![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by Sugardog on July 6, 2014, at 20:21:36
I'd really appreciate some advice.
I've had anxiety, depression, addiction issues, and problems with obsessiveness since high school. I'm now a 47-year-old woman who has tried every antidepressant in the book with very limited success. My Pdoc now thinks I'm ADD for various reasons (I'm skeptical). I'm currently on 20mgs Lexapro, 300mgs gabapentin, 0.5mgs clonazepam, and just recently, 10mgs Adderall.
The Adderall calms my mind but doesn't make me feel good, productive, social, or focused. It makes me physically anxious, too, unless I take clonozepam with it.
I got my gene profile done, and I have an aberration in my OPRM1 gene that makes me less able to experience pleasure (and more prone to opiate addiction, smoking, etc.). I also have an aberration in another gene (can't remember the name) which makes my dopamine receptors inefficient and is heavily linked to addiction, impulsiveness, depression/anxiety, and ADD.
I've been on Wellbutrin, which helped with motivation, but made me more volatile and anxious.
I'm very interested in finding a medication that selectively targets dopamine and doesn't increase norepinephrine. I think the norepineprine increase is what causes me to be jittery and anxious.
Thank you in advance to anyone who can share their wisdom!
Posted by rjlockhart37 on July 6, 2014, at 22:20:38
In reply to Best dopamine enhancing selective med, posted by Sugardog on July 6, 2014, at 20:21:36
there have been dopamine selective uptakes made but they where removed because of side effects, and damage to liver.....one was called Nomifensine and it was removed, another one is called Survector and it's hard to attain because one it's not in the US because of some FDA rules, it's only avaiable in i think brazil or somet country....it does have abuse potential, but not as much as adderall......
my suggestion is get on higher dose of adderall or dexedrine, there are some people here who take Desoysn which is prescrition methamphetamine...but it's vary prone to abuse.....but if it fits the boat, some people take it and say it works great, it's just the fact that doctors see methamphetmaine being used on the streets, but the real reason, is that the meth on the streets is in high concentrated form, it's a crystal form and delivers high amounts of rush and stimulation for hours and addicts repeat it until their health declines, personnally desoyn is not like that....it's smooth, i've done research on it, it's not like the crystal methamphetamine, not as euphoric, so you may ask about that.....
one more suggestion for best dopamine reptake is Focalin.....it's a modified version of Ritilin, strong dopmamine reptake action.....
you may ask about a smart drug like Namenda
and of course cocaine which is pure dopamine surge reptake, but thats not legal lol
hope that helps
r
Posted by Sugardog on July 6, 2014, at 22:37:14
In reply to Re: Best dopamine enhancing selective med, posted by rjlockhart37 on July 6, 2014, at 22:20:38
> there have been dopamine selective uptakes made but they where removed because of side effects, and damage to liver.....one was called Nomifensine and it was removed, another one is called Survector and it's hard to attain because one it's not in the US because of some FDA rules, it's only avaiable in i think brazil or somet country....it does have abuse potential, but not as much as adderall......
>
> my suggestion is get on higher dose of adderall or dexedrine, there are some people here who take Desoysn which is prescrition methamphetamine...but it's vary prone to abuse.....but if it fits the boat, some people take it and say it works great, it's just the fact that doctors see methamphetmaine being used on the streets, but the real reason, is that the meth on the streets is in high concentrated form, it's a crystal form and delivers high amounts of rush and stimulation for hours and addicts repeat it until their health declines, personnally desoyn is not like that....it's smooth, i've done research on it, it's not like the crystal methamphetamine, not as euphoric, so you may ask about that.....
>
> one more suggestion for best dopamine reptake is Focalin.....it's a modified version of Ritilin, strong dopmamine reptake action.....
>
> you may ask about a smart drug like Namenda
>
> and of course cocaine which is pure dopamine surge reptake, but thats not legal lol
>
> hope that helps
>
> rThank you so much for responding so thoughtfully! I asked my pdoc about dexadrine, which from I've read might be a better match for me, but he seems set on the Adderall. Maybe the higher dose would help, as you've suggested. I'll definitely ask him about the other meds you recommended.
Wish I could do coke, but unfortunately, I had an addiction to it in my 20's and am afraid to go back! :)
Thank you again for your very helpful advice!
All my best
Posted by LouisianaSportsman on July 7, 2014, at 15:44:18
In reply to Best dopamine enhancing selective med, posted by Sugardog on July 6, 2014, at 20:21:36
Sugardog,
Thank you so much for posting such an intricate synopsis. Very well done, this kind of stuff is what I really like: my hobby is providing a synopsis of advice right back to ya!
Rj sort of stole some of thunder with the exact suggestions of the medications I was going to recommend: Desoxyn and Focalin. However, at the bottom I elaborate on the best dopamine enhancing selective medication for you, but it's tricky.
Focalin IR is dexmethylphenidate. Take the Ritalin (methylphenidate) dosage and divide it by 2 and that's the equivalent dosage of Focalin. Basically, in layman's terms, Focalin is the "good stuff" of methylphenidate so it's half of it, thus half the dosage. 30mg. = 60mg. of regular Ritalin. It is said to be much smoother and likely has less NE reuptake. I would try this medication first.
I myself was on Desoxyn recently and it was very smooth. I have a very good psychiatrist and had addiction issues that she knew about and still had it prescribed to me, but every psychiatrist is different; if you can't get it prescribed, Zenzedi is your best bet. Typically, Dexedrine (pure dexamphetamine) has come in 5mg. and 10mg. tablets only, but this comes in a variety of dosage strengths: 2.5, 5, 7.5, 10, 15, 20, and 30mg. so you can tailor it to where you need to be in terms of dosing. I find IR medication is always better than the extended release medication when it comes to stimulants, but that's my preference. I've written about it extensively somewhere on the board.
Now, beyond the typical stimulants, we can get creative. I will give you some treatment advice first. I think you would do well on Abilify (aripiprazole). It is a dopamine partial agonist and add-on antidepressant. I think it could alleviate symptoms relate to some of the abberrations in the genes, depression problems which may be the root of some your main problem with anxiety which would allow you to handle stimulants better. You probably have already tried Abilify, however.
OK, lets get back to dopamine *enhancers*.
I highly suggest Nuvigil (armodfafinil). It is superior to Provigil but more expensive, underrated due to cost. I've been on it and I've noticed that it helps wake up and add subtle boost to my day. Many people with fibromyalgia swear by it and you're a 47-old woman with depression problems: a lot of patients with fibromyalgia fit that stereotype.
^^ This is an option than can be concomitant with any therapy. You need to ask yourself now: how much do you value your Lexapro? I believe that the EMSAM patch would be a perfect fit. The B-subtype selective MAOI selegiline is approved for the treatment of depression in the form of a transdermal patch (EMSAM). There have been numerous reports of users taking this drug in conjunction with phenethylamine. This is a dietary supplement that could increase dopaminergic synthesis and boost the effects of the EMSAM. There needs to be a two-week "wash-out" period where you do not consume any 20mg. escitalopram pill as MAOI and SSRI together is a risk of serotonin syndrome.
