Posted by schleprock on August 31, 2012, at 18:33:31
I'm still trying to figure out what I have in order to find the most effective course of treatment. Have been dealing with GAD and depression for a long time, though always usually leaned more towards GAD. First the facts:
Summer 2009: 1.5 mg of clonazepam and 12.5 mg of atenolol was added to my alternating 100/150 mg of Nortriptyline following an "incident". Gradually cut down on the extra meds until september 2011 and I was back on straight nortriptyline with no difficulties (except an inexplicable decrease in libido.)
March 2012: suffered a massive panic attack in the middle of the night. Was fine for 2 weeks. Took nothing extra
Two weeks later: gradual feelings of the onset of anxiety. Woke up one morning with severe GAD (insomnia, restlessness, apathy, agoraphobia, etc.) went back on atenolol and straight 150mg dosage of nortriptyline. Stabilized in about two weeks.
One month later: stopped atenolol, thinking it was the increased AD dosage keeping me together. Felt even better for about 5 days, then hit with GAD again. Decided to take .5 mg of clonazepam. Was relatively stable for another month.
One month later: Hit with GAD again. Relucantly raised dosage of clonazepam to 1 mg. Felt normal for 5 days.
Five days later: gradually felt the GAD strike again. When I was able to see my pdoc, took the brave step of adding respiridone (also slightly increased my clonazepam.) Felt a positive difference after a quarter of a .5 risperidone pill. Went up to half a pill. The effect waned after about 12 days and I felt GAD creeping up. Doubled dose and felt even worse. Tapered off. GAD again.
A few days later: got rx for lamitcal and lyrica from pdoc. Too afraid of lamitcal, but tried 50mg lyrica for about, actually made me feel slightly better. Unfortunately at this time I thought changing from nortriptyline to clomipramine might be a better solution, thinking I might have a serotonin deficiency. Stopped the lyrica (thinking I might be able to return to monotherapy.) Felt REALLY great for a couple of days after stopping lyrica (maybe because my clonazepam was at 1.5 mg?)
A few days later: Added 25mg of Clomipramine to an alternating 100/150 mg dosage of Nortriptyline. Woke up with a severe panic attack the second day. Felt GAD creep up on day 3, day for anxious and extremely sedated. Had to stop. Trying Lyrica again. Still feel terrible.
I'm hoping that from the evidence above someone could somehow infer for me the best course of treatment. My main concern is that I don't know whether I'm currently suffering from GAD or melancholic depression. In the past I usually suffered from the sympoms of both simultaneously, and these periods always resolved themselves within 2 weeks. Now it's like the anxiety componant is fairly mild, but the depression symptoms (mainly anhedonia than actual "mood") are fairly strong. Maybe the clonazepam has something to do with this. I to find out whether all this is strictly anxiety related (since it seemed initiated with a panic attack), or some imbalance related to depression that my current meds don't touch. Maybe the first question to ask is if the illness's initial positive response to clonazepam shifts it more into the anxiety category than the depressive category...
Hopefully I'll somehow find a way to make life more bearable.
poster:schleprock
thread:1024570
URL: http://www.dr-bob.org/babble/20120830/msgs/1024570.html