Confused about meds for comorbid DXs

[HeadsetHellion]

I hope this is the right place to post this...

 

As you can see from my signature, I have multiple dx and have tried several different rx over the years. The problem I've run into is that my depression causes me to be extremely lethargic and fatigued, no matter how much rest I get...but I also have anxiety and panic attacks. Most antidepressants that work for anxiety tend to be pretty sedating. This does not work for me; I'm tired enough already. I've also had problems with SSRIs in general.

 

I've been taking Wellbutrin for a few months now; my dosage was increased about 6 weeks ago. I haven't had any negative side effects. I've heard the concerns about Wellbutrin making anxiety worse. I haven't experienced that. I feel like my mood has improved but not enough. I'm still tired all the time; I still can't focus, have no motivation. I look at my sink full of dirty dishes and it bothers me but it doesn't bother me enough to load the dishwasher. I look at the piles of dirty laundry on my floor and it bothers me but the thought of going out in public bothers me a lot more. I still get overly emotional and cry at inappropriate times.

 

I have a rx for Klonopin that reads "take 1 tablet twice a day and 1 extra as needed." I do not take it every day. I've always looked at benzos as something that's only PRN, so I only take it when I know I'm going into a triggering situation or if I feel a panic attack coming on. Am I wrong? Should I be taking 2 tablets daily, regardless of how I think I feel? If I do this, will it make me tired and basically defeat the purpose of taking a med like Wellbutrin in the first place?

 

I feel like the only days that I feel "normal" and can think clearly are when I have caffeine, which I'm not even supposed to drink. Yeah, it helps with my depressed feelings but it aggravates my anxiety as well as some GI problems I'm also dealing with. So not worth the physical repercussions.

 

I just don't know what to do. I have an appointment with my pdoc next week. I don't want to consider coming off the Wellbutrin; it's the only AD I've taken that doesn't make me feel like a zombie and/or give me terrible side effects. I'm not at 100% but at least I'm noticing a little improvement...should I ask him to increase my dosage again? We've already tried to augment with Lexapro and that didn't work. Any other SSRI is off the table for me, as are most SNRIs. 

 

Has anyone had success augmenting Wellbutrin with an ADD med like Ritalin or Strattera? Is this even a reasonable topic to discuss with my doctor?

 

It just seems like any drug that might help with my depression will make my anxiety worse and vice versa. I feel like I can't win  ...I hope there's someone here who can point me in the right direction.

[melissaw72]

 

I have a rx for Klonopin that reads "take 1 tablet twice a day and 1 extra as needed." I do not take it every day. I've always looked at benzos as something that's only PRN, so I only take it when I know I'm going into a triggering situation or if I feel a panic attack coming on. Am I wrong? Should I be taking 2 tablets daily, regardless of how I think I feel? If I do this, will it make me tired and basically defeat the purpose of taking a med like Wellbutrin in the first place?

 

I take klonopin 2x/day every day on a scheduled basis, then have xanax as prn for breakthrough anxiety.  The klonopin maintains the anxiety and does not make me tired, and the xanax has the extra calming effect I need for emergencies, which also does not make me tired.  It might at first, but once it gets into your system IMO that side effect wears off.

 

I'm also on Wellbutrin, and for me it doesn't defeat the purpose of being on the Wellbutrin (that I know of).

 

Have you tried propranolol for anxiety? That didn't make me tired at all and really helps with my anxiety.

[mcjimjam]

My mother used to take Wellbutrin specifically FOR anxiety. There are always those who react in an unusual way. It is good that you don't have side-effects from the WB. Maybe you do need a bit more of it or to give it some more time, speak to your doc about that. Regarding Klonopin, maybe have a discussion with your pdoc about whether taking it on a schedule would be right for you. He may think that you are already doing that. Benzos can worsen depression for some people, but not everyone. You could be lucky like you were to miss out on the anxiety side-effect of Wellbutrin. The longest I took a benzo (Valium) daily was 2 months. I don't remember it affecting my mood.

Edited May 1, 2014 by mcjimjam

[Phoenix_Rising]

I also take Klonopin daily: 2 mg during the day and 2 mg before bed to control anxiety.  I also take a beta-blocker like melissa mentioned.  I think doing what mcjimjam suggested and talking to your doctor about how best to take the klonopin is a good idea.

 

To deal with the the sleepiness/lack of motivation problem, my pdoc rxed adderall for me, which I take three times a day.  I still take naps the majority of days, but I don't feel like I'm dragging myself through the day.

 

This is all great stuff to talk with your pdoc about.

[Chimako]

I take klonopin everyday, .5mg in the morning.  Small dose but it works to keep my anxiety and panic almost completely under control for most of the day.  I can also take another if I feel severe anxiety.  

[Horizons]

I definitely think it's worth talking to your doctor about trying one of the stimulating ADD meds to counter-act some of your fatigue and motivation issues. I've always found that my Dexedrine has a pretty good anti-depressant effect. Of course these have the potential to make your anxiety worse, but so does Wellbutrin, so there's no way to know if it will make you feel worse or better without trying it. For me, Dexedrine has no effect on my anxiety in either direction.

