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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by g_g_g_unit on September 22, 2011, at 8:52:50
so i cut out the caffeine and z-drugs last night/today and i'm back to my baseline state on lexapro and depakote - which is to say, calm, more emotionally stable, but very inattentive and overcome by a disturbing sense of dissociation.
it's weird, because during my worst bouts of depression or anxiety, i feel this horrific sense of depersonalization, which hasn't really abated for a couple of years. the lexapro takes away the constant anxiety induced by DP/DR, but possibly makes me feel even more empty. i'm a little weary to dump it though, because it's pretty clean and i haven't been able to tolerate much else.
i'm thinking of maybe trying nortriptyline for improved sleep, ADD and am wondering if it might help with alertness, anhedonia and hence my sense of unreality? is there any logic to that? i have a very bad track record with NE drugs as far as anxiety goes. is there reason to think nortriptyline would likewise cause problems?
Posted by SLS on September 22, 2011, at 9:13:46
In reply to nortriptyline with lexapro? + depersonalization, posted by g_g_g_unit on September 22, 2011, at 8:52:50
Depersonalization and derealization often occur when both anhedonia and anxiety are present.
- Scott
Posted by Phillipa on September 22, 2011, at 10:44:09
In reply to Re: nortriptyline with lexapro? + depersonalization, posted by SLS on September 22, 2011, at 9:13:46
High anxiety causes so many wierd symptoms. Maybe a med for anxiety? I still believe in the benzos. Phillipa
Posted by Conundrum on September 22, 2011, at 12:23:14
In reply to Re: nortriptyline with lexapro? + depersonalization, posted by SLS on September 22, 2011, at 9:13:46
> Depersonalization and derealization often occur when both anhedonia and anxiety are present.
>
>
> - ScottInteresting. This is what I experienced in 2003 when I stopped prozac after being on it for 4.5 years. Eventually the D&D went away but the anhedonia remains.
Posted by g_g_g_unit on September 24, 2011, at 5:00:48
In reply to Re: nortriptyline with lexapro? + depersonalization, posted by SLS on September 22, 2011, at 9:13:46
> Depersonalization and derealization often occur when both anhedonia and anxiety are present.
>
>
> - ScottYeah, I think my first genuine episode was triggered by the sheer alienation surrounding severe depression. Since then, though, it's evolved into a chronic problem, (thanks to OCD) such that it's difficult to really determine whether I'm still experiencing it or just afraid of the thoughts it gave rise to.
I have noticed, though, that Lexapro does make me feel noticeably spacey and disconnected.
Do you think nortriptyline would be a worthwhile drug to trial in order to offset the emotional numbness and insomnia from Lexapro? As an NRI, does it have the potential to increase anxiety?
Posted by SLS on September 24, 2011, at 6:46:59
In reply to Re: nortriptyline with lexapro? + depersonalization » SLS, posted by g_g_g_unit on September 24, 2011, at 5:00:48
> > Depersonalization and derealization often occur when both anhedonia and anxiety are present.
> >
> >
> > - Scott
>
> Yeah, I think my first genuine episode was triggered by the sheer alienation surrounding severe depression. Since then, though, it's evolved into a chronic problem, (thanks to OCD) such that it's difficult to really determine whether I'm still experiencing it or just afraid of the thoughts it gave rise to.
>
> I have noticed, though, that Lexapro does make me feel noticeably spacey and disconnected.
>
> Do you think nortriptyline would be a worthwhile drug to trial in order to offset the emotional numbness and insomnia from Lexapro? As an NRI, does it have the potential to increase anxiety?
OCD is really driven by anxiety. It makes sense that you would be particularly vulnerable to dp/dr while you are in the midst of severe depression. Lexapro might exacerbate the dp/dr if it places you in a more anhedonic and mentally numb state. Some people like to attribute this blunted affect to "dopamine depletion". I really don't see how this can happen, though.Maybe add nortriptyline and target a dosage of 75mg or 150mg, depending on your rate of metabolism of this drug as determined by taking blood tests to determine the therapeutic dosage. If you are not happy, you could then switch from Lexapro to a SNRI drug like Effexor or a SSRI known to be effective for treating OCD. If you choose Prozac or Paxil, you will need to reduce the dosage of nortriptyline by approximately 1/2.
Good luck.
- Scott
Posted by g_g_g_unit on September 24, 2011, at 9:27:27
In reply to Re: nortriptyline with lexapro? + depersonalization » g_g_g_unit, posted by SLS on September 24, 2011, at 6:46:59
> OCD is really driven by anxiety. It makes sense that you would be particularly vulnerable to dp/dr while you are in the midst of severe depression. Lexapro might exacerbate the dp/dr if it places you in a more anhedonic and mentally numb state. Some people like to attribute this blunted affect to "dopamine depletion". I really don't see how this can happen, though.
Yeah. It sucks because meds that improve my hedonic tone (e.g. stimulants), and hence one of the markers of the DP/DR, do nothing for the hypervigilance and phobic avoidance that's resulted from it. Lexapro, on the other hand, curtails the anxiety but leaves me feeling more internally lost. I would like to hopefully achieve a balance between the two.
>
> Maybe add nortriptyline and target a dosage of 75mg or 150mg, depending on your rate of metabolism of this drug as determined by taking blood tests to determine the therapeutic dosage. If you are not happy, you could then switch from Lexapro to a SNRI drug like Effexor or a SSRI known to be effective for treating OCD. If you choose Prozac or Paxil, you will need to reduce the dosage of nortriptyline by approximately 1/2.Thanks for your advice. I didn't realize Lexapro wasn't known to be effective in OCD. Prozac causes terrible akathisia, unfortunately. I experience some on the Lexapro, but the anxiolysis masks the worst of it.
I'll suggest Nortriptyline to my psychiatrist at our next meeting. I remember trying it at a low dose for sleep a few years ago and incidentally noticing an improvement in my executive function (I have ADD as well).
My track record with NE-targeting drugs (Mirtazapine, Buspar, Strattera, clomipramine, Ritalin) is terrible though, as far as mood and anxiety goes. Would it be to treat nortrip as its own unique entity?
Posted by SLS on September 24, 2011, at 13:31:35
In reply to Re: nortriptyline with lexapro? + depersonalization » SLS, posted by g_g_g_unit on September 24, 2011, at 9:27:27
> > Maybe add nortriptyline and target a dosage of 75mg or 150mg, depending on your rate of metabolism of this drug as determined by taking blood tests to determine the therapeutic dosage. If you are not happy, you could then switch from Lexapro to a SNRI drug like Effexor or a SSRI known to be effective for treating OCD. If you choose Prozac or Paxil, you will need to reduce the dosage of nortriptyline by approximately 1/2.
> Thanks for your advice. I didn't realize Lexapro wasn't known to be effective in OCD.
It probably is effective for some people. I think Prozac and Luvox are the two SSRIs that I read about most as being effective in OCD.
> My track record with NE-targeting drugs (Mirtazapine, Buspar, Strattera, clomipramine, Ritalin) is terrible though, as far as mood and anxiety goes. Would it be to treat nortrip as its own unique entity?
I am afraid that this is what we must relegate our theories to - wild guesses. Indeed, I would try the nortriptyline without any preconceptions.
Also...
trimipramine
doxepinThese two drugs are known to help with anxiety in addition to depression. Trimipramine seems not to affect NE reuptake.
If you need a last resort, I would choose Nardil. It is effective for:
depression
social anxiety disorder
social phobia
generalized anxiety disorder
obsessive compulsive disorder
- Scott
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