I want to adjust my meds, Is it possible?

[wookie]

I am on two antidepressants, and lorazepam prn (1 to 3mg)

I still am nervous in a few social settings, especially if I am put on the spot, or if I feel put on the spot- not hard to do to me really.

I get social anxiety which is quelled by lorazepam.

I have a panic disorder that is now somewhat controlled, but I take lorazepam for certain situations (haircuts- I've had a panic attack during a haircut).

I have essential tremor, of the upper body.

I sleep better, and cry an awful lot less now that I take antidepressant medication.  I find taking the lorazepam calms me when needed but can create mood swings when I take it sporadically.  It's like my depression and anxiety rebounds after it clears my system.

I feel okay, but not totally okay.

Can I fix that, or is this as good as it gets?

 

[notloki]

Have you ever tried taking a benzo all the time ?

[wookie]

3 minutes ago, notloki said:

Have you ever tried taking a benzo all the time ?

Yes. My doctor doesn't want me to.

[melissaw72]

If you want to change your meds, I would suggest doing it under your pdoc's supervision.

 

2 hours ago, wookie said:

Can I fix that, or is this as good as it gets?

IMO, for me at least, it is as good as it gets.

[wookie]

here is what I was thinking...

Something for mood stabilization? I am maybe a bit tweaked out on these AD's.  Not classically bipolar, but I have trouble relaxing.  If I was truly bipolar I would be up shits creek without a paddle on two antidepressants.  Or maybe that is actually possible.  I don't know anymore.

For anxiety:

Gabapentin?

Lyrica?

Tremors:

Primidone?

Do I switch out one antidep for Lamictil?

I was suggested taking Seroquel.  I don't want to. I had it before and felt it did little and I gained a bunch of weight on a low dose.

I was suggested abilify and it cranked up my anxiety an extra notch.

Sticking with talk therapy.

Any ideas? Thoughts? I was going to make a list and show my doctor.

Do augment?

Rexulti?

Latuda was another suggestion made to me.

Edited March 6, 2017 by wookie
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[notloki]

2 hours ago, melissaw72 said:

If you want to change your meds, I would suggest doing it under your pdoc's supervision.

I'm sure he will. He is just doing some research to better have a dialogue about this issue with his doc.

[melissaw72]

4 minutes ago, notloki said:

I'm sure he will. He is just doing some research to better have a dialogue about this issue with his doc.

Ok ... so ... I said what I did about being under a DRs supervision because of the title of his post.  I also quoted it below.

To me at least, I read it as him wanting to adjust his meds.  He made no mention of researching anything in his OP, as well as any posts he posted after that up until now. 

So I posted about being under a pdoc's supervision in case he was going to actually adjust his meds on his own.

Quote

I want to adjust my meds,

 

[confused]

I find when I am asking if I have to settle, I am usually at a level I am not comfortable.

I have things I have to deal with now: fatigue, tremors... but they are things I can handle.

As far as anxiety, I have considered changing my mood stabilizer to see if it can help.

I have found that everything helps a little: meds helps a little, stress reduction helps a little, exposure helps a little and it adds up.

The only med I take on your list is lamictal. I am not sure how much it helps with anxiety. I have been pondering (for a long time) about switching to depakote, but that can come with weight gain. I just haven't done it because I haven't been in a place where I need an overhaul, everything seems okay.

Not sure if I had a point except anxiety sucks and I have found some relief.

[DopamineSick]

2 hours ago, wookie said:

here is what I was thinking...

Something for mood stabilization? I am maybe a bit tweaked out on these AD's.  Not classically bipolar, but I have trouble relaxing.  If I was truly bipolar I would be up shits creek without a paddle on two antidepressants.  Or maybe that is actually possible.  I don't know anymore.

For anxiety:

Gabapentin?

Lyrica?

Tremors:

Primidone?

Do I switch out one antidep for Lamictil?

I was suggested taking Seroquel.  I don't want to. I had it before and felt it did little and I gained a bunch of weight on a low dose.

I was suggested abilify and it cranked up my anxiety an extra notch.

Sticking with talk therapy.

Any ideas? Thoughts? I was going to make a list and show my doctor.

Do augment?

Rexulti?

Latuda was another suggestion made to me.

I've seen a lot of good reports on Rexulti. I was on it for a while and I was better off. Not great, but better. It's definitely worth a try if your insurance covers it. Otherwise, it's too expensive.

Gabapentin almost feels like a placebo for me. It's worth a try, but it doesn't come close to the effectiveness of benzos. I'm on 400 mg, 3 times/ day and I don't feel a single benefit from it. But, again, it might be worth a try.

[wookie]

I am going to see my family doctor now and can run it by him.  I see my pdoc next week.

[Iceberg]

rexulti helped my depression but did not touch my anxiety, neither did latuda at low dose and at high dose I was a zombie, also you better have good insurance for rexulti. Could you switch to a longer acting benzo that would cover you to prevent an attack as opposed to waiting until it happens and then maybe wear off more gradually?  klonipin/ Xanax XR. I cant imagine lamictil being any better for anxiety or  depression for MDD than an antidepressant would be...but  that's a pdoc preference question.  What about an SNRI  (Effexor, Cymbalta), those can help depression and anxiety pretty well too, but you'd have to ditch the SSRI and monitor closely for serotonin side effects

[Cerberus]

Wookie -

Two things come to mind as you describe the benefit you're getting from the antidepressant. The first is to wonder whether you would benefit from a slightly higher dose of the antidepressants, though you don't want to reach the point where you're "numbed" by them.