Basically, you could try a two week "wash-out" of your Lexapro for EMSAM, augment Abilify for depression related to that "wash out" and switch your Adderall to Focalin and add Nuvigil. I suggest taking Nuvigil with whatever stimulant you are on. You could try it PRN to measure the effect of the stimulant versus the effect of the Nuvigil and judge if you need both or not. I think the modafinils would add an extra boost in your day that you need along with the stimulants, especially with someone that has depression. I think a EMSAM + Abilify (at a low-dose activating effect) + Focalin + Nuvigil + Klonopin + Lyrica would work wonders. Yes, you could switch your gabapentin over to Lyrica as I've found it to be a more effective anxiolytic.
A theoretical regimen:
EMSAM 6mg./24hr.
Abilify 5mg.
Focalin 5mg. BID
Nuvigil 50mg.
Lyrica 100mg.
Klonopin 0.5mg.LOL! I know this is wild, but you could use my suggestions as a possible rubric? Just how I'd handle it if I were in your shoes. The above is a very sophisticated regimen that definitely blasts dopamine and anxiety out of the water!
Anyways take my advice with a grain of salt and good luck with everything!
Posted by Beckett on July 7, 2014, at 16:08:49
In reply to Best dopamine enhancing selective med, posted by Sugardog on July 6, 2014, at 20:21:36
Emsam is great. If you can, give it serious consideration.
Posted by Sugardog on July 7, 2014, at 23:23:45
In reply to Re: Best dopamine enhancing selective med » Sugardog, posted by Beckett on July 7, 2014, at 16:08:49
> Emsam is great. If you can, give it serious consideration.
Thank you very much for your advice!! I'll tell my pdoc about it.
I really appreciate your help.
Posted by Hugh on July 8, 2014, at 17:44:52
In reply to Best dopamine enhancing selective med, posted by Sugardog on July 6, 2014, at 20:21:36
Baclofen, a muscle relaxant, increases striatal and cortical dopamine levels. I wrote this post about my experience with it:
Posted by Sugardog on July 8, 2014, at 20:58:54
In reply to Re: Best dopamine enhancing selective med, posted by Hugh on July 8, 2014, at 17:44:52
> Baclofen, a muscle relaxant, increases striatal and cortical dopamine levels. I wrote this post about my experience with it:
>
> http://www.dr-bob.org/babble/20130222/msgs/1039793.htmlDear Hugh,
Thank you so much for your advice! I read about Baclofen and tried it for about a week two years ago. Unfortunately, it made me sooo tired and out of it. Maybe I didn't stick it out long enough, or maybe it was interacting poorly with the antidepressant I was on at the time (zoloft). I was really nervous to up it to the doses necessary to help with addiction (at this point too much alcohol and lots of cigarettes).
I do think Gabapentin helps relax me and increases my general sense of well-being, but I can only take it in the evening, since I get really spacey on it. When I took it during the day, I was happy but unmotivated, was a terrible driver, and accidentally threw my wallet in a trash can!
I'll ask my pdoc again about Bac. It actually may be a good adjunct to the Adderall to take away the physical tension.
Thanks again!
Posted by phidippus on July 9, 2014, at 21:16:29
In reply to Best dopamine enhancing selective med, posted by Sugardog on July 6, 2014, at 20:21:36
> I'd really appreciate some advice.
> I'm currently on 20mgs LexaproIn order to treat your OCD and depression effectively, you really need to be on a higher dose of Lexapro - I'd recommend you increase the dose to 4o mg (but have an EKG done to check for QT prolongation).
OCD involves lowered levels of serotonin in certain regions of the brain but also raised levels of dopamine in other regions, most importantly the nucleus accumbens. A strategy used to treat these imbalances is to prescribe an atypical antipsychotic to augment treatment with an antidepressant. Two atypicals may be of interest to you which may help with your depression and your OCD: Latuda and Geodon.
> The Adderall calms my mind but doesn't make me feel good, productive, social, or focused.
This response indicates to me that you probably don't have ADHD, but thAT the adderall is helping with your OCD (studies suggest dextroamphetamine can treat OCD) which is why your mind feels calmer.
> I'm very interested in finding a medication that selectively targets dopamine and doesn't increase norepinephrine.
There are two drugs that increase dopamine: Mirapex and Requip, but a possible side effect of those drugs is an increase in addictive behaviors.
I would recommend you drop the adderall and add Latuda or Geodon either of which can potentially help with your depression and OCD.
Any questions?
Eric
Posted by Sugardog on July 9, 2014, at 23:31:09
In reply to Re: Best dopamine enhancing selective med » Sugardog, posted by phidippus on July 9, 2014, at 21:16:29
> > I'd really appreciate some advice.
> > I'm currently on 20mgs Lexapro
>
> In order to treat your OCD and depression effectively, you really need to be on a higher dose of Lexapro - I'd recommend you increase the dose to 4o mg (but have an EKG done to check for QT prolongation).
>
> OCD involves lowered levels of serotonin in certain regions of the brain but also raised levels of dopamine in other regions, most importantly the nucleus accumbens. A strategy used to treat these imbalances is to prescribe an atypical antipsychotic to augment treatment with an antidepressant. Two atypicals may be of interest to you which may help with your depression and your OCD: Latuda and Geodon.
>
> > The Adderall calms my mind but doesn't make me feel good, productive, social, or focused.
>
> This response indicates to me that you probably don't have ADHD, but thAT the adderall is helping with your OCD (studies suggest dextroamphetamine can treat OCD) which is why your mind feels calmer.
>
> > I'm very interested in finding a medication that selectively targets dopamine and doesn't increase norepinephrine.
>
> There are two drugs that increase dopamine: Mirapex and Requip, but a possible side effect of those drugs is an increase in addictive behaviors.
>
> I would recommend you drop the adderall and add Latuda or Geodon either of which can potentially help with your depression and OCD.
>
> Any questions?
>
> Eric
>
Dear Eric,Really interesting thoughts. Thank you!! It hadn't occurred to me that the calming response to Adderall my be linked to OCD.
I was on 40mgs of Lexapro years ago, which helped with my energy and depression but strangely increased my impulsiveness and poor judgement.
I'll definitely bring up the other meds you recommended to my pdoc. I haven't tried any of them yet.
Again, thank you. I'm really determined to find a solution right now. I've been struggling since my teen years.
Posted by Hugh on July 10, 2014, at 7:45:04
In reply to Re: Best dopamine enhancing selective med, posted by Sugardog on July 8, 2014, at 20:58:54
> I read about Baclofen and tried it for about a week two years ago. Unfortunately, it made me sooo tired and out of it.
Olivier Ameisen wrote that each time he upped his dose of baclofen, he would spend a lot of time sleeping, but this side effect would eventually pass. And when he reached his maximum dose and the somnolence passed, he had a lot more energy than he normally did. But if you're taking other psychotropic drugs, it probably wouldn't be a good idea to add baclofen to the mix.
Posted by Sugardog on July 10, 2014, at 22:40:00
In reply to Re: Best dopamine enhancing selective med, posted by Hugh on July 10, 2014, at 7:45:04
Thank you for your response! I'm so impressed by how thoughtful, kind, and smart everyone is on this thread~
Posted by iowamoo on July 11, 2014, at 12:05:30
In reply to Best dopamine enhancing selective med, posted by Sugardog on July 6, 2014, at 20:21:36
I had thee exact same problem with adderal, concerta was not as bad and ritalin was ok but still with each of them i had an underlying anxiety going on inside me so my Dr. put me on
Provigil and i LOVED it!It is very expensive though at $200 a bottle for a month. Since it is usually given for narcolepsy he had to ask me "do you have a hard time staying awake" i said "yes i'm tired all the time" and it was true because i am a poor sleeper so he was able to prescribe it to me for day time sleepiness.
