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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by quasimotor on February 28, 2013, at 1:25:57
i posted a while back and got extremely good feedback. i like what i read here.
diagnosis is atypical/agitated depression and panic disorder/GAD. also (recovered) bulimic and heroin/cocaine/everything addict.
currently on phenelzine 45mg. not working too well anymore. worked like a champ for about three months. then starting falling flat. obvious answer is increase the dose. except every time we did, weird side effects kicked in, specifically insane restlessness/akathisia/whatever you want to call it. tried propanalol to counteract. useless. just started taking low dose of valium. benzos scare the hell out of me. it's not taking them that scares me, but taking them and then not taking them. no fun. dose is so low honestly that i can barely feel it. i'm sensitive to meds but have an enormous tolerance for benzos and opiates.
i'm at a loss. so is the pdoc and he's pretty resourceful. starting to talk about EMDR/ECT/intensive therapy etc. which all sound to me like "ummmm.... i have no idea what to do anymore". nothing against therapy. i have a therapist as well. eat well. exercise daily. don't drink or do street drugs.
and here's the grocery list of things i've tried: paxil pristiq zoloft celexa lexapro effexor remeron prozac wellbutrin cymbalta desipramine tranylcypramine trazadone buspar gabapentin topamax lithium lamictal seroquel geodon zyprexa risperdal abilify clonidine propanalol klonopin xanax serax ativan hydroxizine amantadine. side effects or lack of efficacy all caused me to drop these.
feedback welcome.
thank you.
Posted by Hugh on February 28, 2013, at 13:47:55
In reply to treatment resistant, posted by quasimotor on February 28, 2013, at 1:25:57
Fourteen months ago, I had some bad muscle spasms in my back, so I started taking a high dose of the muscle relaxant baclofen. It had the unexpected side effect of eliminating my depression and anxiety. Poof. Gone. Unfortunately, after about a week on baclofen, it started causing terrible insomnia. I was awake for over fifty hours. So I stopped taking it. (I'm extremely sensitive to many drugs and supplements, so it's likely that most people wouldn't have the problems with baclofen that I did.) After the baclofen cleared my system and I could sleep again, I started taking it at a lower dose. It didn't help my depression and anxiety nearly as much at the lower dose, and it aggravated my mitral valve prolapse, so I stopped taking it. An interesting book about baclofen is The End of My Addiction by Olivier Ameisen. For many people, it's helped to relieve the depression and anxiety that drove them to addiction, but it's a drug that should be used with extreme caution. Stopping it suddenly can cause seizures.
Some non-drug options to consider: tDCS, neurofeedback, acupuncture, TMS. A new form of TMS called Deep TMS was approved by the FDA in January, and should be available soon. It penetrates much more deeply into the brain than the currently available form of TMS.
Posted by phidippus on March 2, 2013, at 14:27:31
In reply to treatment resistant, posted by quasimotor on February 28, 2013, at 1:25:57
>diagnosis is atypical/agitated depression and panic disorder/GAD
An AD is the best treatment for both your depression and anxiety. Have you tried Luvox or Viibryd? Of all the ADs you were on, how long were you on them?
>currently on phenelzine 45mg. not working too well anymore.
Not the best medication for your diagnosis.
>akathisia/whatever you want to call it. tried propanalol to counteract. useless.
Cogentin or Artane are better treatments for akathisia.
>EMDR/ECT
EMDR is more for PTSD. ECT will do nothing for your anxiety.
Eric
Posted by quasimotor on March 2, 2013, at 17:33:53
In reply to Re: treatment resistant » quasimotor, posted by phidippus on March 2, 2013, at 14:27:31
> >diagnosis is atypical/agitated depression and panic disorder/GAD
>
> An AD is the best treatment for both your depression and anxiety. Have you tried Luvox or Viibryd? Of all the ADs you were on, how long were you on them?Tried luvox for about two weeks once. Same reaction as to most SSRIs. Don't know much about Viibryd, but I'll research it. I spent years on Paxil, same with Effexor. Did a 6 month trial with Celexa, also Cymbalta. Most other ones were fairly brief. I have paradoxical reactions to serotonergic drugs. They dramatically increase my general physical restlessness to an intolerable level, even if they diminish the anxiety/depression. I know this is common in initial treatment, but it my case the side effects do not diminish over time.
>
> >currently on phenelzine 45mg. not working too well anymore.
>
> Not the best medication for your diagnosis.
Why not? Just curious. From what I've read, MAOIs can be helpful for people that cannot tolerate/are unsuccessful with newer ADs. Like I said, it actually worked for a little while. Quit pretty quic, though.
>
> >akathisia/whatever you want to call it. tried propanalol to counteract. useless.
>
> Cogentin or Artane are better treatments for akathisia.
Tried those. No luck. I refer to it as Akathisia only because it's the most clinical way to describe it. But I sometimes don't know what it is. Akathisia? Anxiety? Whatever I'm dealing with, it's nearly impossible for me to sit still. Almost like ADHD. But that's unlikely. It's present without medication. But medications generally make it worse.
>
> >EMDR/ECT
>
> EMDR is more for PTSD. ECT will do nothing for your anxiety.
Yeah. I know. But we are grasping at straws I guess. I'm already on psych disability. Every year I function worse than the last, though it is amazing i've managed to recover from heroin addiction and bulimia. Hard to pat yourself on the back when you feel miserable though.
>
> Eric
Thanks for your input, Eric. I appreciate it.
Posted by phidippus on March 2, 2013, at 18:09:02
In reply to Re: treatment resistant @ Phidippus, posted by quasimotor on March 2, 2013, at 17:33:53
>They dramatically increase my general physical restlessness to an intolerable level
This is akathisia. Its not common, but some people get it from ADs. Pindolol, in high doses, could be the ticket to treating it-with the added benefit of treating your anxiety.
Have you ever tried an opiate to treat the akathisia?
>Why not? Just curious
Phenelzine is known to be a very activating AD and may actually worsen your anxiety over time. Nardil would be a better choice for treating anxiety. All in all, MAOIs don't have the same track record as SSRIs or TCAs for treating anxiety.
>It's present without medication. But medications generally make it worse.
Maybe a component of your anxiety, although certain kinds of depression are expressed with motor agitation.
Have you tried an atypical antipsychotic with an AD?
Eric
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