When is it time for a change?

[daisy]

(Some of this is copied and pasted from a Pristiq side effects post. I apologize if you've read some of this before!)

I'm going to see my pdoc on Friday, and I'm wondering if it's time for a change. I've been on Pristiq for 6 weeks. Three weeks ago, my psychiatrist increased my dosage to 100 along with adding 300 MG Wellbutrin XL. I know that the dosage increase and the Wellbutrin haven't had time to kick in yet, but I hope they do soon. For some reason, I feel like maybe this could be a good combination for me. They are both weight-neutral which is very important to me, as I have some pretty severe body image issues. Wellbutrin XL has also helped me in the past, just not quite enough, so perhaps the addition of Pristiq will bring it all the way there.

However, I'm having some issues.

Written April 3:

Honestly, the 50 mg Pristiq seemed to kind of help my depression at first (which went downhill after a series of horrible events in my life all taking place within a week), but now it's like... one minute I'm happy and my life couldn't be better and then the next minute I'm so depressed I physically FEEL it and I can't stop crying. It's starting to REALLY get to me.

I tend to have these complete random 180s in mood without any medication, but this is awful because they are SO often and unpredictable. Often, these mood shifts don't even last a day. I'm literally living moment to moment, hoping that in an hour I'll still be on an upswing and I won't be back in bed in the dark unable to get the energy to move, honestly believing that I will never feel anything other than this ever again. And when I am in the dark in my bed, suddenly I'll find myself completely okay -- better than okay -- like I'm on top of the world and I've never had to deal with depression and I'll never have to worry about it again.

Other than this, I have no side effects, but it sucks. Pretty much every anti-depressant I've tried has given me these back-and-forth feelings, particularly SSRIs, which never actually ended up helping my depression even when they kicked in, but these are SO high and SO low that it scares me. It's been a LONG time since I've been on an SSRI, but I don't remember these complete 180 degree changes in mood happening so frequently.

I know that they're messing with the chemicals in my head, and that it will still take time for them to kick in, but I feel like I'm going crazy in the meantime. The other day I felt like I was both so high and so low at the same time somehow, my anxiety just shot through the roof. I was irritable and antsy, and all I wanted to do was curl up in a ball and die, but I couldn't get my thoughts straight. I don't even know how to explain it. It was the most uncomfortable feeling ever. I think that was triggered by me pulling an all-nighter, though.

I REALLY want to hold out to see if this combination will work, but I'm not sure if I should because of my mood swings. Of course, the majority of the time I'm still depressed, but there are glimpses of light. Today I woke up, got out of bed, and started doing things without even realizing it. Like it was normal. I didn't wake up depressed! And two hours later, I'm still not!!! (Mornings are always bad for me; they are always stable in that I always wake up severely depressed. In fact, this is the first morning in months that I wasn't.)

My hope is that these mood swings will subside (and they've already lessened in severity in the past week since I wrote the part of this post about my mood swings) and that these pills are starting to work. Still, I'm not sure if these are the right pills for me. How do I know if it's time for a change??? Do I wait a little longer on this cocktail, or should I request something different? (SSRIs are not an option for me, but I'm coming to terms that if I have to try an MAOI for my depression, then I'll do it, even though my favorite food groups are tap beer and cheese.) My pdoc is pretty cool about listening to what I'm looking for in a medicine, so if you've had the same issues as me and have found relief on something, please recommend it to me!

(Side note: I've had several people, including my pdoc and tdoc, question whether I am Bipolar. If, in fact, I am, it wouldn't be Bipolar I. It would be a mild case of Bipolar II, mostly marked by severe depression with occasional hypomania. I do fit all of the symptoms, but have not been diagnosed, and to be honest, depression is my big issue. If I do have Bipolar, it would have to be rapid-cycling... in fact, it would probably be Bipolar NOS, since my "hypomanic" episodes don't always last for 4 days. I recognize that my side effects are mimicking Bipolar disorder, but I don't think that means I have it. To be honest, I often wonder if my "hypomania" is just me being normal, so I don't want to jump to conclusions about whether or not I have BPD. I just wanted to bring it up to note that it MIGHT be an issue; however, it probably is not. Even if I have it, my depression is the issue I want to treat!!! Besides, I'm 22, so mood swings are probably pretty normal at my age!)

