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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Peter on October 8, 2003, at 18:05:35
Hi:
Today was day 33 total on lex, and 27 on 10mg (started first 6 days on 5mg).
It seems that everytime I feel that the lex might be beginning to kick in, and I think I'm beginning to feel better, I end up falling again into a pit of depression, social withdrawal, and irritability. Today I got so depressed that I was totally uncaring and unresponsive to anything or anyone around me. And a few days ago, I thought I was feeling better! Then the depression hit again. I'm also waking up at wierd hours of the night, unable to fall asleep again.
I spoke with my pdoc today. Last week he said I should decrease my adderall dose and that we would probably end up INCREASING the lex dose if I didn't feel better by this week.
But when I told him today that I've been really depressed and low, but that I'm also having trouble sleeping, etc., he said that it seems as if the lex is having a dual effect on me - it is activating me (thus the sleep trouble and irritability), but it is also 'flattening' my mood (thus the depression, social withdrawal, etc.). He said that I seem to react that way to SSRI's and even often to stimulants. And he said that, given this info, I should REDUCE the lex to 5mg instead of INCREASE it.
I've been taking every type of med imaginable for 8 years in different combinations - all the SSRI'S, mood stabilizers, benzos, effexor, wellbutrin, dopamine agonists, stimulants, etc. But I never really responded robustly to any of these treatments - if I had, I wouldn't still be constantly changing med regimes still after 8 years.
The only class of Antidepressant that I have not yet tried are the MAOIS, mostly because I was always anxious about their risks and interactions. But my pdoc said today that it would really be worth my consideration to switch to an MAOI, as my seeming lack of response to SSRI's, etc., make me a good candidate for an MAOI. Although there are some diet restrictions you have to follow, I've heard that, with people for whom the MAOI's work well, the benefits far outweigh the risks. An MAOI might very well be the long-awaited 'silver bullet' for me.
But, I'm still very hesitant to undergo this change for a few reasons: Firstly, I am so sick of going from one pharmacological roller-coaster to the next; my body can only take so much. To switch to an MAOI, I'll need to first taper off the lexapro and adderall, then wait 2 weeks after the lex is out of my system; then, of course, I'll have to undergo waiting for the MAOI to kick-in, if it ever does, and again endure all the side-effects that come with starting a new med. I have 33 days of lex under my belt, and it was really hard to get this far; I've seen many posts describing people who felt NOTHING from lex until as far into treatment as week 7,8 or even 9.
So, I don't know if I should go down to 5mg of lex, and then proceed to taper it and go the MAOI route. Or, if there might be a slim chance still, even after this long and feeling this bad, that the 10mg lex might all of a sudden kick in and start working better than any other AD I've taken before. The chance of this happening seems very unrealistic to me, but I just don;t know if it is worth hanging on for a few more weeks. Then again, I'll always be wondering and anxious about if an MAOI would have ever worked for me if I DON"t just try one.
I'm very confused, and would really appreciate some advice/insight. Thanks a lot,
Peter
Posted by Searchlight on October 8, 2003, at 21:06:42
In reply to REALLY NEED ADVICE, PLEASE!, posted by Peter on October 8, 2003, at 18:05:35
Peter! I am going through EXACTLY what you are going through at this very moment. I have taken all kinds of SSRIs and tricyclics and combos and only Prozac worked decently enought to get by for 10 years before it pooped out on me. I have pretty bad atypical depression and at 37, I have had depression since I was 4 (yes, 4), I am sick of the rollercoaster ride myself. I talked to my latest pdoc today about going on Parnate (an MAOI) after years of waffling about it for the same reasons you are. He won't prescribe MAOIs anymore, but he gave me my Mom's pdoc's name and another name of someone I already know who would (problem is neither is on my insurance list, but money is not going to hamper my getting my mental health back, not for anything). My Mom is on Nardil and has been for 15+ years and it has worked wonders for her. She has really gotten the diet thing down to a T. It is very do-able Peter. There is a lot of research on it, Marplan has been used since the 1950's- that is some long-term study on a med! I am so amazed that someone is on this board that is mirroring my situation at this moment! I really hope you find what you need- and please keep in touch, I need the support too!
