57 replies to this topic

[penisbreath]

i'm a 27 year old male who's suffered from lifelong inattentive add and treatment-resistant ocd/anxiety/depression for the past 5 or 6 years.

i've tried most ssri's, benzos, APs, maoi's, tca's, stimulants etc. with too many side-effects or no success. my depression is rooted in low-motivation and anhedonia, and given the fact that i'm highly likely to experience parkinsonian effects on SSRIs and APs (RLS, akathisia), i've wondered if i suffer from some kind of dopaminergic dysfunction. the closet i've come to remission has been on Parnate, but i don't respond to benzos for anxiety and no p-doc will augment otherwise for insomnia and irritability. i was hoping Memantine would be my magic bullet but it worsened anxiety and insomnia.

other things i've noticed is that i'm extremely sensitive to noradrenaline-affecting meds -- i get very irritable, labile mood etc. unfortunately i've never really found a med combination that adequately addresses inhibition vs. excitatory factors and most things that help mood/anxiety leave me heavily cognitively impaired, while most stimulants exacerbate anxiety and worsen mood. there isn't much of a treat-the-whole picture approach here or view to polypharmacy, so it's easy to get stuck -- plus you get pdocs with differing opinions, some will deny the ADD dx. etc.

if i HAD to favor one symptom set in terms of pure day-to-day survival at the moment, it would be OCD and anxiety, which leaves me unable to work or study. however, i also highly prize intellectual pursuits so while cognitive functioning isn't essential to my continuation, i find it difficult to tolerate being in a state where i can't effectively read or concentrate. at this point, i'm not looking for a complete remission but just some combination that will make existence more tolerable.

the only two meds i haven't really tried have been Lithium and Lamictal, though i take Lithium Orotate with some beneficial effects on mood and anxiety. i'm seeing a psychiatrist but he doesn't seem to have any ideas re: treatment and i was thinking of investigating alternative approaches, since i guess i have nothing to lose anymore.

a couple of things i was interested in:

for depression/anxiety ... either SJW (never given it a decent trial) or Zembrin. people are also reporting success with Minocycline (though i don't think it helps anxiety) and my doc just gave me a script to try it out.

for energy/depression ... stacking Zembrin with Forskolin ala CLITEP, or stacking SJW with Ginseng (ala anticipatory anhedonia thread) ..

i'm not sure which of those routes to visit first (Zembrin/Forskin vs. SJW) or if either will be adequate for my needs.

for ADD: nicotine is probably the best stim i've used .. i've realized it might not be the safest long-term but i like it .. otherwise if i can get my anxiety under control, i might be able to tolerate caffeine more easily

for OCD: tried NAC but had respiratory problems, Uridine made me a little irritable though i didn't give it a fair trial (was stacking with Memantine), Sarcosine?

any other suggestions? pretty much open to any ideas at this point, as long as they aren't ridiculously expensive as i'm on a budget..

other things i should mention i guess: vitamin D deficient and supplementing reluctantly as vit D seems to increase anxiety
had signs of inflammation on-and-off (sore throat, bloating etc.) while depressed and white-cell count is often raised ..

thanks!

[socialpiranha]

hey man i can relate, here are some things i'm thinking of trying.

for add/ocd: galantamine, metadoxine, indeloxazine, cannabidiol. Might go back to low dose lamictal(most helpful yet) or try low dose topiramate

for anx/dep: cannabidiol, jdtic, indeloxazine,

[penisbreath]

what did lamictal do for you? what dose were you taking?

[superM]

interesting. i have very similar symptoms, same age, same time of onset.

ssris also make my RLS worse or seemed to have cause it.

my main issues are the anxiety, add-pi, insomnia, and i guess energy/depression. here are some of the things i tried:

pharmaceutical-

methylphenidate: ok, but very anxiety provoking.

amphetamine: (adderrall) helped me a lot. i try to minimize daily usage to reduce tolerance.

lexapro: first ssri i tried, helped with anxiety but worsened energy

prozac: better than lexapro in terms of energy, however, worsened insomnia

ativan: works for anxiety, but its too hypnotic. helps with insomnia though.

temazepam: tolerance built up to quickly, no longer helps with insomnia unless i use a big dose.

(currently i take prozac+amphetamine, temazepam sometimes at night).

supplements -
methyl b12, fish oil, multivitamin, coq10 as a base

piracetam: gave me brain fog worsened anxiety at times

forskolin/artichoke extract: stacked ok with the amphetamine at times, however, with continued usage i got fatigue.

caffeine: its ok for energy but i get a lot of anxiety with higher doses

[socialpiranha]

what did lamictal do for you? what dose were you taking?

lamictal was helpful at 150 mg but it took away some of my creative thinking though which is a big part of my identity. I didnt feel quite myself but i was much more functional. I'm thinking now maybe messing with dosage might be able to strike a balance between feeling myself and being more functional

[penisbreath]

i've read conflicting things about lamictal -- seems to either improve or worsen patients' OCD. did it do much for your anxiety?

not really sure what to try at this point, i won't lie -- my anxiety is completely crippling and is making me more and more agoraphobic. found some clonazepam and 0.5mg takes the edge off, the only benzo that works and allows me to leave the house. i keep wondering if what i really need is something heavy-duty like Nardil, but my last psychiatrist said it won't do anything for ADD.

in terms of herbs, interested in Berberine after reading the thread on it here but might be far too mild for my purposes

Edited by lucky.pierre, 12 June 2013 - 12:24 PM.

