![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by crittercuddler on December 13, 2008, at 6:39:29
Hello all, I am a new member. I have been reading posts for hours so I hope this comes out coherently.
I have severe OCD and major depression, suicidal in nature. I have been unable to obtain relief in the last several years due to the following:
1. I USED to take Celexa, 60mg for the OCD and depression. I took it from Fall of 2001 until December of 2005 at which point I stopped it after completing a taper. I stopped it with the intention of getting on another anti-depressant because I felt the Celexa had lost its effectiveness. (I have since wondered if perhaps the fact that it went generic around the time I first noticed it was losing its effictiveness might have had something to do with it, but it is a moot point now.) When I was on it and it was "working" it only worked partially. It took the edge of my obsessions and slightly helped my depression. I was by no means cured, but it did help me function at a much higher level than I am able to without any medication.
2. Ok, SINCE getting off the Celexa I have not been able to tolerate any other SSRI for more than a couple of days and rarely, for a few weeks, before I had to stop because of the following side effects:
a. awful insomnia, helped only by Seroquel ***b. severe restless feeling, but I don't feel
well enough to do anything about it so I it is very uncomfortablec. obliterates my ability to concentrate or keep my train of thought (it feels like rocket science to straighten out my purse)
d. short term memory difficulties
e. myoclonic jerking when trying to sleep. (this is new and started since I have gotten off of Klonopin) The jerks whenever I try to relax or go to sleep. I will get a jerk everytime I start to drift off. This complicates the insomnia, making any chance I had of getting to sleep go away.
*** I tried 5mg of Prozac and it made me tired. Isn't that odd as it is supposed to be stimulating, right? I discontinued the 5mg because I was getting the other side effects that I mentioned.I have tried tiny doses of the SSRIs and I get the same awful side effects, even at 5mg of Zoloft, 5mg of Paxil, 2.5mg of Celexa... It is insane.
The fact that I can no longer tolerate an SSRI is very strange considering the fact that I took one for several years. Yes? As soon as I finished my Celexa taper I tried a new one and I couldn't handle it. Since then I have been banging my head up against the wall trying them to get on any one of them over and over and over again. What on earth happened?
I desperately need to get stabilized on a medicine, but I have been trying unsuccessfully for 3 miserable years now to do so because of what I mentioned above. I am not able to work or go to school and my functioning has been all but reduced to zero. I am persistently suicidal and living in utter misery. My OCD is out of control. And on top of all that I am still suffering from benzodiazepine withdrawal syndrome.
I am hoping that someone on this forum has had a similar experience and might be able to offer some advice on what medicines I might consider other than the SSRIs as they seem to not be an option for me. Please keep in mind my diagnoses of OCD and major depression.
Posted by crittercuddler on December 13, 2008, at 7:59:23
In reply to SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 6:39:29
Do I need to explain how my OCD manifests itself?
It is very obsessional in nature. The only outward signs you might see would be my over-vigilance, perfectionism at projects, and endless researching on the computer. Most all of my problem goes on in my head where no one can see it. My OCD therapist taught me that I have mental compulsions, which have names, but that I won't go into. Those that have the know what they are....
Some of my biggest obsessions include revolve around the fear of losing my mental abilities, like my creativity, memory, and intelligence. I can't do anything without constantly assessing my mental functions. I therefore do a lot of mental checking which is a compulsion you can't see. It steals all the joy from the precious present moment.
I have severe obsessions about failing or accidentally causing harm to someone, of course related to me being somehow inferior intellectually.
I often find that my mind gets stuck thinking over mundane things... like an insignificant conversation I had with someone or some random thing that happened during the course of a day. I get stuck in these awful thought loops that I can't escape. Even when I feel like I have come to a conclusion my brain just short circuits or something and I start thinking about it all over again. And of course when I am confronted with a problem that really demands my attention or that is worth thinking about I REALLY obsess.
My OCD has changed a lot in the 14 years I have had it. When I first developed it I had extreme germ phobias and ego alien thoughts.
Well, that is just a wee bit about my OCD to give you an idea of what it is like. I just wanted to clarify that I don't have counting compulsions or rituals or anything like that.
Posted by raisinb on December 13, 2008, at 11:04:04
In reply to SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 6:39:29
There are lots of options besides SSRIs. One frequently prescribed med is Remeron, which has a very different mechanism of action. Have you given that a try yet?
