Depression Is Awful. On The Cusp of Trying Meds Again. Help!
January 18, 2018 9:30 AM   Subscribe

I will try to keep this short. I have had lifelong OCD/Anxiety/Depression. I tried meds in the past. I have been in therapy for a decade. I’ve done it all, including ketamine infusions. Docs want me to try meds again. Info inside

I have had lifelong mental issues, primarily OCD. I was on meds years ago and came off when they weren’t working and causing very significant side effects. I went through a crying/shaking/suicidal withdrawal. I think that it may have been the daily Xanax, but I’m not sure. I NEVER want to feel that way again.

I have been off meds for 5-6 years. I have remained in therapy and have done ketamine.

4-6 months ago I started seeing a therapist from the OCD Foundation that specializes in OCD (ERP etc). I also found a psychiatrist through the same site. They want me to try meds.

The PDOC suggests Luvox as it it the gold standard. He wants me to get up to 200-300 as quickly as I can and stay on it for 6 months to see if it is working.

I am TERRIFIED of feeling worse. I have been on Luvox before and feel that it never worked. The only thing that has changed since then is that I have been exercising and eating healthy for years. I wasn’t at the time. I also know that I have MTHFR A1298c ++ and supplement with methyfolate and b12. I am much healthier. I got my vitamin D levels up etc. I did Promthease and populated my 23&me but didn’t come up with anything useful.

Here is my dilehma: Do I try Luvox. He seems to think that I need to be on it for 6 months to know if it is working as long as I can tolerate the side effects. I don’t care about stigma, I am scared of side effects and eventual withdrawal/poop out. He said not to worry about those things.

I have been on other things in the past – Wellbutrin , Prozac, Zoloft, benzos, etc. I know that I was on the generic Luvox. Perhaps that is why? Will the methylfolate help?

I am worried about being tired (already am), losing my libido (been low due to depression) and not being able to drink (can I have ONE beer with friends once a week). I am worried about serotonin syndrome. Can I continue nightly marijuana

Please help me feel like it is OK to try this….or are my fears valid? These docs act like these drugs are no big deal
posted by kbbbo to Health & Fitness (17 answers total) 2 users marked this as a favorite
 
Why on earth would you try a drug that you've already tried and failed? No way would I do this.
posted by Violet Hour at 9:45 AM on January 18, 2018 [4 favorites]


Did it just not work before, or was it a super bad experience? You say that you've tried it, and that you're scared of side effects, but you don't really connect the line between those two things.

Honestly, the way this whole question is phrased, it seems like you should be aware that where you're coming from on this is not rational issues with this particular plan. Try to figure out what this question would look like if you didn't let your brain weasels write it. Do you have rational reasons why this isn't a good idea? You might! Listen to those! But don't avoid stuff just because it worries you when one of the defining characteristics of your problem right now is this kind of worry.

It might not work. That's a risk. But if you've been on it before and your side effects before were tolerable, I don't think it's really your rational brain that's concerned about the side effects, here. I'm saying this as a person with anxiety who has to do this with my decision-making process a lot. You're feeling the anxiety about this, but you need to peel it back a bit and try to imagine how someone else would make this decision--not to necessarily make the same decision they would, but to have that awareness of where you're coming from and how much you want to let your disorder impact the decision.

You're going to be okay.
posted by Sequence at 9:57 AM on January 18, 2018 [3 favorites]


I have had lifelong mental issues, primarily OCD. I was on meds years ago and came off when they weren’t working and causing very significant side effects. I went through a crying/shaking/suicidal withdrawal. I think that it may have been the daily Xanax, but I’m not sure. I NEVER want to feel that way again.

The last time I got back on medication (which I am currently still on), I told my doctor "listen, I quit taking meds before because I was absolutely not willing to cope with these particular side effects, I am willing to give meds another shot but I can tell you right now that I just will not be compliant long-term with a medication that has those side effects." He was absolutely OK with that and we started trying some more unusual meds that did not have the side effects I was concerned about.
posted by showbiz_liz at 10:08 AM on January 18, 2018 [5 favorites]


The most important question may be this: are you satisfied with your current quality of life? If not, you owe it to yourself to try additional treatments. You are so worth it!!

It sounds like your previous experiences with behavioral medications have been just awful. I’m sorry to hear that. Fighting through the stuff that’s supposed to be healing us just isn’t right.

That said, a lot of these medications do help a lot of people. You could be one of them.

Right now it feels like you don’t have enough information to make a decision (thus the ask). I urge you to take every question you have asked here — and any that didn’t make the edit — to your doctor.

