3 replies to this topic

[nlite10]

I need some advice please. This is day 22 on my low dose 2.5mg Escitalopram/Lexapro/Cipralex for my combined atypical/melancholic depression and OCD intrusive looping thoughts that come with it. First of all, I do have some social anxiety (I'm an introvert with some extrovert tendencies, so that's no surprise - but then how can you not have some extroversion in our cherished extroverted world), but I manage and my overall anxiety is manageable prior SSRI treatment.

 

I'm getting waves of that intense jitteriness from SSRIs in the start up phase and they are not letting up. My intention was to increase to 5mg for a treatment period of about 3-6 months. Now I don't know because I really am afraid of SSRI w/d (bitten by the benzo withdrawal bug) if I remain on it longer. So many people on forums rave about how wonderful Escitalopram is for anxiety and I don't get it. Yes, we are all different 

 

I can't handle the awful waves of jitteriness/internal restlessness (without the need for movement - what is that called?)/anxiety/stimulating factor of SSRIs. I don't want to take a benzo because I was on them for 15 years when I started up on Prozac way back then and got the same side effect and the rest is history. Ignorance isn't bliss   I went through an awful isolated 18 month taper plus I'm now 2 years post benzos and recovered, except for depression creeping up AGAIN.

 

I'm not sure which neuros are out of wack?? Maybe I don't need serotonin from SSRIs for my depression? Plus, now research shows that serotonin isn't exactly the only neuro related to depression and SSRIs are questionable. Is it Dopamine, Norepinephrine, GABAa or the other subsets or other neurotransmitters? Over a hundred neurotransmitters at play here and still no one knows jack shit with what works for depression. No blood tests or other tests available yet. Nothing in 2014, maybe 2015. Done rant.

 

So I've been waiting out the jitteriness and it doesn't seem to be subsiding. I'm feeling a little better mentally and am slightly motivated. I'm very sensitive to SSRIs and SNRIs in general. Another popular one, Wellbutrin (XL or SR ) did nothing except for emotional blunting me to the point of being a robot, and I could only handle 150mg.

 

I fare much better with TCAs, namely, 50mg Desipramine because it doesn't cause jitteriness or anxiety and helps with my depression. I go into remission longer if you classify 2 years as long. The only problem with Desipramine is that I get dry mouth which I tolerate but the brutal constipation that doesn't let up even when I increase fibre a hundred fold is too much. It's so frustrating and VERY upsetting because I am usually very regular!

 

Two of my questions is: I was wondering if 25mg Desipramine can be therapeutic? A while back, I tried some Imipramine 10mg for 2 weeks, but that only sedated me more, hence more depression. I understand that at that low dose it is more a histamine and I don't need SLEEP, yet the sympathetic side effects were over a bit over the top. I could only do 2 weeks. Maybe I should try a different dose? 

 

Here's a little background. I eat healthy and sleep well. Exercise, but need to caution myself because I weigh 100 pounds right now due to my SSRI venture. I veer towards hypersomnia because it's my way to escape my brain and life as needed. When very depressed, I start researching suicide methods and have lots of suicide ideation, but don't act on it. I think it's because I've tried to suicide six times in my lifetime. That changes your psyche.

 

I tend to overanalyze problem(s) or read/dwell/obsess on philosophical existentialism/societal issues that overwhelms me beyond belief (yes I know -- don't go there) and that gets me into trouble, but CBT/ACT/etc has helped me with that. I do mediation and yoga when I'm able and keep on top of it. The problem with OCD repetitive looping thoughts is that in major depression, it's useless for me to stop this and CBT doesn't work whatsoever.

 

Distracting is a fruitless at that point and dysphoria has taken over. Trying to perform CBT = blank mind and being frustrated and more depressed. I have had lots of CBT and talk therapy, but my depression keeps coming back.

 

I have tried over 20 ADs (SSRIs, SNRIs, MOA,) plus some anti-psychotic meds (because what else is left) and, of course, combo meds which were of no help. Too much time and distress trying out combos. Typically, I have the following things going on when it comes to side effects, namely, jitteriness, loss of appetite hence loss of weight (have to force feed), increased sleep, fatigue, zombieness, and apathy. 

 

I can only handle low doses of ADs because I'm so sensitive to meds and in the past my pdoc kept trying to increase my AD because he said I have to get to the therapeutic level. Then I am get intolerable side effects. Last pdoc said I had treatment resistant depression and he was going to send me to a med specialist. We talked about ECT - I didn't go there. That was 2 years ago. I don't have a pdoc now nor do I want one. I use my GP to get the meds I want after I do extensive research. I was going to find a psychologist since it's such a happening trend right now.