I lost my insurance with that company so lost my dr. there and my new health insurance Dr. would not give it to me. Anyways there is your alternative for you, and it is only once a day.
Posted by Sugardog on July 16, 2014, at 20:02:07
In reply to Re: Best dopamine enhancing selective med, posted by iowamoo on July 11, 2014, at 12:05:30
> I had thee exact same problem with adderal, concerta was not as bad and ritalin was ok but still with each of them i had an underlying anxiety going on inside me so my Dr. put me on
> Provigil and i LOVED it!
>
> It is very expensive though at $200 a bottle for a month. Since it is usually given for narcolepsy he had to ask me "do you have a hard time staying awake" i said "yes i'm tired all the time" and it was true because i am a poor sleeper so he was able to prescribe it to me for day time sleepiness.
>
> I lost my insurance with that company so lost my dr. there and my new health insurance Dr. would not give it to me. Anyways there is your alternative for you, and it is only once a day.
>
Thank you so much for sharing your similar experience and for your suggestion! I mentioned Provigil or Nuvigil to my pdoc. He gave me Nuvigil samples but warned me it's really hard to get through insurance. I called my pharmacy (CVS, California), and they said it was like $500 a month for the GENERIC Provigil. I'm still thinking of testing out the Nuvigil samples.My husband says if Provigil or Nuvigil really helps me, it's worth the money. He's been so patient but is understandably worn out and probably frustrated about having to come home every evening to a wife who is depressed or anxiety-ridden, has already been drinking beer, and is mad at herself for not accomplishing anything meaningful during the day.
Thanks again!
Posted by iowamoo on July 16, 2014, at 20:46:57
In reply to Re: Best dopamine enhancing selective med, posted by Sugardog on July 16, 2014, at 20:02:07
I was getting provigil free via the company but it does take a few weeks or so to go through it. Can you get a low dose valium for a while? I take half of a 5 mg valium as needed and it is a life saver. Get rid of the beer. Take a nice shower and put on clean clothes and do what you can through the anxiety. You have to feel the fear and do it anyways. You have to just do what you have to do even with the anxiety. You cannot let the anxiety rule your life or you have no life. I live with this daily, I do what I can with the anxiety and I feel it in every step I take and every breath I take but I make myself get up off the chair and do things even if only to empty the dish washer or load it or to run the vacuum in one room at a time...give it a try but go to the website of the company that makes the provigil or the one you take and you should be able to down load a paper to apply for the free meds. Get STRONG!
Posted by Sugardog on July 17, 2014, at 20:11:10
In reply to Re: Best dopamine enhancing selective med, posted by iowamoo on July 16, 2014, at 20:46:57
> I was getting provigil free via the company but it does take a few weeks or so to go through it. Can you get a low dose valium for a while? I take half of a 5 mg valium as needed and it is a life saver. Get rid of the beer. Take a nice shower and put on clean clothes and do what you can through the anxiety. You have to feel the fear and do it anyways. You have to just do what you have to do even with the anxiety. You cannot let the anxiety rule your life or you have no life. I live with this daily, I do what I can with the anxiety and I feel it in every step I take and every breath I take but I make myself get up off the chair and do things even if only to empty the dish washer or load it or to run the vacuum in one room at a time...give it a try but go to the website of the company that makes the provigil or the one you take and you should be able to down load a paper to apply for the free meds. Get STRONG!
Thanks so much! I have clonazepam as the benzo for anxiety. Does Valium work better?
I know I need to get off the beer -- for me it's just another medication. I literally "dose" it, counting it to make sure I'm at the right level every evening. Was thinking of trying Campral for that but haven't yet. The Gabapentin was supposed to help with beer consumption but hasn't really (although it does help with a sense of well-being).
Not to make excuses, but I've noticed after years of being on SSRIs, that every time I upped my dose of zoloft or lexapro, my beer consumption increased. Can't remember about the effect when I was on Paxil or Prozac. Wondering if some of the SSRI's mess with your blood sugar, or if I'm trying to wake up with beer from the Lex or calm down with beer from the Zoloft (didn't help with anxiety).
I think I'm just not that strong, I'm overly sensitive, or I'm really messed up in other ways. My anxiety and depression become so acute, painful, and intolerable, that I basically spend my entire day trying to avoid those feelings.
These past two years have been especially bad, and I'm starting to lose hope that anything will help me function like a normal person.
Maybe I need a much stronger antidepressant or a stay in a facility. I'm SO frustrated with my lack of progress. I've been dealing with pdocs since high school and various meds and med combos since college. It's been 25 years of trying to get my chemistry on track, it's been such a roller coaster, and I feel as if it's been nothing but downhill for the past five years.
I'm very sorry to be so dour. I really want to be a cheerful and positive person.
Posted by iowamoo on July 17, 2014, at 20:26:22
In reply to Re: Best dopamine enhancing selective med, posted by Sugardog on July 17, 2014, at 20:11:10
Is it possible you are on the wrong group of medications? I use to take the ssri and found out I was on the wrong kind of medicine, I was actually bipolar 2 and needed a med for that. I stopped celexa a while back ago and kept slipping into anxiety pits and despair and using valium for it ALL, I think valium is the best but I've never tried anything else. I finally found a Dr that diagnosed me with bipolar 2 and put me on risperdal and then everything changed! I laughed, I felt closer to my husband then I have in years, I had patience with the kids and I had energy! Then I got dumb and scared of the side effects of diabetes and weight gain and I stopped taking it! Dumbest thing I ever did. I tried it twice again and never had the same effect so now seeing pdoc nextTuesday for something new. Just a thought that maybe you need less of some meds and something different?
Posted by phidippus on July 17, 2014, at 23:22:40
In reply to Re: Best dopamine enhancing selective med, posted by Sugardog on July 17, 2014, at 20:11:10
I'm a long time sufferer of OCD, so I understand your plight.
What is the nature of your anxiety? Do you have bad thoughts you can't seem to get rid of?
What medications have you been on?
Eric
Posted by Sugardog on July 18, 2014, at 22:40:44
In reply to Re: Best dopamine enhancing selective med, posted by iowamoo on July 17, 2014, at 20:26:22
> Is it possible you are on the wrong group of medications? I use to take the ssri and found out I was on the wrong kind of medicine, I was actually bipolar 2 and needed a med for that. I stopped celexa a while back ago and kept slipping into anxiety pits and despair and using valium for it ALL, I think valium is the best but I've never tried anything else. I finally found a Dr that diagnosed me with bipolar 2 and put me on risperdal and then everything changed! I laughed, I felt closer to my husband then I have in years, I had patience with the kids and I had energy! Then I got dumb and scared of the side effects of diabetes and weight gain and I stopped taking it! Dumbest thing I ever did. I tried it twice again and never had the same effect so now seeing pdoc nextTuesday for something new. Just a thought that maybe you need less of some meds and something different?
Thanks so much for your reply!! It's very possible I'm on the wrong group of meds. I tried Lamictal, which was really great for anxiety and depression during the day, but at night, I had major rages (almost got a divorce from my husband). I tried Lithium in my 20's, but it completely flattened me out.
