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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Racer on April 16, 2005, at 15:21:39
I'm on Cymbalta -- which I'm out of right now -- 30mg; Wellbutrin XL 150mg; Provigil 100mg; dx Major Depression, Anorexia Nervosa, Anxiety Disorder NOS.
There are so many variables involved right now that I'm not sure which is most important, so I'll list them all as briefly as I can. Whatever combination of these variables is involved in my current depression, I wonder what the best option might be right now, in terms of changing meds? Any bits of wisdom you care to share are appreciated.
Variables:
Running out of Cymbalta -- although I'm not sure it's really doing much for me, so I'm least concerned with this.
Weight gain -- I've gained 35 pounds since November, and just in the past week or two it's been really horrible. I never realized just how much my self-image and self-esteem seem to be tied to my weight and shape. And no -- not getting any treatment related to this, because no one in this area will take on an adult patient with anorexia. (Although they'd be glad to see me if I started to purge, it seems, since they all treat adults with bulimia...)
New therapist -- after being totally shut down emotionally for a year or so, I'm opening up. That may actually have a lot to do with all this, although I'm betting it's the symbiosis between opening up emotionally and that I'm restricitng so much less. AN for me is all about emotional control, so eating more is associated with a lack of that control.
Practical problems, with marital issues involved: this part is the hardest to explain, but the very condensed version is that my husband NEVER does anything to show me that he finds me at all attractive. He will *say* it, when he thinks of it (usually when I'm crying about how hideous I am), but he never does anything like voluntarily hold me. Then there's the practical part: his car isn't running -- hasn't run for about two years now -- so we're sharing mine. This means that, if I want to leave the house, I have to play Taxi Driver for him -- at his convenience. Problem is, he doesn't work a regular schedule -- he goes to work when he's ready to go, so I can't plan. Unfortunately, he doesn't respond to my needs, so I can't consistently do things that I think would help me a lot, like getting to the Pilates class that's supposed to be part of my treatment plan, etc. (Hell, I can't even consistently get to doctor's appointments, unless he accidentally gets ready to go at the right time.) This, as you can imagine, just reinforces my sense of my own worth. Or, rather, utter and entire lack of worth.
So, lots of variables. Part of me says that it's the practical, behavioral things that have to change to remit this depression. Another part says that that ain't likely to happen -- since my husband's behavior is entirely outside my control, but his cooperation would be necessary to make those things happen -- so I better look to meds. And still another part says that it's OK to look to meds, because if they improved my depression, I might find ways to improve the practical side of things.
Anyway, I'm a bit hesitant to consider raising the Cymbalta, because at higher dosages I was entirely amotivated, very lethargic, my blood pressure went up, and I don't think it did anything for my depression. I also think that the lethargy contributed to the depression, by keeping me from doing things that might help me behaviorally.
I'm equally hesitant to raise the Wellbutrin, though, for the obvious reason: seizure risk. I know that the risk is low, and that the "no Wellbutrin for those with eating disorders" is really about bulimia, but I'm still concerned. On the other hand, adding Wellbutrin to Cymbalta lifted longstanding depression within two weeks, so I know it's doing something.
Raising the Provigil won't do anything except make me jittery. It doesn't improve the fatigue or lethargy.
Mind you, right now I feel as though the best thing I can do is to drop all the meds, except maybe the Provigil, and stop eating again, because when I am actively restricting, I have more energy, get more done, feel a hell of a lot better about myself, etc. In other words, I'm depressed, so if you give me your best advice, and I say, "Yes, but..." please forgive me. I know that's how I'm feeling, and I know I would want to slap me, but I figure you all probably understand...
Thanks!
