Psychiatrist is still recommending SSRIs...

[b.matt]

Hey everyone,
About a year ago I took a major hit psychologically, and it left me wondering if I was doing the right thing with my meds. Nothing particularly triggered this low point - it was mainly the gradual realization that, while my panic, anxiety, anger, hypervigilance and depression were getting a lot better since I'd started taking meds, well...there just was nothing happening inside of me in place of those feelings. I had become mostly unfeeling, and when I did have an emotion that needed to get out, I would find it so huge and painful (no matter the emotion) that would force it away. Just think about something else. Zoloft makes this very easy to do.

So I stopped taking Zoloft, and entered into my state's medical canabis program. This was in part because I wanted to continue to vape legally, but mostly because I wanted to see what life would be like, today, without the highest functional dose of an SSRI.

Within a month, the biggest change I noticed was that everything started to bother me again. Everything. The second I'd begin to have an emotional response, I would start to panic again. I don't trust my emotions, and they scare me.

THC and CBD are a great combination for this. They seem to help me with my panic symptoms, both mental and physiological, and are an amazing distraction when my trauma brain starts to lock me up.

The problem is that I am no longer taking anything for depression, and I am very very depressed. Not sad...depressed. The difference is that happiness and sadness come and go in me just like anyone - but those feelings have no relevance in my life...and exist only in hindsight, when its safe.

My Psychiatrist wants to try a different SSRI, even after all of that...and I am unsure. I recognize that I could definitely use something to help me feel better about life again, but I don't want to find myself unwittingly living in a cloud of "okay" again. I have come to value my tears and anger and even the occasional smile; I'm just tired spending the other 99% of my life feeling like I'd rather be dead.

My P gave me 4 choices...and I guess I'm supposed to decide?

1. Low dose of escitalopram (SSRI)
2. Bupropion again (it made me kind of high and giddy last time)
3. Low dose of Lithium
4. Lamotrigine

Well, there it is. Any info or experience would be greatly appreciated.

Thank you
-Brian

 

[EveHarrington]

I’d go for the lamotrigine. I’m on other mood stabilizers and they’ve done wonders for me. I think lamotrigine also works on depressive symptoms?

Zoloft is known for killing feelings. My boyfriend “dated” me for 6 months before he realized he liked me. Zoloft made him feel nothing. As soon as he came off it, he realized he had feelings for me. I told his doc no more Zoloft, EVER!

 

[Sideways]

Have you tried escitalopram before? It’s meant to be a good choice for people that tend to get a lot of side effects. So, if an ssri had some benefits for you before, but too many trade offs, that might be worth considering.

I’m not big on mood stabilizers for depression, in the absence of real mood instability. But your cannabis use is likely impacting your mood stability and making that harder to assess. Do you have a history of mood instability?

Neither of those mood stabilisers were without problematic side effects for me personally, and neither of them took the bottom out of my depression (core issue for me). Lithium comes in a slow release version which is typically softer on side effects, but if ptsd with major depression is your issue? I’m not sure that lithium is really indicated...

Have you spoken to your pdoc recently about his current diagnosis, particularly for your mood? It does seem odd that he wouldn’t trial other types of anti-depressants, unless it’s an issue of availability or insurance.

 

[Friday]

and I guess I'm supposed to decide?

If I’m not familiar with a range of med choices I usually ask my docs what makes them interesting/good possibilities? Because there’s always a (series of) reason(s) why any shortlist gets presented. Understanding their thinking as to why they would be useful / what’s different about them gives me a firm foundation to continue discussing them after we’ve settled on a game plan, as well as giving me a ballpark idea of what to expect & better ability to report back, which feeds right back into that ongoing conversation.

 

[lostforgottensoul]

No SSRI or SSNI worked for me. But I had to take them all to know that. Many SSRIs work for many people and many SSNIs work for many people and many people are helped with a dab or this and a dab of this. Seriquel XR 200 mg does wonders for me (BPD part of my diagnosis, still pending to be dropped) and then I hear Seriquel XR is a bad idea for BPD. Wow! Couldn't of be more of a godsend for me. So, gotta try it to know if it helps.

Take all that for what it's worth.

 

[subtleomen]

I've had a similar experience with MMJ. It does really well for some symptoms, but does not help with depression and in fact might make it worse because if I take too much, it ramps up my negative self-talk. It is not a complete treatment for me, but does very well as a sleep aid and managing acute mood swings.