I'm very anxious about weight gain since I already gained 20 pounds when I upped my zoloft (bizarre response, I know). I have exactly four outfits I can fit in. I may have to go back to my boxed-up pregnancy clothes soon! :}
However, I'll definitely ask my pdoc about risperdal. Thank you so much for your advice!
Posted by Sugardog on July 18, 2014, at 23:47:33
In reply to Re: Best dopamine enhancing selective med » Sugardog, posted by phidippus on July 17, 2014, at 23:22:40
> I'm a long time sufferer of OCD, so I understand your plight.
>
> What is the nature of your anxiety? Do you have bad thoughts you can't seem to get rid of?
>
> What medications have you been on?
>
> EricDear Eric,
Thank you so much for your excellent questions and help.
The anxiety is complex. I think I was born with some natural anxiety based on my mom's anxiety, my sister's anxiety, and my other relative's anxiety issues.
My anxiety consists mostly of negative self thoughts. "I'll never be good enough." "I'm a terrible mom." "Nothing will ever get better because I can't do it right." "I'm a terrible person." "I don't deserve happiness." That kind of thing.
When I was very young though, I mainly had a lot of positive energy and enthusiasm. I was always happy and very high energy. They called me "Jennifer Jump for Joy."
When I was about six years old, my parents started having very violent fights (glass thrown, blood).
Then when I was seven, my dad put a gun to his head and threatened suicide. I ran to his side to try to prevent him from killing himself, and my mom and grandma screamed at me to get away and called him selfish. All I wanted to do was save him because I loved him the most. I thought it was my fault because I bugged him about building the dollhouse he promised to build for Christmas but hadn't done yet. He came up with the gun to his head after working on the dollhouse in the basement.
Divorce. He moved out of the country, and I only saw him about a month out of the year.
When I was 10, sat in my beloved grandfather's room and watched him die of cancer. July. That August, I found out my dad had gotten the bends scuba diving and was paralyzed from the waist down. No one told me earlier. It happened on Father's Day, so of course I felt guilty. He was suicidal when I visited him at the hospital.
Sorry to lay all this crap on you. Obviously I needed to get it out. So in terms of my anxiety, I'm not sure if it comes from genetics, past trauma, or an extreme perfectionism I developed to cope with the past, try to take control of my life, or deal with a critical mom.
To answer your question more specifically, the nature of the anxiety tends to be very focused on judgement. If I'm in situations where I face judgement or a possibility of not preforming to my or others' standards, I go into avoidance/obsessive mode.
I also have a lot of anxiety about heights and driving on bridges or around high, curvy roads. I'm afraid of falling off.
I don't remember all the meds I've been on, but here's an incomplete list: clonazepam, ativan, depekote, a beta blocker, effexor, prozac, paxil, celexa, lexapro, cymbalta, lithium, lamictal, vybrid, abilify, naltrexone, topamax, gababentin, bachalfen, adderall, dexadrine, amitripaline, and wellbutrin. (Sorry for all the misspellings).
Thanks again for your help. Would welcome any advice!
Posted by phidippus on July 19, 2014, at 11:07:09
In reply to Re: Best dopamine enhancing selective med, posted by Sugardog on July 18, 2014, at 23:47:33
> The anxiety is complex. I think I was born with some natural anxiety
Do you have a free floating anxiety? The kind that makes you nervous and worried about all sorts of things?
> My anxiety consists mostly of negative self thoughts.Are these thoughts intrusive and recurrent? Do you try to suppress the thoughts?
> When I was about six years old, my parents started having very violent fights (glass thrown, blood).
> Then when I was seven, my dad put a gun to his head and threatened suicide.These events may well have caused you some PTSD.
>All I wanted to do was save him because I loved him the most.
You may very well have saved him.
I thought it was my fault because I bugged him about building the dollhouse he promised to build for Christmas but hadn't done yet. He came up with the gun to his head after working on the dollhouse in the basement.>It happened on Father's Day, so of course I felt guilty.
Why would that make you feel guilty?
> Sorry to lay all this crap on you.I'm happy to lend an ear.
>So in terms of my anxiety, I'm not sure if it comes from genetics, past trauma, or an extreme perfectionism
It comes from genetics and the past, but I think your perfectionism stems from the anxiety.
>If I'm in situations where I face judgement or a possibility of not preforming to my or others' standards, I go into avoidance/obsessive mode.
I think you may have OCD with some PTSD thrown in for good measure.
> I also have a lot of anxiety about heights and driving on bridges or around high, curvy roads. I'm afraid of falling off.Have you ever tried exposure therapy for your phobias?
> I don't remember all the meds I've been on, but here's an incomplete list:
>clonazepam, ativan
How was your experience with those?
>depekote
You don't need Depakote.
>effexor, prozac, paxil, celexa, lexapro, cymbalta, vybrid,
Did any of these impact your anxiety?
>lithium, lamictal,
Did they think you were bipolar? Are you bipolar?
>abilify,
This combined with a high dose of SSRI may have helped.
>naltrexone,
To ween you off your heroin addiction?
>topamax,
What for?
>gababentin
Did this help with your anxiety?
>adderall, dexadrine
Do you have ADHD. Stuffs also good for OCD.
>amitripaline
You were on the wrong TCA. You need Clomipramine.
>wellbutrin
How did you respond to this?
>Would welcome any advice!
Let's figure out if you have OCD.
Eric
Posted by Sugardog on July 20, 2014, at 21:42:35
In reply to Re: Best dopamine enhancing selective med » Sugardog, posted by phidippus on July 19, 2014, at 11:07:09
>
> Eric
>Dear Eric,
I can't thank you enough for being so caring and thorough! If you're not a pdoc, you should be! You ask all the right questions. I've pasted your response below along with answers to your great questions in caps for clarity.
> > The anxiety is complex. I think I was born with some natural anxiety
>
> Do you have a free floating anxiety? The kind that makes you nervous and worried about all sorts of things?
>
> > My anxiety consists mostly of negative self thoughts.
>
> Are these thoughts intrusive and recurrent? Do you try to suppress the thoughts?THE NEGATIVE SELF-THOUGHTS ARE PRETTY CONSTANT AND PERSIST THROUGH ANYTHING I'M DOING. THEY RANGE FROM GLOBAL NEGATIVE THOUGHTS TO COMPLETELY SPECIFIC THINGS: "I'M A BAD PERSON," "I CAN'T DO ANYTHING RIGHT," "I'M A TERRIBLE WIFE," "I'M A TERRIBLE MOM," "I'M A TERRIBLE WRITER," "I'LL NEVER ACCOMPLISH ANYTHING," "I'M GOING TO DISAPPOINT EVERYONE," "THEY'LL HATE ME," "THEY'LL BE ANGRY AT ME," "I'LL MESS IT UP," "I SUCK. I DIDN'T EMPTY THE COFFEE FILTER BEFORE POURING IN THE WATER," "I WAS SUPPOSED TO BRING THREE THINGS DOWN FROM UPSTAIRS, AND I ONLY REMEMBERED TWO. I SUCK." THAT KIND OF THING. JUST A CONSTANT NEGATIVE VOICE IN MY HEAD.
>
> > When I was about six years old, my parents started having very violent fights (glass thrown, blood).
>
> > Then when I was seven, my dad put a gun to his head and threatened suicide.
