Posted by satsumas on July 7, 2008, at 17:50:07
In reply to Re: Tianeptine » satsumas, posted by Marty on July 7, 2008, at 17:03:07
Thanks so much for your help. What you described is exactly why i dont want to go back on effexor or cymbalta. tended to work at first, then poop out, and just give me side effects (apathy) with no real help in the self-esteem department. so i would just start feeling bad about my lack of motivation, causing mood to plummet anyway.
but i do feel like i need some action on serotonin since i'm prone to obsessive negative thinking, irrationally negative self-image, and a deep, irrational pessimism and hopelessness.
tend to think of mood like a string held between two hands. the effexor can raise the string vertically, but it also makes it taut, so you can't feel negative events or positive events, which in the long run generates the apathy and anhedonia, and ocne you recognize it, is depressing in and of itself, so the string then lowers...but it's still taut. and then at some point, if something bad happens, and stuff has been piling up since it doesn't bounce off the string (OK maybe analogy is breaking down here), the string just frayes and eventually splits...at least in my condition, all my terrible depressive breakdowns have been precipitated by what i consider to be incomplete "processing" of emotionally charged events while on antidepressants, all piling up, until at some point, there is a break. proverbial straw on the camel's back.
i want something that increases the string, but doesn't make it taut -- so my mood is still responsive, but it's baseline is higher than the depths where it has been. i'm hoping tianeptine can do that.
my background. formally diagnosed with BP2, and it's been 95% depression. only two or three hypomanias in the past 5 years, all induced by antidepressants. most recent one lasted about a week and was a lightweight hypomania that went away when i reduced my effexor dosage.
have tried effexor, which worked well for a long time, but i didn't realize the negative effects of anhedonia, apathy, lack of motivation, etc. until too late. also felt it caused cognitive dulling after 18 months of it, combined with lamictal.
then tried wellbutrin, cymbalta, lamictal both on its own and as augmentor, and emsam. also tried provigil and ritalin as augmenters for attention -- both helped, but i hated the speedy feeling of ritalin. felt like i just hyperfocused on whatever was in front of me, which was not necessarily the most useful thing to do.
wellbutrin and cymbalta and effexor all kinda worked, but never got complete response, and had side effects, primarily anhedonia and lack of concentration and zero romantic interest or desire (but the mechanical aspect of libido worked fine, go figure)
emsam gave me lots of energy and what i considered to be an increase in my "free will". improved attention, drive, but caused unrelenting anxiety and probably a touch of psychoticly-smart thinking. would theorize a lot about my past, my family psychological dynamics, business ideas, etc. it felt a bit hypomanic, but without the euphoria. didnt' have much of a serotonin impact, as i still felt bad, low self esteem, etc. worsened obsessive thinking (perhaps thats part and parcel of the smart stuff).
i'm a knowledge-worker as they say and may be going back for my ph.d. someday, but emsam isn't the type of drug i would really take if i was trying to come up with the next theory of relativity. i think the fact that it made me smarter was really just a form of dysphoric hypomania combined with pre-existing anxieties about my life and future.
currently taking lithium, mirapex, desipramine (tapering up, currently at 100), effexor (tapering down, at 75). if i added tianeptine, it would be in addition to / replacement for the desipramine.
originally i thought mirapex helped my desire and anhedonia aspects, but now i'm not so sure, i think it was just the fact that i was coming out of a suicidal depression and moving up very quickly to a high dose of effexor. but i'm keeping it, as i think it has lots of potential, and once i get the other meds stable i will want to experiment with the dosage.
thanks for your help, i'm really quite excited about the prospect of tianeptine being the right drug for me, and i'm just so resistant to going back on an S/NRI or even serotonin-uptake TCA for the exact reasons you described.
thanks,
satsuma
poster:satsumas
thread:835336
URL: http://www.dr-bob.org/babble/20080706/msgs/838699.html