When I have a lot of anxiety about something medical, I try to write down all of my questions and hand a copy to the dr at the start of the appointment. (If I don’t do it first thing, I will often forget or give into fear.) I also ask the dr’s permission to record the appointment with my phone. That way I am not bothered by scribbling notes and don’t have to worry about forgetting something.

It helps the dr out if you supply specific data where possible, eg. I took medication x (dosage) from (date) - (date). I had these side effects: (). I discontinued the medication (date) because (). I was also taking () then. This medication (did/did not) seem to help.

Then you can ask: what is different about my situation now that leads you to believe this medicine might work well for me?

I would also always ask what are some other choices for continuing your treatment. Treatment alternatives might be a different med, kind of therapy, etc. Being able to compare options helps.

Regrettably I cannot offer any help regarding your specific condition or this medication. ISNAD. IANYD. I am, however, an experienced patient of treatment resistant depression. Miracles welcome.

Good on you for keeping up the work on this. It ain’t easy!
posted by Kalatraz at 10:19 AM on January 18, 2018 [2 favorites]


Have you had side effects with a generic drug which you did not experience when taking the brand-name version? If so, then trying Luvox might be worth your while. For some people, and for some medications, brand makes a significant difference.
posted by Iris Gambol at 10:39 AM on January 18, 2018


Have you had this discussion with the psychiatrist? It seems odd to me that they want you to try a drug that has not worked well for you in the past, unless they have some reason to suspect that it will work better this time. I agree that your improved health is a factor. Having taken a generic may also be a factor; I have had personal experience with generics that worked poorly for me when the name-brand worked well. But the prescriber should be aware of all this and should be able to tell you why they think that Luvox deserves another chance, and should also be able to tell you what alternatives are available. Luvox is by no means the only SSRI used to treat OCD, though it is the only one whose primary usage is for that.
posted by ubiquity at 10:57 AM on January 18, 2018 [3 favorites]


I think a lot of this would depend on: how long you took Luvox in the past, what your dosage was compared to what the doctor wants you to get it up to, if you had horrible side effects from it before or if they were tolerable, and were you taking something else at the same time that might have made the drug not work as effectively the first time you tried it.
posted by ilovewinter at 10:57 AM on January 18, 2018 [2 favorites]


Ugh this is the one of the worst experiences to navigate re mental health system.

I've had 2 experiences with being asked to try meds again.

In one case, it was a new specialist who wanted me to try a medication that had previously caused me to become rapidly suicidal. I broke down crying, trying to explain that I never wanted to experience that again. (I never went back to that dr.)

In the second case, I was being asked to try wellbutrin again. Last time it didn't work and by the end resulted in panic attacks that went away after I switched meds. This time it's worked out very well for me because I'm taking it with another medication.

Which situation are you in? And is the doctor trying a particular med because that's the order they do things in or because your circumstances are different enough?
posted by A hidden well at 12:13 PM on January 18, 2018


Honestly, I'd feel more comfortable trying this if I knew I was working with a doctor who knew my history well, understood and acknowledged my concerns, didn't pretend that side effects are some super-rare thing that I should just not worry about, and had a well-thought-out plan with respect to follow-up. I'd need to trust them to be responsive if I felt I wasn't reacting well to the drugs and to taper me off carefully, and I'd need to know that I have access to them or someone else on short notice if necessary.
posted by trig at 12:25 PM on January 18, 2018


NO. With qualifications...

It did not work before, the risks are not worth it because you already have a data point. This medical person sounds like they are trying to shoehorn you into something that probably doesn't work for you.

Other commentators bring up strategies that might maybe make this work, but...? I trust your previous experience and your gut instinct that this is a bad idea, but I do not have experience with this med.

If I were you, I would seek opinions from current and former patients taking this SPECIFIC medication. How else can you judge the risks?
posted by jbenben at 12:38 PM on January 18, 2018


IF you were taking the generic before, definitely give the brand name a try. If not, I would work with your doc to find an alternative.

One thing that I've recently found helpful is the supplement Inositol. It helps with cyclical / obsessive thoughts and is very useful in moderating anxiety and OCD. It can be taken with other meds, but check with your doc to make sure the one you decide on won't have interactions, obviously. You can buy it online, I use a web portal my psych set up for me so I get the wholesale price, but you can also buy it through other online retailers. I take 9000 mg split into two 4000 mg doses daily (your body can't absorb more than that in one go), start low and work up to whatever dose works for you.