>
> These events may well have caused you some PTSD.
>
> >All I wanted to do was save him because I loved him the most.
>
> You may very well have saved him.
>
>
> I thought it was my fault because I bugged him about building the dollhouse he promised to build for Christmas but hadn't done yet. He came up with the gun to his head after working on the dollhouse in the basement.
>
> >It happened on Father's Day, so of course I felt guilty.
>
> Why would that make you feel guilty?MAYBE IT MADE ME FEEL GUILTY BECAUSE I HAD A SECRET FEAR HE NEVER REALLY WANTED TO BE A FATHER.
HE MOVED TO PUERTO RICO AFTER THE DIVORCE, AND I PROBABLY FELT VERY ANXIOUS ABOUT THE ABANDONMENT. I'M NOT SURE. I JUST KNOW I FELT IT WAS SOMEHOW MY FAULT. IF HE HADN'T BEEN MY FATHER, MAYBE HE WOULDN'T HAVE GOTTEN PARALYZED. I ALWAYS FELT RESPONSIBLE FOR ANYTHING BAD THAT HAPPENED TO HIM AS WELL AS FEELING RESPONSIBLE FOR IMPRESSING HIM AND MAKING HIM FEEL BETTER WHEN HE WAS DEPRESSED.
>
> > Sorry to lay all this crap on you.
>
> I'm happy to lend an ear.
>
THANK YOU FOR BEING SO KIND!> >So in terms of my anxiety, I'm not sure if it comes from genetics, past trauma, or an extreme perfectionism
>
> It comes from genetics and the past, but I think your perfectionism stems from the anxiety.I AGREE!
>
> >If I'm in situations where I face judgement or a possibility of not preforming to my or others' standards, I go into avoidance/obsessive mode.
>
> I think you may have OCD with some PTSD thrown in for good measure.VERY LIKELY.
>
> > I also have a lot of anxiety about heights and driving on bridges or around high, curvy roads. I'm afraid of falling off.
>
> Have you ever tried exposure therapy for your phobias?THE HEIGHTS THING HAS DEFINITELY IMPROVED SINCE I MOVED TO A HILLY AREA. UNINTENDED EXPOSURE THERAPY!
>
> > I don't remember all the meds I've been on, but here's an incomplete list:
>
> >clonazepam, ativan
>
> How was your experience with those?BOTH HELPFUL FOR ANXIETY. DOESN'T DO MUCH FOR OBSESSIVENESS, NEGATIVE THOUGHTS, OR DEPRESSION.
>
> >depekote
>
> You don't need Depakote.
> AGREE. THAT DIDN'T WORK.
> >effexor, prozac, paxil, celexa, lexapro, cymbalta, vybrid,
>
> Did any of these impact your anxiety?LEXAPRO (WHICH I'M ON NOW 20MGS) AND PAXIL BOTH HELPED WITH ANXIETY. NEGATIVE SELF-TALK QUELLED SLIGHTLY BUT STILL VERY PRESENT. HAVE A PROBLEM WITH WEIGHT GAIN ON PAXIL AND LACK OF MOTIVATION ON LEXAPRO.
>
> >lithium, lamictal,
>
> Did they think you were bipolar? Are you bipolar?THEY THOUGHT FOR A WHILE I MIGHT BE A SOFT BIPOLAR II WITH VERY RAPID CYCLING SINCE MY MOODS SHIFT OFTEN DURING THE DAY DEPENDING ON MY ANXIETY LEVEL AND SENSE OF SELF-WORTH (DID I ACCOMPLISH ANYTHING? DID SOMEONE MAKE ME FEEL BAD? HAVE I BEEN SHAMED? WAS I A GOOD PERSON TODAY?") ALSO, WHEN I'M AT A PDOC, I'M EXTREMELY TALKATIVE AND ENERGETIC, WHICH COULD BE INTERPRETED AS BEING HYPO-MANIC. I SEE IT MORE AS TRYING TO BE EFFICIENT WITH MY PDOC TIME AND BEING EXCITED THAT SOMEONE WILL LISTEN TO ME AND SEEMS TO CARE. ALSO, I GET VERY ELEVATED BY HAVING INTELLECTUAL CONNECTIONS WITH PEOPLE. NEW PDOC THOUGHT IT WAS SOFT BIPOLAR AND NOW THINKS I'M ADD.
>
> >abilify,
>
> This combined with a high dose of SSRI may have helped.HOW HIGH A DOSE? I WAS ON A THERAPEUTIC DOSE OF ZOLOFT WHEN I TOOK THE ABILIFY, AND I HAD SUCH A STRANGE REACTION TO THE DRUG. I WAS TOTALLY ZONED OUT, THEN VERY TEARY, THEN FOCUSED, CALM, AND HAPPY FOR A FEW HOURS, THEN TEARY AND DEPRESSED AGAIN. FOR SOME REASON IT WAS A BIZARRE ROLLER COASTER RIDE FOR ME. KIND OF LIKE LSD LIGHT.
>
> >naltrexone,
>
> To ween you off your heroin addiction?DID VERY LOW DOSE NALTREXONE TO TRY TO BOOST MY ENDORPHIN LEVEL AND CURB MY ALCOHOL INTAKE. HAD BEEN DIAGNOSED WITH RHEUMATOID ARTHRITIS AT THAT POINT (RHUEMY AND I BOTH NOW DOUBT THE DX) AND THOUGHT IT ALSO MIGHT HELP MY IMMUNE SYSTEM).
>
> >topamax,
>
> What for?
>
DX'ED WITH MIGRAINE-INDUCED VERTIGO BY A NUERO TWO YEARS AGO. HAVE HAD ON AND OFF INSTANCES OF TOTAL DISEQUILIBRIUM FOR A NUMBER OF YEARS, MOSTLY TRIGGERED BY BOUNCING LIGHT, BOUNCING SOUNDS, OR A FLOOR VIBRATING (LIKE NEAR AN ELEVATOR). WHEN GIVEN TOPA, IT WAS AFTER TWO WEEKS OF BARELY BEING ABLE TO STAND BECAUSE I COULDN'T BALANCE. I HAD TO CRAWL TO GO TO THE BATHROOM. STILL GET SPELLS OCCASIONALLY, BUT IT HASN'T BEEN REALLY BAD FOR TWO YEARS. QUIT TOPA AFTER A MONTH BECAUSE I COULDN'T THINK CLEARLY ON IT.> >gababentin
>
> Did this help with your anxiety?YES!! UNFORTUNATELY, I CAN ONLY TAKE IT IN THE EVENING BECAUSE IT MAKES ME TOO MELLOW AND UNMOTIVATED DURING THE DAY.
>
> >adderall, dexadrine
>
> Do you have ADHD. Stuffs also good for OCD.NEW PDOC THOUGHT A LOT OF MY ANXIETY MIGHT BE FROM UNDIAGNOSED ADHD.
DEX MADE ME CATATONIC, EVEN AT A VERY LOW DOSE. 10MGS ADDERALL XR HELPED WITH INTRUSIVE THOUGHTS, BUT I BOUNCED FROM BEING CALM AND HYPER-FOCUSED TO COMPLETELY NERVOUS, AND I WAS FOCUSING ON THINGS LIKE CLEANING CLOSETS INSTEAD OF DOING MY WRITING. WAS VERY ANXIOUS ABOUT AMPHETAMINES GIVEN A COCAINE ADDICTION IN MY 20'S. WENT OFF AFTER TWO AND A HALF WEEKS.