[penisbreath]

interesting. i have very similar symptoms, same age, same time of onset.

ssris also make my RLS worse or seemed to have cause it.

my main issues are the anxiety, add-pi, insomnia, and i guess energy/depression. here are some of the things i tried:

pharmaceutical-

methylphenidate: ok, but very anxiety provoking.

amphetamine: (adderrall) helped me a lot. i try to minimize daily usage to reduce tolerance.

lexapro: first ssri i tried, helped with anxiety but worsened energy

prozac: better than lexapro in terms of energy, however, worsened insomnia

ativan: works for anxiety, but its too hypnotic. helps with insomnia though.

temazepam: tolerance built up to quickly, no longer helps with insomnia unless i use a big dose.

(currently i take prozac+amphetamine, temazepam sometimes at night).

supplements -
methyl b12, fish oil, multivitamin, coq10 as a base

piracetam: gave me brain fog worsened anxiety at times

forskolin/artichoke extract: stacked ok with the amphetamine at times, however, with continued usage i got fatigue.

caffeine: its ok for energy but i get a lot of anxiety with higher doses

thanks super m, unfortunately SSRIs don't seem to do much for me except make things worse. i can't take prozac due to insomnia and all z-drugs/short-acting benzos like temepazem give me the worst rebound with suicidal ideation.

since overstimulation/irritability is such a frequent side-effect, i've been wondering if i would be able to tolerate an AD better if i was placed on something like Lithium or perhaps Lamictal beforehand. for some reason, no psych's ever thought to try this approach

[socialpiranha]

Lamictal is not good for social anxiety, it does help with existential anxiety, fear of death and stuff like that. I think it really depends on your symptoms when it comes to ocd, it helps with repetitive/obsessive thinking but i think it can increase compulsion.

Nardil and parnate are both good drugs, i've seen lots of people over the years who have had their lives totally changed with them, the side effects can be horrible though, i couldn't tolerate nardil. clonazepam is my backup for when i HAVE to have something. I hate benzo's though.

I feel for ya man, I feel like i'm on some dirty drug that i wouldnt give to my worst enemy when i go out in public,(or even thinking about it) i lose all power over my faculties. my sensory perception gets distorted, my attention/thoughts are uncontrollable, everything is just spinning out of control. benzo's slow the machine down but they have so many downfalls. The thing that bothers me most is the feeling i get when i think about doing something, then having to make the decision to do it or not. if i had to name that feeling it would be "can't". it's the body best effort at chemically deterring you and it feels horrible. sometimes it feels like being given the choice to either cut your own cock off or kill yourself, there both such terrible options that its impossible to make a decision so all you can do is get stuck in an endless cycle of hellish contemplation.

[Tom_]

Can we have a list of EVERYTHING you tried please.

[Dinvestor]

My problem is anxiety from a 17 year battle with Lyme disease. I've been trying Zembrin for about 2 weeks. It does help a little, but it's pretty mild so far. I've tried some of the Russian stuff with little noticeable effects. Currently adding Lithium Orotate on the advice of a Lyme doctor along with some Curcumin to see if I can get brain inflammation down.

Still toying with the idea of adding Mexidol since it has antioxidant properties. Like Socialpiranha, clonazepam has always helped (if needed) but, I'm always leery of dependence and/or tolerance.

So, the quest continues...

[Tom_]

Can you post everything you have ever tried for the problems.
How old are you?
What sex?
What medical (including psychiatric) disorders have you been diagnosed with?
When was your last blood test and what were the results?
Do you have a history of drug abuse? What, how often, was there addiction?
Is there a history of self harming behaviour? This could anything from considering cutting your wrist to well thought out suicide attempt
Have you had any psychiatric admissions?
What psycho-social therapies have you tried?
How tall are you and how much do you weigh?
How much physical activity do you get?
Are you employed? Not employed? What do you spend most of your day doing?
Do you have any pain problems?
You said you suffer from chronic insomnia. When was its onset? In childhood, same time as an injury etc?
Is the sleep problem getting, staying or waking up early or not feeling rested after adequate sleep?. (Onset, middle, late, non-restorative insomnia)? How severe? mild <30 mins disruption with mild functional problems, moderate 1 hour, severe 2-3+ hours. You should be asleep at the latest around 12am and awake between 8-9am.
Have you or have ever work shifts or travel time zones often?
Is there any obvious cause to your insomnia? Pain, mania, bright light, loud sound?
How long do you sleep for on an average night?
have you been accused of doing abnormal things at night? This could include moving around (walking, doing normal daily activities e.g cooking), seeming to choke, snore very loudly, move your legs a lot...?

fill out becks depression inventory 2 and give me a number
http://www.ibogaine..../3639b1c_23.pdf

How has your mood been over the last 2 years? Chronically depressed, up and down?

Which sounds most like you when you are depressed?

