Please help make sense of my brain chemistry
July 14, 2009 6:15 PM Subscribe
Guess what! I know you're not my doctor. Get over it. I'm seeing one for depression, though, and need to know what to say next time I see her. I'm losing my marbles here.
This is going to be long. If you were to take the time to read it and relate any comments, observations, suggestions, experiences you have I'd be ridiculously grateful.
For at least the past 7 years or so I've been dealing with something akin to depression, sometimes more pronounced, sometimes less. Took me a while to realize this was not just How People Felt All the Time. The past year or so I've been getting weekly therapy, but as things got worse and worse a doc put me on Wellbutrin. That was two plus months ago.
I'd been on antidepressants before, years ago: Tried zoloft for a while; didn't do much except make me yawn constantly and have weird withdrawal symptoms. Tried Wellbutrin right after that, but my memory of that time is hazy enough that I was willing to give the drug another go.
Somewhat unexpectedly, the subjective effects of the Wellbutrin this time around were different to start with, which gave me some initial hope. For the first two days on the 150 XL dose, I felt... well, I felt like I'd heard being on speed felt. Didn't sleep much, but those two days were wonderful, like someone had upped the color saturation of the world. Then it dissipated, and I settled back to a level similar, if maybe a bit more bearable than what i'd started out with. This was my first and last positive experience with the drug.
A month later I went onto a 300mg dose, but got heart palpitations, elevated blood pressure, blood rushing in my ears, etc. These never really went away. I was on the higher dose for a month. When that month ended, I dropped my dose back to 150, without consulting my doctor this time. Not because I didn't want to. I can probably get hold of her in a few weeks.
Mostly, I need to know what to tell my doctor about the following things I observed over the past months/years:
- A day or two after pleasurable sexual activity of any kind i hit rock bottom, find no joy in anything, and want to die;
- A day or two after enduring painful medical treatment for an hour i hit rock bottom, find no joy in anything, and want to die;
- A while back I had the option of taking Tramadol for pain, but couldn't because the day I took even a single pill I felt Wonnnderful, then next day I hit rock bottom, found no joy in anything, and wanted to die;
- I've taken Strattera long-term in the past, in the low dose (40mg/day) that my GP was willing to prescribe. I found it helped with day-to-day functioning a little bit. Nothing spectacular. I would describe the feeling as traction control... As opposed to everything being of equal importance and on my mind at the same time, I can prioritize somewhat. As well as an analgesic, Tramadol is also an SNRI. Strattera is an NRI.
So... Is there anything here that I'm not seeing? Should I be pursuing/suggesting some course of action?
How about hope? Hope would be nice.
This is going to be long. If you were to take the time to read it and relate any comments, observations, suggestions, experiences you have I'd be ridiculously grateful.
For at least the past 7 years or so I've been dealing with something akin to depression, sometimes more pronounced, sometimes less. Took me a while to realize this was not just How People Felt All the Time. The past year or so I've been getting weekly therapy, but as things got worse and worse a doc put me on Wellbutrin. That was two plus months ago.
I'd been on antidepressants before, years ago: Tried zoloft for a while; didn't do much except make me yawn constantly and have weird withdrawal symptoms. Tried Wellbutrin right after that, but my memory of that time is hazy enough that I was willing to give the drug another go.
Somewhat unexpectedly, the subjective effects of the Wellbutrin this time around were different to start with, which gave me some initial hope. For the first two days on the 150 XL dose, I felt... well, I felt like I'd heard being on speed felt. Didn't sleep much, but those two days were wonderful, like someone had upped the color saturation of the world. Then it dissipated, and I settled back to a level similar, if maybe a bit more bearable than what i'd started out with. This was my first and last positive experience with the drug.
A month later I went onto a 300mg dose, but got heart palpitations, elevated blood pressure, blood rushing in my ears, etc. These never really went away. I was on the higher dose for a month. When that month ended, I dropped my dose back to 150, without consulting my doctor this time. Not because I didn't want to. I can probably get hold of her in a few weeks.
Mostly, I need to know what to tell my doctor about the following things I observed over the past months/years:
- A day or two after pleasurable sexual activity of any kind i hit rock bottom, find no joy in anything, and want to die;
- A day or two after enduring painful medical treatment for an hour i hit rock bottom, find no joy in anything, and want to die;
- A while back I had the option of taking Tramadol for pain, but couldn't because the day I took even a single pill I felt Wonnnderful, then next day I hit rock bottom, found no joy in anything, and wanted to die;
- I've taken Strattera long-term in the past, in the low dose (40mg/day) that my GP was willing to prescribe. I found it helped with day-to-day functioning a little bit. Nothing spectacular. I would describe the feeling as traction control... As opposed to everything being of equal importance and on my mind at the same time, I can prioritize somewhat. As well as an analgesic, Tramadol is also an SNRI. Strattera is an NRI.
