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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 MixedState66 on March 13, 2013, at 0:33:56
This is my first time ever reaching out for advice online. I read some of the posts, and it is amazing how familiar many of you are with your symptoms. I have such a hard time identifying and pinpointing my constant distress that has consumed me for years.
First off, I have been on meds since the age of 18 as a senior in high school. Initially my mom took me in to get diagnosed for ADD so I could take medication for SAT's. It was at that point when the psychiatrist began asking questions relating to my worry, fear, anxiousness, paranoia, inability to concentrate, where I realized I have serious problems. If you are reading and can possibly give advice, please stay tuned and I will get into my symptoms, but I think it is important to inform you when it all happened.
I am a male, and I recall having OCD related symptoms beginning at a young age where I would pull out my eyelashes and eyebrows constantly and also had a phase where I was paranoid about getting sick and exposing myself to germs. I had a lot of energy, and then in the 8th grade when I hit puberty my OCD symptoms continued, but I developed an atypical type of depression where I would get down on myself for minor failures and was extremely irritable to my friends and family, blowing up at them and losing some friends in the process. Those symptoms healed temporarily as a freshman where I was social, confident and making a lot of friends and able to concentrate for the most part.
Somewhere along the line freshman year, something happened (possibly smoking pot occasionally) where I have fallen into a dark depression that I cannot snap out of. I am 26 now and have tried many different meds starting with lexapro which minimally helped my anxiety and racing thoughts, however gave me fatigue a zombie like feeling. Freshman year in college my doc put on a combo of 10mg lexapro, 0.5 mg risperdal, and 150 mg of welbutrin. Looking back at it, that may have helped but my self esteem and anxiety toward taking medication made me very pessimistic about treatment with meds and I thought I could get better through cognitive therapy. Mid freshman year my doctor took me off risperdal and lexapro and I was only on 300mg of welbutrin. My obsessions came back and it was about a girl that I lost and I was rejected by after being mean to her at one point. I Couldn't get her off my mind and would dwell about how I screwed it up and ways I could make it better (obsessed and couldn't get her off my mind for hours a day).
He then thought I was bipolar and put me on lithium which was a disaster. I was more depressed, slept the majority of the day, gained a ton of weight and woke up with racing thoughts and zero motivation - only energy from anxiety would get me through the day. I tried paxil about two years ago which helped the anxiety but did not relieve the depression at all. I had extreme fatigue still, slept a lot, my speech was slow, and anhedonia where I cannot get stimulated by positive events. Combination of wellbutrin and paxil didn't help either, maybe gave a minor boost but not much. I tried celexa, which didn't make me as fatigued as paxil, didn't do much for anxiety and I still am depressed.
I have been depressed now for years, unable to experience happiness or get stimulated by something good that happens like getting a new job, going on vacation, having a girlfriend, I cannot get excited. My sex drive is gone, and although I can get an erection and perform with girls, I cannot get excited or horny. (It has been like this since Freshman year in high school). I have had a pattern of obsessing over certain girls excessively (I've counted 5 since the age of 18) in an unhealthy manner. I pull out my eyebrows and eyelashes and I have zero motivation of going out and being with friends. Even with alcohol, when I get drunk you would think it would ease my anxiety and induce happiness, but the opposite - I get irritable, cranky and still don't have excitement. Cocaine as well, it gives me a boost but my anxiety skyrockets. I wake up with no motivation, everything is in a fog if that makes sense? It used to sensitize me for instance on a summer day to hang out with friends and watch a baseball game, that would put me in a good mood. I don't have anything but a negative mood and I am very self absorbed in my issues and cannot describe how miserable I am.
I am now calling the shots with my psychiatrist and he lets me make the decision on drugs. I have now been on my first TCA (nortriptyline) for 2 months which has helped anxiety somewhat but still not the depression and some of my obsessive ruminating thoughts. Yesterday, he prescribed me risperdal to augment it, and I took my first dose at .25 mg last night, soon to build up to 0.5.