I should probably put something in my signature about my posts being novels, like Meg!

[lysergia]

first of all, i think there should be a club for those of us who write novels

(i don't warn anybody in my sig, either)

second, that's a perfectly reasonable question i think. when i'm experiencing something new or more intense emotionally, i need to know if it is a warning sign. in my case, it comes from having ignored unacceptable medication/side effects for so long... then finding out that it really wasn't okay after all to feel like that for years and years... and i could have done something about it and you know, like, GOT BETTER! now i don't know what is within an acceptable emotional range and what isn't. i think everybody has to find their own "critical limits", and the best way to do that is asking your pdoc. assuming your pdoc isn't on crack of course (mine was).

i don't know anything about pristiq. i did, however, take one of its predecessors for several years (effexor). what you're describing sounds familiar to me and i didn't know that it wasn't my fault. i didn't know it was the meds. so finding out from your pdoc what you might expect is a GOOD idea. you haven't been on the drug that long, i expect there's probably a longer "probationary" period than that before you can say yay or nay.

i do remember wellbutrin started working really quickly once i got past the "stoned" stage. it didn't affect the highs/lows, it just gave me my motivation back along with the ability (and desire) to get out of bed in the morning. i hope it helps you too.

if you are really bipolar, this reaction to ssris et al is pretty common. i should hope your pdoc has seen this before and can explore it with you.

best of luck, daisy.

ETA: my mother always says she's going to margaritaville when she needs a drink, heh... which is about twice a year. now i can tell her i know someone who lives there.

[daisy]

first of all, i think there should be a club for those of us who write novels

(i don't warn anybody in my sig, either)

second, that's a perfectly reasonable question i think. when i'm experiencing something new or more intense emotionally, i need to know if it is a warning sign. in my case, it comes from having ignored unacceptable medication/side effects for so long... then finding out that it really wasn't okay after all to feel like that for years and years... and i could have done something about it and you know, like, GOT BETTER! now i don't know what is within an acceptable emotional range and what isn't. i think everybody has to find their own "critical limits", and the best way to do that is asking your pdoc. assuming your pdoc isn't on crack of course (mine was).

i don't know anything about pristiq. i did, however, take one of its predecessors for several years (effexor). what you're describing sounds familiar to me and i didn't know that it wasn't my fault. i didn't know it was the meds. so finding out from your pdoc what you might expect is a GOOD idea. you haven't been on the drug that long, i expect there's probably a longer "probationary" period than that before you can say yay or nay.

i do remember wellbutrin started working really quickly once i got past the "stoned" stage. it didn't affect the highs/lows, it just gave me my motivation back along with the ability (and desire) to get out of bed in the morning. i hope it helps you too.

if you are really bipolar, this reaction to ssris et al is pretty common. i should hope your pdoc has seen this before and can explore it with you.

best of luck, daisy.

ETA: my mother always says she's going to margaritaville when she needs a drink, heh... which is about twice a year. now i can tell her i know someone who lives there.

Thanks for the response! You gave me the only real advice anybody here can give me, which is to, of course, ask my pdoc. Mine isn't on crack, so he is probably the person I should talk to! I guess I'm just not sure if this is NORMAL, especially since it's probably around that the meds are starting to kick in and they are messing with the chemicals in my brain. Maybe this is totally normal; I'm just not sure. I would like to stay on them if at all possible just because I'm seeing the first glimpses of light (aside from my high periods) in a long time. Maybe this is just what happens in my brain when meds start to WORK! (I wouldn't know what it feels like, since none have worked so far!) I guess I haven't figured out what my limits are, like you mentioned. Despite the amount of meds I've been on, I've never felt such strong side effects that I remember, although my mom tells me that I was like this when I was on Prozac. I was too young to really know.

Wellbutrin works for me the same way it worked for you... it has helped before in a major way... it just never got me completely un-depressed. I know it helps to some extent, though, which is nice to know. However, I never mixed it with anything else. Perhaps it's not either anti-depressant, but the mix of the two, that is causing these side effects.

And yes, I like to pretend I live in Margaritaville! Jimmy Buffett is kind of my role model. (Not really, I promise!) My religious views on Facebook are "What would Jimmy Buffett do?" haha. And my theme song is, of course, "We Are The People Our Parents Warned Us About." I was just born a little too late to be a true Parrot head!!!