So... Is there anything here that I'm not seeing? Should I be pursuing/suggesting some course of action?
How about hope? Hope would be nice.
Response by poster: "When she gets back. Oh, we don't know. Call in a few days? **vacant smile**"
posted by tigrrrlily at 6:30 PM on July 14, 2009
posted by tigrrrlily at 6:30 PM on July 14, 2009
Response by poster: oh, and "new psych" means a time frame of months.
posted by tigrrrlily at 6:31 PM on July 14, 2009
posted by tigrrrlily at 6:31 PM on July 14, 2009
Response by poster: Re: endorphin crash; yes, I know that's what's going on in general. As far as I've heard, though, it's not supposed to make you wish you'd never been born... unless you've been taking ecstasy or something similar, something I don't do.
posted by tigrrrlily at 6:35 PM on July 14, 2009
posted by tigrrrlily at 6:35 PM on July 14, 2009
Okay, you sound desperate. There's really nothing you can get from MeFi beyond what you should already be getting from your mental health professional.
However, you do seem to understand what triggers your bad mental states. Have you been able to talk yourself through the bad points, knowing that they're approaching and will end? Sometimes just understanding that it's a chemical process can help people be more rational about the situation and understand what to do to fix it. It helps a lot of people to understand the misery following a breakup as a physical withdrawal; maybe you can think similarly about your endorphin crashes until you have a pharmacological fix.
posted by oinopaponton at 6:41 PM on July 14, 2009 [2 favorites]
However, you do seem to understand what triggers your bad mental states. Have you been able to talk yourself through the bad points, knowing that they're approaching and will end? Sometimes just understanding that it's a chemical process can help people be more rational about the situation and understand what to do to fix it. It helps a lot of people to understand the misery following a breakup as a physical withdrawal; maybe you can think similarly about your endorphin crashes until you have a pharmacological fix.
posted by oinopaponton at 6:41 PM on July 14, 2009 [2 favorites]
Just tell her what you've said above, or print it out and bring it in - it'll help. While it's a very good sign that Wellbutrin helped you out for the first two days, as it means you're responsive to it, it's entirely normal for the effects to feel like they've worn off soon after. Ideally it will elevate your mood enough for you to function better and go about your life, to feel better and address your underlying problems, and to have fewer bad days. It can't give you no bad days, nothing can. As a depressive you will continue to have occasional bad days, or bad hours; the important thing is to recognize that these feelings are an ephemeral byproduct of biochemistry, they are not grounded in reality and mean nothing. Try breathing and meditation exercises.
- A day or two after pleasurable sexual activity of any kind i hit rock bottom, find no joy in anything, and want to die;
This is useful for the doctor to know, it might help clarify what's going wrong and what drugs can help you. Is it the same with emotional highs of a non-sexual nature, for example watching a very funny movie, exercise to the point of exhaustion, enjoyable socializing, or winning a game?
- A day or two after enduring painful medical treatment for an hour i hit rock bottom, find no joy in anything, and want to die;
How often are you undergoing an hour of painful medical treatment? This is something your doctor should know about even if you weren't depressed!
- A while back I had the option of taking Tramadol for pain, but couldn't because the day I took even a single pill I felt Wonnnderful, then next day I hit rock bottom, found no joy in anything, and wanted to die;
Probably a drug interaction, mention it.
- I've taken Strattera long-term in the past, in the low dose (40mg/day) that my GP was willing to prescribe. I found it helped with day-to-day functioning a little bit. Nothing spectacular. I would describe the feeling as traction control... As opposed to everything being of equal importance and on my mind at the same time, I can prioritize somewhat. As well as an analgesic, Tramadol is also an SNRI. Strattera is an NRI.
Again, an interesting drug interaction worth mentioning.
Other things worth noting are your sleep patterns - excessive short or long length, waking, anxiety attacks and nightmares if any; also your use of (if any) and experience with caffeine, alcohol, tobacco, marijuana - all of which interact with depression in various ways that can be indicative of what's going on with you.
posted by aeschenkarnos at 6:43 PM on July 14, 2009 [1 favorite]
- A day or two after pleasurable sexual activity of any kind i hit rock bottom, find no joy in anything, and want to die;
This is useful for the doctor to know, it might help clarify what's going wrong and what drugs can help you. Is it the same with emotional highs of a non-sexual nature, for example watching a very funny movie, exercise to the point of exhaustion, enjoyable socializing, or winning a game?
- A day or two after enduring painful medical treatment for an hour i hit rock bottom, find no joy in anything, and want to die;
How often are you undergoing an hour of painful medical treatment? This is something your doctor should know about even if you weren't depressed!