It is supposed to be helpful for anxiety and overstimlated depressions. Plus, I seriously doubt you'd experience insomnia on it. At low doses it really knocks you out. The downside of Remeron is weight gain. I used to run 60 or 70 miles a week and still I have never experienced hunger like I did on Remeron. But for many people, I guess that levels out after dosage increases and being on it awhile.
There are other more novel meds like tianeptine, trazodone, etc. to name a couple that are frequently mentioned here. Other posters can give you more info about that, as many of us have tried them.
Posted by Phillipa on December 13, 2008, at 12:16:38
In reply to Re: SSRI insomnia, restlessness, poor concentratio » crittercuddler, posted by raisinb on December 13, 2008, at 11:04:04
I do have the counting ritual and fears about everything seem to come and go. I do take benzos but after 37 years doubt will come off them as pdoc says I'm tolerant now. I'm taking low dose of luvox too as I also had the same experience with ad's l0mg of paxil worked after three months and since then the tiniest doses can't tolerate or feel nothing. And it's 14 years for me too. The benzos were started in 70's due to severe panic attacks which resolved when busy and working. Was even med free for a long time. And then back when thyroid went. So I truly wish I knew as have done so many searches. May this thread bring some answers and welcome. Love Phillipa
Posted by crittercuddler on December 13, 2008, at 14:14:22
In reply to Re: SSRI insomnia, restlessness, poor concentratio » crittercuddler, posted by raisinb on December 13, 2008, at 11:04:04
I have tried Remeron. I tried it once along with Nortriptyline for a two week trial of both medicines, both at the starting dose. This first time the combination seemed to depress me more. I felt so apathetic and just odd. I woke up from a dream and thought I saw a spider hanging from my doorway. It really scared me as I have never had anything like that happen before. I couldn't be sure if it was the Remeron or the nortriptyline.
I tried Remeron again for one dose a few months ago. This time I had some difficulty falling off to sleep and then when I was asleep I had very disturbing dreams like none I had ever experienced before. It was like I was half awake and half asleep, like I could feel the incredible urge in my muscles to act out my dream or that the struggle I was feeling in my dream seemed very real like I was partly concious and experiencing it. Very scary and very odd.
These two experiences have thus scared me from taking it.
I also read that it can lose its effectiveness fast and might cause a feeling of depersonlization. These are claims I read online, each I saw only the one time each, but reading those things caused me to be even more leary of it.
I have been dealing with depersonilization from the benzodiazepine withdrawal syndrome and severe depression I have, so I definitely don't want that.
It is difficult for me trying to get on a medicine with my OCD so rampant because when I get a scary side effect I start to worry it will never go away and I get scared and stop taking it. It really kicks up my fears of hurting my brain somehow.
I must clarify however that I am sure that my intolerance of SSRIs is not a product of the OCD medicine fears... I really can't tolerate them. I admit though with other meds I could likely try them longer than I have.
Can you talk to me more about the novel anti-depressants you mentioned?
Posted by crittercuddler on December 13, 2008, at 14:25:53
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by Phillipa on December 13, 2008, at 12:16:38
Phillipa,
So you have the same problem with SSRIs? You can't tolerate them for the same reasons as me? I am a bit confused about what happened with Paxil. Did it stop working after 3 months? Did you try to tolerate it that long and it still wasn't better?
I really worry about you being on benzos. Long term use can exacerbate depression and cause a whole laundry list of other awful problems. Coming off of them might likely be the hardest thing you ever had to do, but maybe you might consider it anyway? Only you can decide. But, before you do, have you seen "The Ashton Manual"? I encourage you to look it up online and read it. Also, check out sites like www.benzobuddies.org and www.benzoisland.org. These sites are support groups for withdrawaling that follow the Ashton method. Benzobuddies was there for me and still is. I am 6 months Klonopin free now. I took it for a year and a half all together, 3mg daily. I can honestly say it made me much worse and the taper and post withdrawal have been so awful. I hope I am healing a little bit more each day. I am so glad to be free of it.
Well, thank you for sharing and for the welcome.
Posted by desolationrower on December 13, 2008, at 15:16:31
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 7:59:23
Hi, welcome here. Do you think that your disease is interfering with your perception of the medication's effect upon you? I wonder if that is happening, it would be very catch-22. Have you discussed this with your therapist? Unfortunatly benzos are the usual way to get through the sri startup period, and so getting on one will be harder for you. The other commonly prescribed drug is antipyshcotics but they usually worsen ocd if not taken with an sri. Perhaps you would be helped by one of the antiglutamtergic drugs. Opioids are an other option.
