Posted by med_empowered on November 2, 2005, at 20:46:11
In reply to Suggestions wanted on treatment resistant patient, posted by Towervu on November 2, 2005, at 12:34:31
hi! OK, first off...I'd try to ditch the Geodon. You don't have psychotic issues, you're not bipolar, and antipsychotics can exacerbate anxiety in some people (besides, the cardiovascular side effects, blood sugar issues, and potential tardive dyskinesia FAR outweigh any potential benefits). Then, you might want to adjust the benzo...if depression is becoming more prominent (without any signs of bipolar), then you might want to swtich from Klonopin to something else...valium, librium, ativan, and xanax xr are good choices; serax would be another option. You should probably avoid Tranxene if you have depression issues. Personally, I find that although Adderall can help a lot of issues, I usually need two doses--maybe you could try generic adderal (ir-version), breaking it up into 2, 3 doses? That'll give a smoother experience. The Lamictal helps a lot of people w/ treatment-resistant unipolar depression, but can also exacerbate anxiety in some people and induce hypomanic symptoms. So..you may want to evaluate your need for it, and adjust the dose or eliminate it as you see fit. Adding BuSpar might help; in addition to potential anti-anxiety effects (it does NOTHING for some people, but is quite helpful for others), it can also serve to boost antidepressants, while reducing SSRI problems (sexual dysfuntion, anxiety, etc.). I think its usually started at 15mgs/day--5mgsX3--but some docs start at 20. Usually, doses stop at about 45mgs, but you can go up to 60mgs if you feel that'll help. The antidepressants could be adjusted, but that's a trickier area--lexapro and remeron are both good for both anxiety and depression, so you may want to leave them alone unless you're having side effects or they're not really doing much anymore. Propranolol might be useful for stressful situations--it won't get rid of the actual anxiety, but it will reduce the physical symptoms of anxiety, which can help (this would be good for meetings, public speaking, that kind of thing). Some people do well with mood-stabilizers--depakote, trileptal,etc.--for anxiety, but I think they're more trouble (blood work, cognitive dulling, etc.) than they're worth in that area. Good luck!
poster:med_empowered
thread:574526
URL: http://www.dr-bob.org/babble/20051031/msgs/574698.html