- A while back I had the option of taking Tramadol for pain, but couldn't because the day I took even a single pill I felt Wonnnderful, then next day I hit rock bottom, found no joy in anything, and wanted to die;
Probably a drug interaction, mention it.
- I've taken Strattera long-term in the past, in the low dose (40mg/day) that my GP was willing to prescribe. I found it helped with day-to-day functioning a little bit. Nothing spectacular. I would describe the feeling as traction control... As opposed to everything being of equal importance and on my mind at the same time, I can prioritize somewhat. As well as an analgesic, Tramadol is also an SNRI. Strattera is an NRI.
Again, an interesting drug interaction worth mentioning.
Other things worth noting are your sleep patterns - excessive short or long length, waking, anxiety attacks and nightmares if any; also your use of (if any) and experience with caffeine, alcohol, tobacco, marijuana - all of which interact with depression in various ways that can be indicative of what's going on with you.
posted by aeschenkarnos at 6:43 PM on July 14, 2009 [1 favorite]
I'm sorry "new psych" means a time frame of months, because your current doctor's unavailability is way beyond the acceptable limits for someone dealing with people experiencing depression.
To put it bluntly, someone could kill himself before she "gets back" to him.
A good pysch will have an office number to call and an emergency contact (which might also be the answering service at the office number) that can reach the pysch at any time when the need is urgent. Having heart palpitations is an urgent need.
If your current doctor does not have this system in place, you need to get that months-long search process going NOW for someone who does.
If they have a system but are putting you off, Do NOT hesitate to force the issue. Mental health is every bit as important as physical health, and in your case the two overlapped to the point where you should have had the doc on the line right away.
I've been on Wellbutrin and after a while I was where you are, highs and lows and all. At this point I know my own triggers and put in a call to the doc for an unscheduled visit when things got hairy. The response from my doc's service was, "We can get you in Friday [I called on a Tuesday], is that soon enough? Will you be all right?"
I have a very competent therapist who listens to me, and after the consult I switched to Pristiq, which is working well for me--I actually find myself laughing out loud and acting silly and just enjoying life--much better than that flat line we all worry about when we are taking meds, and which I have experienced before. You might want to look into if it is appropriate to you--depression meds are very subjective, though!
Like all good psychs, my doc is monitoring me closely because this medication is new; I am seeing him once a month rather than the every six months we used to go between visits.
I'm telling you all this because your doc is being PAID FOR BY YOU and is supposed to be working FOR and WITH you, to give you the level of care you need when you need it. I feel that mine does this; it's obvious to me that yours does not.
So, yes, start that search for a new psych, because you obviously do not feel you can communicate with your current doctor, even when she is available, and you deserve better treatment.
You also need to remind yourself to use common sense and not put your own needs last--depression is debilitating and it's important to speak up and take action when you need help.
Lastly, I'm worried about you. I hope you will come back and update this thread to let us know what happens, okay?
sorry for the length. I've been where you are.
posted by misha at 6:53 PM on July 14, 2009 [2 favorites]
To put it bluntly, someone could kill himself before she "gets back" to him.
A good pysch will have an office number to call and an emergency contact (which might also be the answering service at the office number) that can reach the pysch at any time when the need is urgent. Having heart palpitations is an urgent need.
If your current doctor does not have this system in place, you need to get that months-long search process going NOW for someone who does.
If they have a system but are putting you off, Do NOT hesitate to force the issue. Mental health is every bit as important as physical health, and in your case the two overlapped to the point where you should have had the doc on the line right away.
I've been on Wellbutrin and after a while I was where you are, highs and lows and all. At this point I know my own triggers and put in a call to the doc for an unscheduled visit when things got hairy. The response from my doc's service was, "We can get you in Friday [I called on a Tuesday], is that soon enough? Will you be all right?"
I have a very competent therapist who listens to me, and after the consult I switched to Pristiq, which is working well for me--I actually find myself laughing out loud and acting silly and just enjoying life--much better than that flat line we all worry about when we are taking meds, and which I have experienced before. You might want to look into if it is appropriate to you--depression meds are very subjective, though!
Like all good psychs, my doc is monitoring me closely because this medication is new; I am seeing him once a month rather than the every six months we used to go between visits.
I'm telling you all this because your doc is being PAID FOR BY YOU and is supposed to be working FOR and WITH you, to give you the level of care you need when you need it. I feel that mine does this; it's obvious to me that yours does not.
So, yes, start that search for a new psych, because you obviously do not feel you can communicate with your current doctor, even when she is available, and you deserve better treatment.
You also need to remind yourself to use common sense and not put your own needs last--depression is debilitating and it's important to speak up and take action when you need help.