The second, and forgive me if I'm asking a question you've already covered elsewhere, but are you engaged in any type of therapy as an adjunct to your meds regime? Relying on meds alone to combat anxiety and mood shift isn't always the quickest, or the most effective, way to achieve control. Depending on your flavor of MI, you might find that some Cognitive Behavioral Therapy would give you the ability to nip those incidental anxiety blooms in the bud by teaching you how to identify their precursors in time to use techniques like mindfulness, control of your breathing, and other conscious physiological mechanisms to prevent your body and mind from cascading into an anxiety attack. If CBT doesn't work for you, Dialectic Behavioral Therapy might by giving you insight into the factors that prompt your reactions.

In any case, there are very good reasons not to fall back too heavily on the benzos.

Also, you say you're "not truly bipolar" - it's important to know your diagnosis, as bipolar and unipolar depression are not the same, and some medications that show good results with unipolar depression are chancy if not absolutely contraindicated with bipolar. Iceberg, above, mentions Effexor, but some bipolars report a worsening of symptoms, particularly hypomania, when using it.

[Iceberg]

I was assuming ads were ok based on the history of high doses of them...but yes...if your feeling manic reaction ur doc has to know 

[crtclms]

12 hours ago, melissaw72 said:

Ok ... so ... I said what I did about being under a DRs supervision because of the title of his post.  I also quoted it below.

To me at least, I read it as him wanting to adjust his meds.  He made no mention of researching anything in his OP, as well as any posts he posted after that up until now. 

So I posted about being under a pdoc's supervision in case he was going to actually adjust his meds on his own.

 

Come. On. Your interpretation of what the OP meant is no more valid than notloki's. People can disagree with you without its being a personal attack. And vice versa.

[melissaw72]

1 hour ago, crtclms said:

Come. On. Your interpretation of what the OP meant is no more valid than notloki's. People can disagree with you without its being a personal attack. And vice versa.

I know that people disagree.  What I wrote was not a personaI attack on anyone, and wasn't based on a personal attack. 

I just said in my post my POV, replying back to notloki.  I didn't see it as a personal attack ... I just wrote my view.

Sorry if it was misinterpreted to mean something otherwise.  That was not my intention.

[wookie]

Ahem.. *whispers*...  She.  I am a female unicorn.

Clearing up my diagnosis is another detail i am working with my psych next week.  I see a psychologist almost every week now.

[wookie]

10 hours ago, Cerberus said:

Wookie -

Two things come to mind as you describe the benefit you're getting from the antidepressant. The first is to wonder whether you would benefit from a slightly higher dose of the antidepressants, though you don't want to reach the point where you're "numbed" by them.

The second, and forgive me if I'm asking a question you've already covered elsewhere, but are you engaged in any type of therapy as an adjunct to your meds regime? Relying on meds alone to combat anxiety and mood shift isn't always the quickest, or the most effective, way to achieve control. Depending on your flavor of MI, you might find that some Cognitive Behavioral Therapy would give you the ability to nip those incidental anxiety blooms in the bud by teaching you how to identify their precursors in time to use techniques like mindfulness, control of your breathing, and other conscious physiological mechanisms to prevent your body and mind from cascading into an anxiety attack. If CBT doesn't work for you, Dialectic Behavioral Therapy might by giving you insight into the factors that prompt your reactions.

In any case, there are very good reasons not to fall back too heavily on the benzos.

Also, you say you're "not truly bipolar" - it's important to know your diagnosis, as bipolar and unipolar depression are not the same, and some medications that show good results with unipolar depression are chancy if not absolutely contraindicated with bipolar. Iceberg, above, mentions Effexor, but some bipolars report a worsening of symptoms, particularly hypomania, when using it.

To answer your questions as highlighted above-  My family doc is monitoring my meds and thinks I am at the top end dose of what is reasonable for someone who is not OCD, and doesn't want me to go higher.

I saw him yesterday and discussed trying latuda, or replacing my escitalopram with latuda.  He kindly told me to follow up with my psychiatrist which I will do so next week.

Today I see my psychologist.  I am going to discuss some of my fears and reservations about life in general, and why I am an anxious person.  It is dead obvious why I am anxious but realizing and then relaxing about it doesn't always work that way.  I have fears about new situations, performance anxiety that is a bit out of control.  Basically I am happy to not have to talk to most people, see them, interact etc.  It is obvious why I hate people to me,  I haven't found a way to feel better about it.

I was labelled bipolar, then the same people thought it was a mistake.  I suffered silently for years, and then the new doctors said, definitely not bipolar.  Did a full workup which was a confused mess, that questioned whether I had a mixed episode before I started meds (emphasis on maybe- aka still not clear) and a recognition of some traumatic experience.  This was summed up in about 27 pages.  No definite bipolar.

Did an independent work up of my diagnosis.  The psychiatrist just said, "it's not clear."  He sent a document to my previous family doc saying possible bipolar with a list of meds she wasn't comfortable prescribing to me.  This doctor said nothing to me, did not remark that I have a choice of meds.  I had no idea I had a choice of meds, or possible bipolar.  A year later, and after becoming homeless due to an apartment fire, my family doctor remarked it must difficult being bipolar and all.  I asked for the diagnosis sheet and replied that I'd like meds to cope with stress.  She said she could refer me to a psych- which could take 6 months to a year.

Found a psych 10 months later.  Said bipolar II.  Then changed her mind.

I gave up.

Found a new psych who got me med compliant to an antidepressant that partially remitted some depression symptoms (40mg citalopram).  Got on a low dose of seroquel.  New docs said definitely not bipolar. Did alright for a while (3 years)  Went off meds.  Crashed. Rinse repeat.

So as you can see my dx is as clear as mud.  I had a shitty reaction to lithium (450mg- accidentally missed a dose went into a crazy episode of an intensity I had never experienced before), and to a low dose of effexor 9mg.

As clear as mud.  Just sticking with whatever works for now.

Edited March 7, 2017 by wookie
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