[daisy]

Well, things are looking up. I am not going to ask for a change in my meds when I see my pdoc tomorrow. I'm going to stick with this for a little longer, since this drug treatment actually might be working!

I stayed un-depressed for the entire day yesterday. Even when something happened that would usually upset me greatly, I dealt with it perfectly fine! It didn't even phase me! I woke up today feeling the same way... it's like my depression disappeared all of a sudden, like the sky opened up after the rainy day and there it was -- the sun. I am pretty sure that this is a different feeling from the mood swings I was having.

I've been able to get out of bed (!!!), shower (!!!), and do my hair and makeup. I've even cared about the clothes I put on, which is not something I even have the energy to think about when I'm depressed. I've gotten so much done as well. I can't remember the last time I was as productive as I have been yesterday or today!

I don't want to get TOO excited, as I don't think this euphoric feeling is going to last. It's only euphoric because it feels so foreign and new to me. It has been a very long time since I felt good. Obviously, the depression didn't disappear overnight and I will still have to work on it, but I think the drugs are a good combo for me and are starting to make a difference. Now that I think I have that covered, I feel as if I have the energy to actually work on my depression through therapy or journaling or writing poetry, which I didn't have a few weeks ago.

Now let's just all hope this isn't another random mood swing! I don't think it is, though.

[tryp]

I'm glad to hear it Daisy I've been feeling a little better too recently - maybe we'll swing up together.

Just be careful not to push yourself too hard too soon

[meg]

I was just thinking as I was reading 'sweet, another consistently long-posting CBer, score!' and then finished reading and got to this:

I should probably put something in my signature about my posts being novels, like Meg!

haha.

first of all, i think there should be a club for those of us who write novels

hear, hear!

but who would be our club secretary/recorder?

I think that wouldn't end well for some trees.

Well, things are looking up. I am not going to ask for a change in my meds when I see my pdoc tomorrow.

I'm glad that you're feeling so positive! I really hope the combo is working for you (for real) too--

I just wanted to throw in a caution here though-- make sure to tell the whole story to your pdoc. It's easy when you're feeling better to go in there and (if you're me...) go on and on about how great things are going and forget to tell the doc about how different things were just a few days ago. They need to know the whole story if you want lasting stability. I'm sure your pdoc will want to know about the rapid mood swing stuff as well as this good period.

I started posting this yesterday and never got to finish so sorry if I've missed some posts inbetween!

keep us in the loop

m

[meg]

hey miss daisy,

hope your pdoc appointment went well and that you're still feeling good

pop your head in when you get a chance and let us know how it went!

m

[daisy]

I'm glad to hear it Daisy I've been feeling a little better too recently - maybe we'll swing up together.

Just be careful not to push yourself too hard too soon

I hope we do swing up together! Every time I read your posts, I think we have more and more in common. We will have to chat someday soon!

but who would be our club secretary/recorder?

I think that wouldn't end well for some trees.

We would probably spend so much time coming up with ideas for our club that there wouldn't be any trees left in the world to give us paper to write down our notes! Good thing I'm a typist and keep all of my poetry/writing on the computer... otherwise, the world would probably already be screwed! And like I told tryp... I love reading your posts, because it sounds like we have a lot in common as well. (Except the fact that I love makeup but cannot apply it to save my life!!!) We need to chat someday too!

I'm glad that you're feeling so positive! I really hope the combo is working for you (for real) too--

I just wanted to throw in a caution here though-- make sure to tell the whole story to your pdoc. It's easy when you're feeling better to go in there and (if you're me...) go on and on about how great things are going and forget to tell the doc about how different things were just a few days ago. They need to know the whole story if you want lasting stability. I'm sure your pdoc will want to know about the rapid mood swing stuff as well as this good period.