I'd also be a bit concerned with the seroquel, as it might be worsening things, taken without an sri. Have you tried trazodone for sleep?I suppose you could try starting with buspirone, which could possibly be helpful, but mostly as something to take before starting ssri and might help you get onto an ssri. You might have some slight benefit to your depression from an nri like desipramine. Nortriptaline with an sri (either citalopram or clomipramine) showed more rapid and greater OCD effectiveness than sri alone. that might be worth trying instead of a long slow titration up.
-d/r
Posted by crittercuddler on December 13, 2008, at 16:11:33
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 13, 2008, at 15:16:31
d/r -
Yes, I would agree that my OCD is making it very difficult for me to get on and stay on a medication.
The SSRI situation is real and not caused from medication fears (the insomnia, restlessness, and other stuff I mentioned), but I would agree that the OCD has likely caused me to stop many drugs other than SSRIs before I gave them an adequate chance. Just about every drug I take I have a lousy reaction to... I feel really doped up, or I feel blank, or I can't think very well, or I have insomnia... etc... etc... It is very much a catch 22. I desperately need a medication to help me, yet without a medication I find it nearly impossible to cope with any moderate side effect. I become so scared that the drug is damaging my brain and it really puts my OCD fears about losing my mind into high gear. I also just have poor coping skills I am sure. I don't think "hey, I can make it through it". I try to think positive but I always end up stopping the med as a compulsion. I don't know if I am having odd reactions or if reaction to the drug is normal. All I know is that to me it feels extreme and I can't imagine living that way for days on end.
I realize in many ways I am working against myself. But I have tried outpatient treatment with a wonderful OCD therapist (but my severe depression was undermining my therapy as I was not medicated and the therapy wasn't helping me get medicated), I tried Klonopin to get on an anti-depressant (that is why I got on it in the first place), and I have generally been trying on my own will power to get on an SSRI for 3 years now. It is an awful nightmare. I can't break the cycle.
Which antiglutamergic drugs do you suggest? Are any even available in the United States? I don't want to take an Opiod. I believe that will open the same can of worms and carry the same risks as a benzo.
I was given trazadone in the hospital, to try and help me sleep when they were trying to get me on Paxil. It didn't do a lick of good. With the Paxil in my system I couldn't sleep even with Klonopin, Trazadone, and Vistaril. The insomnia is SOOOOO bad. I only tried it that one time in the hospital though, just one dose, and I am sure it was like a smaller dose, like 100mg or something? I am not sure of the dosing.
I don't think combining and SSRI with another anti-depressant would help. I just can't tolerate the SSRIs.
Thank you for your suggestions. Hoping to hear back from you about the drugs that work on glutamate. I know that they are focusing on that now in OCD research, right?
Posted by Racer on December 13, 2008, at 17:57:13
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 16:11:33
From reading this thread, there are two issues I'd like to focus on:
1. Your OCD seems to be working against you.
Since my OCD gets into lockstep with my depression whenever I try to start something new, that's as far from criticism as it's possible to get on this planet. The question, though, is what to do about it?
Since it's such a problem for me, I'll offer you some of the things that have helped me:
Discussing my OCD-related reactions with my doctor in advance, so that we can work together to head them off. We've hit on two strategies that work well together, and have helped more than everything else we've tried put together -- and far more than benzos, for me.
A: Before starting a new medication, we discuss what we'll do if it doesn't work. We'll go through our entire list of possibilities -- it's a lot quicker now, since we've already discussed the options so many times. That reduces my anxiety -- not only about the medication and whether I'll have a good or bad experience on it, but also that my doctor will still be helping me even if this drug isn't a good one for me. That last part is the important part, by the way: a huge part of the fear is that the doctor will be angry and blame me if the drug doesn't work. (Unfortunately, I have had that experience.)
B. We set up a schedule of check ins during the start up period. We do it via email, because that's how we usually communicate between sessions, but telephone could work just fine, too. The check ins are short -- just whether anything is happening, good or bad, really. The reassurance is beyond my ability to communicate to you. I think that's been the best part -- I know that, if I do have a bad experience, my doctor will know within days (unless it's so bad I email right away instead of waiting), and I trust him to help me with it. Sometimes that means stopping a drug right away, other times, he's got a way to help me stay on it. Those email check ins are great for me.
