Jump to content
CrazyBoards.org

Skeletor

Why do strong SRIs induce apathy, indifference and laziness?

Recommended Posts

1 hour ago, crazyguy82 said:

This is my new diagnosis. I don’t really understand it all can anyone help explain it?

 He provided again clinical evidence consistent for him suffering, at axis-I, recurrent depressive disorder (i.e. F-33 as per the ICD-10 diagnostic criteria) rather a bipolar affective disorder or cyclothymia, along with mixed anxiety and depressive disorder (F-41.2, as per the ICD-10 diagnostic criteria) as a differential diagnosis and having, in background or at axis-II, traits of an anxious (avoidant), as to some extent also of an obsessive, personality with ineffective coping skills in general under any added/acute life stress /pressures.        

It is worth noting initially that the diagnosis is written using DSM-IV methodology. The DSM acts as a guidebook for mental health clinicians to diagnose various disorders. The DSM-IV used a multi-axial system to describe various portions of a patient's mental condition.

Axis I: mental health and substance use disorders

Axis II: personality disorders and mental retardation

Axis III: general medical conditions

Axis IV: psychosocial and environmental problems (e.g. problems at home or at work)

Axis V: Known as the GAF Score/scale, was an assessment of overall functioning

Quote

He provided again clinical evidence consistent for him suffering, at axis-I, recurrent depressive disorder (i.e. F-33 as per the ICD-10 diagnostic criteria) rather a bipolar affective disorder or cyclothymia...

Axis 1 would describe mental health disorders like major depressive disorder, bipolar disorder, schizophrenia, etc. This indicates that you have a recurrent depressive disorder. In ICD-10 coding, this would be F33, but your pdoc seems to imply here that he would rather diagnose you as a bipolar disorder, unspecified (F31.9) or cyclothymia (F34.0).

Quote

...along with mixed anxiety and depressive disorder (F-41.2, as per the ICD-10 diagnostic criteria) as a differential diagnosis...

F41 is the ICD10 major code for some anxiety disorders including panic disorder, generalized anxiety disorder, etc. It does not include social phobia (otherwise known as social anxiety disorder). F41.2 is a relatively new code to imply a mixed anxiety and depressive disorder as he has described. Many times people feel that their anxiety or their depression is stronger, one leading to the other. This statement by your psychiatrist implies that anxiety is tightly intertwined with depression in a way that cannot be described with other anxiety disorders. This is not unusual for a comorbid anxiety diagnosis with a mood disorder like bipolar disorder or cyclothymia (a possibly less mild form of bipolar disorder).

This all could also explain why you didn't respond well to imipramine, which is a fairly strong tricyclic AD.

Quote

...and having, in background or at axis-II, traits of an anxious (avoidant), as to some extent also of an obsessive, personality with ineffective coping skills in general under any added/acute life stress /pressures.

Axis 2 would imply personality traits independent of any mental disorders. In a nutshell, your pdoc has assessed you as having an avoidant personality with obsessive qualities and that these qualities combined with a lack of coping mechanisms can lead to a problem. Don't take this as an attack on who you are as a person but rather as an assessment of what you're capable of under stress.

For example, one of my favorite coping skills for anxiety is 4-7-8 breathing:

https://www.healthline.com/health/4-7-8-breathing

This is a physical coping mechanism for my anxiety. When I feel anxious or stressed, I'm out of my CBD:THC tincture, and I don't want to take a clonazepam or don't have time for it to kick in (which can take a few hours), 4-7-8 breathing is my godsend. Your doctor is looking to see if you have these kinds of coping mechanisms to handle your day-to-day.

In summary: Under the DSM-V, you have been re-diagnosed as having bipolar disorder comorbid with a mixed anxiety/depressive disorder, most likely a secondary diagnosis to the bipolar disorder. A comorbid diagnosis (having 2 or more conditions simultaneously) is a fairly common diagnosis for those with bipolar disorder. However without the actual ICD-10 codes that the pdoc's office is using, it's hard to say for sure what their final diagnosis is, and they usually keep that pretty close to the chest (i.e. you usually can't just call your pdoc and ask them what they're using as their diagnosis for your billing claims).

Considering that you're already taking Seroquel and Lamictal for some time now, a re-diagnosis as bipolar isn't that far-fetched at all, as both of those medications are for bipolar disorder (although Seroquel has an indication for treatment-resistant MDD and Lamictal is used off-label for that as well).

Share this post


Link to post
Share on other sites
4 hours ago, browri said:

It is worth noting initially that the diagnosis is written using DSM-IV methodology. The DSM acts as a guidebook for mental health clinicians to diagnose various disorders. The DSM-IV used a multi-axial system to describe various portions of a patient's mental condition.

Axis I: mental health and substance use disorders

Axis II: personality disorders and mental retardation

Axis III: general medical conditions

Axis IV: psychosocial and environmental problems (e.g. problems at home or at work)

Axis V: Known as the GAF Score/scale, was an assessment of overall functioning

Axis 1 would describe mental health disorders like major depressive disorder, bipolar disorder, schizophrenia, etc. This indicates that you have a recurrent depressive disorder. In ICD-10 coding, this would be F33, but your pdoc seems to imply here that he would rather diagnose you as a bipolar disorder, unspecified (F31.9) or cyclothymia (F34.0).

F41 is the ICD10 major code for some anxiety disorders including panic disorder, generalized anxiety disorder, etc. It does not include social phobia (otherwise known as social anxiety disorder). F41.2 is a relatively new code to imply a mixed anxiety and depressive disorder as he has described. Many times people feel that their anxiety or their depression is stronger, one leading to the other. This statement by your psychiatrist implies that anxiety is tightly intertwined with depression in a way that cannot be described with other anxiety disorders. This is not unusual for a comorbid anxiety diagnosis with a mood disorder like bipolar disorder or cyclothymia (a possibly less mild form of bipolar disorder).