>
> >amitripaline
>
> You were on the wrong TCA. You need Clomipramine.I'LL TAKE TO MY PDOC ABOUT THAT.
>
> >wellbutrin
>
> How did you respond to this?DEFINITELY HELPED WITH DEPRESSION AND ENERGY. HOWEVER, MORE IRRITABLE, JITTERY AT TIMES, AND PRONE TO IMPULSIVELY LASHING OUT AT PEOPLE. NO HELP WITH CIGARETTE SMOKING, WHICH WAS ONE OF THE BENEFITS I WAS HOPING TO GET.
>
> >Would welcome any advice!
>
> Let's figure out if you have OCD.YOU ROCK!!!!
Posted by phidippus on July 21, 2014, at 9:52:53
In reply to Re: Best dopamine enhancing selective med, posted by Sugardog on July 20, 2014, at 21:42:35
>If you're not a pdoc, you should be!
I'm studying neuroscience.
> THE NEGATIVE SELF-THOUGHTS ARE PRETTY CONSTANT AND PERSIST THROUGH ANYTHING I'M DOING.
Do they cause you anxiety or depression or both? Have you ever tried to 'agree' with the thoughts? For instance, you have a negative thought and you respond, "That's right, I'm the worst person this side of the Mississippi!". Another thing to try is writing all the negative thoughts down as you have them then later reading what you wrote.
>JUST A CONSTANT NEGATIVE VOICE IN MY HEAD.
This seems a bit obsessive. Beating yourself up repeatedly. On the medication side of things I'd recommend a higher dose of Lexapro(40 mg) and augmentation with an atypical antipsychotic that agonizes 5ht1a receptors (these receptors improve mood and lessen anxiety when agonized)-Latuda, Geodon(it is also an SNRI) and Abilify all agonize 5ht1a receptors.
You could also try Brintellix. On top of being an SSRI,it agonizes 5ht1a receptors and 5ht1b receptors which both effect mood. It also antagonizes 5ht1d receptors which helps lessen anxiety and it antagonizes 5ht7 receptors which helps with mood.
> MAYBE IT MADE ME FEEL GUILTY BECAUSE I HAD A SECRET FEAR HE NEVER REALLY WANTED TO BE A FATHER.Even when you were young you had a lot of fear.
>I PROBABLY FELT VERY ANXIOUS ABOUT THE ABANDONMENT.How did you cope with your anxiety?
>IF HE HADN'T BEEN MY FATHER, MAYBE HE WOULDN'T HAVE GOTTEN PARALYZED.
There's no logic in that.
> WHEN HE WAS DEPRESSED.
How often was this?
> LEXAPRO (WHICH I'M ON NOW 20MGS)This negative self talk may be recurrent and intrusive, which would indicate you have OCD. OCD is often treated with higher doses of SSRI. Usually the highest recommended dose is doubled-in your case you would take 40 mg of Lexapro.
> HOW HIGH A DOSE? I WAS ON A THERAPEUTIC DOSE OF ZOLOFT WHEN I TOOK THE ABILIFY
A normal therapeutic dose of Zoloft is about 100 mg, whereas a dose for OCD would be 200 mg. Then add Abilify at a low dose and adjust upward until you feel results.
>AND I HAD SUCH A STRANGE REACTION TO THE DRUG. I WAS TOTALLY ZONED OUT, THEN VERY TEARY, THEN FOCUSED, CALM, AND HAPPY FOR A FEW HOURS, THEN TEARY AND DEPRESSED AGAIN.Abilify can cause mood shifts which usually pass after a few doses.
> DX'ED WITH MIGRAINE-INDUCED VERTIGO BY A NUERO TWO YEARS AGO.
Yuck. I have chronic daily headache.
> YES!! UNFORTUNATELY, I CAN ONLY TAKE IT IN THE EVENING BECAUSE IT MAKES ME TOO MELLOW AND UNMOTIVATED DURING THE DAY.Have you tried Gabitril for the anxiety?
> NEW PDOC THOUGHT A LOT OF MY ANXIETY MIGHT BE FROM UNDIAGNOSED ADHD.
I doubt it.
> Clomipramine.
>
> I'LL TAKE TO MY PDOC ABOUT THAT.Gold standard for depression and ocd.
> > Let's figure out if you have OCD.
>
> YOU ROCK!!!!you're intrusive thoughts seem to center around negative self-talk and these thoughts are recurrent causing you anxiety. How does your depression figure in? I think it comes after the negative thoughts. I don't think medication is going to help you all the way with the negative thoughts. I think you need to see a therapist who specializes in anxiety disorders, like OCD, to help you train your brain to more effectively deal with the thoughts. Go to psychologytoday.com and you can find a therapist by specialty.
How does your anxiety affect your mood?
Eric
Posted by Sugardog on July 22, 2014, at 23:17:45
In reply to Re: Best dopamine enhancing selective med » Sugardog, posted by phidippus on July 21, 2014, at 9:52:53
Dear Eric,
Thank you again for your patient help and support.
I'll put my responses to your questions below in caps. I know caps are annoying, but I can't figure out how to do it in italics.> >If you're not a pdoc, you should be!
>
> I'm studying neuroscience.
>
YOU ARE SO INSIGHTFUL AND PRECISE. I'M HAPPY THEY HAVE YOU IN THE FIELD!
> > THE NEGATIVE SELF-THOUGHTS ARE PRETTY CONSTANT AND PERSIST THROUGH ANYTHING I'M DOING.
>
> Do they cause you anxiety or depression or both? Have you ever tried to 'agree' with the thoughts? For instance, you have a negative thought and you respond, "That's right, I'm the worst person this side of the Mississippi!". Another thing to try is writing all the negative thoughts down as you have them then later reading what you wrote.HAVEN'T TRIED AGREEING WITH THE NEGATIVE THOUGHTS. THEY SEEM SO DEFINITE, CONVINCING, AND UNDENIABLE WHEN I'M HAVING THEM. HAVE TRIED SAYING, "THIS IS JUST MY CRITICAL VOICE," WITHOUT MUCH SUCCESS. YEARS AGO, TRIED WRITING THEM DOWN AND TALKING BACK TO THEM, BUT DIN'T FOLLOW THROUGH ON THAT TECHNIQUE. I BELIEVE I'M SOMEHOW ATTACHED TO THE SELF-CRITICISM, SELF-HATRED, AND DISAPPOINTMENT IN MYSELF -- AS IF MY WHOLE IDENTITY AND WORLD WILL DISINTEGRATE IF I LET GO OF THIS THINKING. MAY ALSO BE A DEFENSE MECHANISM AGAINST OTHER PEOPLE'S JUDGEMENT, SHAMING, OR ANGER -- IF I BEAT MYSELF UP FIRST, I CAN'T BE TRAUMATIZED BY THEM.
>
> >JUST A CONSTANT NEGATIVE VOICE IN MY HEAD.
>
> This seems a bit obsessive. Beating yourself up repeatedly. On the medication side of things I'd recommend a higher dose of Lexapro(40 mg) and augmentation with an atypical antipsychotic that agonizes 5ht1a receptors (these receptors improve mood and lessen anxiety when agonized)-Latuda, Geodon(it is also an SNRI) and Abilify all agonize 5ht1a receptors.
