Psycho-Babble Medication Thread 659549

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Help w/ perspective

Posted by puravida on June 20, 2006, at 23:37:28

Hi all,

I used to post here a lot - it has helped me a lot. I've spent the past few years self-medicating w/ wine and sometimes food, and finally stopped the booze 5 months ago. I mean, completely. Since then I have been trying to shake the depression I seem to always have a bit of, but things are actually seeming worse lately. I've been doing everything I can w/natural/alternative stuff, but it only lasts a day or two - I can't seem to get all the balls in the air again/still.

I have asked my doc, casually, 3x since Feb if he things I need an adjustment on my meds. He did up my Prozac from 10 to 20, but that hasn't helped. He just says "stay sober and exercise". Well, besides staying sober and going to work, I am not doing much more in the way of self care, and it is getting harder and harder. Two weeks ago I saw him again and was more hopeful he would make a change, but no. My binging is really, really bad, plus I can tell I am not right, and am dabling with drinking just to try to feel "normal". I guess he thinks that if I can get to work I am not bad off enough.

I have been on meds over 10 yrs now, and have had times of very good mental and physical health - as well as bad, of course. Now I am on Wellbutrin SR 200 am and 200 afternoon, and 20 mg Prozac. This is the 3rd time for Prozac and 2nd for WB. Come to think of it, toward the end of the last time on Wellbutrin, I had a lot of problems w/ binging on whatever I could find.

So, I am drinking as I type, hoping to maybe feel confident and alive for a bit. Of maybe it's a "look!" to my PD. I know its not the long term answer, and really hope the result of this night is that my meds get adjusted and I stay off the wine from here on out.

Anyhow, can anyone give me some perspective, cuz I'm too busy trying to keep all my balls from rolling downhill, much less juggle them. Since the increas in Prozac didn't work - does that maybe mean it pooped, and another increase won't work? Should I ask to try another one of the newer AD's? Oh - I have also been taking 600 SAMe, aminos, fish oil, you name it, as often as I can remember. But like exercise, I think I am basically hopeless that anything will work (cuz it doesn't seem to be) so I don't stay on it for long. But I am religous about the prescription meds.

Anyhow, sorry this is so long. I would really appreciate your helping remember what I am supposed to do when I am in this state.

puravida

 

Re: Help w/ perspective

Posted by fca on June 21, 2006, at 13:29:46

In reply to Help w/ perspective, posted by puravida on June 20, 2006, at 23:37:28

I do not know what to suggest--My daughter left yesterday for a 45 day residential program that specializes in substance abuse (alcohol in her case) and eating disorders. We all know that she also has some form of long term anx/dep disorder. What I do know and what she freely and clearly admits is that the eating (binging) destabilizes her sobriety and drinking destabilizes her eating disorder. She was very close to death from acute alcohol poising 3 weeks ago and has started to develop some kidney problems from the combination of alcohol and her ED--fortunately her liver is fairly resilient but her enzymes were off the charts but have come down.. My message--alcohol will never get you to where you want to be unless you have a well astablished pattern of very moderate drinking in primarily social situations.
Personally I wou;ld look at some of the other ssri's (perhaps the old faithful paxil) and discuss with your dr. that wellbutrin is almost never recommended if you have an eating disorder--I am not sure but I think it is because it surpresses your appetite (anorexia) and can cause seizures. Please stay in touch and keep the hope. My Best fca

 

Re: Help w/ perspective

Posted by Racer on June 21, 2006, at 13:44:45

In reply to Re: Help w/ perspective, posted by fca on June 21, 2006, at 13:29:46

>...and discuss with your dr. that wellbutrin is almost never recommended if you have an eating disorder--I am not sure but I think it is because it surpresses your appetite (anorexia) and can cause seizures.

Wellbutrin is contraindicated for eating disorders, but it's mostly bulimia, because the resulting electrolyte imbalance combined with the WB lower the seizure threshold too much. Something like one in 250 with that combination will have a seizure. Not bad if you're one of the 249, but do you really want to risk that?

As for perspective, here's mine: Fire your pdoc. Go find a pdoc who actually listens to patients who say, "This just ain't doing the job." Find one whose goal in treatment is OPTIMAL functioning, and not simply survival.

I don't know what else to suggest, but do look into at least getting a second opinion. You're not doing well, and your doctor isn't doing much of anything, it doesn't sound like.

Good luck.

 

Re: Help w/ perspective

Posted by fca on June 21, 2006, at 17:35:28

In reply to Re: Help w/ perspective, posted by Racer on June 21, 2006, at 13:44:45

racer, thanks for the clarification--sounds absolutely right and makes sense--so does your recommendation regarding a new doc.

Even though I am a MH professional I have learned so much as I have watched my daughter struggle with these cooccuring disorders--it has been said that 80% of bulimics are alcoholic and 50@ of bulimics have cooccuring depression. Please find some one who will take the whole package seriously. BTW, my daughter has had significant remissions but they are diseases of relapse. They are treating bulimia more and more with CBT ( based on success with ocd)and aggrssive management with medication. Good Luck and best wishes--obviously you story really rings home and in the heart/ Please stay in touch

 

Re: Help w/ perspective

Posted by puravida on June 21, 2006, at 18:33:16

In reply to Re: Help w/ perspective, posted by fca on June 21, 2006, at 17:35:28

Thanks to you both. I have a call in to the Dr, but they are telling me that instead of adjusting my meds, that I need to do a cognitive therapy course - 4 hr a week for 3 weeks.