I also take Lamictal, which is technically a mood stabilizer. It helps a lot with my anxiety, though it's not generally prescribed for OCD. Perhaps the combo will work as well for you as it does for me. It's a fairly unusual script, but I don't tolerate most traditional antidepressants / anxiety meds well and my psych is very invested in finding solutions even if they might not square with conventional treatments.
posted by ananci at 1:04 PM on January 18, 2018 [1 favorite]


Have you tried N-Acetyl Cysteine (NAC)? I have moderate OCD and anxiety, and I find taking two 600 mg capsules per day helps a lot with both. It takes a week or more to notice a difference, but for me it has really helped. There are studies that have shown promise. I've gone off it for periods of time (usually due to a combo of feeling better, being lazy and hating to take pills) and I've never noticed any kind of withdrawal symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423164/

It might be worth a try before going on a medication that has not worked in the past and you are clearly reluctant to try again.
posted by Serene Empress Dork at 1:10 PM on January 18, 2018 [4 favorites]


I think this has been said in other ways upthread, but I think the answer may depend on how you are currently doing. My willingness to try medication, despite previous negative experiences, was predicated on how totally unsustainable my level of unhappiness had become. Had that not been the case, I would not have been willing to try again. Is that true for you? Or are things OK-ish and therefore the risk may not be worth it? It's kind of a complicated personal mathematics, but for me a helpful way to look at it.
posted by jeszac at 1:13 PM on January 18, 2018


I think your suspicion that the Xanax withdrawal may have been the biggest player in your terrible withdrawal experience is supported by lots of evidence. Benzodiazepines are notoriously awful to withdraw from, and with higher doses withdrawal can actually precipitate seizures. I have seen it occur.

No advice to offer on other possible OCD meds, but Xanax and its cousins Ativan, Klonipin and Valium are all habit forming and potentially physically addictive. Withdrawal can also precipitate anxiety, palpitations, nausea, sleep problems, panic attacks and disorientation, the very symptoms that may have prompted you to take it in the first place.

Good luck finding a solution in consultation with your doctor. I hope there is a good solution you can find together.
posted by citygirl at 2:58 PM on January 18, 2018


I think you just need to ask your doctor: what will you do if I experience side effect x, y, etc. What will you do if there is no improvement? He/she may have a plan, such as adding another prescription. Or just changing to a different one.

I do know what it's like to be terrified to go back on a certain med. I'm sorry.

Please don't be too discouraged. It looks like you have only tried SSRIs. I honestly don't know anything about OCD treatment, but there are numerous drug classes out there and your doctor knows about them. I'm sure there's a plan for getting you where you need to be.
posted by kitcat at 3:45 PM on January 18, 2018


I feel that whether to start fluvoxamine is a personal decision - from a non-anxious mind, the way I approach these concerns is: what if I feel worse? Then I will stop the medication. What if it doesn't work? Then I'll try something else. What about withdrawal symptoms? I'll make sure that I have a plan with my psychiatrist to treat withdrawal symptoms that we can work through if I need to stop the med. What if I feel really bad? I'll get through it, I will feel bad for a short time but it will be in the name of trying to treat this mental health issue that is really bothering me, so it will be worth it. I realize that how my mind works is different from how an anxious mind works so it's hard for me to say that this thought process should apply to your situation.

IANYD, you should ask your doctor the questions about using alcohol and marijuana with fluvoxamine. The boilerplate answer is that alcohol and marijuana aren't good for people with anxiety and depression and you should avoid them regardless of what antidepressant you're taking. But I can add that there is evidence to suggest that alcohol and fluvoxamine have no significant interaction. As for serotonin syndrome, it is a rare entity, and probably not worth worrying about as a potential side effect of cannabis specifically. Fluvoxamine could potentiate the effects of THC, and anecdotally it appears that cannabis users can get less enjoyment out of smoking pot because of this, with more experiences of paranoia and fear. I'm a doctor (NYD) in the emergency department and my personal anecdote is that I see patients every week with negative effects from marijuana usage, whereas I quite rarely ever see patients with side effects of SSRI usage (they usually don't rise to the ER visit level), so I'd see the marijuana use as having more potential to harm than the SSRI use.
posted by treehorn+bunny at 8:24 PM on January 18, 2018 [1 favorite]


Have you asked your doctor about rTMS? I just finished 3 months worth of sessions and my depression, which had been ongoing for 15 years, is now in remission. And I was completely skeptical of it and only tried because I was desperate and running out of new meds to try.

My doctor also uses it to treat OCD. You may be a good candidate, it's worth asking about!
posted by mollywas at 2:08 PM on January 21, 2018 [1 favorite]


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