Mood stabilizers

[pocono]

From a different thread I started yesterday (or the day before???) it is clear that i am in a depression tailspin.

I am very medication sensitive -- side effects hit me hard with very little dosage. I've been on a low dose of nephazadone for the past few years since i've been dealing with the depression.

In general it has helped me in the day to day. However, I go through these eposodic episodes of intense low's -- always triggered by something in the ongoing therapy related to ptsd stuff.

My psychiatrist tried me on seroquil the last time this happened. He said it is a "mood stabilizer" and might help smooth out the intense lows I experience. I could not tolerate it; however, even at very low dosages I felt literally tranquilized by it. The depression started to abate on its own. He told me to be in touch with him immediately the next time I felt myself crashing, and we would try something else.

So now I'm in it again. I tried to reach him on Fri. only to find out that he is out of the country until mid-March. My therapist is trying to reach the person who is covering for him to help facilitate an appointment (I'm really quite afraid of seeing someone new......although I know i need to do it; it is scary to be so vulnerable.)

I've never really had the aversion to taking meds that I know many people struggle with. When I get this low, I just want relief -- I want back to my life.....Has anyone had experience combining anti-depressants with "mood stabilizers"? Is there hope in this approach?

 

[braveheart]

Re: mood stabilizers???

No, I personally haven't tried it, although, had my psychiatrist had a different policy/plan on medicating me, or if I had landed with a different psychiatrist, I would have. I know that quite a few people with recurring depression do take them, though.

 

[David Baxter PhD]

Actually, seroquel is not a "mood stabilizer", per se - it is one of a family of medications called (unfortunately) "atypical antipsychotics".

I say "unfortunately" because, while these medications are used to treat disorders like schizophrenia and mania, in low doses they are also used to enhance the effectiveness of antidepressants.

Someone like you, pocono, would be a good candidate for this type of medication in adition to an SSRI because of your sensitivity to / low tolerance for SSRIs. What the Serquel does is enhance the "serotonin boosting" effect of the SSRI without having to increase the disage to a point where the side-effects would be a problem. It has the added benefit of helping to reduce anxiety and improve sleep.

 

[pocono]

Do you think it is possible, Dr. Baxter, for there to be something other than Seroquel (since it knocked me out so much) that will do what you said the seroquel might do?

 

[David Baxter PhD]

What else have you tried besides nefazadone (Serzone)? There are a lot of other options...

 

[pocono]

I tried Paxil, wellbutrin and zoloft. I can't remember which caused which side effects -- some were sexual, pretty pronounced. I was grateful the psychiatrist took this seriously because my sexual relationship with my husband is something I've worked very hard at and am deeply grateful for. (Again, not anything you might expect I could achieve given my background). I don't want to give this up.

The other bad side effect I had with one of them -- I think Wellbutrin -- was a racing heart/pulse rate.

The nefazadone was a relief because it did not cause either of these side effects and did provide some relief....

 

[David Baxter PhD]

Well, you still have several to try - notably Effexor, Luvox, and Prozac. It's hard to say whether these will cause side-effects in your case since that's quite individual (Paxil is one of the worst for side-effects including sexual side-effects in my experince).

There are also alternatives to Seroquel if the Serzone is otherwise working well for you. You could certainly try one of the mood stabilizers, or a low dose of one of the other atypical antipsychotics.

I understand that your doctor isn't available at the moment but whoever is covering for him should have access to your records and should be able to make an informed decision for you - just make sure you talk to him about previous side-effects.

 

[Miette]

I have been on a combination of lithium and wellbutrin. It worked well for a while, but I eventually went off the wellbutrin altogether because, as far as I understand, the antidepressants can destabilise mood. I felt myself crashing into depression, even while on the wellbutrin, so we decided to go it alone with the lithium.

 

[pocono]

I don not actually think this doctor will have access to my dr's medical files. Things don't work like that in the us. This got me upset that he might prescribe something I've already tried and had bad luck with. So I went to my pharmacy and asked them to print out for me a list of all my meds over past two years. It was longer than I thought:

trazadone
effexor
lexapro
Paxil
bupropion
zoloft
seriquel

then finally, nephazadone

 

[foghlaim]

if you can, maybe write a little note beside each one about the effects or ineffects? might help the doc in trying to decide which one to try you on next.

just a thought!

 

[pocono]

if you can, maybe write a little note beside each one about the effects or ineffects? might help the doc in trying to decide which one to try you on next.

just a thought!

It's a good idea. The problem is I can't remember which side effects went with which drugs. When I started therapy and meds I was in a near total breakdown. I cried all the time. I was frightened all the time. I hated myself and was terrified of both therapist and doctor. Every new med that I tried was traumatic when it failed and I had to switch again. The time I got the racing heart rate, I almost literally drove of the road in despair......

