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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Daniel Woodfield on July 29, 2004, at 9:49:13
OK, so im going to try my best to explain this in order for you kind people to make some kind of suggestions.
I hope i fit everything in, there is so much i always leave something out. Please be patient, and all comments are more than welcome.
So, im ill. I have been ill for as long as i can remember. Obsessive as a kid, had a good patch between the age of 11-15, made a silly mistake in a sexual situation when i was 15 (lost my virginity when i didn't want to, with someone i didn't want to), and have been ill ever since.
To cope with my self loathing and guilt after said incident i smoked marijuana chronically for the next three years whilst procrastinating over whther i had caught an STD or not. Most of the time telling myself that i deserved to, so i probably would have. These three years were dark, and i destroyed my personality, health and largely my soul. (Of course when i finally had a test at 18, everything was hunky dorey, and while at the time i assumed my life would fit back together, the damage had already been done.)
So i quit marijuana, feeling i didn't need to feel sorry for myself anymore, and started to get bad panic attacks. (Well none of them are easy hey!!!). I didn't know how to live in the real world anymore, i had lost all my vigour, confidence, infact most of what i had learned about myself and life up until THE incident. Life scared me, i couldn't handle it, so i went to the doctors.
PAXIL (Seroxat here in the UK), according to my doctor was going to be the thing to save my life. It was a gaurantee, no arguing, it WOULD work, so who nam i to question???So i started the Paxil and went off to University to start my first year.
Three months later i woke up in bed at uni, and surveyed the situation. My Room was an absolute tip, i smelt really disgusting, had no friends and my room mate had moved out and into someone elses smaller room where he had to sleep on the floor. On top of that i was having electric shock type sensations everytime i moved, i ached all over and hadn't been to ONE lecture since starting at uni. I had woken up from a stupor having not taken a paxil tablet for three days, and was starting to realise the unwelcoming, mess of a zombie i had turned into, the effect i was having on others and the effect the drug was having on me. I noticed an envelope by the door of my room, opened it to find that i had been kicked out of uni for not going to lessons, and generally being a waste of their time and space. SOMETHING WAS WRONG.
So, i came home, mother was crying, angry, angry, crying, it was horrible to deal with. I decided to get off the drug, the Paxil.
Over the next six months i struggled with the taper, struggled with the withdrawal, struggled with a disbelieveing and angry parent and struggled with my weight. When i finally kicked the Paxil i was at a life high of 301 lbs.
I went back to a uni closer to home so i could stay in my own bed and attempted to get my life back on track.OK SO THATS THE BACKGROUND UP UNTIL 2 YEARS AGO, FASTFORWARD TO TODAY.
Today i am 201 lbs exactly, having lost 70ilbs in one effort, put a few back on and then lost the rest to where i am today. Im proud of myself.I am just about to start my final year at uni, and am on for the second best class of degree that can be awarded in the UK. Im proud of myself.
However, i am ill.The Paxil has left me emotionless (Bar anger, dissapointment, self worthless etc, all the negative symptoms that categorise depression).
I have absolutely no interest in anything except looking up medications and ways out that other people have had success with on the Internet.
I define myself as dysthymic, anhedonic, alcoholic, having social anxiety to the extreme, with other forms of anxiety mostly regarding my health, weirly though only about things that aren't realistic. I recently had a breast cancer scare because i found a lump and this didn't bother me AT ALL, i was much more interested in dreaming up unrealistic afflictions that i had. VERY ODD.
Anyway having read this board now for about a year and a half, i find myself in a position where i feel that i know a fair bit about this area of the medical world, a damn site more than my local doctor (who i have to deal with because i can't afford a psychiatrist, and they won't give me one on the NHS unless im being medicated.)HOWEVER, even though i feel i know a fair bit, i also find myself extremely confused with all of the information i have read in here over the period of time i have been around.
To recap, Dysthymia, anhedonia and social anxiety are my main complaints, and i clearly need to be medicated for these complaints in order to regain any part of my life. (I just sit infront of my computer for 17 hours a day, go to uni and stare into space a couple of times a week, thats my life.)
Now, doctors in England are very different to doctors over there, there is no give whatsoever, its what they say goes, and what they offer is very basic and very little.If its not an SSRI, or an SNRI, then you are screwed. (This is dependant on diagnosis of course, but in my doctors case there is either depression, anxiety or some kind of phsycosis. When i suggested Dysthymia to him, he stared at me blankly and said, you mean depression??? God, help me!!).
He is however open to suggestion and i honestly feel i have eductade him in this area more than any other and apart from the fact that we are only allowed a five minute slot with a doctor over here, i honeslty think he would love to hear my input so he could get ahead in helping patients like myself, for selfish reasons, unfortunately, but still he will listen.