Searchlight
Posted by wsj on October 8, 2003, at 23:42:17
In reply to REALLY NEED ADVICE, PLEASE!, posted by Peter on October 8, 2003, at 18:05:35
peter, still hanging w/ you on the lex - have mild improvement on 10mg but only when augumented by dexedrine. what ever dexedrine gets you up you must come down to sleep . taking 1mg klon to help. i am also thinking strongly about going to parnate but wondering when to give up on lex. i'm thinking 6 weeks is a fair trial. so like you i only got a couple of weeks to go!
good luck
wsj
Posted by Peter on October 9, 2003, at 4:39:25
In reply to Re: REALLY NEED ADVICE, PLEASE! » Peter , posted by wsj on October 8, 2003, at 23:42:17
Hi guys:
Thanks a lot for your feedback. Although I am probably going to end up on an MAOI, I've decided to just give the lex the full 6-8 weeks (It's been 34 days). If I don't respond well by then, I'll start the voyage to MAOI-land.
I'm beginning to realize, though, that all of this has as much to do with my attitude as it does with the efficacy of the meds themselves. The lexapro is doing SOMETHING; I can see that by the fact that I am waking up earlier, etc. But I have not really been 'allowing' it to work positively because I'm letting my pre-conceived notion that all SSRI's suck get in the way. So this is where the psychosomatic element of the med not working comes in. I'm also not cooperating, so to speak, as much as I could with the med. For instance, when I'm jolted awake early in the morning, I've been taking ambien and going right back to sleep again, only to sleep through my alarm, wake up extra late, feel crappy, and waste the whole day. What I could try is 'going with the lexapro flow' and getting out of bed when I wake up, taking advantage of some free time in the early morning, do some exercise, etc..I think that, this far into treatment, I can do things that could increase my chances of responding well to the lexapro - things that are conducive to my health. I've realized that psychology plays a big role in my reaction to meds; if I go into it thinking it ain't gonna work, chances are that attitude will affect it. So I'm going to give the lex a couple more weeks, since I've come this far, but for these weeks I will concentrate on doing what I can to 'cooperate' with the med and have a positive attitude about it working. My pdoc agrees that if I can get past the stress and just find a way to deal with the ambiguity of whether the med will work, day by day, there's more of a chance that it will have some sort of efficacious effect. I think it's worth the last stretch. Meanwhile I've heard nothing but terrific things STILL about MAOI's, but instead of jumping impulsively to one, I'm just gonna ride the lexapro thru a bit more and put the MAOI on the backburner for now.
Good luck to you both. Keep in touch, please.
thanks a lot,
Peter
Posted by Bill LL on October 9, 2003, at 10:42:13
In reply to REALLY NEED ADVICE, PLEASE!, posted by Peter on October 8, 2003, at 18:05:35
Since you are already on Lexapro, I think that the simplest, and most logical next step is to increase the dose to either 15 or 20 mg (I have been on 20 for the past year with very good results). Give the increased dose a couple weeks before you give up on Lexapro.
Address the sleep problem separately. If you have trouble sleeping, there are good and safe drugs such as Ambien.
Posted by Jasmine Neroli on October 9, 2003, at 23:52:35
In reply to Re: REALLY NEED ADVICE, PLEASE!, posted by Bill LL on October 9, 2003, at 10:42:13
Yeay Peter, way to go there with your determination to give Lex a chance for a few more weeks!!!
I think you have been so afraid that you're wasting precious time on what might be the wrong drug, that you are in danger of sabotaging its possible positive effects, cuz of psychological attitudes (just as you say!). And MAOI's are right around the corner to try, right?
Well, you are really helping me, right now (believe it or not!). Cuz I'm trying to stick with BuSpar for my GAD even though after 4 weeks at 20mg I have NO improvement in my anxiety levels. The dose has now been increased to 30mg (as of today), and whilst I've been pessimistic about it's potential effectiveness, you have inspired me to stick with it and change my attitude towards BuSpar!!! I will LET it work, if it's gonna - haha! (Thank heaven for the Klonopin PRN, tho').
Keep checkin' in.
Jas.
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