Mood improvement to positive things (like hearing a joke, going somewhere nice) severe hypersomnia, physical feeling of heaviness in limbs and head even to the point of it being hard to move limbs, hyperphagia and weight gain (eating shit loads), long standing pattern of sensitivity to social rejection as mild as feeling a little low to severe enough to lead to a serious suicide attempt. Suicidal thoughts are usually reactive to an event but can present as chronic. They revolve mostly around feeling unwanted, rejected or to escape unendurable agony. Symptoms tend to worsen though out the day. Returning to normal functioning is not common and tends to be a chronic disorder until treated to remission. Age of onset is most common in late teens and early twentys.

Low mood is constant with no changes no matter what happens, true anhedonia (total inability to feel pleasure not just reduced hedonic capacity), severe guilt bordering on irrational and/or psychotic, changes in psychomotor activity severe enough to impact your normal functioning e.g. slowing of thought processes and physical activity or increase in physical activity and thought processes. Thoughts of suicide, mostly relating to guilt, "people better off without you", ending unendurable agony, symptoms tends to be worse in the morning. Sleep disturbances tend to be related to insomnia (onset is common) late insomnia is a diagnostic criteria. Very much episodic with return to optimal functioning more common than not. Most common age on onset is 65 + and associated with vascular dementia. As a mental disorder alone its most common presentation is 40-55.

Tearfulness, low mood that's mostly constant but does respond to positives a bit, either eating to much or two little, sleep problems mostly center around circadian rythem abnormalities but hypersomnia and onset insomnia are common (most common presentation difficulty getting to sleep + long sleep time), feelings of guilt and self reproach are common but not severe, episodes tend to be medium length with good recovery in between but no return to optimal functioning. Suicidal thoughts tend to 'appear out of no where" according to the patient but have a relation to stressful life events. Age of onset most commonly is 20-45.

[penisbreath]

Lamictal is not good for social anxiety, it does help with existential anxiety, fear of death and stuff like that. I think it really depends on your symptoms when it comes to ocd, it helps with repetitive/obsessive thinking but i think it can increase compulsion.

most of my OCD is thought-based, so it could be an option.

Nardil and parnate are both good drugs, i've seen lots of people over the years who have had their lives totally changed with them, the side effects can be horrible though, i couldn't tolerate nardil. clonazepam is my backup for when i HAVE to have something. I hate benzo's though.

Parnate changed my life for six months, but it caused too much insomnia and agitation. I was on 60mg. Haven't found a psychiatrist who will go higher, but I've heard higher doses can be more calming. I've wondered if I should try Nardil again (like you I was bombarded by side-effects) as it seems to be the gold-standard for treatment-resistant anxiety

I feel for ya man, I feel like i'm on some dirty drug that i wouldnt give to my worst enemy when i go out in public,(or even thinking about it) i lose all power over my faculties. my sensory perception gets distorted, my attention/thoughts are uncontrollable, everything is just spinning out of control. benzo's slow the machine down but they have so many downfalls. The thing that bothers me most is the feeling i get when i think about doing something, then having to make the decision to do it or not. if i had to name that feeling it would be "can't". it's the body best effort at chemically deterring you and it feels horrible. sometimes it feels like being given the choice to either cut your own cock off or kill yourself, there both such terrible options that its impossible to make a decision so all you can do is get stuck in an endless cycle of hellish contemplation.

yeah, the agoraphobia makes leaving the house near impossible, but my home environment is so noisy and overwhelming that i'm sort of stuck between a rock and a hard place. stims help with the sensory-integration problems, but i find them too abusable.

you describe being 'paralyzed by analysis' pretty well.. it's like everytime i do make a decision, i'm simulatenously obsessing over that decision and whether or not it's right. i spend 99% of my life in my head these days. again dopaminergics are helpful for 'getting me out of my head' and can cut down on rumination at the right dose, but often end up being abusable

[penisbreath]

Can we have a list of EVERYTHING you tried please.

(all given full therapeutic trials at max. tolerable dose, though those doses were usually low as i'm very sensitive to meds)

luvox
lexapro
zoloft
prozac

pretty much all gave me akathisia/restless legs, stimulating ssris too much anxiety, sedating ones literally stripped me of any inner 'will', i could sleep all day, making tiny decisions like going to the library seemed so monumental it took hours to work up the effort

mirtazapine - OCD way worse

clomipramine
nortriptyline
amitriptyline

all worsened anxiety, tho nortrip help ADD

Nardil
Parnate

parnate helped ADD and depression, but not anxiety, couldn't sleep; nardil had bad side-effects (insomnia, twitching legs), but good for depression too, didn't stay on it long enough to judge effect on anxiety

Depakote
Neurontin

both good for anxiety, but felt really stupid and dissociated

Dexedrine
Ritalian
Strattera

ritalin and strattera made me very irritable, helped executive function in very low doses; Dex could also only tolerate in very small doses, effect varied a lot .. sometimes brain fog/sleepy, sometimes helped attention

Zyprexa
Seroquel
Risperdal

all increased anxiety, bad akathisia on Seroquel

Xanax
Valium
Clonazepam
Lorazepam

had paradoxical effect (more anxiety) on all except clonazepam .. i can take 0.5mg clonazepam which helps anxiety but is also energizing for some reason, so have to take it in morning

Edited by lucky.pierre, 13 June 2013 - 04:39 AM.