The other thing that helps me is simply reminding myself that it's likely I'm experiencing a start up phase effect, rather than a long term effect, and reminding myself that I will never get relief if I can't get through the start up phase.
B. You seem to be focused on SSRIs, which don't appear to be helpful to you right now.
You only managed the one dose of Remeron, which would be high on my list of suggestions. I'd suggest trying again -- just on its own. (I hate hearing about starting multiple drugs at once -- not good science.) If you can set up a check in with SOMEONE -- your doctor, a nurse or PA in his/her office, even the receptionist! -- you might find it possible to get through the start up phase.
Otherwise -- Effexor or Cymbalta? Effexor is considered an old reliable by a lot of doctors -- it's a good medication, and worth trying. Despite the stories one hears about the discontinuation, it's still a good drug. Cymbalta, though, might be a better choice to try first. It's like a kinder, gentler Effexor -- although not as reliable, according to anecdotal reports.
Zyprexa, which might be helpful for the OCD, and help you get onto the antidepressant.
And, if you are convinced that you will respond best to one of the SSRIs, I suggest strongly you choose one -- Zoloft is my favorite, for whatever that's worth -- and take something with it to counter the insomnia. Personally, I like Rozerem best -- I try to take it the same time every day, about an hour before I go to bed. It's subtle, but I sleep well on it -- I sleep nearly all night, it doesn't seem to affect my dreams at all, it doesn't seem to have any negative effects on my sleep quality, and it's the only one I've tried that doesn't leave me feeling a little weird the next day.
Those are my suggestions. I hope something in here helps.
Good luck.
Posted by Phillipa on December 13, 2008, at 18:52:57
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by crittercuddler on December 13, 2008, at 14:25:53
No after three months the l0mg of paxil side effects went away with the benzos low doses as seems not a problem for me to cut down whenever. I took for two years when nursing with benzos and my afterwork beer . Felt great went off cause Son coming to live with us and he's antimed so stopped it. They thyroid went or escalated again and pdoc changed the SSRI and never been the same again been on them all and cymbalta and effexor. Funny the cymbalta first time didn't have one side effect with benzo low dose but stopped after three months as it did nothing but did relieve backpain. OCD is why I stay with the luvox low dose. I trust it and brain seems to need it. So all docs say stay on it. Seems the lower the dose the better I do been years now and cutting down on benzos as now make me tired opposite of beginning as then gave energy. Love Phillipa
Posted by desolationrower on December 13, 2008, at 19:08:44
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 16:11:33
Well, not only would combining another med with an ssri make it work better, it could also work faster, so you might start to get some benefit within a few days. Also, the sort of symptoms you describe relating to cognition are often helped by nris. even if it doesn't help you get on an ssri, you might get some benefit for your depression at least. I guess i'm trying to think of how to get you onto an ssri in a way that doesn't bother you because they're really the gold standard, and it sounds like theyve helped you in the past. Perhaps being hospitalized for a week or two could help you? also have you tried nefazodone
Oh and inositol has shown efficacy in ocd, through soem of the same mechanisms as ssris, but with fewer side effects. buy it bulk, you need 15-20g a day. its tastes like sugar though (actually it is a sugar...). i have no idea if that would synergize with an nri as sris appear to do.
as for glutamatergics, N Acetyl cysteine would be the easiest, its an over the counter drug that is usually used to boost glutathione levels, which might be beneficial as well. Riluzole and memantine have been used as well. I'd go in order NAC->memantine->riluzole, just because of price and there isn't much data on whihc is best. Generally they have been studied as augmentation to ssris. probably need 1.5-3g of NAC a day, probably split doses. Memantine, i'd aim for 40mg.
Theres also psylocin. If you have time to go for a nice nature walk to prescribe it, its certainly the most pleasant way to reduce OCD.
Not that you asked about it, but hopefully you are doing healthy things like getting fish oil and meditating that also can help.
-d/r
Posted by azalea on December 13, 2008, at 21:51:00
In reply to SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 6:39:29
Are you currently taking any medications, prescription or over-the-counter?
Have you tried inositol supplements?
> Hello all, I am a new member. I have been reading posts for hours so I hope this comes out coherently.