Lastly, I'm worried about you. I hope you will come back and update this thread to let us know what happens, okay?
sorry for the length. I've been where you are.
posted by misha at 6:53 PM on July 14, 2009 [2 favorites]
Response by poster: Thanks, misha, you're probably right in that I could make things happen faster w/ the doc's. I'm actually quite persuasive, an effective communicator and a great self-advocate... when I'm feeling OK. That hasn't really happened in weeks. Just posting this question here is freaking me out right now.
posted by tigrrrlily at 7:02 PM on July 14, 2009
posted by tigrrrlily at 7:02 PM on July 14, 2009
Agreed with the others on your doc's (lack of) responsiveness. You need to be seen by someone who listens to your concerns and doesn't just make a pronouncement before you open your mouth. I had a PCP who, before I told her about the issues that eventually led me to have an EEG and brain MRI, cut me off and told me I should simply up my dose. That was the last straw for me, and I kicked her to the curb.
I tried Wellbutrin several years ago and had extremely vivid dreams that really weirded me out. Then I went off of medication for a while, but I went back on after some big life changes (with more on the horizon, wooo!) and stopping hormonal birth control. Effexor has worked well for me; I tried to go onto Celexa for a while (because it supposedly has fewer side effects) and WHOA, I was NUTS. Like, muttering crying jags and feeling violent nuts. This was a great, albeit scary, reminder that different drugs work very differently in different people. So back onto Effexor I went, and I am really pleased with how it's gone for the last year and a half. The only problem I've noticed with Effexor is that I get the zaps if I don't take my pill the day before, which isn't horrible but is a good incentive to remember.
I've been on Strattera for the last year or so, too, and actually they are supposed to work pretty well together. Like you, I wasn't noticing any major improvement (60 mg), so I went off it for about a month, and I found that I was really out of it at that point. So I went back on, and my doctor thanked me for doing my own little drug study.
You sound like you're juuuust hanging on... but you also sound like you're doing a great job of recording your symptoms and when/how they occur. That's a sign that you want to understand what's happening and want to be better. In the meantime, take some time to pamper yourself with little things that get you through the day, and keep on looking for a better doctor. I wish you the best of luck, and I know that this perseverance will see you through.
posted by Madamina at 7:10 PM on July 14, 2009
I tried Wellbutrin several years ago and had extremely vivid dreams that really weirded me out. Then I went off of medication for a while, but I went back on after some big life changes (with more on the horizon, wooo!) and stopping hormonal birth control. Effexor has worked well for me; I tried to go onto Celexa for a while (because it supposedly has fewer side effects) and WHOA, I was NUTS. Like, muttering crying jags and feeling violent nuts. This was a great, albeit scary, reminder that different drugs work very differently in different people. So back onto Effexor I went, and I am really pleased with how it's gone for the last year and a half. The only problem I've noticed with Effexor is that I get the zaps if I don't take my pill the day before, which isn't horrible but is a good incentive to remember.
I've been on Strattera for the last year or so, too, and actually they are supposed to work pretty well together. Like you, I wasn't noticing any major improvement (60 mg), so I went off it for about a month, and I found that I was really out of it at that point. So I went back on, and my doctor thanked me for doing my own little drug study.
You sound like you're juuuust hanging on... but you also sound like you're doing a great job of recording your symptoms and when/how they occur. That's a sign that you want to understand what's happening and want to be better. In the meantime, take some time to pamper yourself with little things that get you through the day, and keep on looking for a better doctor. I wish you the best of luck, and I know that this perseverance will see you through.
posted by Madamina at 7:10 PM on July 14, 2009
I've never been treated for depression but my mom is bipolar and I've recently started trying treatment for possible adhd. I was instructed to call my doctor immediately no matter what time of night or day if I had any troubling side effects of any of the medications I've been trying. Things like heart palpitations can be serious and I don't blame you for being scared of a side effect like that. That said, from what I'm told a lot of the antidepressants take weeks at the same dosage to start having any discernable impact and if you change up the medication on your own it can sometimes result in things staying the same or getting worse. So I don't think it's generally a good idea to start changing stuff around without talking to a doctor, especially if you're at the point of wanting to die. If your doctor isn't accessible enough that you can get answers quickly then I'd agree that the time has come to find a different one. I have a doctor I can call whenever and I'm not even in a very serious place or in that much psychological pain. I definitely think someone in a more serious situation should have that too.
As far as the rising and crashing goes, can you arrange to have pleasurable sexual activity every day? ;) I'm only somewhat joking.
The only thing I've ever noticed having an immediately noticeable positive impact on my moods besides getting enough sleep and sex is exercise, esp. yoga. It has that same immediate mood lift for me. It's relatively doable to arrange to have it happen reliably at the same time each day.