>
> You could also try Brintellix. On top of being an SSRI,it agonizes 5ht1a receptors and 5ht1b receptors which both effect mood. It also antagonizes 5ht1d receptors which helps lessen anxiety and it antagonizes 5ht7 receptors which helps with mood.THANK YOU FOR YOUR SUGGESTIONS. HAVEN'T TRIED GEODON BUT NERVOUS BECAUSE I HEARD IT CAUSES WEIGHT GAIN (ALREADY GAINED 20 POUNDS IN THE PAST TWO YEARS). IS BRINTELLIX AVAILABLE IN THE US? WILL IT CAUSE A LOT OF WEIGHT GAIN? I'M LITERALLY HAVING TO WEAR MY OLD MATERNITY CLOTHES RIGHT NOW.
>
> > MAYBE IT MADE ME FEEL GUILTY BECAUSE I HAD A SECRET FEAR HE NEVER REALLY WANTED TO BE A FATHER.
>
> Even when you were young you had a lot of fear.DEFINITELY. I WAS ALWAYS WORRIED ABOUT MY PARENT'S FEELINGS, THINGS FALLING APART, BEING GOOD ENOUGH, ETC.
>
> >I PROBABLY FELT VERY ANXIOUS ABOUT THE ABANDONMENT.
>
> How did you cope with your anxiety?BRILLIANT QUESTION. I BECAME HYPER AWARE AND SENSITIVE ABOUT OTHER PEOPLE'S FEELINGS AND TONES OF VOICE AND LEARNED HOW TO ADAPT MY BEHAVIOR TO MAKE THEM FEEL HAPPY AND NOT ANGRY OR SAD. BASICALLY HYPER-VIGIL ABOUT MY ENVIRONMENT AND EMOTIONAL CUES. I ALSO THREW MYSELF INTO SUCCEEDING IN SCHOOL, READ A TON OF BOOKS INSTEAD OF PLAYING AFTER SCHOOL, MEMORIZED AND RECITED POETRY BECAUSE I THOUGHT IT WOULD BE GOOD FOR ME, SECRETLY READ THE DICTIONARY INSTEAD OF GOING TO RECESS, THAT KIND OF THING.
>
> >IF HE HADN'T BEEN MY FATHER, MAYBE HE WOULDN'T HAVE GOTTEN PARALYZED.
>
> There's no logic in that.
I KNOW. IT'S A BIZARRE CHILDISH RESPONSE TO THE SITUATION THAT I HAVEN'T BEEN ABLE TO COMPLETELY SHAKE.
>
> > WHEN HE WAS DEPRESSED.
>
> How often was this?HE WAS THE MOST LIVELY, FUN PERSON IN THE WORLD (ALTHOUGH A HEAVY DRINKER, A WOMANIZER, AND IRRESPONSIBLE) UNTIL MY MOM THREATENED TO ABANDON HIM. WHEN SHE PUT HER FOOT DOWN ABOUT THE DIVORCE, THAT'S WHEN HE PUT THE GUN TO HIS HEAD.
HE ALWAYS CARRIED A LOT OF GUILT AND SHAME ABOUT HIS DAD'S DEATH BECAUSE WHEN HIS DAD DIED OF CANCER WHEN MY DAD WAS 13, IT WAS KEPT SECRET FROM MY DAD. MY DAD FELT TERRIBLE LATER ABOUT BEING DEEPLY ASHAMED OF HIS DAD WHEN HE HAD DIARRHEA ON A BOAT, NOT UNDERSTANDING HIS DAD WAS DYING OF CANCER AT THE TIME. HE NEVER GOT TO SAY A PROPER GOODBYE AND HAD A VERY RIGID, EXTREMELY CRITICAL MOM. SO I THINK HE WAS AVOIDING ALL THESE FEELINGS BY BEING HEDONISTIC WHEN HE WAS YOUNG. AFTER HE GOT IN THE WHEELCHAIR (AGE 33, I THINK), HIS DEPRESSION WAS VERY PRONOUNCED AT FIRST, THEN WENT UP AND DOWN. HE WAS ALSO DRINKING A LOT AND ON TONS OF MUSCLES RELAXANTS AND PAIN KILLERS.
>
> > LEXAPRO (WHICH I'M ON NOW 20MGS)
>
> This negative self talk may be recurrent and intrusive, which would indicate you have OCD. OCD is often treated with higher doses of SSRI. Usually the highest recommended dose is doubled-in your case you would take 40 mg of Lexapro.I WAS ON 40MGS LEXAPRO FOR A NUMBER OF YEARS, WHICH DID HELP ME BE MORE PRODUCTIVE. MY ONLY CONCERN ABOUT GOING BACK TO THAT DOSE IS I WAS ALSO QUITE IMPULSIVE, MORE ADVENTURE SEEKING, AND MADE SOME BAD DECISIONS (HAVING SEX WITH THE WRONG PEOPLE, ETC.).
>
> > HOW HIGH A DOSE? I WAS ON A THERAPEUTIC DOSE OF ZOLOFT WHEN I TOOK THE ABILIFY
>
> A normal therapeutic dose of Zoloft is about 100 mg, whereas a dose for OCD would be 200 mg. Then add Abilify at a low dose and adjust upward until you feel results.I CAN'T REMEMBER WHAT DOSE I WAS ON. I GAIN A LOT OF WEIGHT ON THE HIGHER DOSES OF ZOLOFT. THINK IT MESSES WITH MY BLOOD SUGAR AND MAKES ME WANT TO DRINK MORE.
>
>
> >AND I HAD SUCH A STRANGE REACTION TO THE DRUG. I WAS TOTALLY ZONED OUT, THEN VERY TEARY, THEN FOCUSED, CALM, AND HAPPY FOR A FEW HOURS, THEN TEARY AND DEPRESSED AGAIN.
>
> Abilify can cause mood shifts which usually pass after a few doses.MAYBE I SHOULD TRY ABILIFY AGAIN. I WAS ON IT FOR AT LEAST A WEEK AN WAS AN EMOTIONAL WRECK. HOW MANY DAYS DOES IT USUALLY TAKE TO STABILIZE?
>
> > DX'ED WITH MIGRAINE-INDUCED VERTIGO BY A NUERO TWO YEARS AGO.
>
> Yuck. I have chronic daily headache.
>
> > YES!! UNFORTUNATELY, I CAN ONLY TAKE IT IN THE EVENING BECAUSE IT MAKES ME TOO MELLOW AND UNMOTIVATED DURING THE DAY.
>
> Have you tried Gabitril for the anxiety?NO. IS THAT AVAILABLE IN THE US?
>
> > NEW PDOC THOUGHT A LOT OF MY ANXIETY MIGHT BE FROM UNDIAGNOSED ADHD.
>
> I doubt it.ME TOO. WAS A RELIEF TO GET OFF THE AMPHETAMINES.
>
> > Clomipramine.
> >
> > I'LL TAKE TO MY PDOC ABOUT THAT.
>
> Gold standard for depression and ocd.CLOMIPRAMINE MAY BE A GREAT SOLUTION. THANKS SO MUCH FOR SUGGESTING IT!
>
> > > Let's figure out if you have OCD.
> >
> > YOU ROCK!!!!