However due to the five mionute per session fact (How can someones mental issues be explained, understood and treated with a five minute consultation????? Criminal!!!), i find it very hard to explain what i wanted to when in the doctors room. Mind goes blank, i mumble some rubbish and get sent packing.
The last time i was there i came home with a prescription for effexor but having read the messages here i really wasn't sure i wanted to go there. I dont think my illness is serotonin related, im convinced its dopamine (but i fear i also could be manic at times which is something that has never been suggested to me. I often find that im ready to climb the walls with nervous energy, irritated, but never mental clarity or mental energry, which is what i thought mania would do to someone. It would be nice if someone could clear that up for me!!).
Bloody hell, my fingers hurt.SO THE REASON IM HERE.
Can anyone suggest to me what i should be asking the doctor to help me with tomorrow when i go the appointment.
Baring in mind my symptoms.Low mood for seven years.
Irritated/agitated.
Cant look at the TV, read a book, do one task without becoming extremely agitated.
Have no emotions. (Bar anger etc).
Enjoy nothing
Socially anxious
Socially withdrawan
No interest in sex in the subconscious. Overly interested in sex in my immediate conscious.
Aches and pains.
Bored.
Prone to abuse alcohol through boredom, (yet im 100% sure if i was to be medictade i have no desire to be sedated. Absolutely none.)
It would be nice to hear your thoughts guys, thank you in advance. Apologies about the spelling by the way, but im not going to check back, i have gotten irrittated just by writing this huge essay and need to play some football on the PS2 or something.
Oh and one final thing, i did try the effexor for four days (original version), and it was interesting. Totally different to Paxil, none sedating, totally enervating without touching my mood. Just a whole load of side effects which weirdly i actually enjoyed. Made me feel alive even though it increased my energy level but didn't touch the depression. Is that odd??? Who knows, maybe im just odd!!Dan
Posted by jaby on July 29, 2004, at 10:29:09
In reply to Help required. Very Confused. Kinda Urgent., posted by Daniel Woodfield on July 29, 2004, at 9:49:13
As you've eluded to, you could use a stimulating medication. A true stimulant may not be your best choice due to your past alcohol abuse. Things you might try would be wellbutrin, lamictal, provigil, prozac or zoloft (if you want to give the SSRI's another chance), etc. Sounds like you may have tried wellbutrin since you mention a SNRI. I would give provigil or lamictal a go. Don't give up on the idea that there isn't something out there to help you. I've taken 25+ medications at age 28 in many combinations and have something that's been working fairly well for some time now. Not perfect, but I am very highly functioning and very happy for the most part. I wish you the best!
Posted by Racer on July 29, 2004, at 11:05:47
In reply to Help required. Very Confused. Kinda Urgent., posted by Daniel Woodfield on July 29, 2004, at 9:49:13
I'm not sure how helpful I can be about the medication issues, but I do have some very general suggestions for you. I hope they help.
First, though, I'll tell you something about my own experience on Paxil, since sometimes just hearing that I wasn't alone helps me. Years after coming off the Paxil, I was describing its effects to a new doctor, telling her that I was constipated, anorgasmic, lethargic, etc -- and that I felt unable to experience my emotions. She said, "So, you felt emotionally constipated?" I'd never have thought to put it that way, but as soon as she said it, it clicked into place. That's exactly what it felt like. I don't think that it's all that rare to experience something like that on Paxil. Of course, it did help my depression, and I know that it's very helpful for others. As we all like to say here, "Your Mileage May Vary".
If you have a very short time allotment with your doctor, I strongly recommend writing a list of topics and points to take with you. Just like any other outline for any other purpose, and it serves the same purpose. Write down all your concerns, all your ideas for exploration, and any medications you think might be worth discussing. In your case, I'd also suggest mentioning your unease with the diagnostic term "depression" rather than "dysthymia." (Think of the two as points on a spectrum, with the popular name of that spectrum being "Depression" -- does that help make his response any easier to accept?)
I'm assuming you're a young man, in which case what you're describing about the course of your illness really does fit with depression -- even if you're more aware of the anger and irritability than sadness per se. The lack of energy, feeling like a zombie, even the anxiety -- all can be part of depression for many people. (I have a little mood diary I made up for myself, but the "mood" section has separate columns for agitation, irritation, and despair, because I can't always see them in combination. I have to make a different notation for each in order to get at my overall mood. Together, they make up "depression" for me, even though I may not be aware of sadness all the time.) Besides, the diagnosis isn't what you want treated, is it? If your doctor diagnoses you as suffering JellyBaby Disorder, but treats your dysthimic anhedonic anxiety effectively, won't you still be satisfied with the outcome? Hard as it is, let go of any investment you may have in convincing him to recognize any specific disorder, and concentrate on what you really want: effective treatment of your most distressing symptoms.
