Posted by mtdewcmu on November 26, 2009, at 11:05:59
In reply to Re: calling all armchair psychs, posted by g_g_g_unit on November 26, 2009, at 4:06:02
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> > Reading along with this thread, I knew you weren't going to like Ritalin. I think your attention problems are caused by anxiety, rather than the other way around. I have the same issues (except I lean more toward GAD than OCD). Your next move should be to pick one of the best antidepressants (Lexapro, Zoloft, Celexa, Effexor) and make sure you get to a sufficient dose. That means 20mg Lexapro, 100-150mg Zoloft, 40mg Celexa, or 150mg Effexor.
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> thanks for your advice. the only reason i tried Ritalin was so that i could have a chance to try Dexedrine (which as far as i know has studies backing its use in both OCD and GAD).
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> i really don't think an SSRI alone is the whole answer at this point, unless i'm basically willing to just cut my losses. SSRI's make me feel schizoid, amplify my social anxiety, and really make writing (what i was doing professionally) a difficult task. i understand it's the only real appointed treatment for my "condition", but i wish i had made more considered decisions about medication management (easy to say now i guess); i've finally accepted that i have an impulse (even addiction) problem, which has come to encompass meds (though never narcotics).
>You have not given Lexapro a chance at 20mg. Although 10mg may work for some people, for others it will produce only side effects while being too low to provide benefits. Moreover, the side effects you described sounded (to me) mild, and they are likely to respond to adding Wellbutrin. However, if your experience on Lexapro was really that bad -- and only you can know that -- you can still just try a different serotonin reuptake inhibitor, such as Zoloft.
> i don't think anxiety is the (whole) source of my concentration difficulties at present. i feel like i have no working memory - like my mind is just always blank, to the point where it's hard to even put a thought together. Low-dose memantine (a D2 agonist) felt like someone had turned a light-switch on in there; Bacopa (an acetylcholine agonist?) enrichened my inner dialogue to the point where i could 'hear' myself thinking again.
>It's interesting that you found improvement from memantine and Bacopa, but it's difficult to say what that actually means. Psychiatry is not scientific enough at this point.
Please bear in mind that depression can cause terrible cognitive problems. Personally, I thought my brain was damaged and I would never recover. I tried ADD meds such as Adderall, Strattera, and Ritalin, but antidepressants have been by far the most helpful.
> the only way i feel i'll overcome my depression is if i can return to writing, and i realise that, for me, most 'cures' are worse than the disease in that respect. i guess if i had chosen any other path in life, i might've been okay, but SSRI's just always dampened by creative drive and the 'buzz' i got off working, which is why i was so conflicted about staying on them. i also think SSRI's suck when it comes to treating dysthymia.
>Only you can decide whether the cure is better or worse than your unmedicated life. I fully encourage you to try nonmedicinal options, like CBT, if you want.
> i'm intensely committed to CBT at the moment (i never really invested much energy into it in the past), and am focusing on that while i think about what to do next med-wise. i would really just like to take the simplest approach possible. zoloft sounds appealing because at least it has the modest DRI feature. maybe i should try that in combination with Memantine.
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> i hope i don't sound stubborn, and possibly even insensitive by complaining in this respect. i often feel a "just take your medicine and shutup" vibe from doctors. what i would like is one who cares as much about my individual needs than just trying to treat me based on the DSM
>I do not want you to "shutup." I just think you are doing things the wrong way around by trying exotic medications before you have given the simple ones a decent chance to work. It is a symptom of depression to imagine that your illness is unique and will never respond to treatments that have worked for others. I have been there.
It's true that you have tried normal antidepressants, but you tried the SSRIs at such low doses that you may have missed the potential benefits. I went through a fuzzy period with increased anxiety when starting Celexa, but I stuck with it and ended up taking it successfully for several years. Your ability to write may go away temporarily, but return after the side effects diminish. I went through a similar thing with my ability to enjoy reading during my recent 3 months of med trials.
poster:mtdewcmu
thread:924919
URL: http://www.dr-bob.org/babble/neuro/20091104/msgs/927040.html