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Dear Pharmacogods...


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Well, my meds track record is pretty dirty, as you can see. The last cocktail I was on was the one on my signature which I now reduced to just Adderall for some not good reasons. I started Luvox a few months ago, it wasn't doing much for my obsessions and depression at 100mg, so my doctor gave me the go to try 150-200mg. I went up to 150mg, and the next day, it put me into a suicidal depression for about a week. So I took it upon myself to taper off as slowly as possible to avoid the withdrawals, which I didn't quite do. Anyway, after being off the Luvox, I continued to feel super depressed and still somewhat suicidal, with the addition of homicidal ideation. For some strange and unfounded reason, I kept experiencing these murderous fantasies involving random people I would see. I made the mistake of writing my accounts to my psychiatrist and she almost hospitalized me because she considered them "too specific threats." Whatever! I didn't feel like I was a threat to anyone, they were just thoughts. I was able to argue for my competence and avoid hospitalization. At 160mg of Geodon, I started developing hyperglycemia as my fasting blood sugar was above normal. So I started tapering off that. The Elavil I am tapering because I suspect its increasing my appetite, even at such a low dose. I was on Trazodone previously, and it would help put me to sleep, which is what I needed. I will take the Elavil at 7PM and still not be able to sleep by 11PM so I'm looking for something faster acting. So thats my recent meds history.

Ok, so after reviewing my records and recollecting my experiences, I have noticed a pattern. I noticed that my depression is noticeably relieved by the introduction of antipsychotics to my meds. The first was Risperdal which I was taking with Celexa. That was one period of time I remember feeling better than I did for years. Eventually, I stopped it because it was causing weight gain. Later on, I tried Abilify, and that had the same effect. Unfortunately, it complete drained me of any sort of human emotion and I was a walking zombie while I was on it, so I stopped it. Looking back, it also caused me to gain 30 lbs, but that was not the reason I stopped it. I was on Abilify in conjunction with Cymbalta for the most part. The third antipsychotic I tried was Geodon and that had the same effect. For over two months of starting a low dose, I was feeling good. At that feel good time, I was taking the Geodon in conjunction to Lamictal. Then it started pooping out and doses began to increase without efficacy. The other pattern I noticed was that I am extremly sensitive to sedation with SSRIs, they also make me gain weight. SNRI's cause profused sweating at night, but that is all.

Right now, I am highly umedicated and I am barely scraping by. I can't seem to pay attention, follow directions, or organize myself enough to get anything done. The last time I saw my doctor, she offered me Haldol. Which gave me the impression she is running out of ideas. I'm scrambling for some ideas from Essential Pharmacology in case shes fresh out! I don't know, I feel like a big pharmacomess! Any feedback is highly appreciated. Thanks!

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Just to let you know that I am looking at your meds and your not being ignored.

It's a giant list and that's probably why it's taking so long for anyone to answer.

Just wanted to give you the heads up.

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Speaking as someone who has been there, it's important, critical, that you not give in to any obsessive fears you might have about side effects. The fact of the matter is that all meds have side effects and they all suck ass. Most of the time they don't suck as much as OCD. As long as the side effects of a med don't leave you more impaired than the condition for which you are taking it, you pretty much come out ahead. It can just be hard to see this if you don't stay on them long enough to get relief. Don't forget that many side effects fade in time as well.

If at all possible, make a deal with yourself where you won't stop a med until you the full positive effect from it so you can judge the side effects in light of the positive effects and determine if it's a worthwhile tradeoff.

How long did you give the above mentioned meds. Can you be sure the side effects were really that bad or were you just obsessing about the possibility of side effects?

You haven't tried seroquel have you? I did better on it than pretty much anything else. Paxil and Prozac are older, but at high doses they were the most effective SSRIs for me.

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The most useful advice I can offer is: keep trying stuff. I went through about fifteen meds before I found ones that worked for me. I went through three antipsychotics before I found one that worked (and worked with relatively few side effects). My pdoc prefers to prescribe other stuff before seroquel because of the risk of diabetes - but seroquel works well for me. People are very idiosyncratic in their responses to meds. Some people do better on haldol. Your pdoc may have reasons to think it would work well for you, instead of running out of ideas. If you're worried she's running out of ideas, you might try asking her what she would suggest if the haldol doesn't work, and if whatever after it doesn't work - it's possible she has a specific reason for wanting to try haldol, rather than not knowing what else to do.