To clarify - I don't have a problem w/bulimia or anorexia - I just binge. Lately it has been up to 3 supersize meals a day, plus apple pies and a tub of Ben and Jerry's. Suprisingly I am not gaining much weight - I'm only about 20 lbs over "ideal".

I appreciate the feedback. Thanks -

pv

 

Puravida-- bulimia is defined by binging

Posted by fca on June 21, 2006, at 20:24:25

In reply to Re: Help w/ perspective, posted by puravida on June 21, 2006, at 18:33:16

and puring so you are right--but binging which I have a hunch you are doing, reinforced by your own description, is often considered a form of eating disorder. I would caution you to not distance yourself from the reality of co-occuring disorders. CBT sounds like it could be extremely helpful but don't hesitate to find the right meds-- keep on pushing for what is best for you. good luck fca

 

Re: Help w/ perspective » puravida

Posted by Racer on June 21, 2006, at 23:08:55

In reply to Re: Help w/ perspective, posted by puravida on June 21, 2006, at 18:33:16

> Thanks to you both. I have a call in to the Dr, but they are telling me that instead of adjusting my meds, that I need to do a cognitive therapy course - 4 hr a week for 3 weeks.

Yeah? That's a whopping 12 hours, which is probably your entire year's worth of benefit if your insurance is like most that I've seen. And it would be less than civil of me to offer my reaction to the whole thing...

Don't get me wrong -- I really and truly do believe that therapy is in your best interest, and that therapy and meds is the best way to treat any form of depression. I'm still not impressed by your doctor's take on this. It bothers me a great deal that he is dismissing your concerns this way. A friend of mine, who is a doctor's daughter, told me something once: "It's a time honored tradition for doctors to blame the patient." Meaning, if the doctor's treatment isn't working well, it's because YOU are doing something wrong.

Again, though -- therapy is a good thing. Go for therapy, even if it's not this particular program. And you don't have to go to this one program, just because your doctor's office recommended it. You can find another therapist who works for YOU, if you choose to.

Whatever you do, though -- I strongly urge you to consider getting a second opinion.
>
> To clarify - I don't have a problem w/bulimia or anorexia - I just binge.

Binge Eating Disorder, a subgroup of Eating Disorder Not Otherwise Specified. But I didn't think you meant you had one of the two biggies. Consider yourself lucky about that...

 

Juggling with my hands tied » puravida

Posted by curtm on June 22, 2006, at 11:54:02

In reply to Help w/ perspective, posted by puravida on June 20, 2006, at 23:37:28

> I can't seem to get all the balls in the air again/still.

> Anyhow, can anyone give me some perspective, cuz I'm too busy trying to keep all my balls from rolling downhill, much less juggle them.

This is exactly how I am feeling right now. I have felt this coming on too and tried to turn it around before I lose my balls. I only need one ball going to keep me going, but I have nothing right now. All of them have stopped.

If I can get one ball rolling, even a little bit, I concentrate on it and try to get it rolling better. What this does for me is gives me hope at the same time forget about my balls that aren't rolling. Then I start feeling better, more confident, "lighter." I keep rolling the one ball, but I don't push it hard. I just ride it and help it sometimes. Before I know it my other balls start to roll ever so slowly. Once they are going they are easier to manage.

I don't know about your balls, but mine are "self, marriage, family, and work" mainly. There are more, but I don't feel like thinking too hard about my balls right now. I lean a lot on my spouse, but she couldn't care any less about my balls right now, so I have to lean on something else.

I have a couple things in the works. Some new balls! Like a T. T-ball. Going to see if I can get the self ball rolling with my T and screw the other balls for now. Self is the most ignored one usually anyway and should come first. I am finally learning that.

Good luck with your balls. Here's a gentle push for the one you would like to get rolling the most (uffda!)

 

An update

Posted by puravida on June 23, 2006, at 10:15:49

In reply to Juggling with my hands tied » puravida, posted by curtm on June 22, 2006, at 11:54:02

Hi all,

Thanks for the feedback and support. Yesterday and the day before I took an extra 10 mg of Prozac. I also took 800 mg of SAMe (had been taking 600). It is probably too early to tell for sure, but I see some light peeking through the fog. All my "balls" look fairly managable today - it occurs to me that I can enjoy them if I could stop worrying about them.

Anyhow, it occurs to me, once again, that to a certain degree, trying to get out of depression without meds is like trying to unroll yourself out of a cocoon of saran wrap - doable - maybe. Taking the right amount of meds is like having one arm free - the rest is still a sticky mess, but you can do something about it.

I am sure there is a better analogy, and I may get back down in the dumps again quite soon, but my "real" thought is - screw the "underlying beliefs" that "cause" my depression. I don't stew in my "underlying beliefs" when I am not depressed. Or, maybe more accurately, my underlying belliefs get CHANGED when I am depressed. How can the depressed me be the same person as the one I seem to forget when I am depressed, who was pretty cool? How is it that all of a sudden my "underlying beliefs" have taken control of me and are negative?