Posted by Phillipa on April 16, 2005, at 16:29:30
In reply to Breakthrough depression, any advice?, posted by Racer on April 16, 2005, at 15:21:39
I kind of had to laugh. Not at you of course. But the issue of opening up in therapy is my theory of why you feel like you do. I think I have left various therapists when they started to get to issues that for me were impossible. An example, one said to me Do you think you would be better if you hadn't married your husband? Well, since I've been married several times, yes it's true[I'm embarrased to admit] I didn't want to hear this. Because when I married my current husband I married someone l3yrs younger than me which is totally against what I believe. And ironically, and I hope it was coincidence, I became sick one week after we were married. That was when my thyroid went. And the anxiety and depression began. We really had nothing in common. I already had 3 grown children and he had never been married and had none. I worked as an RN evenings and he worked during the day. And we both drank beer nightly. He never wanted to go anywhere and have fun and I was always used to going out. At least I had work then and the people I worked with to joke around with and have fun. The times at home i was content to read. Now since I've been out of work it's hard. Like right now, he's out in the back working at fixing a pitch fork. Why I don't know, while I sit in here alone. I don't think any of the AD's can fix this. I feel guilty every time I ask him to go somewhere and do something. And I don't like to be alone anymore. I think so much of how we feel is related to how our relationships are in life. I'm done looking and will work with what I have as he can be very caring. But I've tried to dull things with meds and it didn't work. I wish I knew the answer, truly I do, but unless you strongly feel a med will make you feel happier than I'd stick with the relationship theory. If you do find a magic combo I really would like to try it. Fondly, Phillipa
Posted by Maxime on April 16, 2005, at 20:35:41
In reply to Breakthrough depression, any advice?, posted by Racer on April 16, 2005, at 15:21:39
Hi Racer -
Hum. I wonder if Parnate would help you. I find it odd that you take Wellbutrin and Provigil yet you have an anxiety disoder. Don't these meds make your anxiety worse?I'm sorry you are feeling so depressed and your are right, if could be the therapy. But I am worried that if your depression continues to get worse, then you won't be responsive to therapy.
And why the hell won't they treat a non purging anorectic at your age? Is it because they think you will never change (because I was told that once). Anyhow I think it's disgusting that they will not treat you. Have you ever thought about going somewhere like Remuda or Renfrew for IP treatment? Or do you not have insurance?
I am really sorry you are in this rut. Now how are we going to get to out of it?
I haven't been helpful at all, I know. Sorry. Although I might be able to make you laugh. When you wrote "Then there's the practical part: his car isn't running -- hasn't run for about two years now -- so we're sharing mine." I thought you were talking about impotency and then I wondered what part of you he was sharing (it was because you were talking about hugging). But I am really tired and crashed from Dexedrine several hours ago, so that's my excuse.
Maxime
> I'm on Cymbalta -- which I'm out of right now -- 30mg; Wellbutrin XL 150mg; Provigil 100mg; dx Major Depression, Anorexia Nervosa, Anxiety Disorder NOS.
>
> There are so many variables involved right now that I'm not sure which is most important, so I'll list them all as briefly as I can. Whatever combination of these variables is involved in my current depression, I wonder what the best option might be right now, in terms of changing meds? Any bits of wisdom you care to share are appreciated.
>
> Variables:
>
> Running out of Cymbalta -- although I'm not sure it's really doing much for me, so I'm least concerned with this.
>
> Weight gain -- I've gained 35 pounds since November, and just in the past week or two it's been really horrible. I never realized just how much my self-image and self-esteem seem to be tied to my weight and shape. And no -- not getting any treatment related to this, because no one in this area will take on an adult patient with anorexia. (Although they'd be glad to see me if I started to purge, it seems, since they all treat adults with bulimia...)
>
> New therapist -- after being totally shut down emotionally for a year or so, I'm opening up. That may actually have a lot to do with all this, although I'm betting it's the symbiosis between opening up emotionally and that I'm restricitng so much less. AN for me is all about emotional control, so eating more is associated with a lack of that control.
>
> Practical problems, with marital issues involved: this part is the hardest to explain, but the very condensed version is that my husband NEVER does anything to show me that he finds me at all attractive. He will *say* it, when he thinks of it (usually when I'm crying about how hideous I am), but he never does anything like voluntarily hold me. Then there's the practical part: his car isn't running -- hasn't run for about two years now -- so we're sharing mine. This means that, if I want to leave the house, I have to play Taxi Driver for him -- at his convenience. Problem is, he doesn't work a regular schedule -- he goes to work when he's ready to go, so I can't plan. Unfortunately, he doesn't respond to my needs, so I can't consistently do things that I think would help me a lot, like getting to the Pilates class that's supposed to be part of my treatment plan, etc. (Hell, I can't even consistently get to doctor's appointments, unless he accidentally gets ready to go at the right time.) This, as you can imagine, just reinforces my sense of my own worth. Or, rather, utter and entire lack of worth.
>
> So, lots of variables. Part of me says that it's the practical, behavioral things that have to change to remit this depression. Another part says that that ain't likely to happen -- since my husband's behavior is entirely outside my control, but his cooperation would be necessary to make those things happen -- so I better look to meds. And still another part says that it's OK to look to meds, because if they improved my depression, I might find ways to improve the practical side of things.