I usually do the same thing and forget to tell the doctor how bad it was before! This time, I did tell the whole story to my pdoc. He didn't seem to think it was that big of a deal. I told him how bad my depression has been, but he said things like, "Well you're doing much better now!" I kept trying to remind him that I had only been doing better for about 3-4 days, but I'm not sure if he grasped how bad it had been. I told him I had missed a month of class because of my depression, but he didn't seem to think I could be all that depressed because I'm making all A's. (Uhh maybe because I pulled all-nighters the nights before all my tests and managed about 7-8 hours of studying? I pick up the material easily because it's a topic I'm interested in and that comes naturally to me. I don't see how studying 7-8 hours a month for each class means I'm not depressed. That's NOTHING, especially when you take into consideration that I did about 95% of the readings for my classes in that time. Plus I took my supplemental Adderall during those times... and that's a lot of ADHD medicine running through my system to allow me to get that energy!)

When I'm not depressed, I'm NOT depressed. You would never have any idea. I'm bubbly and positive and energetic and whatnot, so I can see why he would assume that I was doing fine, despite the fact that I continuously told him I haven't been. Add that to the fact that when I last saw him, I was depressed. And when I'm depressed, I'm REALLY depressed. It's very obvious. So the extreme change in signs probably made him think I really was doing great.

I also mentioned my major mood swings. He had mentioned the possibility of bipolar before, and the more I read about it, the more I feel that I do have some sort of issues with that. I don't have mania, but I definitely deal with hypomania or some sort of other mild manic mood swings. The frequency of change in mood swings has increased a lot since I've been on these meds, so I think that's why he didn't take me seriously when I mentioned them -- my moods are simply changing WAY too fast for it to be considered Bipolar. Day to day, or sometimes even hour to hour. It has slowed down a bit, though, and now they seem to be lasting several days, like they did before I went on medication. (I say this based on my mood this past week, which looking back seemed very hypomanic, that lasted about 4-5 days, then turned back into depression. My depression seems to last longer than my hypomanic moods.)

He didn't seem to take that seriously, either. I mean, I'm not diagnosing myself with bipolar, and I'm not even claiming I have it. I don't think I do have full-blown Bipolar I or Bipolar II disorder. I do, however, have some problems when it comes to my cycling of moods, and I'm not sure how to fix it. Hell, my depression is the major issue, and while I obviously do have issues (behavior, spending, rapid thoughts, etc.) in hypomanic periods, I like the feeling! I do not, however, like switching back and forth all of the time. I think if I had the right tools to deal with this, I could even handle it without medication. However, neither my tdoc (who is awful, and I'm looking for somebody else) and my pdoc seem to think it's an issue.

But it IS an issue for me. I can't explain to people why I'm totally euphoric one day and totally anxious and irritable the next day and so depressed I want to kill myself the next day. And besides that, it's not fun for me, either. If I could stay stable in one mood, I could learn how to control my feelings and minimize the feelings. However, they change so often that once I get a hold on one mood, I feel another one!!!

Wow. This turned into a rant. I'm debating about seeing a psychiatrist at my school to figure out what the hell is wrong with me. (I want to stay with my current pdoc for medications because of my ADHD issues. I was diagnosed, but never got tested for it. Now I'm having trouble finding people willing to prescribe me ADHD meds, even though I've been on and off of them for about 8 years. I have no idea why a diagnosis isn't enough, but I have a guess that it has to do with the fact that I'm a college student and Adderall is a commonly abused drug at my school. I would just do the testing, but I can't afford it! So at least until I'm out of school, I'm sticking with this pdoc.) I don't need to be diagnosed with anything, but I do want some idea of what the hell is going on in my brain and what I can do to control it. Would this be more appropriate for a tdoc or a pdoc? I would talk to my pdoc, but he only gives 15-20 minute appointments, and while he's great in EVERY other way, I don't think he understands why my mood swings bother me so much.

Anyways, other than all of that... the pdoc appointment went well. He gave me Aplenzin to try instead of Wellbutrin XL. It's new on the market (less than a week old) and I'm kind of his guinea pig. It is supposed to have less side effects than Wellbutrin. I have a thread on the anti-depressant forum where I'm keeping track of my experiences on it. I thought it might help people since there are literally ZERO reviews and very little info on the internet. Even though I've complained a lot about him in this post, I really like my pdoc. He's so funny and we have so much in common. I do wish I had a pdoc that was a little less clinical, but I like him so much that I'm willing to accept that he's just a purely clinical guy.

Well, it looks like I've written another novel without intending to do so. Hope somebody makes it through!