>
> I have severe OCD and major depression, suicidal in nature. I have been unable to obtain relief in the last several years due to the following:
>
> 1. I USED to take Celexa, 60mg for the OCD and depression. I took it from Fall of 2001 until December of 2005 at which point I stopped it after completing a taper. I stopped it with the intention of getting on another anti-depressant because I felt the Celexa had lost its effectiveness. (I have since wondered if perhaps the fact that it went generic around the time I first noticed it was losing its effictiveness might have had something to do with it, but it is a moot point now.) When I was on it and it was "working" it only worked partially. It took the edge of my obsessions and slightly helped my depression. I was by no means cured, but it did help me function at a much higher level than I am able to without any medication.
>
> 2. Ok, SINCE getting off the Celexa I have not been able to tolerate any other SSRI for more than a couple of days and rarely, for a few weeks, before I had to stop because of the following side effects:
>
> a. awful insomnia, helped only by Seroquel ***
>
> b. severe restless feeling, but I don't feel
> well enough to do anything about it so I it is very uncomfortable
>
> c. obliterates my ability to concentrate or keep my train of thought (it feels like rocket science to straighten out my purse)
>
> d. short term memory difficulties
>
> e. myoclonic jerking when trying to sleep. (this is new and started since I have gotten off of Klonopin) The jerks whenever I try to relax or go to sleep. I will get a jerk everytime I start to drift off. This complicates the insomnia, making any chance I had of getting to sleep go away.
>
>
> *** I tried 5mg of Prozac and it made me tired. Isn't that odd as it is supposed to be stimulating, right? I discontinued the 5mg because I was getting the other side effects that I mentioned.
>
> I have tried tiny doses of the SSRIs and I get the same awful side effects, even at 5mg of Zoloft, 5mg of Paxil, 2.5mg of Celexa... It is insane.
>
> The fact that I can no longer tolerate an SSRI is very strange considering the fact that I took one for several years. Yes? As soon as I finished my Celexa taper I tried a new one and I couldn't handle it. Since then I have been banging my head up against the wall trying them to get on any one of them over and over and over again. What on earth happened?
>
> I desperately need to get stabilized on a medicine, but I have been trying unsuccessfully for 3 miserable years now to do so because of what I mentioned above. I am not able to work or go to school and my functioning has been all but reduced to zero. I am persistently suicidal and living in utter misery. My OCD is out of control. And on top of all that I am still suffering from benzodiazepine withdrawal syndrome.
>
> I am hoping that someone on this forum has had a similar experience and might be able to offer some advice on what medicines I might consider other than the SSRIs as they seem to not be an option for me. Please keep in mind my diagnoses of OCD and major depression.
>
>
>
>
>
Posted by raisinb on December 13, 2008, at 21:53:41
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by crittercuddler on December 13, 2008, at 14:14:22
I don't know a lot about the other meds I mentioned, as I haven't been on them. Others on this board have.
On Remeron, I *did* experience mild hallucinations and crazy, crazy dreams that were hard to get--mentally or emotionally--out of once I was awake. This was on a 30 mg dosage. These are common side effects and not necessarily dangerous, though if they freak you out a good deal, I can see why you wouldn't want to take it. Take things you read online with a grain of salt. People's experiences vary so widely. One person's wonder drug can send another person into major psychosis or suicidal depression, or cause terrible side effects.
Posted by crittercuddler on December 14, 2008, at 3:54:43
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 13, 2008, at 19:08:44
d/r -
I see you mentioned an NRI could help an SSRI work faster and better. My next question would be, would it also help me tolerate the SSRI better? Also, when you say NRI, you don't mean an SNRI (like Cymbalta or Effexor), do you? Are you considering Serzone an NRI? I read that it does inhibit NE uptake, but it is also described by other terms as well so I wasn't sure. I am guessing that you were suggesting Serzone as an NRI since you mentioned it in the same paragraph.
I must say that looking at Dr. Bob's fact sheet on nefazadone is encouraging where he mentions that is seems to not cause insomnia, or as he put it "sleep disturbances". Of course, I wouldn't count on that to be true for me. I guess I would just have to see. Also, I of course like how you said NRIs can help congnition. Of course, they also say SSRIs are supposed to help with memory and concentration by alleviating depression! Perhaps that would be the case were I able to get back on one and stay on it long enough. I will ask my doctor about it.
I have been hospitalized three times this year, each for a week, already. Each time I was titrated up quickly or started on a dose of an SSRI I couldn't handle. I spent all three weeks with terrible insomnia. The acute hospitalization strategy has not worked for me. With my sensitivity issues, it is just not practical. This year was the first time I had ever had to go to a hospital for the depression and OCD being so out of control.
Do the glutamatergics show efficacy in alleviating depression, or just in OCD?