[penisbreath]

[quote name='Tom_' timestamp='1371060865' post='593276']
Can you post everything you have ever tried for the problems.
[/quote]

Meds (see above), herbs like SJW, exercise, CBT, psychodynamic therapy

[quote]How old are you?[/quote]
27

[quote]What sex?[/quote]
male

[quote]What medical (including psychiatric) disorders have you been diagnosed with?[/quote] [b]
ADD, OCD, atypical depression, obsessive-compulsive personality disorder

[quote]When was your last blood test and what were the results? [/quote]

two weeks ago, low vit D (supplementing now but increases anxiety), raised liver enzymes (had been taking a product for nausea with paracetemol in it .. ), everything else normal

[quote]Do you have a history of drug abuse? What, how often, was there addiction?[/quote]

abused alcohol for a year when OCD first started .. would binge drink on weekends, then stopped .. over the past year or two if i go out partying i'll abuse stims/benzos, but it's never been a regular thing and i always stop when i run out, never go drug-seeking

[quote]Is there a history of self harming behaviour? This could anything from considering cutting your wrist to well thought out suicide attempt[/quote]

yes self-harmed before, one overdose (for attention, knew it wouldn't kill me)

[quote]Have you had any psychiatric admissions?[/quote]

no

[quote]What psycho-social therapies have you tried?[/quote]

not sure what psychosocial therapy refers to .. is that just therapy? i've seen multiple OCD therapists for CBT/ERP/ACT, one psychdynamic therapist for two years, unfortunately never really had suitable remission from all disorders (depression/OCD/ADD) to fully engage in therapy


[quote]How tall are you and how much do you weigh?[/quote]

6", weigh around 67 kg

[quote]How much physical activity do you get?[/quote]

used to swim regularly, post-major depression never had the energy so walked never every day, for the past 6 months nothing (before you lecture me, understand that this comes after 7 years of battling severe ocd and being in the psychiatric system, have just given up on myself at this point)

[quote]Are you employed? Not employed? What do you spend most of your day doing?[/quote]

have a college degree, worked 'til i became depressed 5 years ago. now, not employed - again, used to try see friends, have some structure, but past 6 months have just sat on internet, watched TV, slept.

[quote]Do you have any pain problems?[/quote]

just sore neck/back from too much sitting i guess

[quote]You said you suffer from chronic insomnia. When was its onset? In childhood, same time as an injury etc?[/quote]

i've had delayed sleep phase syndrome since a teenager, insomnia's become far worse with depression though

[quote]Is the sleep problem getting, staying or waking up early or not feeling rested after adequate sleep?. (Onset, middle, late, non-restorative insomnia)? How severe? mild <30 mins disruption with mild functional problems, moderate 1 hour, severe 2-3+ hours. You should be asleep at the latest around 12am and awake between 8-9am.[/quote]

trouble falling asleep and not feeling rested when i wake up.. mild/moderate .. again, most of my day is spent consumed by anxiety/phobia these days so i don't try keep any schedule

[quote]Have you or have ever work shifts or travel time zones often?[/quote]

no

[quote]Is there any obvious cause to your insomnia? Pain, mania, bright light, loud sound?[/quote]

i imagine depression and lack of activity contribute the most

[quote]How long do you sleep for on an average night?[/quote]

as much as i can .. i used it to escape .. 10-12 hours usually

[quote]have you been accused of doing abnormal things at night? This could include moving around (walking, doing normal daily activities e.g cooking), seeming to choke, snore very loudly, move your legs a lot...?[/quote]

not that I know of

[quote]fill out becks depression inventory 2 and give me a number
http://www.ibogaine..../3639b1c_23.pdf[/quote]

36

[quote]How has your mood been over the last 2 years? Chronically depressed, up and down?[/quote]

chronically depressed, would react to positive events, still felt semi-hopeful about psychiatric treatment .. now zero hope for treatment/future

[quote]Which sounds most like you when you are depressed?

Mood improvement to positive things (like hearing a joke, going somewhere nice) severe hypersomnia, physical feeling of heaviness in limbs and head even to the point of it being hard to move limbs, hyperphagia and weight gain (eating shit loads), long standing pattern of sensitivity to social rejection as mild as feeling a little low to severe enough to lead to a serious suicide attempt. Suicidal thoughts are usually reactive to an event but can present as chronic. They revolve mostly around feeling unwanted, rejected or to escape unendurable agony. Symptoms tend to worsen though out the day. Returning to normal functioning is not common and tends to be a chronic disorder until treated to remission. Age of onset is most common in late teens and early twentys.[/quote]

mostly this

[quote]Low mood is constant with no changes no matter what happens, true anhedonia (total inability to feel pleasure not just reduced hedonic capacity), severe guilt bordering on irrational and/or psychotic, changes in psychomotor activity severe enough to impact your normal functioning e.g. slowing of thought processes and physical activity or increase in physical activity and thought processes. Thoughts of suicide, mostly relating to guilt, "people better off without you", ending unendurable agony, symptoms tends to be worse in the morning. Sleep disturbances tend to be related to insomnia (onset is common) late insomnia is a diagnostic criteria. Very much episodic with return to optimal functioning more common than not. Most common age on onset is 65 + and associated with vascular dementia. As a mental disorder alone its most common presentation is 40-55.[/quote]