I'm trying not to invest quite so much emotion in this visit...but having to go into this man's house, through a back door and down flight of stairs has me pretty freaked out, to tell the truth! Not to mention the fact that he said it will be an hour appointment! What do I talk to him about for a whole hour? I certainly don't want to get into the trauma itself.

 

[Halo]

Not to mention the fact that he said it will be an hour appointment! What do I talk to him about for a whole hour? I certainly don't want to get into the trauma itself.

If you are going to see this man to discuss changing your meds then I highly doubt that you will end up having to go into the depths of the traumas that you have suffered. I have just recently had an appointment similar to the one that you are describing and it was not as much about my past history per se but more about my history with medications. I am sure that the hour will go fast once he starts with asking questions and clarifying your answers about medications.

One thing that helps me with appts. like these is to remind myself of the following:

• It is only one hour
• It is only one appointment
• Time will not and does not stand still
• I have survived much worse
• I can do this

I don't know if this will help you but for me it does.

Take care and good luck
:hug:

 

[pocono]

Thanks Nancy... I will try to use that.

 

[foghlaim]

He told me to be in touch with him immediately the next time I felt myself crashing, and we would try something else, I go through these eposodic episodes of intense low's, So now I'm in it again.

maybe start here with him? the Why you are seeing him? and take it from there. You have your list of previous meds..
if maybe you can see him as crisis intervention until your own psych gets back, I don't see that you would need to get into the trauma issues.

maybe keep in mind why you are going and what you want to get out of this apt.

hope this helps..

 

[Halo]

Pocono,

As I said, I really found that trying to keep the whole appointment logical in my head and even repeating these sentences to myself as close as walking in the door has really helped to calm my anxiety down. I hope they help for you too.

Take care

 

[ThatLady]

Pocono, you can go to your doctor's office and ask that your records be forwarded to your new doctor. They'll probably have a release for you to sign, but doctors are able to share patient records between themselves with the patient's permission. Call your doctor's office first and tell them you'll want the records sent. That way, they can have everything ready when you get there.

I don not actually think this doctor will have access to my dr's medical files. Things don't work like that in the us. This got me upset that he might prescribe something I've already tried and had bad luck with. So I went to my pharmacy and asked them to print out for me a list of all my meds over past two years. It was longer than I thought:

trazadone
effexor
lexapro
Paxil
bupropion
zoloft
seriquel

then finally, nephazadone

 

[pocono]

There is actually no way for me to do that That Lady. My doctor is out of the country until mid-March. He has a solo practice -- doesn't even keep a secretary. He has control of my records, and I can't reach him. I'm seeing the doctor who is covering for him, but unfortunately that does not mean he will have access to my records. I checked with my therapist to see if I was correct about this, and he is sure I am. If I decide, for some reason, to stay with this new Doctor, I can have the other Doc. send my records in mid-March. I doubt I will do this -- probably go back to normal Dr. when he gets back. He is a bit intimidating, but I think he is really smart and good with problem solving medication problems. He is some kind of international trauma specialist, so he often travels abroad to consult and work with Dr.s in other parts of the world.

I've got about 30 minutes of down time in between work appointments right now. A 12:30 lunch appointment and then straight to 2:00 with the doctor. It is difficult to admit how anxious I feel. I know it is not rational, but I'm so afraid of being hurt rather than helped.......I need to try to keep those fears in some check. I've reread posts here to try to reassure myself.

Thanks for advice and support people have offered.

 

[pocono]

In another thread I described how this meeting went...good new and bad news.

The good news (potentially) is that he prescribed something that may work and sounds like it is line with what my own Dr. was trying to do last fall. He has suggested adding a small dosage of Avilifi (?) to the nephazadone. If I can tolerate it without getting to sleepy or stimulated, he thinks it may help and help quickly. That would be a god send. I would be so happy to start feeling better fast.

The appointment itself was difficult....his office is a wood paneled basement office which reminded me in my gut of the basement room in my own house where the worst of the trauma occurred. So I had flashbacks and dissociation happening as we were trying to meet.

If the medication works; however, I'm willing to say it was worth it.

 

[Halo]

Pocono,

I am happy to hear that you made it through the appointment although it was difficult. I too hope that the medication works for you. Please keep us informed and again good job on making and keeping the appointment :goodjob:

Take care

 

[foghlaim]

Hi Pocono, glad to hear you have gotten something to try out at least, hopefully it will do the job for you..

Well done okay.. i know it was really rough on you.:hug:

Are you feeling better today,? more settled now that the apt is behind you?

if you are up to it, let us know how things are going.

all the best with the new med!