I do remember reading about inositol last year. I had forgotten about it though. I get so wrapped up in trying to get an a prescription drug since one had worked for me in the past.
I know, I am stuck on the desire to want back on an SSRI myself, as well. I have been endlessly trying being driven by that desire for three years now. It is so frustrating.
Posted by crittercuddler on December 14, 2008, at 3:57:59
In reply to Re: SSRI insomnia, restlessness, poor concentratio » crittercuddler, posted by azalea on December 13, 2008, at 21:51:00
azalea,
OTC - I take fish oil and a organic whole food multi vitamin daily. I have been doing that for only a couple of weeks. I often miss days though because I am in bed not wanting to live, much less get up and take a vitamin. I also have been taking gingko biloba for that same amount of time hoping it would help with my tinnitus.
I am not taking any prescriptions right now.
Posted by crittercuddler on December 14, 2008, at 4:01:56
In reply to Re: SSRI insomnia, restlessness, poor concentratio » crittercuddler, posted by raisinb on December 13, 2008, at 21:53:41
raisanb - Thank you for the reminder. :-)
All the possible drug combinations overwhelm me very much. I am constantly obsessing about how endless my search will ultimately be to find the "perfect" combo and I just end up spiraling deeper into depression. Whatever I am prescribed, through research and much obsessing I soon decide it would probably be a better idea that I be on something else. I spend 30 minutes trying to pick out boxed tea in the grocery store... so you can imagine the difficulty I have with a decision like this. I am just convinced that I will make the wrong decision and be miserable forever. I am so caught up in the OCD thinking cycle. :-(
Posted by crittercuddler on December 14, 2008, at 6:58:21
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 13, 2008, at 19:08:44
So, should I try inositol or N Acetyl cysteine?
Or can I try both of them together?
Posted by Racer on December 14, 2008, at 10:51:06
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by crittercuddler on December 14, 2008, at 4:01:56
>I have been hospitalized three times this year, each for a week, already. Each time I was titrated up quickly or started on a dose of an SSRI I couldn't handle. The acute hospitalization strategy has not worked for me. With my sensitivity issues, it is just not practical.
A lot of times I read things on this board about people being "medication sensitive," with a negative implication involved. The way I see it, being sensitive to a medication can be a very, very good thing -- it means that one is sensitive to the effects of a medication, which is a necessary component for any medication to be effective. If you're not sensitive to its effects, after all, it isn't likely to work.
And while there are a lot of good arguments in favor of a slow, gradual upward titration on medications, the argument I use with my psychopharmacologist is the opposite: since I'm going to experience adjustment effects every time a dosage is increased, let's titrate more quickly and get it over with. I don't mean going from 0 to 60 at NASCAR speeds, but I do mean not cutting pills into quarters to start with. It's hard, but again -- the strategies we have in place to help me tolerate the adjustment phase work to minimize my distress at a faster titration schedule.
> All the possible drug combinations overwhelm me very much. I am constantly obsessing about how endless my search will ultimately be to find the "perfect" combo and I just end up spiraling deeper into depression. Whatever I am prescribed, through research and much obsessing I soon decide it would probably be a better idea that I be on something else.It sounds as though you're aware that your obsessiveness in this area is not serving you well. Aside from all the psychological aspects, it also seems to be preventing you from staying with any course of treatment long enough to benefit from it.
Can you think of anything you might try to improve your ability to tolerate these adjustment periods?
It also sounds to me as though you may be getting into a vicious circle of expecting bad side effects, which creates anxiety about whether you'll experience them, leading to symptoms which might be the anxiety and might be side effects of the medication, and so on. Do you think there might be an element of the self-fulfilling prophecy there?
I do wish you luck.
Posted by Phillipa on December 14, 2008, at 17:57:58
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 14, 2008, at 6:58:21
Personally I'd try the nefedazone as one pdoc here started me on it and no anxiety. And believe me meds make if anxious. He the pdoc did start at low doses so as to alleviated anxiety. Might be useful for you. Love Phillipa
Posted by desolationrower on December 14, 2008, at 19:18:44
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 14, 2008, at 3:54:43
> d/r -
>
> I see you mentioned an NRI could help an SSRI work faster and better. My next question would be, would it also help me tolerate the SSRI better? Also, when you say NRI, you don't mean an SNRI (like Cymbalta or Effexor), do you? Are you considering Serzone an NRI? I read that it does inhibit NE uptake, but it is also described by other terms as well so I wasn't sure. I am guessing that you were suggesting Serzone as an NRI since you mentioned it in the same paragraph.