I don't think it's your job to figure out a course of action. That's what you're paying them for. I do think it's your job to make sure that you have a competent doctor who listens carefully and takes you seriously and responds promptly/makes themself accessible. It sounds like your current one may not be in that category.
posted by groovinkim at 7:29 PM on July 14, 2009
Is there someone who could call the doctor for you and have the necessary Come-To-Jesus with the receptionist?
posted by chesty_a_arthur at 7:32 PM on July 14, 2009
posted by chesty_a_arthur at 7:32 PM on July 14, 2009
First: Things will get better. You've just got to get your meds right. Hang on.
To that end: It's pretty hard to advocate for yourself when you are depressed. This is a time when it is appropriate and normal to make some demand. Your doctor should have an emergency contact number or an alternate doctor who can see her patients when she is not available. The receptionist should have this telephone number or alternate doctor's name and number.
Call, and tell the receptionist, "I am having a medical emergency with the medication Dr. X gave me. I need you to call her emergency number or alternate physician right now. I will wait on hold while you do this; I must speak to someone now."
I bet/hope the doctor has an answering service who can take your call right now. Now is a fine time to call. You are not inconveniencing anyone -- you need her medical care.
If you are having heart palpitations and mood swings this severe, it's time to ask for that emergency call to the doctor.
Her receptionist is an ass, btw. She should know when the doctor will be back. She should not ask you to call her back. And you should not have to be persuasive in order to see the doctor. When you are feeling better, you can address this obnoxious level of unprofessionalism with her boss.
posted by Houstonian at 7:51 PM on July 14, 2009 [2 favorites]
To that end: It's pretty hard to advocate for yourself when you are depressed. This is a time when it is appropriate and normal to make some demand. Your doctor should have an emergency contact number or an alternate doctor who can see her patients when she is not available. The receptionist should have this telephone number or alternate doctor's name and number.
Call, and tell the receptionist, "I am having a medical emergency with the medication Dr. X gave me. I need you to call her emergency number or alternate physician right now. I will wait on hold while you do this; I must speak to someone now."
I bet/hope the doctor has an answering service who can take your call right now. Now is a fine time to call. You are not inconveniencing anyone -- you need her medical care.
If you are having heart palpitations and mood swings this severe, it's time to ask for that emergency call to the doctor.
Her receptionist is an ass, btw. She should know when the doctor will be back. She should not ask you to call her back. And you should not have to be persuasive in order to see the doctor. When you are feeling better, you can address this obnoxious level of unprofessionalism with her boss.
posted by Houstonian at 7:51 PM on July 14, 2009 [2 favorites]
Response by poster: Ok, I didn't want to go into that much detail but this is a psych who spends a half day to a day every two weeks at the health center of the school i attend(ed). Kinda feels like being a bastard stepchild patient, but that might just be the depression talking.
posted by tigrrrlily at 8:04 PM on July 14, 2009
posted by tigrrrlily at 8:04 PM on July 14, 2009
Is your doctor a psychiatrist? and is your doctor a specialist in medication? Cause that's what you need. Call the office, tell them it's urgent that you get a referral to a psychiatric medication specialist. Antidepressant meds have come a long way. The meds I took in pre-SSRI (Prozac-class) days were much less effective with lots more side effects. So, be persistent, because when the meds really work, it's so great. Zoloft works reasonably well for me.
Ditto on more exercise, appropriate sleep and add sunshine and fresh air.
You sound like you're also experiencing anxiety, and your doctor should assess that, as well. In some cases, when you start to feel better, increased energy comes out as anxiety.
If you have to, consider an Emergency Room visit. This is your life. You're losing big chunks of it to depression. Plenty of health care professionals think of it as "just depression" and don't treat it with the time and care required. Depression can lead to suicide. It's serious and should get a serious response.
If you are suicidal, please read How Not to Commit Suicide, a great article in any case. If you are suicidal, go to te Emergency Room.
You deserve to feel better. You deserve a health care provider who takes you seriously. Good luck.
posted by theora55 at 8:30 PM on July 14, 2009 [1 favorite]
Ditto on more exercise, appropriate sleep and add sunshine and fresh air.
You sound like you're also experiencing anxiety, and your doctor should assess that, as well. In some cases, when you start to feel better, increased energy comes out as anxiety.
If you have to, consider an Emergency Room visit. This is your life. You're losing big chunks of it to depression. Plenty of health care professionals think of it as "just depression" and don't treat it with the time and care required. Depression can lead to suicide. It's serious and should get a serious response.
If you are suicidal, please read How Not to Commit Suicide, a great article in any case. If you are suicidal, go to te Emergency Room.