not so much, except for guilt/suicidal thoughts

[quote]Tearfulness, low mood that's mostly constant but does respond to positives a bit, either eating to much or two little, sleep problems mostly center around circadian rythem abnormalities but hypersomnia and onset insomnia are common (most common presentation difficulty getting to sleep + long sleep time), feelings of guilt and self reproach are common but not severe, episodes tend to be medium length with good recovery in between but no return to optimal functioning. Suicidal thoughts tend to 'appear out of no where" according to the patient but have a relation to stressful life events. Age of onset most commonly is 20-45.
[/quote]

not really me at all

Edited by lucky.pierre, 13 June 2013 - 05:02 AM.

[socialpiranha]

27 seems to be a pivotal age for mental health, I.e the 27 club(hendrix et al)... Don't lose hope for the future man i turn 28 on the 26th of this month, and i've been noticing a few things changing lately about my illness not because of anything i've done, i think the body goes through phases of endocrine changes and one is around now.If they make it that far, people often tend to start getting better in their late twenties early thirties from what i've observed. There are also some good drugs on the horizon for ocd and related stuff.

[socialpiranha]

I keep forgetting about this but i tried candesartan as an alernative to propranolol for the physical symptoms of anxiety years ago and within a few days it totally obliterated my anxiety and panic. It did cause severe fatigue but i didnt really play around with dosage and stopped after 3 or 4 days, here are a few studies that might help explain why it eliminated anxiety so well(better than benzo's imo) After having tried it, i saw a report on another forum about someone using it for stimulant anxiety and it working extremely well. i keep forgetting about it otherwise i would have gotten some again by now and done a more thorough trial, possibly trying it with dexedrine. I would strongly suggest looking into it dinvestor, superm and luckyp if only to use like clonazepam as needed but it might(at the right dosage) actually be a sustainable option. As you will see in the last link, it could possibly reverse anhedonia in certain cases as well.

A centrally acting, anxiolytic angiotensin II AT1 receptor antagonist prevents the isolation stress-induced decrease in cortical CRF1 receptor and benzodiazepine binding
http://www.ncbi.nlm....pubmed/16205776

Angiotensin II AT1 receptor blocker candesartan prevents the fast up-regulation of cerebrocortical benzodiazepine-1 receptors induced by acute inflammatory and restraint stress
http://www.ncbi.nlm....pubmed/22503782

Peripherally administered Angiotensin II AT₁ receptor antagonists are anti-stress compounds in vivo
http://www.ncbi.nlm....les/PMC2659765/

Candesartan prevents impairment of recall caused by repeated stress in rats
http://link.springer...0213-012-2829-3#

Candesartan decreases the sympatho-adrenal and hormonal response to isolation stress
http://jra.sagepub.c...uppl/S130.short

Preclinical evidence for the efficacy of angiotensin receptor antagonism in a rodent model of vulnerability to comorbid depression and cardiovascular disease
http://d-scholarship.pitt.edu/8497/

[Tom_]

You need meds - so I'm not saying that but you also need to 'face your fears'. Start out as small as you have to and get bigger - that is it in a rediculously simplified nutshell. Its called behavioual desensitisation. I wouldn't even bother with cognitive therapy at this time (also soon) and now you would be best served working with an Occupational therapist or Behavioual therapist.

You've had responses to MAO-I-A/B so I'd suggest you try:

Moclobemide Its an MAO-I-A inhibitor, less stimulating more antidepressive. A doctor really should have put you on it before considering the other MAOIs.

You should swap the benzo for clonidine or guanfacine. They are moderately effective in ADHD (although from the way you are presenting I remain somewhat dubious of its diagnosis at all...chronic affective disorder can screw up cognitive function) and also good for anxiety.

Propranolol cannot be taken with clonidine/guafacine. It however reduces physical anxiety and is often useful for getting out of the house, the general idea that your reduce the dose until you can do something without needing it. It works similarly to Guanfacine (the one I recommend) but pro wont effect how anxious your feeling, your body just wont show signs (less nausa, shaking etc)

Other meds on the list to try:
Pregabalin (the only antiepeleptic they should have ever prescribed you)
Buspirone
Aripiprazole

With the side effects problem if you can last four weeks on a drug the side effects tend to lessen. I really think you should try Moclobemide, if need be try and manage problems like anxiety or restlessness with antiaxiety drugs and headaches with paracetamol etc and feel free to start at a shit low dose.

Discontinue the clonazepam and everything else you are on. (if you haven't been using it everyday there probs wont be withdrawal) benzos are indescribely bad for you.
Guanfacine for two weeks
Initiate Moclobemide

report back...thats what I'd suggest.

With the right meds AND psycho-social treatment I dont see why we can't have you back on your feet at all.

[Dinvestor]

Hey Socialpiranha:

Thanks for the tip. That is interesting about candesartan. My question would be what kind of dose were you taking before? It might be a challenge to find that right dose that A) provides anxiolytic activity without B) providing too much hypotension activity, hence maybe why you experienced the severe fatigue.

