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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Louisa on January 21, 2000, at 15:28:42
A few months ago, I started treatment with Paxil (eventually 40 mg in the morning) for depression. Just as I was starting to see the fog lift (after a long time -- I think I must be a very slow responder), my mother landed in the hospital, and I ended up nursing her at home for a couple of weeks over the holidays. Given my relationship with my mother, I suppose it's no surprise that my depression returned, worse even than before. I should add that I'm also a graduate student trying desperately to finish a dissertation, and that I'm currently teaching a heavy load. After an appointment where I described my very high level of self-loathing, the pdoc decided to tweak the Paxil with Wellbutrin SR (150 mg, in the morning) to see if that might make a difference.
My side effects with the Paxil were minimal, but still a bit disturbing: a slight tremor, and then complete and utter disinterest in anything remotely sexual. From what I read here and elswhere, the Wellbutrin may help with that, which would make me happy (and my husband too!). Side effects with the Wellbutrin (which I only started on Monday) have been more dramatic. The tremor has increased, and now I get these incredible involuntary muscle spasms when I sleep. This used to happen to me occasionally, especially when I was stressed, but now it's happening many times during the night, and three times this afternoon during a nap. I don't really get enough sleep, which isn't so great, since I'm also recovering from the flu. Today and yesterday, I felt so exhausted by mid afternoon that I completely collapsed and had to nap, which naps were then greatly disturbed by muscle twinges.
I'm not supposed to see the pdoc again for 3 weeks (I've run out of insurance, and can't really afford to keep visiting her). Does anyone have any suggestions? I can't tell if the exhaustion is another side effect of the Wellbutrin, or whether it's the flu, or merely because I'm not getting enough sleep. The twinges are really bugging me -- will they go away? I don't want to give up on the Wellbutrin too soon, but I don't think I'll make it through the quarter if this keeps up. On the other hand, I'm not going to make it through the quarter if the depression doesn't lift sometime soon.
Very discouraged, tired, and wishing I were someone else,
Louisa
Posted by Noa on January 21, 2000, at 17:17:36
In reply to Paxil and Wellbutrin - is it me or the meds?, posted by Louisa on January 21, 2000, at 15:28:42
I can't speak to all of the issues. But the myoclonus (muscle twitches while at rest) is definitely something I am familiar with. On Paxil, I had significant myoclonus, which would wake me up just as I was falling asleep. My muscles would jerk randomly. A few times, my arm shot straight up in the air. Most of the time it is muscles I couldn't ever flex volitionally. Anyway, my pdoc said it is from the serotonin. I have had it on Effexor, as well, but less severely. Also, it is calmed by the serzone I take. I think you might need an augmenter that doesn't add more serotonin to your system. BTW, have you had your thyroid checked? This is one of the ways my AD is augmented--with thyroid meds. My other aumenters are ritalin and lithium (in addition to the serzone mentioned and the 2 thyroid meds).
Posted by judy on January 21, 2000, at 19:48:42
In reply to Paxil and Wellbutrin - is it me or the meds?, posted by Louisa on January 21, 2000, at 15:28:42
As Noa mentioned, spasms are fairly common with Wellbutrin. You've described a great deal of stress in your life- so you probably have a situational depression which any competent therapist should be able to help you with. I shook my head when you said you were a slow responder to paxil- most depressions are self-limiting, with or without medications they will end. Unless you are suicidal or psychotic (and you don't sound like either), talk to a professional (psychologists are about 1/2 the price of shrinks) and see if he/she can help you with coping with the stresses in your life. I was a basket case when I was doing my dissertation and I didn't have the added burden of parental problems. Doesn't your school offer some kind of student counseling? You will get through this, I wish you the best.
Posted by Louisa on January 22, 2000, at 17:29:51
In reply to Paxil and Wellbutrin - is it me or the meds?, posted by Louisa on January 21, 2000, at 15:28:42
I guess I should have made it clear that this is not the first time I've suffered from depression -- I spent 2 years on zoloft a while back. Prozac, too, but that made me really crazy. So while I know that this is a very bad time in my life, what with the dissertation and all, I do still have to get through it -- hence the meds.
I appreciate your suggestions, Judy, but I am already doing the therapy thing, though it's killing my finances. Unfortunately, my university has a lifetime limit on visits to the counseling service. The only good thing is that they do now at least pay for the medications! (they didn't several years ago) So I need to figure out how to cope. And while I don't quite know whether or not I'm REALLY suicidal, I do think a little too much about the sharp knives in the kitchen. In fact, when I've been this down, I obsess about them. So I fear that this is at least somewhat worse than just any old grad student and a dissertation.
I'm glad to find out the name for my muscle twinges, Noa, and to know that they're not too uncommon. I may try to call the pdoc on Monday, to see what she thinks.
Thanks for your thoughts -- I'd love input from anyone else, too. I really appreciate the knowledge found here on Psychobabble...
Louisa
Posted by Sam on January 23, 2000, at 0:18:02
In reply to more info, posted by Louisa on January 22, 2000, at 17:29:51
Did the zoloft work for you? Have you tried the other SSRI's? Have you tried any of the tricyclics? That thing with the knives sounds like OCD. Can you talk to your advisor about your problems? Good luck......
Posted by Louisa on January 23, 2000, at 8:44:03
In reply to Re: more info, posted by Sam on January 23, 2000, at 0:18:02
The zoloft worked for me at the time, but some of the side effects were really awful, which is why we decided to try something else. I was shaking like the pope, even when I split up the dose and took some in the morning and some at night. I haven't tried the tricyclics -- who knows? maybe that will be next.
Unfortunately, talking with my advisor is less than a good idea, since I'm on the job market, and he's the one writing recommendation letters... So I'm trying to keep it from him for now. But we'll see. If this gets worse, I may need to tell him. But thanks for your thoughts.
Louisa
Posted by judy on January 23, 2000, at 15:07:17
In reply to to Sam, posted by Louisa on January 23, 2000, at 8:44:03
Dear Louisa,
I'm sorry to hear about your recurring depressions- the atypical AD's like wellbutrin and effexor tend to have more side-effects (in some people) than SSRI's- unfortunately tricyclics don't have a very benign profile. Suicidal ideation is fairly common in depression, I hope you speak to your therapist about it. Are you taking anything for anxiety (not that I'm pushing benzos), but sometimes that helps until you find an AD that works. Also, if you have access to a GP or an internist at your University (and they tend to be more knowledgeable than most), I'm sure they would help with medications if you can't immediately see your pdoc. When I was in grad school and dxed bipolar, my advisor was extremely kind in allowing extensions, etc. when he was aware of what I was battling. If you have a good relationship with yours, I'm sure he/she will be the same. (Believe me, you won't be the first student that has asked for help when faced with depression, nor the last). Please take care.
Posted by Louisa on January 24, 2000, at 12:33:29
In reply to speaking to advisor, posted by judy on January 23, 2000, at 15:07:17
There's been a lot of talk on the forum before about the risks of telling people. In fact, my advisor knows that I have battled depression before, since I had to tell him a few years ago when it first hit. But I'm extremely reluctant to bring it up with him again now, with the job market upon me. We have a good relationship, but he's very old-fashioned. Other women have had a hard time getting reasonable recommendations out of him because they've chosen to have children. I really don't want him to write me a "qualified" recommendation when the time comes! It's certainly a quandary.
The muscle spasms do seem to be calming down (they didn't wake me up last night), so maybe this will all work out, anyhow. Just taking it day by day.
Louisa
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