There is an argument to be made for looking for a stimulating medication, but my experience has been that improving the depressed mood will generally increase energy without augmenting agents. That's only one person's experience, and it won't hold for everyone, but it goes along with another piece of advice: try one drug, and only add another if that first drug provides partial relief after an adequate trial at a therapeutic dose. (No, I'm not a scientist, but I could play one on TV...) Starting off with an SSRI or SNRI alone is fine, and some of them are known to be more stimulating than others. Prozac and Zoloft, as far as I know, are more stimulating than Paxil or Lexapro. Remeron is sedating, Wellbutrin activating. Effexor has as many peculiar effects on the up-taper as on the down-taper, but it can be very effective for many people. (It was a lifesaver for me, in combination with Prozac, although it did stop working for me eventually.)
Best luck to you. I hope something in here helped.
Posted by Sebastian on July 29, 2004, at 11:51:38
In reply to Help required. Very Confused. Kinda Urgent., posted by Daniel Woodfield on July 29, 2004, at 9:49:13
Stick with the Effexor. It takes a while for the meds to start working, the depression lifts slowly as you keep taking the same med. Could be months, years. Since you like the effects of Effexor, which is lucky, you should stick with it. Could be very hard to to find another med that works better, most likely you won't. Just keep remembering that, like when you want to stop it or change, if you do you will regret it.
Posted by Sebastian on July 29, 2004, at 11:57:57
In reply to Help required. Very Confused. Kinda Urgent., posted by Daniel Woodfield on July 29, 2004, at 9:49:13
I'll just throw these in to throw you off. If its dopamine you need and you want to stay energised, the only ones I know of are Abilify and selegelin.
Posted by woolav on July 29, 2004, at 18:18:04
In reply to Re: Help required. Very Confused. Kinda Urgent., posted by Sebastian on July 29, 2004, at 11:57:57
Dan, Hello. I hope the above posts helped some. I thought i had it bad here (usa) with my pdoc, 15 min. and out the door w/ a prescription. But she does listen to what i say and that is good. She had me on paxil for about 5 months. Before that, effexor, zoloft, celexa and serzone. I have long term depression, since i was little ppl always asked me why i was sad. I also have social anxiety and panic disorder. I keep trying different med combo's and pray i will find the right one. I got off paxil last week, and now that my head is clearing, i was such a zombied fog head on paxil. I hate it. and I too gained weight from it! But my pdoc recommended prozac, lamictal and xanax for me now. Its day 8, I went right from 37mg of paxil to 20mg prozac. So, Im going through some issues right now, but from what i have heard they will subside. I have been, happy as hell, crying, angery, hyper and exhausted all in the last 8 days. But I am going to give this cocktail a try. Prozac is suppose to last the longest of its type of medication (everyting else i ever take poops out in about 5 months) and lamictal is suppose to boost the AD effect of prozac and be a mood stabelizer. I would suggest that combo to your doc and see what he/she says. We seem to have very similar symptoms.
Good Luck,
San
Posted by jane d on July 30, 2004, at 2:39:45
In reply to Help required. Very Confused. Kinda Urgent., posted by Daniel Woodfield on July 29, 2004, at 9:49:13
You don't sound at all odd to me. From silly sexual mistakes around 15 to lost adolescence to afterwards feeling, as you put it so well, as though I'd also lost most of what I'd learned about myself and life up to that point.
I was a bit luckier in that I did well on an SSRI (prozac) at first. Later I had problems that sound like a milder case of what you experienced. One day I looked up and didn't know where the last year went. Being in the US, I went the poly drug route and found that adding wellbutrin helped a bit. So did lots of other drugs. A bit.
Since you have to work within your system there and elaborate drug combos aren't an option I'd suggest you give the effexor a real try. In fact I'd say that even if you were in the US. Since Effexor doesn't work on serotonin alone it may not cause you the same problems that paxil did. And four days is enough for you to feel a temporary stimulant effect (I often do) but not nearly long enough for you to know if it would work as an antidepressant. I have friends who swear by it.
If that doesn't work you could then try a tricyclic. Same idea - that something that doesn't just work on serotonin may not cause you the same problems with apathy. And since they are old (and cheap) I expect they are on the NHS formulary. Just in case one of these drugs did cause the same problems as the paxil did I'd make sure my family and doctor knew about what happened. That you have someone clearheaded watching out for you.