You deserve to feel better. You deserve a health care provider who takes you seriously. Good luck.
posted by theora55 at 8:30 PM on July 14, 2009 [1 favorite]
It doesn't matter how often she is at your school's location. You are her patient. Believe me, she probably wants to know all this... but the receptionist is not being very helpful. Perhaps you can go to the office, get the run-around with the receptionist, then ask to speak to her supervisor. Seriously. If she works that infrequently at your school, then she's working somewhere else the other days. She's got an emergency number. It's available to office staff for emergencies.
Understandably, you are adjusting your meds due to heart palpitations. But, she wants to know about this and she wants to know about your drastic mood swings. She wants to know now.
If you don't feel comfortable laying this all out for the receptionist, how about dropping in for a visit to the clinic to speak with any available doctor or nurse? A receptionist may not (clearly does not) understand, but a trained medical professional will or should, and will make that telephone call.
posted by Houstonian at 8:30 PM on July 14, 2009
Understandably, you are adjusting your meds due to heart palpitations. But, she wants to know about this and she wants to know about your drastic mood swings. She wants to know now.
If you don't feel comfortable laying this all out for the receptionist, how about dropping in for a visit to the clinic to speak with any available doctor or nurse? A receptionist may not (clearly does not) understand, but a trained medical professional will or should, and will make that telephone call.
posted by Houstonian at 8:30 PM on July 14, 2009
If you can't get an appointment with the psychiatrist, make an appointment with an MD at the clinic. MD, not some other kind of practitioner. Even if the doctor's not a specialist, he/she should understand common side effects of psychiatric meds, and be able to provide basic treatment. Also, they will probably have enough authority in a student health center to get you lined up with a psychiatrist who can actually treat you and/or fix the office staff problem.
posted by nckd at 9:54 PM on July 14, 2009
posted by nckd at 9:54 PM on July 14, 2009
One thing that I find super frustrating is that alot of GPs who don't really know better just dole out wellbutrin the minute they see a male come through the door with depression. Why? Because it lacks the side effect of erectile dysfunction that many antidepressants have. But getting an erection kinda seems like a minor consideration if you are so depressed you can't get pleasure from anything. And the sexual side effects can sometimes be helped by changing the time of day you take the meds so that at the time of sex you are not experiencing the problem. For example a patient I know who takes Cymbalta takes it before bed because that allows him to have sex at night time without experiencing the problem-but sex during the daytime can be a problem as the meds have worked their way into whatever part of the brain governs sexual function and creates a problem until the med level has had a chance to peter out again.
Also, wellbutrin has a tendency to be stimulating and NOT effective in treatment of anxiety disorders. It can even contribute to anxiety and cause some shakiness. Since you felt an upswing at first maybe you are onto something that an SSNRI is the way to go. But their are other SSNRIs that might work alot better for you. There's cymbalta, effexor, or the new "designer" effexor (that advertises fewer side effects than the original) called Pristiq. One thing to remember with these few I've just mentioned is that they have notoriously short half lifes so you feel withdrawal fast and hard. They don't remain in the body for a couple of weeks like prozac does. So do NOT NOT NOT go off abruptly whatever you do. They have to be stepped down gradually. (paxil is also known for having bad discontinuation as well so anyone on it keep that in mind).
A knowledgeable doctor can adjust or add things to really make the meds work better for you. Just adding a small bit of abilify or lamictal has been known to really increase the effectiveness of some antidepressants and make a huge difference for some patients. Since you've been experiencing ups and downs a mood stabilizer might help.
And if there is one thing that made a huge difference to the way I understand depression it's a book called The Noonday Demon: An Atlas of Depression by Andrew Solomon. It is a truly amazing description of depression which is a phenomenon that really does defy explanation often times for the people going through it. The author investigated ALL KINDS of meds and treatments among lots of differnt people and even cultures. It will open your understanding of the way your own mental life operates and how external things (whether meds, therapy, experiences) affect the neural pathways and therfore the way you feel.
posted by roosterboy at 10:51 PM on July 14, 2009 [1 favorite]
Also, wellbutrin has a tendency to be stimulating and NOT effective in treatment of anxiety disorders. It can even contribute to anxiety and cause some shakiness. Since you felt an upswing at first maybe you are onto something that an SSNRI is the way to go. But their are other SSNRIs that might work alot better for you. There's cymbalta, effexor, or the new "designer" effexor (that advertises fewer side effects than the original) called Pristiq. One thing to remember with these few I've just mentioned is that they have notoriously short half lifes so you feel withdrawal fast and hard. They don't remain in the body for a couple of weeks like prozac does. So do NOT NOT NOT go off abruptly whatever you do. They have to be stepped down gradually. (paxil is also known for having bad discontinuation as well so anyone on it keep that in mind).
