bothering you. You were taking Trileptal as a treatment for benzodiazepine withdrawal, and we know that's not the case. Also, I sincerely believe antidepressants will help you more in improving your symptoms than Trileptal, but with time. Antidepressants need 2 to 6 weeks to work, it depends on the individual. A 3 week trial of paroxetine as you did before is not enough to know if it is beneficial for you or not.?
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Having said all that I really do not want to discuss further this issue about taking or not taking Trileptal (there is not such an important reason against it) and as it will not do harm (apart from side effects) I let you restart it as you wish. If it helps, we shouldn't care if it is due to the placebo effect or due to its antidepressant-like effect, we should just be grateful it helps. ?/div>
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On the other hand, I understand your derealization as an anxiety symptom. Anxiety symptoms are many and respond differently to SSRI. Some respond quicker than others. The slowest ones could take one and a half or two months to disappear or to become better. Some might be resistant to an SSRI and need further treatment (another antidepressant, an antipsychotic...). We will need to give paroxetine a chance to improve this particular symptom. At the beginning of the treatment with SSRI there is a chance of worsening of symptoms, that is one of the reasons why, I am sure you already know about that, FDA imposed the drug companies a black box warning to SSRI saying at the beginning of the treatment it could increase suicidality.
poster:qbsbrown
thread:629831
URL: http://www.dr-bob.org/babble/20060408/msgs/631926.html