OK, I guess you can tell I feel somewhat more confident that the perspective that I had and that you guys helped me see was accurate.

Sometimes I think that it should be a prerequisite for all Dr's who deal with depression and anxiety to have struggled with it themselves. It is only after the fog clears a bit and I stop blaming myself that I see how insideous it is - how important it is to get help from people who understand.

Today, while I don't feel sure of this - I certainly feel closer to taking care of myself - self care, like you mention, curt, is one of the most important things I neglect. I don't feel tempted, really at all, to binge - in fact I am feeling like getting some exercise and eating a healthy meal.

Is all of this cognitive? Did I think my way out of it? To me - I can't explain why I have these more positive urges any more than I can explain the destructive ones. The only thing I can think of, and the only thing I have had consistent results from, is a change in medication - and that allows me to get the balls organized - especially the self-care ball that is so important.

OK - enough - thank you all again. I will post again to let you know if the funk/bingeing comes back, or if I am still getting free, bit by bit.

pv

 

Re: An update

Posted by dave45 on June 23, 2006, at 10:48:49

In reply to An update, posted by puravida on June 23, 2006, at 10:15:49

Hi. There is alot of research done on alcoholism, and it has been shown that alcoholics have a lower d2 receptor density. This has lead soem researchers to theorize that people who can't stop drinking are attempting to compensate and increase their dopamenergic transmission to "normal" levels. I am not suggesting your an alcoholic, however since alcohol seems to relieve your depression, perhaps you would consider augmenting your current antidepressant with a pro-dopamenergic drug. It may provide the same kind or relief you get from alcohol and on a more consistent basis.

 

Re: An update » dave45

Posted by puravida on June 23, 2006, at 11:34:39

In reply to Re: An update, posted by dave45 on June 23, 2006, at 10:48:49

Thanks for reminding me of this. I have often thought dopamine might be more of an issue than seretonin. I did take Serax as needed to help with anxiety and also to help me quit drinking. It doesn't seem to do much for bingeing though and I am worried it could cause more depression.

I do take Wellbutrin - but I read on wiki (http://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitor) that it not only inhibits reuptake but also the release of dopamine??? Maybe the WB is working against me?

I'll revisit this - again, thanks for reminding me. Adhedonia is definately a problem, made worse by ADD-ish fog/noise. My Dr thinks not having fun is a cause of my depression - thanks for reminding me that it is more of a symptom. I mean, who chooses not to have fun/feel good?

Do you have any thoughts on particular drugs I could look into? Books, etc? I have messed around with taking GABA (not much effect) and tryrosine (seems to give me a headache). I may have to sit down and rethink this all again - in addtion to finding a Dr who will work with me.

pv


> Hi. There is alot of research done on alcoholism, and it has been shown that alcoholics have a lower d2 receptor density. This has lead soem researchers to theorize that people who can't stop drinking are attempting to compensate and increase their dopamenergic transmission to "normal" levels. I am not suggesting your an alcoholic, however since alcohol seems to relieve your depression, perhaps you would consider augmenting your current antidepressant with a pro-dopamenergic drug. It may provide the same kind or relief you get from alcohol and on a more consistent basis.

 

Re: An update

Posted by dave45 on June 23, 2006, at 14:58:43

In reply to Re: An update » dave45, posted by puravida on June 23, 2006, at 11:34:39

As for wellbutrin, it's mechanism of action is complex and poorly understood. It breaks down into about five or six different metabolites, all of which seem to have different pharmacodynamic actions. It does promote dopamine release, but you are correct in that it also increases the reuptake of dopamine. Many people believe wellbutrin's effects come from more from its noradrenergic effects. This would make sense to me, as the feeling i got from wellbutrin was similar to what i experienced on remeron, both of which have strong pro-noradrenergic action. For me, wellbutrin helped a little intially (not alot) but then made me frist very angry, then absolutely crayz with anxiety. A different kind of anxiety then I usually experienced, more of a "death is upon me" kind of feeling. For me, very bad.
As far as dopamenergic drugs go, there are direct dopamine agonists, things that are usually used to treat parkinson's, that have some efficacy in depression. The most popular of these is mirapex. That is somewhat preferential for the d3 receptors. There is also dostinex (cabergoline) and one other brocriptomine or something similar. Those are preferential fro the d2 receptors. Other dopamenergixc drugs which are used as adjuncts in depression are stimulants, such as dexedrine or adderal. There are the MAOIs such as parnate and nardil, which increaser the amounts of all three neurotransimtters. There are also reversible MAOIS that tend to deaminate the enzyme MAO B more then MAO A. Mao B is the enzyme that mostly break downs dopamine, whereas MAO A breaks down serotonin, and if your problem is dopamine related these might benefit you without the side effects of the MAOIS. Examples of this are moclobemide or deprenyl, which is currently available in patch form under the name emsam. Of course all this you should discuss with your doctor before making any changes. Hope this helps. Good luck.


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