Posted by West on March 3, 2009, at 6:14:44
I was recently diagnised with moderate depression with co-morbid anxiety, however, at the time i had been effective taking an effective dose of an antidepressant (escitalopram) for long enough to make some difference.
Had he seen me a month prior, in rapid deterioration after being put on dothiepin by an inexperienced gp, i'm postitive the diagnosis would have been more severe. I suffer DESPERATELY without antidpressants, my brain TURNS IN ON ITSELF, it is a WAKING NIGHTMARE and turning to sleep offers no respite when you have TERRIBLE insomnia.
So. I have come to the conclusion that the unipolar type will in 90% of cases have multiple co-morbidities, and you see it a lot. Especially among those of you from the US, where awareness and diagnosis of conditions like social phobia, and disorders of attention defecit, alongside depression, are much more prevalent than over here (mostly due to drug manufacturers gaining license for indications applicable to as large a potential market as possible - though, profiteering aside, greater availability of drugs in the armorarium can hardly be a bad thing)
So. This is how it goes, my fast-track guide to recovery from unipolar depression. How to pull yourself up from the stinking mire with selective pharmacology:
AM
* Modafinil 50mg am
* Escitalopram 10mg am
* Bupropion 150mg SR bid (2nd dose at 1:30pm)
* 2 cups of good coffee, some webtime, something good and upbeat to listen to. I recommend:
http://str.beatfactor.ro/Rokolectiv_2008_-_Pantha_du_Prince_-_Radio_Alternativ.mp3
PM
A walk, or jog if you can face it. Get into nature wherever this is possible, if you live in a city, a park. Headphones are an option.
See somebody you have a connection with, this is vital since forging new relationships will be more difficult at this point. Tension tends to breed tension, and any further beration will serve only to create fresh wounds, not heal old ones. Sundown approaches, get the room lights up, a little television. As evening/nighttime comes around, a film, dreamy rather than realistic or action-packed.
This will encourage restful sleep. I recommend Werner Herzpg.
* Clonazepam 1mg noct.
* Zopiclone 7.5mg si op
* Diphenhydramine 25mg (as above, especially in cases of bupropion causing skin irritation and itching)
And so it goes. You should be starting to enjoy the things you are naturally drawn to, and be brushing yourself off, back on your feet, and making plans for the future typically within a month. The clonazepam may be tapered off at a comfortable pace or if preferred, maintained at a low dose, taken at night to avoid cognitive dulling in the daytime. The zopiclone and diphenhydramine are presently essential but i do not foresee them being permanent fixtures but an intial boot in the gut to bupropion-induced insomnia. For some starting out on bupropion, or with preexisting insomnia from an ssri, 50mg diphenhydramine alone may be enough for sleep.
Go carefully and be strong
West
poster:West
thread:883465
URL: http://www.dr-bob.org/babble/20090223/msgs/883465.html