Posted by SLS on August 11, 2004, at 7:09:35
In reply to Re: depersonalization help needed » SLS, posted by JahL on August 10, 2004, at 16:54:46
Hi J.
Nice to see you too!
> Hope this finds you better than the last time I spoke to you (a few times probably a couple of years ago - I don't expect you'd remember).
Of course I remember!
I am not in a real good place right now, but it is not excruciating.
ECT has well and truly brought me to my knees in the meantime.
How so?
> I know you're particularly frustrated by cognitive retardation and boy can I empathise; my current working IQ is around 30-40 points down on my euthymic IQ. It's the single most frustrating aspect of my disorder.
Me too. Actually, it is this point exactly that is weighing on me so heavily right now emotionally. It is nothing short of dementia, and it is tugging at me with suicidal ideation. My memory is profoundly impaired.
> > > SSRIs just worsen my depersonalistion.
> > I think I can understand how this might happen. Depersonalization might, in large part, be the result of chronic anxiety superimposed upon anhedonia.
> Mmm. Certainly anhedonia and complete mood unreactivity are a central feature of my disorder. I am pathologically bored.Do you actually experience boredom? I don't like to brag (ha ha), but I am so vegetative, that I can't experience boredom. I am content to stare at a blank TV screen. I do experience boredom, however, when my depression begins to lift as with a transient response to medication. Boredom heralds a potential remission for me.
> My anxiety is chronic and presents itself mostly as acute social phobia.
Do you experience any anxiety outside of social situations? Perhaps it is such a constant with you, that you don't even recognize it.
> >Prozac can produce both. [anxiety + anhedonia/apathy]> I agree. I've tried (for the appropriate time period) around 15 antidepressants and without exception, they have all worsened my condition, which would encompass anxiety and anhedonia. Interestingly, most antidepressants I have taken have worsened the derealisation almost instantly, with some being worse offenders than others, whilst the extra depression, as you say, does not normally kick in for a few weeks.
Out of curiosity, which would you identify as being the worst offenders?
Does it help to titrate the dosage very gradually?
> >The anxiety usually develops right away with Prozac. However, the anhedonia/apathy usually takes a few weeks or longer. The two together could make depersonalization worse, especially in the absence of an antidepressant/anxiolytic response.
> Mmm. As I say, speaking for myself, the depersonalisation appears well before any anxiety...Maybe serotonin reuptake inhibition is clinically toxic for you. Have you ever tried trimipramine or Remeron? What about Provigil or adrafinil? Is Wellbutrin anxiogenic for you? You might consider adding a stimulant like Adderall. It can actually help to promote social confidence and reduce anxiety. I guess you've probably visited these things already.
I am looking into a few different things. I had a transient antidepressant response to memantine. Because of this, I have an interest in riluzole (Rilutek). The other thing I got my doctor interested in is mifepristone. It is a potent cortisol receptor antagonist. Right now, though, I am waiting for the newly-approved Cymbalta (duloxetine) to reach the pharmacy shelves. It is a SNRI with high affinity for both transporters, and is less biased towards serotonin than Effexor.
> > Have you ever focused on ameliorating the chronic anxiety?
> Yeah, as I say in a post elsewhere, Sulpiride has been pretty effective (no complete remission tho') where *everything* else (55 meds and counting...) has failed. It is truly a lifesaver since I cannot function and interact socially w/o it.
Some people get a pro-social/antidepressant kick from adding Abilify into the mix.
> Sorry this this is so long. It's just nice to see a familiar 'face'. I don't see anyone else from 'way back' here.
Time flies! It really doesn't seem so long since you were here last. Ouch.
:-)
I hope there is something you can learn from the new folks here that can help pull things together for you. They're a smart bunch (as always).
- Scott
poster:SLS
thread:374412
URL: http://www.dr-bob.org/babble/20040811/msgs/376318.html