This all could also explain why you didn't respond well to imipramine, which is a fairly strong tricyclic AD.

Axis 2 would imply personality traits independent of any mental disorders. In a nutshell, your pdoc has assessed you as having an avoidant personality with obsessive qualities and that these qualities combined with a lack of coping mechanisms can lead to a problem. Don't take this as an attack on who you are as a person but rather as an assessment of what you're capable of under stress.

For example, one of my favorite coping skills for anxiety is 4-7-8 breathing:

https://www.healthline.com/health/4-7-8-breathing

This is a physical coping mechanism for my anxiety. When I feel anxious or stressed, I'm out of my CBD:THC tincture, and I don't want to take a clonazepam or don't have time for it to kick in (which can take a few hours), 4-7-8 breathing is my godsend. Your doctor is looking to see if you have these kinds of coping mechanisms to handle your day-to-day.

In summary: Under the DSM-V, you have been re-diagnosed as having bipolar disorder comorbid with a mixed anxiety/depressive disorder, most likely a secondary diagnosis to the bipolar disorder. A comorbid diagnosis (having 2 or more conditions simultaneously) is a fairly common diagnosis for those with bipolar disorder. However without the actual ICD-10 codes that the pdoc's office is using, it's hard to say for sure what their final diagnosis is, and they usually keep that pretty close to the chest (i.e. you usually can't just call your pdoc and ask them what they're using as their diagnosis for your billing claims).

Considering that you're already taking Seroquel and Lamictal for some time now, a re-diagnosis as bipolar isn't that far-fetched at all, as both of those medications are for bipolar disorder (although Seroquel has an indication for treatment-resistant MDD and Lamictal is used off-label for that as well).

Thanks for such a detailed response. It seems I get more complicated by the second. The doctor is quite insistent that I go back to lithium. I’ve flat out said no due so rather horrible side effect issues.

He also wants me to consider coming off Seroquel. I’m not sure the reasoning for this. 
 

I have to submit the report to my NHS GP and consultant. I really don’t like the diagnosis of bipolar disorder. I have known myself for some time about the bipolar issues but not really had the conversation with NHS doctors.

I will send it in. I’m lucky to have a job that provides private health cover.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


  • Similar Content

    • By Skeletor
      Both are second-generation SSRIs, both exhibit minimal drug interactions via Cytochrome P450, both are the most prescribed SSRIs and are considered first line antidepressants. Who's been taking both and what were your experiences? (How did they compare to each other?). I am looking forward to read your experiences...
      Which one did you like more?
    • By Blahblah
      Have a strong itch to drop Effexor...(I won't go cold turkey). It stopped my dysphoric crying spells, but now, 10 months later, I'm feeling increasingly flat, apathetic, numb, no motivation (even after dropping to 75mg). I hate how all A/Ds have this lobotomy effect on me longterm. It's initially fine in acute episodes, I'm not sad now, but I can't function properly, and I continue to score Moderate-Severe on the depression scale.
      I think it's counteracting my Ritalin (which I increased to 30-40mg)? I don't want to increase Effexor above 150mg, I'd never be able to go off.
      I'm trying dosing at night instead, will this make any difference @mikl_pls ? I skipped yesterday's morning dose (then came the intense nausea, over stimulation & brain slosh awfulness @10 hours later) and I took my dose with dinner.
      I'm seriously considering going on low-dose mild SSRI instead (Prozac?) I'm sensitive to meds & side effects, and I'm also VERY worried about withdrawals. Especially from Effexor, they are the WORST, and I just read study that Effexor withdrawal syndrome is not dose-dependent:
      https://www.researchgate.net/publication/7402189_Venlafaxine_and_Serious_Withdrawal_Symptoms_Warning_to_Drivers
      https://metro.co.uk/2018/01/24/woman-shares-coming-off-antidepressant-ruined-life-7255570/
       
       
    • By Blahblah
      Starting this thread because boredom, idleness, lack of stimulation is often a key trigger of depression and bad habits. When I get bored, I feel an emptiness, uselessness and physical/mental lethargy, cue ruminations, then I sleep excessively. This isn't always fatigue: It's an automatic (and very negative) avoidance behavior.
      This link lists 150 ideas (from high effort to minimal effort - from "fun" to mundane) in order to build healthier habits. I need to stop waiting to "feel good" before taking any action. Any thoughts?
      https://www.developgoodhabits.com/what-to-do-bored/
      Today, I:
      Journaled, Cleaned my desktop, Backed up computer, unsubscribed to some junk email, Did some stretching, called a relative, dealt with an admin issue, read some blogs about depression, provided some words of support/appreciation for someone.
    • By Blahblah
      Anyone find Zoloft more motivating than Effexor? Any weight gain? (it made me insomniac with psychosis 20 years ago). But meds often act differently over time. I've already done trials (some multiple times) of:
      Prozac (lethargic), Celexa (fatigue/apathy), Lexapro (similar to prozac), Cymbalta (vigilance/restlessness legs, but dissociative mind/feeling), Wellbutrin (no effect), Trintillex (no effect), Remeron (sedating/+appetite), Notryptaline (don't recall), Abilify (++appetite, RLS), ..Doc won't RX MAOIs and says that TCAs typically more sedating effects.
      Basically, I don't want to take more than 3 meds (keeping with Lamictal & Ritalin). I want to avoid A/Ps...I like the calming feeling of Prozac & Effexor, but it's as if I am in this fuzzy cloud and I can't move or do anything, comfortably numb. Totally apathetic, in addition to sexual dysfunction, maybe my dosage is wrong. I'm also considering Viibryd, but don't know if it works on Serotonin...?
×
×
  • Create New...