>
nri would be probably desipramine, nortryptiline, atomoxetine, or reboxetine. they can be energizing and nort is the most sedating so maybe that one, though the cleaner ones can sedate some people too. you said you took it before, what symptoms did it make you feel more deprssed? They might help somehwat with your depression, prevent/counteract the cognitive side effects you experience on sris, and make make an sri more effective and work faster. Pfizer put a patent on reboxetine+pindolol treatment for OCD. I suppose that have some chance of working. Oh, and there was that one study with buspirone+pindolol without a ssri that had a faster response too. I guess i forgot about pindolol; noone uses it because it only hastens response, not increases no. of responders. But thats important for you. all these were tested for depression not ocd btw. Don't know why you doctors didn't add that. don't be easy on the pindolol most studies didn't use enough for it to have an effect.nefazodone is a weak serotonin and norepinin reuptake inhibitor, but a stronger 5ht2 antagonist, so its an unusual drug. i wouldn't say thats a best option, but it might help depression somewhat.
> I must say that looking at Dr. Bob's fact sheet on nefazadone is encouraging where he mentions that is seems to not cause insomnia, or as he put it "sleep disturbances". Of course, I wouldn't count on that to be true for me. I guess I would just have to see. Also, I of course like how you said NRIs can help congnition. Of course, they also say SSRIs are supposed to help with memory and concentration by alleviating depression! Perhaps that would be the case were I able to get back on one and stay on it long enough. I will ask my doctor about it.
>
> I have been hospitalized three times this year, each for a week, already. Each time I was titrated up quickly or started on a dose of an SSRI I couldn't handle. I spent all three weeks with terrible insomnia. The acute hospitalization strategy has not worked for me. With my sensitivity issues, it is just not practical. This year was the first time I had ever had to go to a hospital for the depression and OCD being so out of control.ouch, that sounds bad.
> Do the glutamatergics show efficacy in alleviating depression, or just in OCD?
hm, not sure about rizulwhatever, but both of the others have some positive evidence, i think added to other ADs for treatment resistant people.
> I do remember reading about inositol last year. I had forgotten about it though. I get so wrapped up in trying to get an a prescription drug since one had worked for me in the past.
>
> I know, I am stuck on the desire to want back on an SSRI myself, as well. I have been endlessly trying being driven by that desire for three years now. It is so frustrating.oh, i just realized too to ask: what sleep drugs did you try when on an ssri? its the 5ht2 receptors that are thought to cause the agitation/insomnia; high dose cyproheptadine, mirtazapine or a trycyclic (and which one, i don't think they all count)? some drug with strong 5ht2a/c blockade. fluoxetine is a decent 5ht2c antagonist, so the fact it caused less insomnia might be b/c of that.
theres no reason you couldn't start inositol and NAC together, along with another drug too...usually doing one thing at a time you know what is doing what, but i'm impatient so i don't like that...
have you talked to your pdoc about bipolar? the reaction to antidepressant could possibly be because of that.
-d/r
Posted by NewQuestions on December 15, 2008, at 14:31:12
In reply to SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 6:39:29
See this thread: "Strange shift in 5HT tolerances" started by zzz7. Also, see anything posted by me.
I am experiencing similar sensitivities after years of SSRI use. I have tried almost every drug I can think of. I don't know what the resolution is. I have found a handful of people with similar experiences. If you need more details, I am happy to provide them. These drugs have left me unbalanced, and yet I can't take them anymore. I am very frustrated.
Posted by crittercuddler on December 15, 2008, at 21:47:56
In reply to Re: SSRI insomnia, restlessness, poor concentration » crittercuddler, posted by Phillipa on December 14, 2008, at 17:57:58
Thank you Phillipa. I have Nefazodone on my list of meds to talk to my doctor about tomorrow.
Posted by crittercuddler on December 15, 2008, at 22:07:30
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 14, 2008, at 19:18:44
d/r - Thank you so much for your wonderfully detailed and thoughtful posts. You are giving me so much help! Thank you so much!!! :-)
"you said you took it before, what symptoms did it make you feel more deprssed?"
>I have come to believe that me feeling more depressed and odd while on nortriptyline the time I tried it was because I was also taking Remeron with it... which I think I have discovered I don't tolerate well. It was comforting to read about other people who had the same experience with Remeron.