A knowledgeable doctor can adjust or add things to really make the meds work better for you. Just adding a small bit of abilify or lamictal has been known to really increase the effectiveness of some antidepressants and make a huge difference for some patients. Since you've been experiencing ups and downs a mood stabilizer might help.
And if there is one thing that made a huge difference to the way I understand depression it's a book called The Noonday Demon: An Atlas of Depression by Andrew Solomon. It is a truly amazing description of depression which is a phenomenon that really does defy explanation often times for the people going through it. The author investigated ALL KINDS of meds and treatments among lots of differnt people and even cultures. It will open your understanding of the way your own mental life operates and how external things (whether meds, therapy, experiences) affect the neural pathways and therfore the way you feel.
posted by roosterboy at 10:51 PM on July 14, 2009 [1 favorite]
Response by poster: hal_c_on, I didn't elaborate on the type of activity because my emphasis was on the "pleasurable" aspect... that is, whether it's sex w/ a committed partner, or masturbation, or as innocuous as a bit of naugthy online chatting with said partner while he's a few states away, the commonality seems to lie in the pleasure derived.
Also? Perhaps the one thing I wasn't complaining about was sexual side-effects, no matter how common a complaint that is when some of the same keywords are used. If I had been, this question would have needed to be anonymous.
posted by tigrrrlily at 2:18 AM on July 15, 2009
Also? Perhaps the one thing I wasn't complaining about was sexual side-effects, no matter how common a complaint that is when some of the same keywords are used. If I had been, this question would have needed to be anonymous.
posted by tigrrrlily at 2:18 AM on July 15, 2009
Just wanted to second liketitanic's advice. You want to think of helping yourself get better as a project, and the doctor and medication are only a part of it.
Do the easy things first: add fish oil, and cut any crap out of your diet (OMG so true about the sugar---I haven't eaten candy for years, but then a few months ago I went out to a movie with my girlfriend, and shared her sour straws. The next day I was really depressed and down for no reason I could figure out; a week later I realized it was the sugar.).
Trickier, but not very hard, is the sleep: get on a good, regular sleep schedule, and especially don't be sleeping too much.
Lastly is the exercise; it's nontrivial, but it's worth it, and I think you'll notice a difference.
----
Finally, the only other thing I can think of is that maybe you're more bipolar than depressed? In my definitely-not-a-doctor opinion, some of the symptoms you describe and the lack of efficacy of previous treatments lean in that direction. Apparently they're treated very differently.
posted by Jacen Solo at 2:57 AM on July 15, 2009
Do the easy things first: add fish oil, and cut any crap out of your diet (OMG so true about the sugar---I haven't eaten candy for years, but then a few months ago I went out to a movie with my girlfriend, and shared her sour straws. The next day I was really depressed and down for no reason I could figure out; a week later I realized it was the sugar.).
Trickier, but not very hard, is the sleep: get on a good, regular sleep schedule, and especially don't be sleeping too much.
Lastly is the exercise; it's nontrivial, but it's worth it, and I think you'll notice a difference.
----
Finally, the only other thing I can think of is that maybe you're more bipolar than depressed? In my definitely-not-a-doctor opinion, some of the symptoms you describe and the lack of efficacy of previous treatments lean in that direction. Apparently they're treated very differently.
posted by Jacen Solo at 2:57 AM on July 15, 2009
You need to get in contact with your doc. Today. If the receptionist balks, make it clear that this is an emergency. You are having heart palpitations. This does qualify as an emergency situation, even if you can make them go away by lowering your dosage.
You have also been feeling like you want to die regularly for years. Make it clear that this and other medications have been total failures. Not to plant an armchair diagnosis in your head, but you really should be asking whether this could be something other than regular depression. Trying to fix the same issue for this long with no results means it just might not be that particular issue. There are other conditions which can result in feeling heavily depressed.
Call up, or better yet, go in person. Firmly insist that you absolutely must talk to the doctor, as this is an emergency. If you must, tell them that you have been having heart palpitations. Those letters "M. D." after a doctor's name mean that they are sworn to a code of ethics, and taking urgent calls is something they expect at times. Any doctor even remotely worth that title is going to be more irritated by the idea that you didn't call them immediately regarding heart palpitations.
So there you have it. Call immediately, make sure you get in contact with the doctor, explain the immediate issue (Increased dosage of Wellbutrin gave me heart palpitations, I cut the dosage, and it's not happening at the moment), and arrange for an appointment as soon as possible. It should be a lot sooner than you would expect. At that point, you can ask whether it might be something other than regular depression and if they have any ideas.
Feel free to mefi mail me if you want more personal detail. First, call that doctor's office and get through.
posted by Saydur at 4:53 AM on July 15, 2009
You have also been feeling like you want to die regularly for years. Make it clear that this and other medications have been total failures. Not to plant an armchair diagnosis in your head, but you really should be asking whether this could be something other than regular depression. Trying to fix the same issue for this long with no results means it just might not be that particular issue. There are other conditions which can result in feeling heavily depressed.