Does anyone think this is a good combination since the risperdal may have helped when I first went on it freshman year? Should I give another drug a shot? I am open to any suggestions, and I apologize that this may be the longest thread on this website. I promise next thread I post will be more to the point, but as you can see I am having difficulty identifying my symptoms and trying to somehow inform you of how awful i feel.
Posted by ChicagoKat on March 13, 2013, at 10:48:52
In reply to Anxious Depression (maybe) - Medication Advice?, posted by MixedState66 on March 13, 2013, at 0:33:56
Hi, welcome to Babble. It's a great forum where one can get lots of advice and support. I'm sorry, though, that you have a reason to be here.
Remeber to take all the advice you will get with a grain of salt: what works great for one person may even be detrimental to another, even between 2 people with the same diagnosis. Our brains are all different in lots of little ways that, taken together, lead to different responses to the same drug. It's all more an art than a science, as is most of medicine.
Anyways, looks like you got the 3 course belt-buster going on. Depression/anxiety/OCD. First of all, have you tried Luvox? It's an SSRI that helps depression, but also has affinity for a whole nother receptor, the sigma receptor, and by binding this receptor it helps to treat anxiety AND is FDA approved to treat OCD. You maybe possibly get all 3 of your types of symptoms treated with one drug :) But no worries if that doesn't work. As my beloved pdoc says 'there's always another drug' I think giving Luvox a try if you haven't already is the best first step. If you have tried it and it didn't work well, let us know how it didn't work, or if it partially worked. And don't forget, some of these drugs, like SSRIs, can take weeks and weeks to kick in. And I must add, you'll get those sexual side effects you spoke of with Luvox too. Actually you get them with lots of drugs. But that may explain why you've been tried on Wellbutrin b/c it is one of the few that doesn't have that problem.
Now you'll probably get lots of other posts giving you lots of different ideas. There are some *really* smart people here. Feel free to ask lots of questions and make an informed choice for yourself. And try not to worry too much if your choice(s) don't work out at first. You're very early in the game, it shouldn't be too difficult to find drug therapy that works for you. Me, I'm twenty years older than you and I am a fast metabolizer, which basically means drugs 'poop out' on me relatively quickly. But even after decades of different regimes,I have still been able to find relief with Lexapro for anxiety and Ritalin for depression. Main thing is to hang in there and don't give up if one or two or ten regimens don't work. You'll find something. Also find the best pdoc you can. One who is compassionate, one who will listen to youru ideas, and one who is a bit of a maverick and willing to try novel things out, as long as they are safe. The best of luck to you!
Kat
Posted by Tomatheus on March 13, 2013, at 11:05:55
In reply to Anxious Depression (maybe) - Medication Advice?, posted by MixedState66 on March 13, 2013, at 0:33:56
MixedState66,
Hello, and welcome to Psycho-Babble. Thank you for sharing your story with us. I think it's interesting how our symptoms can change over time as situations change, as our bodies change, and as we introduce different chemicals to our bodies. Unfortunately, it sounds like you have a variety of different symptoms to contend with, which in my experience seems to make treatment all the more difficult. That's not to say that finding effective treatment is impossible when you've got a variety of symptoms to contend with, but sometimes when treatments improve certain symptoms while making other symptoms worse, that can lead to a lot of frustration.
Anyway, I think that there are some others on this site who can give better advice than I can on what can be combined with a tricyclic, but I think that the decision to augment your nortriptyline with Risperdal makes sense, given your past response to the antipsychotic as part of another combo. So, I would recommend staying on the 0.5 mg of Risperdal with your nortriptyline for a little while to get a good idea as to how the combo will affect you. If the combo helps to a good degree with your depression and obsessive ruminating thoughts, then maybe that will be a combo that you'll want to stick with for some time. If adding the Risperdal doesn't end up helping, then you'll obviously want to try something different, and hopefully some of the other posters on this site will give you some ideas for other medications that might mix well with nortriptyline for you.
Well, I'm sorry if I couldn't be of more help, but I wanted to respond to your post and let you know what I thought. I wish you the best of luck with your ongoing treatment.