"Pfizer put a patent on reboxetine+pindolol treatment for OCD. I suppose that have some chance of working."
>I live in the United States and Reboxetine is not available here. I read that the reason for that is that there was conflicting evidence as to its efficacy compared to more established treatments.
"Don't know why you doctors didn't add that."
>The doctor that I had back when I was still on medicine was incompetent. I wish I would have had a good doctor that kept up with her research. Perhaps I could have been augmented properly and avoided these last three years of misery. Even the doctor I have now, while much better, admits that he doesn't have time to keep up with research. It is so frustrating that while being so sick I have to take up the slack for my doctor... doing my own research. It makes me so angry. =( I mean, I get it... they are human and after a long day of seeing patients the last thing they want to do is go home and do research. BUT, I think that is something you have to be prepared for if you are going to be a competent doctor. You are going to have to make that sacrifice. Is is the nature of the job. Right? It is just crazy how these doctors don't know what I can go look up so easy in a book- and this information is critical to my care- it is not like it is some random fact. Ugh. I am going to go to the doctor tomorrow and talk to him about 5HT2A antagonists. All this time I have been expressing how I don't understand this mystery of me being intolerant to SSRIs and that might help me. I don't know why he didn't mention it. Also, we talked about how I can tolerate Seroquel, which works on Serotonin, and his answer for that was that Seroquel just hits Serotonin the least of the atypicals. He didn't even mention that the reason I was likely to tolerate it was because of 5HT2A antagonism. Ugh!!!
"have you talked to your pdoc about bipolar?"
>It had been postulated by my last doctor that I might be biploar 2, but it was more like a soft bipolar. My reaction to SSRIs is physical, not mental. I don't get mania or hypomania in a mental sense. It seems like a purely physical thing. I don't have insomnia because my mind is racing... you know? My current doctor does not think I am bipolar... but of course he is not going to rule it out 100%.
"what sleep drugs did you try when on an ssri?"
>I tried a low dose Trazadone for one dose while in the hosptial. At a low dose it didn't help me sleep. Seroquel does help me sleep when on an SSRI, but at the 25mg I have used for that purpose it doesn't help with the other symptoms. I haven't desired to be on Seroquel more than a PRN basis.
Posted by crittercuddler on December 15, 2008, at 22:14:07
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by NewQuestions on December 15, 2008, at 14:31:12
New Questions-
Thank you so much. It is comforting to know there are others like me out there. Maybe we can figure this out together.
Did augmenting an SSRI with a 5HT2A antagonist not help? That is what people have been encouraging me to do.
I will look up that post. Thank you. Keep me updated, okay?
Posted by yxibow on December 15, 2008, at 23:22:12
In reply to Two comments » crittercuddler, posted by Racer on December 14, 2008, at 10:51:06
> A lot of times I read things on this board about people being "medication sensitive," with a negative implication involved. The way I see it, being sensitive to a medication can be a very, very good thing -- it means that one is sensitive to the effects of a medication, which is a necessary component for any medication to be effective. If you're not sensitive to its effects, after all, it isn't likely to work.Its a curious opposite view I haven't seen, but unfortunately medication sensitivity for me hasn't brought good things. I am unusually sensitive to some side effects, which may be genetic, somatic, its hard to say, but definitely very real.
>
> And while there are a lot of good arguments in favor of a slow, gradual upward titration on medications, the argument I use with my psychopharmacologist is the opposite: since I'm going to experience adjustment effects every time a dosage is increased, let's titrate more quickly and get it over with. I don't mean going from 0 to 60 at NASCAR speeds, but I do mean not cutting pills into quarters to start with. It's hard, but again -- the strategies we have in place to help me tolerate the adjustment phase work to minimize my distress at a faster titration schedule.
Well that works for some people, but titrating up on Anafranil at 75 and then going up to 100 because I sort of insisted that well, that might be good because I prefer more changes in medication, as though that will make things better -- it doesn't always, in fact it backfired with me being in a very wierd wired, jumpy, and not pleasant place.
Went back to 75, and its going to percolate for a while. The way the brain responds to psychotropics isn't overnight, which is why I always wonder when I see people ditching a medication a week after taking it because it either did nothing or it had a side effect. Medications will always have side effects.I mean, if its something life threatening or life reducing, it may have to be stopped to be prudent, but sometimes focusing on improving yourself in other ways while the medication takes its time is equally valuable.
-- tidingsJay
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