Posted by Amelia_in_StPaul on April 21, 2009, at 13:12:24
Desolation rowers (what a great name by the way),
I am crashing, fast (5 days off fluoxetine for a sleep study--atypical depression getting worse). I need to come up with a regimen that works for me and am hoping that I could get your input. I hope you bear with me as I give you a little history.
I am in my late 30s. In pre-teen years, my father died suddenly in front of me (only me) and I was unable to save him. After, my sister showed signs (unbeknownst to us) of being in the prodromal stages of schizophrenia and, as a result, she was often violent in our home. Looking back, I had periods of melancholy in high school, but nothing too bad until I was 17 and in an abusive relationship with my boyfriend. I tried to kill myself, but my mother found me. I went in hospital for two weeks. They did not want to give me medication b/c my brain was still developing. I had psychotherapy after and then went off to college, which seemed to solve my problems for a couple of years. At 20, I had a melodramatic relationship with a guy whose presence triggered something in me so that he felt like home, he felt like the missing piece, and then when he left me I had a bout of depression. That was the first time I was on Prozac.
Over 15 years I was on and off of it, mostly on. In the meantime, I tried multiple other drugs, but couldn't last a trial b/c of overwhelming side effects (listed below). I never had much of a problem with anxiety, though I was a worrier, and had a bit of a problem with compulsions when I was 7.
Flash forward. My husband and I endured a ton of stress related to our house. Part of it actually collapsed, we ended up almost in bankruptcy, my in-laws gave us some money so we could try to fix the house, contractors created more structural problems--a period of about 9 years of hell, during which time I broke my back, got mono, etc. My relationship with my husband is sometimes bad so that is an ongoing stressor (as is the house--still not finished yet).
In January of 2008, I ended up with anxious depression, something totally new to me. This was after going off of my fluoxetine in April 2007 (with very brief trials of other meds, all failed, after the fluoxetine). I ended up on the couch, unable to move, shaking, not eating, not showering, just waking up and moving to the corner of the couch, where I sat all day, freaking out. I thought I was becoming schizophrenic. I was obsessed with that thought. I went inpatient, ended up being verbally abused by the staff, manipulated and retaliated against when I complained to the hospital ombudsman, and left the hospital worse than when I came in. Spent four weeks in a state of extremely severe anxiety, ironically the only thing that would get me out of my head for seconds at a time was to read, so I read a ton of light novels. Went into a partial hospital program at another hospital, went inpatient for awhile to sort out my sleeping, started the road to healing. 9 months after 20mg of fluoxetine, became severely apathetic, sleepy (in addition to fatigue), amotivated, and again, in periods of depression. I am now back to suicidal ideation and sitting on the couch.
My diagnoses are PTSD, Major Depression recurrent, GAD, OCD, social anxiety, and borderline features (the emotionally labile part), and non-restorative (lack of stage 4) sleep. All of them fit, although my OCD therapist balks at the notion that someone could have so many diagnoses.
Med History-Failed Trials
Effexor (eye dilation, intense nausea, double vision, flu-like symptoms lasting 24 hours)
Serzone (migraine headache)
Paxil (double vision, unable to see/focus)
Zoloft (first trial in 1993, slept for most of the next 72 hours, flu-like symptoms; second trial in 2008, chest paint for four days, sleepy but not helping me sleep)
Elavil (zombie-feeling, bumping into things, unable to concentrate)
Lexapro (eye dilation, woozy, spacey, tried for two days but couldn't take it)
Wellbutrin (as an adjunct to fluoxetine it used to work to wake me up, but then I started to have panic attacks on it; tried it on its own in 2008, on 35mg daily ended up incredibly hostile, angry, climbing walls)
Seroquel (tried in 2003, knocked me out for 13 hours but didn't seem to help with deep sleep, got up and slept most of hte next day. Headache and flu-like symptoms; tried in 2008 in the hospital, ended up with panic attacks, agitation, hyperventilation, and unable to judge accurately the distances between me and objects and the size of some objects)Now Prozac. In the past, trying it at 30mg, I was just dead basically. 20mg always worked, but with fatigue. Now on 20mg, I am totally wiped out, falling asleep during the day etc. My reaction to it seems to have changed. Before hospitalization, I tried to get back on it, twice: the first time, it made me incredibly sleepy, and the second time, it made me absolutely wired, anxious, and agitated, with a resting pulse of 80 (normally more like 50). In hospital, I was also placed on ativan, and then, back on Trazodone, the only thing that has ever worked for deep sleep.
Okay, so in sum, the things that have only ever worked out of these trials:
Prozac/fluoxetine (was on 20mg until 5 days ago)
Ativan (was for a year and half on .5 in morning, 1.5 in evening; I started tapering off and am on .25 in the morning, same evening dose)
Trazodone (but I develop tolerances to it, and then take more, but anything over 25mg just makes me non-functioning the next day, without necessarily keeping me asleep the night before).Family History
Mother - depression
Sister - schizophrenia
Sister - nothing
Father - depression (tried meds in the late 70s, couldn't tolerate them)/fatal heart attack (fit as a fiddle--genetic cholesterol condition)
Grandparents - maternal side, both undx'ed depression
Grandparents - paternal side, one with undx'ed personality disorder
Great-grandparent - maternal, suicideAlthough in females, the timeframe for developing schizophrenia is most commonly 20-35, it is still possible to develop it later in life, especially with hormonal changes. In the last year and a half, I have had what my doctor calls a stress-induced brief hallucination (last summer, after a huge amount of caffeine and lack of sleep), and quasi-hallucinations. I now have hpynogogic and hypnopompic hallucinations (occurs in normal populations, but new to me). All of this was probably brought on by my intense obsessions over fear of becoming schizophrenic, as I would think of all the things I could think or see or hear that would be unreal. I unfortunately have an intimate knowledge of my sister's delusions and hallucinations, and I have absorbed them and obsessed over them.
So I am not psychotic but feel I could tilt that way.
In sum, I am looking for a medication regimen that may have some dopamine but does not carry with it a higher risk of psychosis (as does the TCAs). I am looking for wakefulness without inducing anxiety. I am looking for something to level out my days, whether that be an AD or a mood stabilizer, if that seems appropriate (and sometimes it does).
I am also looking to not be on a medication that carries a risk for metabolic syndrome or high cholesterol, since heart attacks due to high cholesterol is genetic in my family (father and uncle).
I'm not asking too much am I? ;-)
Willing to try proven alternative therapies.
Whew. If you have read through this entire post, d/r, and anyone else, you are a saint.
Desperately yours,
Amelia
poster:Amelia_in_StPaul
thread:891937
URL: http://www.dr-bob.org/babble/neuro/20090129/msgs/891937.html