 

I'm taking Vit D3, B6/12 and L'Theanine. I can't take magnesium sups on an ongoing basis unless it's in food. I ultimately end up having a paradoxical effect to it. My bloodwork is all normal eight months ago, except Vit D 25Hydroxy which was at 42 and in the mid end of insufficient range. I do make it a point to get out in the sun at noon for about 10-15 minutes plus Vit D3 sups. I was considering doing my thyroid T3 and T4 again.

 

One final question for anyone daring to venture. I have a rare blood type. It's AB Rh-. I was wondering if the Rhesus negative protein in my blood causes my intolerance to ADs. Eight-five percentage of the world is Rh+. Thought that might be my problem with ADs.

 

Any help on any points would be very appreciated.

 

[Tom_]

First of all, atypical and Melancholic depression aren't exactly heavily research based. Secondly they don't combine, they are pretty much opposites.

You don't have treatment resisant depression. Treatment resistant depression is defined as 2 successive trials of an approved antidepressant which have both failed after an adequte trial and with adequate dosing (above the minimum and at least half the maximum is generally accepted).

I suspect a significant portion of your side effect burdon is due to rumination, worrying about side effects and hypervigilance, how much - well that is up for debate. 2.5mg is a tiny dose of Escitalopram and I can't see that causing what you seem to be describing which is termed restlessness or sub-clinical agitiation. On the other hand dry mouth and consiptation can be seen even at realtively low doses with TCA's. Your very typical 'anxious depression' is also a risk factor for experiencing worse side effects.

As full a list of drugs you have tried would be useful. Including lenght of trials, effiacy, combinations and dosage and any other mediaction or supplements you were using at the time. Its ok if you can't give all the information, just  as much as you can.
Also if you can tell us some more about anything else you have used; including psychotherapy (what types, with who, for how long and results), supplements, behavioural changes (exercise, more socializing etc...).

 

There are definately some possible medication, psychotherapy and behavioual stuff I can recommend.

 

Additionally information of family history of mental health problems, any diagnoses you have rescieved or suspect (why do you suspect them) any medical disorders you have had diagnosed, any history of suicidal or deliberate self harm and drug use/abuse include booze. How do you sleep (how long, how restful, when, is it broken into multiple times, do you nap in the day), what do you do -  do you work, are you on sick pay/leave...?

[Tom_]

Who ever 'ill informed' me, can you explain why please?

[nlite10]

Tom, thanks for responding to me. Very kind. I'm in no condition to put together such an elaborate list for you. I will try to put some things down anyway.

 

My mom was a bi-polar and she was mostly in a severe manic state with psychosis every year of my life. She was in denial to the end. She always went off her meds and that set the mania in motion for months on end and she refused treatment.

 

I do have treatment resistant depression according to my last psychiatrist. I have been on pretty well all the ADs (SSRIs, SNRIs (with Effexor I attempted an OD), Wellbutrin (felt like an alien), Remeron, antipsychotics (Risperdal, Lithium, Zyprexia (horrible), Seroquel (was a zombie that slept 24 hours)) and some trials were augmented) for over 15 years and trialled most for 8 months+. The last one was a TCA, Desipramine 50mg that helped my depression a little without that anxiety, jitteriness and internal restlessness I get from SSRIs and SNRIs, but the constipation was intolerable. Throughout all this I was on a benzo. I'm no longer on benzos and have no intention of going on again. 

 

I can't tolerate stimulating ADs (anxiety, jitteriness and internal restlessness are horrible) and sedating ADs are even worse because my depression takes the form of worsened apathy, lethargy and oversleeping which fuels my depression. I can sleep 12+ hours a day. 

 

I'm beginning to suspect that being consistently on one AD after another created my recurring depression to get more frequent. I've had psychotherapy for over a decade and by different psychiatrists to no avail. It's a joke. I was in therapy for CBT and ACT and that was useless because I tend to rationalize or I don't comprehend or don't have any will or energy because I'm too depressed, but I really don't fancy being brainwashed either.   

 

I was on Escitalopram about 8 years ago for over a year, and I did trial up to 40mg (couldn't tolerate) because my depression didn't ease, but back then, the benzo masked the anxiety etc. but cycled/rebounded my depression.

 

I've aborted the 2.5mg Escitalopram trial because my anxiety, jitteriness and internal restlessness have gotten worse. It didn't help my mood that much either. I thought I'd try it again after I've researched the idea to trial a low dose of Escitalopram from posts and links by Ex-Dubio's and others on Mind & Muscle (they had some good studies to look at ) plus other sources to avoid that anxiety side effect. 

 

I'm taking Vitamin D3 and Vitamin B12. I'm eating whole foods, fruits and vegetables (sometimes forcing myself due to loss of appetite). I'm experiencing hypersomnolence, dysphoria, apathy, lethargy and anhedonia. I can manage to function to an extent, but it takes a lot of effort and sometimes I wished I didn't exist.

 

I must say that right now, I'm in limbo and not in a good place. I'm considering a homeopath.