Posted by fachad on March 21, 2002, at 12:23:10
In reply to Feeling alone, miserable - depression patterns, posted by Janelle on March 21, 2002, at 0:57:13
Janelle,
I manipulated the way I posted my responses so they would show up in the order they did. I think that order is reflective of how basic they are and their importance to you.
The most basic thing is your perspective and the overall belief that you will overcome your problems.
The second most important thing is for you to have resources to draw on including social support, financial support, health care resources, and a pdoc that knows you.
Finally there are meds. The right meds at the right doses can really make a difference.
How often do you see your pdoc? When is your next appt? Does your pdoc do phone check-ins with you? All of this applies to meds, because it affects how often you can change doses or start new meds if the old ones aren’t working.
So here are my thoughts on your meds:
EFEXOR: Have you tried to push your dose all the way up to 225mg/day? What other ADs have you tried? Did you push them to the maximum dose before giving up?
LAMICTAL: I can't say I know much about BPII, so I can't really comment on the Lamictal. Maybe you could start a new thread on BPII and how the different meds work. JohnX2 seems to be very knowledgeable here.
ZYPREXA: As to your Zyprexa, I'm probably overcautious, but I wouldn't take an anti-psychotic unless I was psychotic. Maybe you could take Remeron instead of Zyprexa at night to quiet your mind and help you sleep. Also, I've heard that Remeron + Effexor is an especially potent antidepressant combination. Maybe that combo is just what you need.
KLONOPIN: I know that it is important not to abruptly stop taking klonapin. But it may be in your long-term best interest to taper off and discontinue it. The reason I think it might be a good idea is that taking a benzo long term, especially klonapin, can cause depression or make depression worse. It can also cause cognitive impairment and cloudy thinking, which you have complained of having.
So maybe Effexor or the Effexor/Remeron combo could address your anxiety and you wouldn’t need an anti-psychotic for sleep and a benzodiazapine for anxiety.
My strategy with meds is to focus in on specific target symptoms, the things that are bothering you the worst, and try to treat those. That is a different strategy from starting from a (somewhat arbitrary, IMHO) DSM diagnosis and then treating the diagnosis with the meds that are used for that diagnosis.
Also a key strategy with meds is to cause no harm. This seems basic but people forget it all the time. It is better, IMHO, to take a med that does not work very well, but does not cause terrible side effects, than it is to take a med that works great, but causes overall harm to you. Safety first, then tolerability, and then efficacy.
Keeping med regimens as simple as possible is also very beneficial. If you are lucky, one med can do it for you. Most likely there will be some combination. Whenever you go down the polypharmacy trail, there are always consequences you did not expect. Like klonapin treating anxiety but worsening depression, or maybe one drug interferes with the action of another, or the metabolism of another. However you look at it, when you are using a combination it is more difficult to manage.
So it is best to ask of each med, what benefit are you getting from it? What side effects is causing? How would you be worse off, in terms of your target symptoms, if you were not taking that med? Even if you had problems from not taking a particular med, is it still possible that you would be better off overall? Could a more benign med be used instead?
These are all things to go over with your pdoc at your next visit. Just tell your pdoc that you want to focus on target symptoms, because that is what YOU are experiencing. Also that you want to make sure that all of your meds make sense, and if some that are causing you problems could be eliminated or replaced with a less problematic med.
Well, Janelle, I hope all this helped and that it was not too much for you to take on one day. I hope you’re doing better soon.
> I've been in and out of depression/anxiety for years now, but this past year has been particularly bad. I've had either a day or a few in a row where I basically don't get out of bed except to eat (sometimes I don't even do that) or use the bathroom, and I've also done the *stay in bed* thing for several WEEKS at a time. I get to the point where I basically cannot function beyond survival mode. Needless to say, when this happens I get even more anxious.
>
> From the posts I read on here, people are struggling yet y'all sound so much more together than I am when I get really depressed.
>
> Is there ANYONE out there who goes through periods where they basically can't get out of bed? Any feedback, words of wisdom or support greatly appreciated.
poster:fachad
thread:99162
URL: http://www.dr-bob.org/babble/20020318/msgs/99218.html