![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by chiron on April 23, 2006, at 16:54:28
33, have been depressed for at least 23 years. Started Prozac about 20 years ago (was it available then?)
On and off with mostly SSRIs – helps my pms
Currently on 100 mg Zoloft & 300 mg Wellbutrin
Mostly functional, but miserable. Offer me the blue pill to permanently end my existence and I would take it any day.
SSRIs seem to take the edge off. I’m confused about my body’s reaction when I try to increase Zoloft. At times it has been stimulating, and other times at has created too much sedation.
I remember the last time I increased my Wellbutrin to 450- I felt really good for a couple of days but then it faded.
I recently tried Adderall. At 30mg I was feeling great (to my surprise) for about a week. Then it didn’t seem to do anything (except make me feel acidic), and then it seemed to make my depression (pms?) worse. I stopped, but then have been actually taking it here & there with okay-to-neutral responses. It definitely helps me study.
I also recently tried Abilify. I was on about 5mg for a couple of weeks, then up to 10mg. It increased my ‘crazyiness’ feeling and made me gain weight.
My ‘craziness’ feeling: dark isolated tunnel in my head (& sometimes my gut?)– agitated to do something, yet don’t feel like doing anything – feel stuck in time – can’t figure out how people can handle living day to day – will I have to exist when I’m dead?
I’m pretty much always down, but sometimes I observe how sometimes my head gets even darker for no situational reason. Sometimes I have more motivation, sometimes not at all. Sometimes I feel ‘crazier’ than others. It’s hard to say if it is just screwy hormones or some rhythm problems.
My dr is thinking that maybe because I had a positive response to the adderall, that I just need more...?
Other meds I’ve tried:
Effexor
Paxil
Lamictal – bad acne
Seroquel
Tegretol
Lexapro
Zyprexa
Posted by blueberry on April 23, 2006, at 17:39:26
In reply to Linkadge or anyone - advice on meds, posted by chiron on April 23, 2006, at 16:54:28
I can relate to the "craziness" stuff you speak about.
I think for some of us it is so hard because we find that what helps the most...dopamine...also poops out real fast due to tolerance. And too much dopamine actually creates depression and also craziness. So it is a fine balance with no apparent answer. Just a guess, but maybe the dopamine agonism of abilify is what amplified the craziness. The dopamine increase of a higher wellbutrin dose caused depression. Maybe.
A close alternative though is norepinephrine. I wonder how you would do with cymbalta instead of an ssri? I know for me anyway, that extra little norepinephrine kick feels just as good as dopamine, but doesn't seem to develop tolerance as quickly or craziness. You could get the serotonin dampening and a norepinephrine boost at the same time with cymbalta. Maybe. You could probably do it without any drastic changes by reducing the zoloft to 75mg and adding in 20mg cymbalta. If that goes decent, then adjust as needed.
Sometimes this craziness stuff is glutamate related. Too bad you couldn't retry lamictal at a slow pace with tiny dose increases and slow down the glutamate.
There are other easy things to try. Xanax for example, whether it makes any sense or not. All you need to do is try it for 3 days. If you don't like it, then try klonopin for 3 days.
And the mood stabilizers. You could try depakote extended release 500mg for just a week. That's all it would take to find out what it can do. For me it had considerable calming, mood lifting, stabilizing, and anticraziness stuff to it even on the first day. The fogginess side effects eventually got me frustrated with it. Other mood stabilizers I am not familiar with, other than lithium which even at low doses greatly increased my craziness in just 24 hours.
I wish there were some obvious easy answers. But hopefully there might be something in here to think about. My heart goes out to you with lots and lots of compassion for your bravery.
Posted by Racer on April 23, 2006, at 18:15:54
In reply to Linkadge or anyone - advice on meds, posted by chiron on April 23, 2006, at 16:54:28
I'm not Link, but here's a tiny bit for you, anyway: according to my pdoc, one not too uncommon a side effect of Adderall is increased depression. I certainly experienced it, which is why I no longer take Adderall.
Dexedrine doesn't seem to do that for me, and it maybe boosts my AD a bit. (Hard to tell, because of situational factors.) Ritalin boosted my mood A LOT, but I had trouble with it in other ways, so it's not an option I'm willing to try again. (No big deal -- it increased my appetite -- but it was a big deal to me, and I didn't think I could get through the time necessary to see if that would pass.) Provigil also boosted my mood, and I took it for a couple of years.
