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It worked last time but….


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So I’ve been feeling shitty lately. That kind of generalized shitty that’s hard to totally describe but sticks with you and everytime you distract yourself it stays there waiting until your mind is vulnerable again. I’d say getting worse over 2 months, but exponentially over the last 3 weeks. The irritability really frustrates me, I don’t like being an ass. I’m having some passive SI, not dangerous for me, but the alarm bells are ringing. Every night I sit alone trying not to think about feeling shitty. 
 

Talked w pdoc Tuesday. He was hesitant to make changes in the hopes that it spontaneously remits like it spontaneously started. I don’t blame him for this. A med change for me (especially for depression) can turn into a marathon. We both rack our brains for something creative but it’s all Third line options that will probably suck pretty bad. He is often good at figuring out whether my symptoms are gonna stabilize or head downhill and I respect his opinon- I don’t usually disagree…. But I’m not sure here 

We have agreed to do ketamine again if things get really bad and he said he’d sign off on it asap if I need it. This made me feel better until I remembered that most ketamine docs/clinics don’t want their patients on lamictal. Ideally less than 100/day, some are fine with 150. Above that it reduces effect. Who knows how much it does- but if In paying over 3k for the treatment I’m not really keen on taking a chance. This means there would be a month delay. So there goes my rapid fix. The confidence I was already losing is now receding fast.

i am concerned about acute episode, but also that this will be my new baseline as it used to be when I was a teen. I am trying to take pdocs advice, so I’ve resigned myself to going at least one but Ideally 2 weeks before I call. It doesn’t really fucking matter since nothing seems to do shit anyway.

for anyone who wants to throw in any med comments-  these are a couple thoughts I had. Some seem ridiculous but that’s where we are: dopamine agonist like mirapex (but won’t play well with irritability), a little known typical called molindone that was considered back in the day (because good for weight, but can cause risperdal- like prolactin issues and would only help with irritability - the idea being if I chill again night it will help me feel better the rest of the day)  restarting Vraylar at low dose. we’ve agreed that ADs are off the table for now. I’m also probably not going to do caplyta for various reasons. 
 

thanks everyone, I needed to channel some frustration

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Man, that’s rough. My pdoc suggested ketamine and/or psilocybin (sp?) for my depression before my BP went into remission. I have no experience with either (for MI, anyway). Normally I just deal, using stims (adderall and/or Ritalin) to help prop me up a bit. ADs no worky for me (and I’ve tried most all of them, typically multiple times, save for MAOIs, which I refuse to take). I hope you can find some relief.

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the dopamine agonist idea is an interesting one. have you taken one before and experienced irritability? it's been about 10 years or so since i took requip (or perhaps it was mirapex) for depression but i wasn't on it for long because my anxiety disorders were very poorly controlled. i would be open to trying one again if i were in your position.

i have read, though, that there is an issue taking dopamine agonists long-term with tonic vs phasic dopaminergic transmission with the former over time potentially causing anhedonia. if you are already experiencing anhedonia/severe depression, then this may not be much of a worry, although it's something to think about if you are considering taking it over an extended period of time.

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53 minutes ago, dancesintherain said:

cabergoline. 

Technically it’s contraindicated with clozaril. I don’t think that’s the only issue pdoc would have though lol. The other major reservation id have is potential for akathisia as I’ve historically had issues with that 

26 minutes ago, basuraeuropea said:

the dopamine agonist idea is an interesting one. have you taken one before and experienced irritability? it's been about 10 years or so since i took requip (or perhaps it was mirapex) for depression but i wasn't on it for long because my anxiety disorders were very poorly controlled. i would be open to trying one again if i were in your position.

i have read, though, that there is an issue taking dopamine agonists long-term with tonic vs phasic dopaminergic transmission with the former over time potentially causing anhedonia. if you are already experiencing anhedonia/severe depression, then this may not be much of a worry, although it's something to think about if you are considering taking it over an extended period of time.

I also know that there is a high chance of rebound issues if you have to discontinue after time because of this. Also I mentioned the irritability because most of the research has been on more traditional depression and less on mixed depression (which is usually my issue) 

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39 minutes ago, Iceberg said:

I also know that there is a high chance of rebound issues if you have to discontinue after time because of this.

Yeah, dopamine agonist withdrawal syndrome or DAWS can be pretty brutal according to some who have gone through it but if the medication helps you it can be a lifesaver. I suppose that you would have to weigh the pros and cons as well as your current state in order to determine if it’s worth trying. I doubt a short trial would cause any problems upon discontinuation if it weren’t to work out. 

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