Posted by mtdewcmu on January 10, 2010, at 11:12:00
In reply to ADD/OCD+perfectionism+med choices-plz help(long), posted by g_g_g_unit on January 10, 2010, at 0:47:15
> i've been doing my best to commit to therapy lately, and have been astounded to discover how much of a deblitating effect perfectionism has had on my life - to the point that's it's pretty much made me rethink my entire approach to medication.
If therapy is helping you, then you ought to stick with it. That is, unless the cost is more than you can afford. (There's no way I could afford it.)
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> what's most difficult is trying to ascertain why the perfectionism was aroused in the first place; in my case, the perfectionism has graduated to full-borne OCD - no doubt about that - but the underlying condition feels more vague.
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> i was wondering if anyone can maybe quantify whether any of this sounds familiar, and might be more an outgrowth of OCD or ADD. prior to the OCD fully taking root at around 18, in high school i demonstrated the following problems:
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> - great ease in 'hands on' subjects like mathematics, where my attention was constantly occupied. i was excellent with detail, but often unable to see the 'bigger picture' - for example, i could memorize large passages of information with ease, but often failed to intuit the core ideas behind them.
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> - feeling extremely lost when instructions on how to perform a task weren't clearly delineated. if i didn't know what was 'wanted from me', i found it hard to take initiative and act.I have had this problem at my jobs. I have come to see it as a combination of an inability to concentrate fully on a task due to anxiety and depression, and the lack of energy and enthusiasm for the task due to depression. I used to be employed as a computer programmer, but it required too much concentration. I ended up having to quit, because it was clear that the issues weren't going away.
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> unfortunately, i've become so reliant on that perfectionistic 'inner voice', that i often feel lost acting without it.I think I know what you mean. In myself, I see this as being preoccupied with my inner state due to depression. When I am less depressed, I can focus on something outside myself.
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> my therapist and i have tried to work out more logical goals for me to attempt to undertake. my family is moving to a new country soon, which means that i need to prioritize. at this point, my former line of work as a freelance writer is causing too much grief (due to too much freedom afforded) for me to really pursue it as a realistic career. so in that sense, i think it might be better to return to university in order to undertake an honor's/masters in an area that might allow me to get a normal job. i also suffer from pretty crippling social anxiety, so feel like that side of things needs to be taken care of.
>You may want to look for something that requires less decision-making and personal initiative, unless you are hopeful that you can conquer your anxiety and depression.
> SSRI's i guess helped by suppressing the need to perform things perfectly, but they don't indirectly improve concentration as a result, and also make socializing even more difficult. the exception might be prozac, which helped brain fog at first, but which i was taken off due to initial insomnia.
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> Nardil i liked a lot. unfortunately, i kept upping the dose in order to pursue the euphoria. at 75mg+, i couldn't deal with the cognitive and neurological side-effects (RLS, leg-twitching, etc.) which i get on all SSRI's. my anxiety also got a lot worse. i've been thinking maybe a lower dose (60mg) of Nardil might be suitable. i know it can effect short-term memory though. is this more of a temporary or last side-effect? and as for the neurological (and memory) problems, could something like memantine, which might increase dopamine concentrations? improve the problem?
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> finally, my doctor has arranged for a Dexedrine script, which i get in two weeks. i can see how in the hands of a perfectionist, it might be a disaster, but i guess if there is an ADD component at work, i'll know because hopefully it might correct an underlying imbalance.
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> so, Nardil seems to cover most of my bases, and thereotically memantine seems like it might be a good augmentation for brain fog issues etc.?
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> otherwise, i wonder about a more targeted approach like Prozac +dex or an NRI, though am a little concerned about long-term SRI use. all i know is that this time if i find something that works, i really need to try sticking with it, so i'm doing my best to think this through semi-logically.
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> thanks for anyone who had the patience to read this.
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I think you are trying to slice up your problem into excessively small pieces and trying to treat each one individually. I think that you could re-envision all of your symptoms as manifestations of depression and anxiety, and treat them all with antidepressants. From what you have written on this board, I don't think you have given SSRIs a fair chance to work.
poster:mtdewcmu
thread:933106
URL: http://www.dr-bob.org/babble/20100103/msgs/933121.html