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!
poster:Racer
thread:485122
URL: http://www.dr-bob.org/babble/20050413/msgs/485122.html