>
> you're intrusive thoughts seem to center around negative self-talk and these thoughts are recurrent causing you anxiety. How does your depression figure in? I think it comes after the negative thoughts.SPOT ON. I DEFINITELY THINK THE ANXIETY COMES BEFORE THE DEPRESSION. I START THE DAY FULL OF HOPE, THEN COMES THE ANXIETY/NEGATIVE THOUGHTS, THEN I SPIRAL INTO DEPRESSION. OR I GO INTO A DEPRESSION IF I'M FACING AN ANXIOUS SITUATION I'M SURE I CAN'T HANDLE.
I don't think medication is going to help you all the way with the negative thoughts. I think you need to see a therapist who specializes in anxiety disorders, like OCD, to help you train your brain to more effectively deal with the thoughts. Go to psychologytoday.com and you can find a therapist by specialty.
>
THANKS! I'LL CHECK IT OUT. MY PDOC WANTS TO TRY EMDR THERAPY WITH ME BECAUSE OF PAST TRAUMA. ANY THOUGHTS ON THAT?> How does your anxiety affect your mood?
AGAIN, GREAT QUESTION. A LOW LEVEL OF ANXIETY IS OFTEN MOTIVATING AND FEELS TOLERABLE AND, UNFORTUNATELY, NATURAL. A MEDIUM LEVEL OF ANXIETY CAUSES ME TO BE AGITATED, BECOME MORE OBSESSIVE, AND START TO HAVE MOOD SWINGS. A HIGH LEVEL OF ANXIETY CAUSES ME TO BECOME VERY UNCOMFORTABLE, VERY OBSESSIVE, AVOID THINGS I NEED TO DO REALLY DO, AND SPIRAL HEAVILY INTO SELF-HATRED AND DEPRESSION.
THANKS AGAIN!!!!
>
> Eric
>
>
Posted by phidippus on July 23, 2014, at 15:26:33
In reply to Re: Best dopamine enhancing selective med, posted by Sugardog on July 22, 2014, at 23:17:45
OCD
> HAVEN'T TRIED AGREEING WITH THE NEGATIVE THOUGHTS. THEY SEEM SO DEFINITE, CONVINCING, AND UNDENIABLE WHEN I'M HAVING THEM.
Find the right therapist and they will teach you how to take the power out of those thoughts. In your case, I don't think medication is going to be as effective as CBT, DBT and ERP therapies. Agreeing with the thoughts and using humor is one method you can use. Another would be to pretend to be all the bad things your thoughts say you are. Dress up like a loser. Talk funny. In other words act out your thoughts.
You see, what's going on in your brain is your having all sorts of thoughts then all of sudden a thought is flagged, say,"I'm no good". This thought raises a flag and your brain treats it like a dangerous thought, so instinctively you start trying to figure it out-argue with it and such. This leads to an emotional response-in your case depression. SO you've got this circuit going on and the only way to short it is to take the power out of the thoughts causing the distress.
HAVE TRIED SAYING, "THIS IS JUST MY CRITICAL VOICE," WITHOUT MUCH SUCCESS.
Maybe a better thing to think would be, "Oh, hello, muppet. How's my favorite muppet? What bad thing do you have to say now? Oh, right, I'm a loser and will never be an astronaut."
Be silly about it. You take the power out of the though by making git funny instead of scary.
>TRIED WRITING THEM DOWN AND TALKING BACK TO THEM
No need to talk back to them. Just read them whenever you can until they become so boring they have no power. You can also get a voice recorder and record your bad thoughts then play them back.
>I'M SOMEHOW ATTACHED TO THE SELF-CRITICISM, SELF-HATRED, AND DISAPPOINTMENT IN MYSELF -- AS IF MY WHOLE IDENTITY AND WORLD WILL DISINTEGRATE IF I LET GO OF THIS THINKING.
So, this obsessive self-deprecation is a crutch. The thoughts can stay or go, they just don't need to have so much power over you. What does it matter if your whole identity disintegrates? Will you die?
>IF I BEAT MYSELF UP FIRST, I CAN'T BE TRAUMATIZED BY THEM.
That's like saying if I stab myself in the eyes first no one else can make me blind.
Your presuming someone is going to judge you. That's just you judging yourself more.
>JUST A CONSTANT NEGATIVE VOICE IN MY HEAD.
Do you recall at what age you started having this voice?
> HAVEN'T TRIED GEODON BUT NERVOUS BECAUSE I HEARD IT CAUSES WEIGHT GAIN
I've been on Geodon for a year now and have experienced no weight gain.
>IS BRINTELLIX AVAILABLE IN THE US?
Yes it is
>WILL IT CAUSE A LOT OF WEIGHT GAIN?
No. But remember it is better to be fat than insane.
>BASICALLY HYPER-VIGIL ABOUT MY ENVIRONMENT AND EMOTIONAL CUES.
Are you still this way?
> I WAS ON 40MGS LEXAPRO FOR A NUMBER OF YEARS, WHICH DID HELP ME BE MORE PRODUCTIVE. MY ONLY CONCERN ABOUT GOING BACK TO THAT DOSE IS I WAS ALSO QUITE IMPULSIVE, MORE ADVENTURE SEEKING, AND MADE SOME BAD DECISIONS (HAVING SEX WITH THE WRONG PEOPLE, ETC.).
You know this indicates bipolar II, which would explain a lot of your anxiety. Have you tried lithium and lexapro together?
> MAYBE I SHOULD TRY ABILIFY AGAIN. I WAS ON IT FOR AT LEAST A WEEK AN WAS AN EMOTIONAL WRECK. HOW MANY DAYS DOES IT USUALLY TAKE TO STABILIZE?
I forgot to mention Abilify can cause mood swings in people who are bipolar.
> SPOT ON. I DEFINITELY THINK THE ANXIETY COMES BEFORE THE DEPRESSION. I START THE DAY FULL OF HOPE, THEN COMES THE ANXIETY/NEGATIVE THOUGHTS, THEN I SPIRAL INTO DEPRESSION. OR I GO INTO A DEPRESSION IF I'M FACING AN ANXIOUS SITUATION I'M SURE I CAN'T HANDLE.
Your mood shifts seem quite apparent to me now. I think a mood stabilizer might help you-along with an antidepressant.
> MY PDOC WANTS TO TRY EMDR THERAPY WITH ME BECAUSE OF PAST TRAUMA. ANY THOUGHTS ON THAT?
I'm not impressed by thee data on EMDR, but it won't hurt.
> > How does your anxiety affect your mood?
>
> AGAIN, GREAT QUESTION. A LOW LEVEL OF ANXIETY IS OFTEN MOTIVATING AND FEELS TOLERABLE AND, UNFORTUNATELY, NATURAL. A MEDIUM LEVEL OF ANXIETY CAUSES ME TO BE AGITATED, BECOME MORE OBSESSIVE, AND START TO HAVE MOOD SWINGS. A HIGH LEVEL OF ANXIETY CAUSES ME TO BECOME VERY UNCOMFORTABLE, VERY OBSESSIVE, AVOID THINGS I NEED TO DO REALLY DO, AND SPIRAL HEAVILY INTO SELF-HATRED AND DEPRESSION.There's definitely alot of mood shifting going on and I think what's happening is your anxiety shifts as your mood worsens. People who are bipolar 2 tend to experience a lot of anxiety as mood shifts.
What was your experience on lithium?
Eric
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