Anyway, the point of all that is that it's still worth trying other stimulants. Just because one doesn't work, doesn't mean the others won't be helpful. I hope that helps.
Good luck.
Posted by chiron on April 23, 2006, at 20:25:13
In reply to Re: Linkadge or anyone - advice on meds » chiron, posted by blueberry on April 23, 2006, at 17:39:26
thank you racer & blueberry. you've given me some hope to my hopeless day.
how closely related is cymbalta to effexor? the effexor withdrawal i went through was pure hell (my craziness multiplied many times)
depression sucks but is seems more simplified than when I have the 'crazy' feeling. i just don't get it. are all of my neuro systems just wacked out?
i've tried to tell a few people that i'm crazy and no one believes me :)
Posted by Phillipa on April 23, 2006, at 22:20:23
In reply to Re: Linkadge or anyone - advice on meds, posted by chiron on April 23, 2006, at 20:25:13
To relieve your mind if you think you are crazy you probably not. Effexor is much stronger than cymbalta. They are SSNRI's. But seriously with so many meds things going on. Your pdoc should be called in the am. Let him decide what to change first if anything. Good luck and really sorry you feel so bad I can relate. Love Phillipa
Posted by jerrympls on April 24, 2006, at 7:32:34
In reply to Linkadge or anyone - advice on meds, posted by chiron on April 23, 2006, at 16:54:28
Ever try a calcium + magnesium supplement? There's a lot of research out there showing it's amazing effectiveness for depression and anxiety. I've had treatment resistant depression for 14 years - been on everything including ECT and the VNS implant. I started taking Magnesium Taurate about 2 weeks ago and my anxiety, feelings of dread, etc have significantly decreased.
Something to think about.
Jerry
Posted by linkadge on April 24, 2006, at 9:08:33
In reply to Re: Linkadge or anyone - advice on meds » chiron, posted by jerrympls on April 24, 2006, at 7:32:34
Hows your sleep throughout all of this. How would you rate your sleep on your current med regiment ?
Linkadge
Posted by chiron on April 24, 2006, at 10:07:11
In reply to Re: Linkadge or anyone - advice on meds, posted by linkadge on April 24, 2006, at 9:08:33
> Hows your sleep throughout all of this. How would you rate your sleep on your current med regiment ?
>
> Linkadgemy sleep is okay.
can the adderall make you higher but then lower?
Posted by jerrympls on April 24, 2006, at 16:56:45
In reply to Re: Linkadge or anyone - advice on meds, posted by chiron on April 24, 2006, at 10:07:11
> > Hows your sleep throughout all of this. How would you rate your sleep on your current med regiment ?
> >
> > Linkadge
>
> my sleep is okay.
> can the adderall make you higher but then lower?
>Oh Certainly it can. I'm on Adderall XR - which I like more than the immediate release form because it's smoother and has less of a crash.
Jerry
Posted by linkadge on April 24, 2006, at 17:04:06
In reply to Re: Linkadge or anyone - advice on meds, posted by chiron on April 24, 2006, at 10:07:11
Yeah, adderal may or may not be a good idea in certain mood disorders. Stims can usually cause significant, (but temporary) improvement in some depression.
You may get more help from an older tricyclic antidepressant. You may also see improvement with the use of certain alternative supplements.
You mentioned feelings of craziness, do you ever have mind racing, or mind noise, or is it more dark and suicidal feelings?
You might do better by reducing the zoloft a little, and replacing the wellbutrin with a TCA like nortryptaline.
Linkadge
Posted by chiron on April 24, 2006, at 17:26:46
In reply to Re: Linkadge or anyone - advice on meds, posted by linkadge on April 24, 2006, at 17:04:06
"You mentioned feelings of craziness, do you ever have mind racing, or mind noise, or is it more dark and suicidal feelings?"
dark, want to die but scared to die, so i feel stuck in a black hole. it's worse today, i had to leave work. this feeling started even when i took the adderall...?
this feeling is familiar to me, but it is usually not this bad. and because it is familiar it makes it worse - i can't go on like this.
Posted by linkadge on April 25, 2006, at 10:43:08
In reply to Re: Linkadge or anyone - advice on meds, posted by chiron on April 24, 2006, at 17:26:46
It seems to me that your depression simply isn't responding to the medication you're taking.
You could try a TCA or an MAOI if you knew a doctor who might support that choice.
Linkadge
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.