Tomatheus
Posted by MixedState66 on March 13, 2013, at 14:37:41
In reply to Re: Anxious Depression (maybe) - Medication Advice? » MixedState66, posted by ChicagoKat on March 13, 2013, at 10:48:52
> Hi, welcome to Babble. It's a great forum where one can get lots of advice and support. I'm sorry, though, that you have a reason to be here.
>
> Remeber to take all the advice you will get with a grain of salt: what works great for one person may even be detrimental to another, even between 2 people with the same diagnosis. Our brains are all different in lots of little ways that, taken together, lead to different responses to the same drug. It's all more an art than a science, as is most of medicine.
>
> Anyways, looks like you got the 3 course belt-buster going on. Depression/anxiety/OCD. First of all, have you tried Luvox? It's an SSRI that helps depression, but also has affinity for a whole nother receptor, the sigma receptor, and by binding this receptor it helps to treat anxiety AND is FDA approved to treat OCD. You maybe possibly get all 3 of your types of symptoms treated with one drug :) But no worries if that doesn't work. As my beloved pdoc says 'there's always another drug' I think giving Luvox a try if you haven't already is the best first step. If you have tried it and it didn't work well, let us know how it didn't work, or if it partially worked. And don't forget, some of these drugs, like SSRIs, can take weeks and weeks to kick in. And I must add, you'll get those sexual side effects you spoke of with Luvox too. Actually you get them with lots of drugs. But that may explain why you've been tried on Wellbutrin b/c it is one of the few that doesn't have that problem.
>
> Now you'll probably get lots of other posts giving you lots of different ideas. There are some *really* smart people here. Feel free to ask lots of questions and make an informed choice for yourself. And try not to worry too much if your choice(s) don't work out at first. You're very early in the game, it shouldn't be too difficult to find drug therapy that works for you. Me, I'm twenty years older than you and I am a fast metabolizer, which basically means drugs 'poop out' on me relatively quickly. But even after decades of different regimes,I have still been able to find relief with Lexapro for anxiety and Ritalin for depression. Main thing is to hang in there and don't give up if one or two or ten regimens don't work. You'll find something. Also find the best pdoc you can. One who is compassionate, one who will listen to youru ideas, and one who is a bit of a maverick and willing to try novel things out, as long as they are safe. The best of luck to you!
> KatThank you ChicagoKat and Thomaeus for the feedback. As I mentioned in my first post, I was very hesitant and afraid with the idea of medication to treat my symptoms. However, through the years of contemplating my condition, I've accepted that meds are necessary and potentially can save my life. I understand as well that everyone reacts differently to a certain med, although it is tempting to interpret posts containing negative side effects and ineffective results as reality if I were to take them myself.
ChicagoKat- I will keep Luvox in mind as a possible alternative. One thing I try to tell my doctors again and again which they don't seem to grasp is that I have had low libido consistently with no improvement since the age of 18, with or without meds, so I'm not too concerned about sexual side effects like delayed orgasm or loss of libido. Do you have suggestions for accurately identifying my depressive/anxious depression with certain tests I should take online for instance? I wish I could provide an accurate description to my psychiatrist, because I only have about ten to fifteen minutes to meet with him each month?
Also, a question for anyone who can provide useful tips: I notice that a common side effect with risperdal is fatigue and improved sleep. However, from my experience I have drowsiness during the day and more energy and difficulty sleeping at night. With these effects, should I take in the morning instead of night? Any sleep aides I should consider (natural over the counter /or prescribed by my doc)?
Posted by Phillipa on March 13, 2013, at 16:27:47
In reply to Re: Anxious Depression (maybe) - Medication Advice?, posted by MixedState66 on March 13, 2013, at 14:37:41
Hello there I did take luvox up to 250mg a day and with it ativan. But I must say it's the only ad that I had absolutely no side effects with. I kept waiting for them and nothing happened negative. I was very relaxed and happy on this dose. And it does work for OCD and anxiety. I think it's the most sedating of the SSRI's. With a twist of difference. One to consider. Prsonally I could not tolerate the atypical antipsycotics. At the time my husband even took a tiny dose and both of were "stoned" the next day. Phillipa
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