Thoughts?

D

[penisbreath]

27 seems to be a pivotal age for mental health, I.e the 27 club(hendrix et al)... Don't lose hope for the future man i turn 28 on the 26th of this month, and i've been noticing a few things changing lately about my illness not because of anything i've done, i think the body goes through phases of endocrine changes and one is around now.If they make it that far, people often tend to start getting better in their late twenties early thirties from what i've observed. There are also some good drugs on the horizon for ocd and related stuff.

yeah that had actually been on my mind a bit lately .. i mean some of those deaths were accidental (? drug overdoses), but you have people like sylvia plath who suffered some kind of defining psychotic break at 30, cobain's suicide etc. it might be a coincidence -- my life circumstances have never been worse, and i've tried pretty much most meds .. plus lost a girlfriend, pdoc who i really liked let me go -- but suicide has been on my mind more than ever this past year ..

I keep forgetting about this but i tried candesartan as an alernative to propranolol for the physical symptoms of anxiety years ago and within a few days it totally obliterated my anxiety and panic. It did cause severe fatigue but i didnt really play around with dosage and stopped after 3 or 4 days, here are a few studies that might help explain why it eliminated anxiety so well(better than benzo's imo) After having tried it, i saw a report on another forum about someone using it for stimulant anxiety and it working extremely well. i keep forgetting about it otherwise i would have gotten some again by now and done a more thorough trial, possibly trying it with dexedrine. I would strongly suggest looking into it dinvestor, superm and luckyp if only to use like clonazepam as needed but it might(at the right dosage) actually be a sustainable option. As you will see in the last link, it could possibly reverse anhedonia in certain cases as well.

A centrally acting, anxiolytic angiotensin II AT1 receptor antagonist prevents the isolation stress-induced decrease in cortical CRF1 receptor and benzodiazepine binding
http://www.ncbi.nlm....pubmed/16205776

Angiotensin II AT1 receptor blocker candesartan prevents the fast up-regulation of cerebrocortical benzodiazepine-1 receptors induced by acute inflammatory and restraint stress
http://www.ncbi.nlm....pubmed/22503782

Peripherally administered Angiotensin II AT₁ receptor antagonists are anti-stress compounds in vivo
http://www.ncbi.nlm....les/PMC2659765/

Candesartan prevents impairment of recall caused by repeated stress in rats
http://link.springer...0213-012-2829-3#

Candesartan decreases the sympatho-adrenal and hormonal response to isolation stress
http://jra.sagepub.c...uppl/S130.short

Preclinical evidence for the efficacy of angiotensin receptor antagonism in a rodent model of vulnerability to comorbid depression and cardiovascular disease
http://d-scholarship.pitt.edu/8497/

thanks, i know someone who did really well with candesartan for panic. my sympathetic system feels f*cked, it's like i'm getting adrenaline rushes all day, can't cope with the slightest stressors anymore. nothing's helped that constant hypervigilance except neurontin which left me feeling retarded. stims help me control my thoughts and aid the stress response , but aren't good for mood long-term

did you find candesartan had any effect on your personality? beta-blockers make me really dull.. wish i'd known about something like candesartan when I was on Parnate, could have helped the overstimulation

Edited by lucky.pierre, 13 June 2013 - 01:11 PM.

[penisbreath]

You need meds - so I'm not saying that but you also need to 'face your fears'. Start out as small as you have to and get bigger - that is it in a rediculously simplified nutshell. Its called behavioual desensitisation. I wouldn't even bother with cognitive therapy at this time (also soon) and now you would be best served working with an Occupational therapist or Behavioual therapist.

thanks, behavioural therapy kind of worked (the approach my last psychologist was trying) but it's complicated by the severe OCD and OCPD/perfectionism which rule everything. the last therapist i saw was highly skilled in treating OCD and the first to fully get the whole picture, but he retired unfortunately. can't really afford therapy at present

You've had responses to MAO-I-A/B so I'd suggest you try:

Moclobemide Its an MAO-I-A inhibitor, less stimulating more antidepressive. A doctor really should have put you on it before considering the other MAOIs.

Moclobemide was actually the first med i ever tried .. forgot to mention it. i stayed on it for 6 months, it was okay for anxiety but i feel pretty anhedonic/empty on it

You should swap the benzo for clonidine or guanfacine. They are moderately effective in ADHD (although from the way you are presenting I remain somewhat dubious of its diagnosis at all...chronic affective disorder can screw up cognitive function) and also good for anxiety.

no guanfacine available here unfortunately. ADD isn't dubious, i had sx. all my life, OCD/major anxiety only started around 19 .. grandfather, mother and 2 brothers all show heavy sx. of ADD (without any complicating disorders) but never dx'd (they just never pursued anything academic). unfortunately because i'm such an anxious mess these days and people hate dx'ing ADD here, most psychiatrists just gloss over it, but i'd love to hear another explanation for why someone with a 130+ IQ has never been able to read for more than 40 minutes at a time in my entire life. the only thing that changed that was stimulants.