There are also a lot of non-SSRI antidepressants that you can try. You're not even close to scraping the bottom of the barrel on antidepressants.

And like VE said, it's often a matter of side effects versus symptoms. Some side effects are intolerable, but many are manageable, and some disappear with time as your body adjusts.

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Lots of icebergs in those waters.

Maybe the first thing to do is determine which side effects you can live with, or even which problems can be left undermedicated.

Since APs often negate part of the effects of Adderall anyway, I'd assume that keeping the ADD under control isn't the top priority. Maybe shifting to a noradrenergic AD like Wellbutrin or desipramine might be helpful (in place of the Adderall.) A low dose of Haldol would probably knock a lot of the anxiety or insomnia potential from either one down quite a bit.

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I hope you're not counting on meds alone to relieve your symptoms. Meds are a part of the solution. Some pdocs will have you believe that all you have to do is find the right med combo and you're done. In reality, the people who really have a handle on their MI are those who take a more complete approach to their self-care. This would include regular exercise, therapy (by someone qualified to treat your specific MI), a healthy diet of whole (not processed) foods, regular sleep, time management, and a network of people who are supportive, among other things. I urge you to read up on your diagnoses, and explore other types of self-care to include along with your meds :)

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Thanks for the replies everyone, I appreciate them very much. I have to admit that coming from an eating disordered background, I absolutely dread the idea of weight gain on any of these medications. I try to be careful about it and for the most part, I've been able to manage it, but there have been times that I let it get out of hand. As far as giving these medication fair trials, I believe some were given a fair chance, others have not. However, when I consulted a neuropsychiatrist as UCLA for a second opinion, he said all the medications I was on were on subpar doses and he suggested my doctor exceed recommended doses and try her best to counter the side effects with other medication to give the medications a fair trail. What is killing me now is mainly the depression. I have a very difficult time getting things done and functioning. I can't hold a steady job and my life grows increasingly difficult, despite a lack of real difficulities. My OCD has dramatically improved since childhood where I would spend hours touching or looking at things and doing all sorts of bizzare and illogical rituals. I still have small rituals, mainly with touching objects, or breathing, but they do not interfere the way it once used to. I noticed that as I got older, I became more and more obsessional and a lot of things do not transcend externally but happen in my head. This makes it very difficult to concentrate and do things. All I can say about past medication was that some were given a fair trial, and others were discontinued after side effects I did not bother to give time to subside.

I have not tried Seroquel, but it has been on my mind moreso than Haldol. Of course, after my experience with Geodon, I am fearful of hyperglycemia and the other possibilities that might arise. Further, it all comes down to the weight issue when I choose to deal with antipsychotics. At, this point, I am getting a little more desperate than the usual, so I might give it more thought. I asked her about trying Anafranil after going off the Luvox, but she quickly dismissed the idea with "Well, you're on Elavil and they're similar." However, I am on a low dose of Elavil, and as far as I know, Anafranil's anti-obsessive properties are far superior to it. In the attachment below are the medication recommendations I received for my second consultation. Any opinions on his recommended treatment? The only thing we tried out of his recommendation was Lamictal and that did not work well in monotherapy, but did work for a while in conjunction with Geodon. Of course, those effects later subsided.

post-4018-1183921143_thumb.jpg

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Did you ever try taking anything like a beta-blocker to control the sweating caused by the multiple reuptake inhibitors? Those can have a decent effect on anxiety in their own right.

Everything I've read recently has pointed in the direction of OCD responding to SSRIs at doses above the recommended max for other indications. I think I was on either 60 or 80 of Paxil and around 100mgs Prozac. I had no penis.

Since depression typicaly responds at lower dose than OCD, anything you take for OCD should help with depression at least some along the way.

I think anafranil really is the classic for OCD, IIRC.

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I can tell you that I LOVE Seroquel. It's the only AP I've taken, so I can't offer much in the way of a comparison to the others, but I was very resistant to trying an AP at all, and I love it.

What about the possiblity of revisiting other AP's you listed and mentioned that you had found effective in the past, but had discontinued because of weight gain concerns?

And I don't know all that much about OCD, but I know that topamax has been incredibly helpful to me in dealing with obsessive thoughts. What I don't know *at all* is how much overlap there is between OCD and the kind of obsessive thought stuff I was having. So that might well be a completely useless suggestion, but I thought I might as well go ahead and put it out there... ?

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