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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Peter on September 21, 2003, at 19:24:24
Years and years of one med cocktail after the next. Years of different pdocs giving me different diagnoses, from 'BP otherwise unspecified' to 'depressive-anxiety' to adult ADHD to social anxiety to 'all of the above.'
After 7 years, my pdoc and I thought we might be getting close to helping my major symptoms. We ditched the AC 'mood stabilizers,' which I'd been taking for years to no effect, and narrowed everything down to klonopin + stim (adderall) + SSRI. I've tried every SSRI; they helped to differing degrees, but I always ended up having to come off them after a few months, usually because I became impulsive; whether this was a sign of mild hypomania or a down-regulation of dopamine which led to emotional-numbness which in turn led to my seeking stimulation and becoming impulsive, no doctor knows. But the fact that a stim+SSRI seemed to work better in the past than an SSRI alone or a SSRI+mood stabilizer made us tend to think that it was less an issue of SSRI-induced hypomania that caused the impulsivity that made me have to stop each SSRI, and more likely the dopamine down-reg/emotional numbness. Nevertheless, even though the SSRI worked better for me with a stim, my last trial of the combo was not a success, so we decided to try one more AC-lamictal, and we eventually ended up getting me on a pile of meds along with it (adderall, strattera, klonopin, temazepam, ambien), and ended up having to add Prozac in the end anyway. I was fairly stable on this cocktail for a few months but became too symptomatic and anxious, and we weaned me off 1 at a time (which sucked). Then we tried me on just a higher dose of klonopin + adderall, but my overarching anxieties and depressive tendencies were still there, so we decided, for the sake of geting me to at least somewhat of a functional level again, to just throw me back on an SSRI - the only one I hadn't yet tried - lexapro.
So that's what I'm taking now. Day 16 of lexapro 10mg (the first week was hell and now is not much better, maybe even worse) + 40mg adderall + 3mg klonopin. Usually I'm a fairly quick responder to SSRI's, even though they don't really work in the long run for me, but this lexapro doesn't seem to be doing a thing during week 3 of treatment except making me feel worse. My most recent overall mood characteristic has been dysphoria; just unable to be interested in anything, feel disgusted by everything, avoid everyone, etc.
I know a lot of people have had success with lexapro, and SSRI's in general, but I just really wonder if I should keep taking it and give it the full 6-8 week trial, or say screw it, taper off it, and try a med from the one existing med class I've never tried - an MAOI, like parnate or Nardil. I've been to anxious to even start an MAOI up in the past because of fear that I'll end up in an ER after having eaten something that I didn't know contained tyramine. But I can't tell you how sick I am of this never-ending pharmacological roller-coaster. I've tried everything else. Everything. I really feel like giving up. I was watching a movie tonight with my family, and the whole time I couldn't wipe this frown-even grimace-off my face. I was disgusted and depressed, and I'm so sick of feeling like this. I'm a musician, and I can't even try to approach the piano to play or compose. The adderall doesn't even help me feel more alert, gregarious, or motivated anymore. What can I say? I'm a miserable lump. Is it worth sticking with the lexapro through this with a chance, however slim, that it will end up helping me more than other SSRI's have? Or should I just go through what hopefully will be one last purge and withdrawal from my meds and begin an MAOI? BTW, I've tried a RIMA before - moclobemide; if it worked, I'd still be taking it. I've really held back from the MAOI's out of fear, telling myself I'd venture into MAOI-land only as a last resort if nothing else works. After all these years, maybe it's time to put the MAOI stigma aside in my mind and go for it. I really need, and would appreciate, some advice. Thanks.
Peter
Posted by wsj on September 21, 2003, at 21:25:44
In reply to end of my rope-should I change meds AGAIN?, posted by Peter on September 21, 2003, at 19:24:24
i am in almost the same position as you. 2 weeks into lexapro 10mg and have only had one day i would consider good. i am also thinking of going the maoi route, and wondering if i should even give the lexapro 4 wks. im thinking of trying parnate because of its stimulating effect. i have always augumented w/ dexedrine but it doesn't seem to work anymore wonders. this evening after taking lex this morn and 20mg dex thru the day i just feel agitated and took a .2mg bite out of a klon to relax. and im already worrying about tomorrow! how long after stopping lex can you start an maoi?
Posted by Peter on September 22, 2003, at 5:27:48
In reply to Re: end of my rope-should I change meds AGAIN?, posted by wsj on September 21, 2003, at 21:25:44
> i am in almost the same position as you. 2 weeks into lexapro 10mg and have only had one day i would consider good. i am also thinking of going the maoi route, and wondering if i should even give the lexapro 4 wks. im thinking of trying parnate because of its stimulating effect. i have always augumented w/ dexedrine but it doesn't seem to work anymore wonders. this evening after taking lex this morn and 20mg dex thru the day i just feel agitated and took a .2mg bite out of a klon to relax. and im already worrying about tomorrow! how long after stopping lex can you start an maoi?
>>Sounds like we're in the same situation! I'm wondering the same thing; I think you hae to wait 2 weeks after stopping an SSRI before starting an MAOI - except for Prozac, which requires 5 weeks after stopping before starting an MAOI. I think lex would be like celexa - 2 weeks needed after stopping before MAOI. I'm not completely sure though. You know, my adderall isn't doing anything Anymore either. And everyday I wake up feeling like I have a huge hangover; I can't even get out of bed. I am really considering the Parnate route also, instead of Nardil, though I've tried neither. But I know that Parnate is stimulating. Another confusing issue: in the literature for MAOI's, it says CNS stimulants, including amphetamines, are contraindicted with them. However, once before when my pdoc and I were considering an MAOI trial, I was at the time taking adderall, and he said there really isn't any danger in the two combined; likewise, I've read about people who succesfully augmented MAOI's with ampthetamines. But what about the contraindictions? If we go to an MAOI, do you think we would also have to taper off of the stims AS WELL AS the lexapro? 'Cause man, I sure am not looking forward to another horrible 'taper-everything withdrawal period.'
Posted by wsj on September 22, 2003, at 11:56:26
In reply to Re: end of my rope-should I change meds AGAIN? » wsj, posted by Peter on September 22, 2003, at 5:27:48
my pdoc said off dex 1 week prior to maoi. but i also have read of people using both - i guess its up to the pdoc.
Posted by sjb on September 22, 2003, at 14:34:10
In reply to end of my rope-should I change meds AGAIN?, posted by Peter on September 21, 2003, at 19:24:24
Wow, I can relate to a lot you said. In brief, I would not be hesitant to try an MAOI because of the diet restrictions. It really isn't that bad and when I "cheated" nothing happened. That is not to say to throw caution to the wind and not be careful, because I'm sure some folks are more sensative than others, but, I just think it's not that big of a deal. Other than that, I'm not sure what you mean about the stigma of MAOI's as opposed to the rest.
I would give the MAOI's a try. From my observation on this board, they seem to be more effective for men than women, generally.
Posted by sjb on September 22, 2003, at 14:39:23
In reply to Re: end of my rope-should I change meds AGAIN? » wsj, posted by Peter on September 22, 2003, at 5:27:48
You might have to taper off the Lexapro but I dont' think that will be too much of a problem. I stopped cold turkey from 10 and 20mgs with no problem. I do not know about the stims. I do know that weeks are required to get all SSRI's out of your body before starting MAOI's. Stim and Effexor withdrawal can be tough, depending on your dosage, but SSRI withdrawal usually not bad if dosages are not high.
This is the end of the thread.
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