Posted by Elizabeth on April 5, 1999, at 23:55:07
In reply to Re: question for Matt, posted by mila on April 1, 1999, at 19:43:34
(Jumping in)
Mila,
Adding to and concurring with what Matt says:
Seroquel might be worthwhile to try (start at 25mg b.i.d., increase until you plateau). I've never heard of acne from Risperdal; weight gain is an unfortunate side effect of all the current antipsychotic drugs, although I've heard some people say that it is less with Seroquel.
There's also, of course, high-dose BuSpar, since I notice that wasn't on your list. "High-dose" meaning at least 90mg (as tolerated).
BTW, you don't have to be floridly "psychotic" in the traditional sense (hallucinations, delusions, bizarre behavior and speech, etc.) to benefit from antipsychotics. In particular, there are "negative" symptoms (i.e., symptoms indicating a lack of something "normal" rather than the presence of something "abnormal"). This is from DSM-IV, describing the not-officially-recognized category "simple deteriorative disorder" which consists mainly of negative symptoms:
"... Emotional responses become blunted, shallow, flat, and empty. Speech becomes impoverished of words and meanings. There is a definite change in `personality,' with a marked loss of interpersonal rapport. Close relationships lose warmth and mutuality, social interaction generally becomes awkward, and isolation and withdrawal result. Initiative gives way to apathy, and ambition to avolition. Loss of interest extends to the daily details of self-care. ..."
(Sounds a lot like (some kinds of) depression.)
Nortriptyline and desipramine are both good tricyclics to start with.
I'm not sure that adding pindolol is worthwhile if you've had no response whatsoever to three SSRIs (it might be good if you could only get a partial response to the SSRIs, though).
Remeron is definitely worth trying, although you should be warned that a lot of people say it increases their appetites. Serzone is another one that you didn't mention, and it generally *doesn't* cause weight gain. Some people feel that it doesn't work as often as other ADs do, but I've also heard of it working where several other things had failed. Both Serzone and Remeron share a pharmacologic property (blockade of type 2 serotonin receptors) with the atypical antipsychotics.
I do think it's true that one benzo may help even if another one doesn't - they're not interchangeable. OTOH, I'm not sure it's going to be especially useful for you to try another one if you tried adequate doses of two of them already. Usually, you should notice at least something good happening from smaller doses, though.
It might help to know your specific symptoms, since "depression" and "anxiety" could mean a number of things.
I'm glad to hear you're planning on finding a better doctor. It doesn't sound as if your present one has been very helpful.
-elizabeth
poster:Elizabeth
thread:3795
URL: http://www.dr-bob.org/babble/19990501/msgs/4438.html