>
> Anyway, I'm a bit hesitant to consider raising the Cymbalta, because at higher dosages I was entirely amotivated, very lethargic, my blood pressure went up, and I don't think it did anything for my depression. I also think that the lethargy contributed to the depression, by keeping me from doing things that might help me behaviorally.
>
> I'm equally hesitant to raise the Wellbutrin, though, for the obvious reason: seizure risk. I know that the risk is low, and that the "no Wellbutrin for those with eating disorders" is really about bulimia, but I'm still concerned. On the other hand, adding Wellbutrin to Cymbalta lifted longstanding depression within two weeks, so I know it's doing something.
>
> Raising the Provigil won't do anything except make me jittery. It doesn't improve the fatigue or lethargy.
>
> Mind you, right now I feel as though the best thing I can do is to drop all the meds, except maybe the Provigil, and stop eating again, because when I am actively restricting, I have more energy, get more done, feel a hell of a lot better about myself, etc. In other words, I'm depressed, so if you give me your best advice, and I say, "Yes, but..." please forgive me. I know that's how I'm feeling, and I know I would want to slap me, but I figure you all probably understand...
>
> Thanks!
Posted by banga on April 16, 2005, at 21:05:17
In reply to Breakthrough depression, any advice?, posted by Racer on April 16, 2005, at 15:21:39
>> There are so many variables involved right now that I'm not sure which is most important, so I'll list them all as briefly as I can. Whatever combination of these variables is involved in my current depression, I wonder what the best option might be right now, in terms of changing meds? Any bits of wisdom you care to share are appreciated.
Hi!
I certainly think that this probably is not the time to think of dropping meds...if you are going into difficult areas in therapy you need that support there!! What does the Provigil give you right now?
I agree with Maxime's comment--that these meds are pretty stimulating, may not help the anxiety. I do not know your med history, what else you have tried. I would think switching the Cymbalta for a different medication is logical.YOu are right, you are dealing with many variables--fortunately you don't have to choose to deal with one over the other.
So do the meds;
And concentrate on where therapy is right now taking you. I bet it is hard...Perhaps for now, instead of changing the entire dynamic of the relationship with your husband, maybe you can choose one thing to deal with--maybe say talk to your therapist about how to assert yourself with your husband regarding the car issue?
Relationship dynamics take a while to change. Sadly said from experience....so to feel less hectic try to target changing specific smaller things....maybe youd gain a sense of control in that way if even a little bit.B.
Posted by Racer on April 17, 2005, at 23:04:21
In reply to Re: Breakthrough depression, any advice?, posted by Maxime on April 16, 2005, at 20:35:41
> Hi Racer -
> Hum. I wonder if Parnate would help you. I find it odd that you take Wellbutrin and Provigil yet you have an anxiety disoder. Don't these meds make your anxiety worse?
>Actually, I think it makes me feel less anxious, since I'm less depressed -- if that makes sense? The Provigil helps me with motivation just enough that I can usually get something done, which makes me feel a bit better, which also makes me less anxious.
My anxiety is the type that doesn't include anxious thoughts, by the way. I don't even know I'm anxious, until I really stop and think about it. In fact, I didn't believe that I really had an anxiety disorder until the first time I took propranalol -- about half an hour later, the anxiety was gone, and then I knew it had been there...Thanks for your input. I haven't taken any of the MAOIs, partly because of low BP, partly suicide risk, and partly I'm afraid of weight gain...
Who me? Worried about my weight?
Mwahaha
Posted by anneL on April 18, 2005, at 23:52:10
In reply to Breakthrough depression, any advice?, posted by Racer on April 16, 2005, at 15:21:39
Hi Racer,
I ask myself, is my depression exogenous, meaning coming from outside of myself (how I handle external stressors) or endogenous (my chemistry and genetics)? I think that medication and therapy can certainly help give us the support that we need in order to take better care of ourselves and be assertive where appropriate. Sounds like you need to blow a little steam off in a safe place and come to a decision as to how the car management can be more equitable. This sounds more preferable than increasing/changing meds to be able to tolerate your current situation. I fully understand how you got there and why. Been there and find myself revisiting similar situations quite frequently. I hope you find some solace in knowing that other women on this board have similar issues in their relationships to their significant other and question whether it is a depressive rebound or tired and fearful of rehashing the same old problems.
This is the end of the thread.
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