I'm sure it's frustrating to read about all these new drugs and elaborate combinations that you can't get. But after years of trying various combinations myself I'm not convinced they work particularly well. It's easy to say that xyz drug increases dopamine and therefore taking it will increase your motivation. Or energy. Or whatever. And sometimes it does but it seems to work out far better in theory then when you are actually standing there swallowing those handfuls of little pills.
Another thing you can try even without a cooperating health system is to stop or cut back on the alcohol. I found it was true that when I started an antidepressant my need for alcohol just evaporated. It surprised me at the time. Now think that stopping the alcohol first might have lightened my depression sooner. If I drink now I find my mood gets worse most of the time. This may not be true for you but it's worth a try.
It sounds like you have a good doctor and that's a real plus. If you think he'd be interested in some of the general information you've dug up you might try printing it out for him. Even if he can only give you five minutes he might find time to look at it later since it would benefit more people than just you. I also blank out when at an appointment no matter how much time I have. I've tried writing stuff down in advanace the way people tell you to but when I'm actually there I often forget that I've got notes to look at and just sit there mumbling. My current definition of a good doctor is one who manages to ask the right questions anyway.
Good luck and don't be too hard on yourself. It sounds like you've gone a long way already towards getting yourself back on track.
Jane
Posted by Daniel Woodfield on July 30, 2004, at 5:52:20
In reply to Re: Help required. Very Confused. Kinda Urgent. » Daniel Woodfield, posted by jane d on July 30, 2004, at 2:39:45
Thanx a lot for the replys guys, some very helpful stuff in there.
On the effexor subject, i have a friend at Uni who was tried first with paxil and then went to effexor and she loved Effexor, bar the sxual side effects.
When i tried the effexor, actually being quite excited about it with my friend singing its praises, i wasn't really in the right frame of mind because i was concerned about my weight.
I was about 40 lbs heavier than i am now and was not prepared to go any higher than that. I understand weight gain to be a side effect of effexor in some people (weight loss in others), but regardless of the fact that i enjoyed the stimulation of effexor i just wasn't ready to gain weight.
I do remember thinking "This drug could really help me, lets lose some weight and go at it full force." Its definitely what my doctor wants me to do, and i am not against it, especially thinking back to how i felt at the time of starting it up six months ago.However having looked at this site it just appears that there may be things out there that can help without causing dependance. the withdrawal from paxil was so hard to take, dealing with that again might just finish me off.
Anyway, i have been to the doctors now and presented him with some information. (Annoyingly i don't have a printer at home, so i saved some we adresses in my e0mail account and had to walk him through getting them up on his screen. Drawn out, but it has resulted in me coming home with a prescription for low dose AMISULPRIDE.He clearly wasn't happy with doing it though, telling me it was a heavy duty drug for somewhat crazy people, but he knows me enough to know i wouldn't let it go without giving it a try.
If this doesn't work then i figure i have two options.
KLONOPIN + BUSPAR
or
EFFEXOR.
Both of these combinations though as i see it will produce dependance so i have to weigh up the pros and cons.
I have tried Klonopin (Rivotril in th UK) before and loved it but i wasn't prepared to become dependant on it, (nor ws my doctor prepared to prescribe it full time), and it didn't touch my depresion obviously, just made me calmer. My doctor has no problem prescribing the Buspar but i would have to make my own arrangements regarding the Klonopin. Something i can do very easily, but i would feel very alone and unconfident in treating myself.
Baring in mind what i felt with the effexor before (I couldn't believe it was so different to paxil, they must have been hitting the same receptors as each other surely, i was only at 37.5mgs???), i will probably be on that within four weeks with a view to giving it a good eight weeks to kick in, depending on the Amisulpride trial. I just hate the thought of future withdrawal. AARRGGHHH!!! We have to try to get better i suppose.
Anyway, thanx again for your replies. Much appreciated.
Oh and before i go, i don't hold too much hope for amisulpride (anyone currently taking it with benefits???), because i have had a supply of ADRAFINIL for about a month (which i have read is another helpful drug for my symptoms), and apart from the first three days, have really felt absolutely no benefit from it at all. I may aswell be eating sugar, although i might get more stimulation from the sugra to be honest.Thanx again.
Dan.
Posted by starlight on August 3, 2004, at 13:35:35
In reply to Re: Help required. Very Confused. Kinda Urgent., posted by Daniel Woodfield on July 30, 2004, at 5:52:20
Hi Dan,
One thing I want to mention is I think all of the antidepressants have withdrawl effects. When I came off of Wellbutrin I was miserable, so no matter what they say about dependency, in my opinion, they all create it. To me Effexor takes care of the klonopin need, and klonopin makes me even more depressed. I think I need to bump up my dosage of effexor, just a little bit, and maybe add a touch in the evening. Good luck,
starlight
This is the end of the thread.
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