[jt07]

I find that Abilify helps me a lot with fatigue and motivational problems. The downside is that it increases anxiety, especially in the beginning and at low doses. It's a great med for me. I also take Ritalin, however it does not do much for me by itself. It works great in combination with Abilify though.

 

I think the others have given great advice about the Klonopin. I took Klonopin 1 mg three times a day for over three years. I did not have any problems coming off it when the time came. Talk to your doctor about it.

[kateislate]

If you're not actually having increased anxiety from the Wellbutrin, then I wouldn't worry about what it's "supposed" to do. For myself I take three theoretically activating Meds and my anxiety has never been more under control. The Strattera helps most of all with anxiety - even though it's an ADD med. I also calm down from caffeine. People can react very differently to different medications is the take-home.

[HeadsetHellion]

Thank you all so much for your replies; you've given me a lot to think about. I had about four paragraphs typed out in response when my browser closed without even asking my permission (the nerve!) so please forgive me if this sounds like a rattled-off mess.

 

I'm going to start taking my Klonopin 2x/day as prescribed and see how that works out. I have an appointment w/ my pdoc next week and I'm going to "come clean" to him that I've been afraid to take it every day because of my fatigue. I also want to ask him about a RX for something like Ativan or Xanax that I can take PRN when I have a panic attack, because when I have a breakdown...my Klonopin does nothing. Ok well except the one time I was sobbing and hyperventilating in front of my boss and took a second pill within 4 hours? Let's not talk about that...

 

I haven't tried propranolol or any other beta blockers. It hasn't been suggested by my pdoc and I didn't realize it was an option. I did take Lyrica two years ago for a physical injury and noticed a marked improvement in my mood. Unfortunately it's not available as a generic (my surgeon gave me free samples) and I've heard that Gabapentin isn't as good...any advice on that? I guess I should also mention that I was taking a low dose of Valium at the same time to prevent muscle spasms; I'm not sure if that makes any difference.

 

I did consider asking about Abilify, but I don't think it would be a good fit me because of the side effects. It seems to cause a lot of GI issues, and I have enough of those already (actually have an appt w/ my GI specialist the same day as my pdoc next week.) I just feel like ultimately it's not worth the risk; I already have ulcers covering my esophagus, KWIM?

 

I am going to ask him about ADD meds, though, and not just because they're "stimulating." I genuinely believe that I have ADD and have felt this way for years. As an adult who doesn't exhibit the hyperactive traits, I haven't found a dr yet who's taken me seriously. Very frustrating and a topic for another post, because I will get off topic!

 

I have also tried hydroxyzine/Vistaril, which was a joke. No dice. I know a lot of people swear by it, but it makes me ill and I have felt less hung over after a night of tequila shots. Thankfully I now have an ENT specialist who has explicitly forbidden me from taking antihistamines (yes, I have a lot of problems. My calendar is a hot mess). I wish I could get all of my dr's together for a nice little conference, but I can't even get my family together without someone getting drunk and starting a fight.

 

There was more I had written out that I can't remember now, sorry, and trying to recall is just making me frustrated. I hope this post makes sense, because I really do appreciate the replies that you guys have taken the time to send me. 

[melissaw72]

 

I've heard that Gabapentin isn't as good...any advice on that?

 

Personally, and this is only my experience, for me gabapentin initially worked, but my tolerance level kept increasing to 4,000 mg. 

 

Then I had to come off of it because it wasn't doing anything.  It was terrible weaning off neurontin.  Edginess, irritability, anxiety, etc, and the weaning had to be done slow enough so these things were minimalized.  Even slow though it was terrible for me.  And it took forever.  The last few hundred mg's were the worst to come off of. 

 

So I would never go back on it ever again because if for whatever reason I had to wean off again, I would go insane from those side effects.

[HeadsetHellion]

Wow, that's good to know! I had no idea that Neurontin was even a drug that caused withdrawals, let alone to that degree!

[San]

Gabapentin helped my anxiety a lot.

Klonopin is a longer acting benzo and takes a while to kick in. i don't recommend this, and it tastes terrible, but sometimes if I have a panic attack, I'll chew the pill so it kicks in faster. I find it no good for a panic attack. Other benzos, like ativan, you mentioned, kick in faster. Sublingual ativan (not covered by most insurance, but with regular ativan, you can stick it under your tongue, it will absorb, it just tastes terrible and the pill is bigger) will knock the anxiety away fast.

 

If you haven't had anxiety from the wellbutrin yet, odds are you won't in the future.

 

A PRN benzo is a good idea, rather than taking them regularly, just don't take more than prescribed or you'll build up a tolerance. I do take klonopin twice a day with a 3rd to use PRN, but I find it useless as a PRN.

[melissaw72]

Sublingual xanax and sublingual klonopin should be covered by insurance.  You *might* need a prior auth, but I'm on both and both are covered by insurance.  They taste decent also and really work within seconds of taking them.