Other meds on the list to try:
Pregabalin (the only antiepeleptic they should have ever prescribed you)
Buspirone
Aripiprazole

tried buspirone too, made me more anxious (it's an alpha-2 antagonist or something i believe, like mirtazapine). i'm guessing aripiprazole would just cause akathisia -- seems to be most pdocs opinion.

do you think Lamictal might be of any benefit?

With the side effects problem if you can last four weeks on a drug the side effects tend to lessen. I really think you should try Moclobemide, if need be try and manage problems like anxiety or restlessness with antiaxiety drugs and headaches with paracetamol etc and feel free to start at a shit low dose.

when i was initially on moclobemide, i think i only went up to 300 or 450mg. do you know if it's better for depression/anhedonia at higher doses?

With the right meds AND psycho-social treatment I dont see why we can't have you back on your feet at all.

i think the biggest obstacle is my current environment .. don't get on with my parents at all and they're not particularly sympathetic to my plight. house is also very noisy, which obviously isn't good for ADD/OCD issues. wish i could move out but too incapacitated to work and don't qualify for disability for another 2.5 years

[Tom_]

There is really no reason why you can't give yourself intesive behavioual therapy - if you really really can't afford a psychologist, all the information is avaliable and maybe getting a support worker involved. It will take time, deication and expect failure, it will be learning to deal with the failure and push on to trying again. Obviously here low dose anxylotics can be used.

No single med is going to be perfect. You had a partial response the the Meclobromide you weren't at the maximum dosage (600 but I've heard of about 1200). The whole bluntness is no fun but if it improves the anxiety enough for you to start making some big changes in your life then when you titrate down to a maintence dose things could be really looking up. You you feel like side effect heaven low dose stimulants can give you enough up and go.

You said you hadn't tried Venlafaxine (I'd be suprised if you haven't) - it does have a brilliant evidence base. You could always combine it with Pregabalin and then even mirtazapine (I know you said it made everything worse but in combo its promising)...more effective than tranny.

I think lamotragine is bad idea. Its mildly stimulating and its very much a mood stabilizer. The only approved and effective anxlolytic mood stabilzer is Pregabalin - its not sedating as such and side effects tend to be manageable. If someone hasn't suggested it, they soon will...Li+ isn't effective in OCD treatment and is a nasty drug to play around with by most accounts.

You really haven't tried anywhere near all the drugs out there dude, so don't worry about that. I think you might almost subconciously expect more from the meds than is fair. You won't see more improvement from a medication alone than you have seen with the tranny...its the king of the antidepressants bar prehaps amitryptaline. The rest is going to have to come from you. If its stepping both feet out the front door once a day for a week or getting out of bed before 12 or not indulging in mopping behaviour...find what triggers you and thrash it, thrash it so bad it has to home to mommy and cry.

Key Key Key skills:
Anti panic - deep breathing, mindfulness, meditation, rationalizing, counting to 10...there are lots of options out there and I imagine you would have lots of oppotunities to try them out. When you feel unbareable anxiety or panic attacks starting the first thing you should do is take control of your breathing (with a bag if you have to)
Distraction - Have something prepared. Whether its stairing at a TV screen, having a wank, doing push-ups, reading a book...
Exercise - If you can't get out of the house, do exercise in. It doesn't have to be much at all. Anything even 1 push-up a day.

[penisbreath]

thanks Tom, no haven't tried Effexor, most experienced psychiatrists I've met here are against it (if they're going to use an SNRI they prefer Pristiq), and they claim it doesn't have a very good track-record in treating anxiety..

i think i might ask my doctor for a candesartan trial, since i've definitely heard good things before on mind-and-muscle and it's a novel anxiolytic approach. if i can get my insane anxiety under control, i might be able to think more clearly and make better decisions about how to move forward from here.. right now i'm basically paralyzed with fear, anxiety, irritability

[Tom_]

If you want that you should be looking at a mix of propranolol/guanfacine and Pregabalin. That would I imagine halt anxiety in its tracks no matter how big, bad and ugly it was.

I would never recommend candesartan - no where near enough hard evidence, obviously thats your choice.

Venlafaxine has one of the highest track records I can think of and desvenlafaxine is almost exactly the same thing, just without the evidence base.

[penisbreath]

no guanfacine here, otherwise i would've been all over that stuff years ago .. and impossible to find sources to import.

i know propanolol works, but it does blunt affect and Pregabalin is really expensive here (unless you're taking it for epilepsy or a sleep condition) , so i figure i don't have anything to lose by trying candesartan first as long as it's safe (which it seems to be?)

i need to get my anxiety under control before i go near another AD (and everything that touches noradrenaline-reuptake has caused the most problems thus far) .. so yeah i'll start simple with candesartan, and if that doesn't work move onto your suggestions .. then start to explore ADs/stimulants

thanks for your help guys. i'll let you know how things go and if anyone with similar issues wants to post here, or people come up with other ideas feel free to let me know

[Tom_]

Stimulants are a bad idea...such a bad idea for a true anxiety disorder.

Your reasoning is sound, as far as I'm aware its safe. You almost certainly won't achieve remission of anxiety without an AD but reducing it is reasonable. Wow that infuiates me, people are prescribing pregabalin as a hypnotic...fucktarded money grabbers.

Would you try clonidine over c....however you spell it (to lazy to scroll up)?

