Posted by papillon2 on March 14, 2012, at 3:03:09
In reply to New med advice? (sorry, long post!), posted by kagome on March 10, 2012, at 10:30:43
Hi Kagome,
I haven't read all the responses to your thread, they are a bit overwhelming! But from reading your initial post a few things spring to mind.
The first is that you may benefit from an anti-depressant which is more activating, to help with the hypersomnia and lack of motivation. I have melancholic depression, not atypical depression, but they share the symptoms of fatigue and leaden paralysis. Like you, SSRIs do nothing for me and Effexor was successful until it stopped working.
I found that Mirtazepine (Remeron/Avanza) gave me a significant boost in energy. This was from 45mg but mainly at 60mg. Doses up to I think 30mg (?) tend to be sedating, then something kicks in at higher doses and flips the energy switch. I don't know if it helps with social anxiety.
I have also benefited from Nortriptyline, which I switched to due to the side effects of Mirtazepine. However, I don't know how it compares to the other TCAs you have tried.
The other thing which stood out for me is your struggle with negative thoughts. I find that low dose Lithium helps with this, especially with my severe suicidal rumination. Lithium is often used in unipolar depression to augment an anti-depressant. Much lower doses are used than for those with bipolar disorder. You don't have to be on the bipolar spectrum to benefit from Lithium.
And for a non-medication approach, Cognitive Behavioural Therapy and Dialectical Behaviour Therapy can be really beneficial for helping one deal with distress and to challenge automatic negative thoughts. I think CBT would be especially helpful for your social anxiety.
I am sorry to see that your thread has been somewhat derailed into another pro/anti medication/Lou debate. You have some good responses though, from some very knowledgeable and experienced posters. I hope their replies and my own give you some things to think about and that things start looking up for you soon. Until then, and always, please take gentle care of yourself.
Papillon
Ring the bells that still can ring
forget your perfect offering
there is a crack in everything
that's how the light gets in
~ Leonard Cohen
poster:papillon2
thread:1012720
URL: http://www.dr-bob.org/babble/20120302/msgs/1013020.html