I just started with an SNRI. This is my first time with psychiatric care, and I am finding it helpful so far. It's only been a few weeks but definitely heading in the right direction and I am not numbed out. Also really helps me with anxiety and hypervigilance.

 

[Nessa7]

If genetic testing is a possibility, it might be helpful in your case to see how your metabolism handles different drugs so you can hopefully find one that doesn't require you to be on the highest dose for it to work.

 

[b.matt]

Hi everyone.
Thanks so much for all of your responses. I have read, and am considering what's been said here.

I am not sure if I have BPD. Either it is that, with a tendency to be on the depressed side most of the time...or just straight up depression with extended periods of avoidance-fueled manic thinking and feeling.

I am not ready to park the THC/CBD, but if I am going to start a new med...should I stop that while I try the new med? If I don't, how will I know what is doing what?

I am leaning toward one of the stabilizers which helps with depression, but...honestly I'd really like it if my P-doc would be more committal.

Thanks again :)
-B

 

[subtleomen]

Hi everyone.
Thanks so much for all of your responses. I have read, and am considering what's been said here.

I am not sure if I have BPD. Either it is that, with a tendency to be on the depressed side most of the time...or just straight up depression with extended periods of avoidance-fueled manic thinking and feeling.

I am not ready to park the THC/CBD, but if I am going to start a new med...should I stop that while I try the new med? If I don't, how will I know what is doing what?

I am leaning toward one of the stabilizers which helps with depression, but...honestly I'd really like it if my P-doc would be more committal.

Thanks again :)
-B

My wife has Bipolar type 2. This is the one with hypomania. It is subtle, but there are times when she gets going and cannot stop talking. It doesn't bother me because I find her so interesting, but it is hard to get a word in. Could be worth exploring with a professional if you are concerned about it.

I did not stop, but cut way back when going on this medication. Down from 1-2 dosages per day, to 1-2 per week for the first 3 weeks, only when I felt like my mood swings were going to be a detriment to my family. I am new to psychiatric medicines, but I think this was beneficial for me because it helped give me confidence that the medication was doing what it is supposed to do.

 

[b.matt]

My wife has Bipolar type 2. This is the one with hypomania. It is subtle, but there are times when she gets going and cannot stop talking. It doesn't bother me because I find her so interesting, but it is hard to get a word in. Could be worth exploring with a professional if you are concerned about it.

I did not stop, but cut way back when going on this medication. Down from 1-2 dosages per day, to 1-2 per week for the first 3 weeks, only when I felt like my mood swings were going to be a detriment to my family. I am new to psychiatric medicines, but I think this was beneficial for me because it helped give me confidence that the medication was doing what it is supposed to do.

Hi omen...
This type 2 - hypomania thing sounds like it deserves consideration. I have long believed that there may be some genetic pieces at play (thanks nessa) which perhaps were confused or masked by the PTSD in childhood. It is all a jumble. Perhaps nailing down the inherent "abnormality" and treating it, would give me the 'level playing field' my PDoc keeps prophesying. Thanks.

Interesting, about your second paragraph. My doc over at the MMJ office just told me the same thing. It's a very flexible medication.

Peace...
-Brian

 

[joeylittle]

I am not ready to park the THC/CBD, but if I am going to start a new med...should I stop that while I try the new med? If I don't, how will I know what is doing what?

Correct. It would be best to stop the THC/CBD.

I'm late to the thread, but FWIW - I tend to think it's good to eliminate the lighter med options before moving into the heavier (stronger) meds. But only you can really know how badly you are in need of relief....

Have you tried escitalopram before? It’s meant to be a good choice for people that tend to get a lot of side effects. So, if an ssri had some benefits for you before, but too many trade offs, that might be worth considering.

Just wanted to agree with Sideways, here. I can only speak as a fellow sufferer, not a doc - but the mechanism of action on escitalopram is different enough from sertaline (Zoloft) to make it worth a try. Also, of everything on that list - it's the smallest degree of change, and that's a good way to go when you are OK enough to try smaller changes first.

If buproprion made you giddy before, it will just do it again - unless you were only on it for 3 weeks or less. If the giddiness was happening in the second or third week, then it may have been a temporary side effect. Low dose lithium is gaining popularity in the US as an approach to depression...I've got no experience with it personally, I just know my last 3 psychs have been in favor of it. Lamictal is extremely effective, but it's much stronger than the others on the list, and I'd recommend taking 4-6 weeks and trying something less heavy first.