You also need to make changes in your behaviour at the same time, if you don't you will get no where and end up in the same rut as ususal. Thats a simple fact. If you don't, you won't see reasonable improvement. They don't need to be big but they need to start now and not stop.

[penisbreath]

i think it depends on the case .. there's a study where dexamphetamine was used as monotherapy to treat OCD, and it's pretty commonly prescribed with SSRIs in comorbid OCD/ADD. the worst effect it had was on my mood/irritability .. it helped cognitive anxiety in terms of giving me better control over my thoughts

i tried clonidine in conjunction with Parnate to try calm down overstimulation .. it was a pretty good sleep aid, but from memory it might have worsened depression. i'll have to check my diary to make sure

i was pretty good about maintaining good behavioural patterns for the past 6 years, but you reach a limit .. i ate well, exercised, socialized, read when i could etc. but my brain fog, anxiety, depression etc. remained the same.. i was very mildly functional at best. i'm aware i have to make behavioural changes but when your baseline never changes the cost/benefit just doesn't seem worth it eventually. i need to see better results in terms of symptoms to help motivate the behavioural aspect. the biggest motivator would be if i could regain some cognitive functioning and actually read again and make some use of my intelligence. sadly, i could probably count on one hand the number of books i've managed to finish in the past 5 years.

[Tom_]

I know what you are talking about. In the last five or so years I've read maybe 15 books - most of them academic (I find much easier to read). Before that I had a 1 or 2 a day book habbit.

You won't start seeing improvement until you start doing stuff but you can do stuff to slowly stimulate your brain. Pick up an easy book, maybe and old favouaite and read a page or as far as you can - if that is literally a sentence then that is where you start. Its something. Next time you read double what you did last time. It might take you three or four months to read the first book but it does come back. When I was semi-functioning, I had a brief period of semi-remission (Suffer from fucked up sleep disorder, neurodevelopmental spectrum (full blown ADHD, mild pure O & autisic spectrum), depressive disorder, anxiety (generalized, social) and self harmer and symptoms of cluster B/C personality disorder) that was how I did it, with a book.

[socialpiranha]

Its true you wont get better until you are able to start doing things toward recovery, but the inability to do so is the sickness. its not a lack of undestanding of the fact that "the more productive things you do the better you'll feel". Its also not lazyness or lack of determination. its the sickness which doesnt allow you to do those things for whatever reason. Many people have ended their lives out of frustration from people continuing to treat them as if all they had to do was pull up their socks and try harder and that their illness is just a weakness of character.

[penisbreath]

but my point is you can do all those things and then you reach an upper limit where you're desperately trying to maintain a really measly baseline. i used to keep reading in the hope that i'd slowly be able to do more, but my attention span CAPPED at 20 minutes (while depressed and ADD untreated), i exercised everyday but after years couldn't manage more than a 25 minute walk, i put myself in social situations but people kept wondering why i was such an awkard, introverted retard, i tried to force myself to enjoy my interests again but it never worked ... sometimes continual exposure doesn't expand your perimeters past a certain point and that point isn't currently acceptable to me after spending most of my 20s nearly disabled.

i'm not disagreeing, i know behavioural therapy is integral, but for example when i was in remission on Parnate and motivated and could concentrate, i got more done in 6 months than the previous 3 years. carrying out behavioural changes became so much easier. for me the cost/benefit of maintaining some sub-human existence just isn't worth it anymore unless i can see real changes made in my crippling anxiety/cognitive symptoms

[penisbreath]

socialpiranha, what do you think of this re: candesartan ... i found it in an old thread on angiotensin blockers here ..

Wikipedia said:

Myocardial infarction controversy

Whether angiotensin receptor blockers may or may not increase the risk of myocardial infarction (heart attack) was announced in BMJ[4] and was debated in 2006 in the medical journal of the American Heart Association.[5][6] To date[when?], there is no consensus on whether ARBs have a tendency to increase MI, but there is also no substantive evidence to indicate that ARBs are able to reduce MI.

In the VALUE trial, the angiotensin II receptor blocker valsartan produced a statistically significant 19% (p=0.02) relative increase in the prespecified secondary end point of myocardial infarction (fatal and non-fatal) compared with amlodipine.[7]

The CHARM-alternative trial showed a significant +52% (p=0.025) increase in myocardial infarction with candesartan (versus placebo) despite a reduction in blood pressure.[8]

Indeed, as a consequence of AT1 blockade, ARBs increase Angiotensin II levels several-fold above baseline by uncoupling a negative-feedback loop. Increased levels of circulating Angiotensin II result in unopposed stimulation of the AT2 receptors, which are, in addition upregulated. Unfortunately, recent data suggest that AT2 receptor stimulation may be less beneficial than previously proposed and may even be harmful under certain circumstances through mediation of growth promotion, fibrosis, and hypertrophy, as well as proatherogenic and proinflammatory effects.[9][10][11]

i've actually been excited about the idea of trying to candesartan since scattered reports are cropping up from people who found it *excellent* for anxiety, but the study does scare me a little. that said, i'm not at any genetic risk of a heart attack as far as i'm aware -- everyone in my family is lean, normal blood pressure etc., no history of cardiac issues