Call up, or better yet, go in person. Firmly insist that you absolutely must talk to the doctor, as this is an emergency. If you must, tell them that you have been having heart palpitations. Those letters "M. D." after a doctor's name mean that they are sworn to a code of ethics, and taking urgent calls is something they expect at times. Any doctor even remotely worth that title is going to be more irritated by the idea that you didn't call them immediately regarding heart palpitations.
So there you have it. Call immediately, make sure you get in contact with the doctor, explain the immediate issue (Increased dosage of Wellbutrin gave me heart palpitations, I cut the dosage, and it's not happening at the moment), and arrange for an appointment as soon as possible. It should be a lot sooner than you would expect. At that point, you can ask whether it might be something other than regular depression and if they have any ideas.
Feel free to mefi mail me if you want more personal detail. First, call that doctor's office and get through.
posted by Saydur at 4:53 AM on July 15, 2009
If you're badly depressed or having heart symptoms now, and your doctor won't see you — really won't see you, even if tell her or her slack-ass receptionist in detail what you're experiencing — then you have no choice, you have to see another doctor. Go to the ER if that's what it takes.
When you see a doctor, tell them exactly what you've observed. Don't extrapolate and don't second-guess. "Sex makes me feel like X; pain makes me feel like Y; Tramadol did Z to me." It might be appropriate to ask "Do you think it has something to do with endorphins?" — but first, just give all the raw data on your symptoms, since that's what the doc really needs.
In the long run, find a new shrink to see on a regular basis. One way or another, you need access to basic emergency psych care. It's not unreasonable, and totally not "just the depression talking," to demand that. In fact, if anything, the little voice telling you that you don't deserve better care is the depression talking. If you're gonna ignore an impulse, ignore that one.
(FWIW, It is common practice for psychiatrists to give their existing patients an emergency contact number — either their own cell phone or pager or one for another doc who's available when they're not. Not everyone does it, but it's a totally reasonable and realistic thing to expect, and it sucks that your doesn't.)
Use your next AskMe question to get the name of the best, kindest and most responsive psychiatrist in your area. Put yourself on their new patient wating list now. Keep seeing your current doctor, if she's the best you can do for now, until you come to the top of their waiting list.
posted by nebulawindphone at 6:14 AM on July 15, 2009
When you see a doctor, tell them exactly what you've observed. Don't extrapolate and don't second-guess. "Sex makes me feel like X; pain makes me feel like Y; Tramadol did Z to me." It might be appropriate to ask "Do you think it has something to do with endorphins?" — but first, just give all the raw data on your symptoms, since that's what the doc really needs.
In the long run, find a new shrink to see on a regular basis. One way or another, you need access to basic emergency psych care. It's not unreasonable, and totally not "just the depression talking," to demand that. In fact, if anything, the little voice telling you that you don't deserve better care is the depression talking. If you're gonna ignore an impulse, ignore that one.
(FWIW, It is common practice for psychiatrists to give their existing patients an emergency contact number — either their own cell phone or pager or one for another doc who's available when they're not. Not everyone does it, but it's a totally reasonable and realistic thing to expect, and it sucks that your doesn't.)
Use your next AskMe question to get the name of the best, kindest and most responsive psychiatrist in your area. Put yourself on their new patient wating list now. Keep seeing your current doctor, if she's the best you can do for now, until you come to the top of their waiting list.
posted by nebulawindphone at 6:14 AM on July 15, 2009
(Oh, and I had heart palpitations on high-dose Wellbutrin too. They're still a serious side effect and you need to take them seriously. But they're common, you're not imagining them, and your shrink, if she's worth anything as a doctor, will know to be looking out for them.)
posted by nebulawindphone at 6:17 AM on July 15, 2009
posted by nebulawindphone at 6:17 AM on July 15, 2009
Shot in the dark: What about going to a regular doctor and seeing if you have a vitamin B deficiency? Maybe a vitamin B shot will help. I have a friend with that deficiency and she feels fantastic for a few months after her shot, but then when she starts to feel tired, cranky --> horrible, wants to die, she knows she has to get another one. You never know until you ask, right?
posted by lizbunny at 8:37 AM on July 15, 2009
posted by lizbunny at 8:37 AM on July 15, 2009
Crazy Meds has a lot of information about the different medications prescribed for mental health issues. Their forums have sections listed by diagnosis and medication, so you can talk to other people who are taking the same thing and see if they're having similar reactions.
I would also encourage you to get on the list for a psych doc. I know it takes months. That's why you need to get on that list sooner than later. I waited longer than I should have because it was depressing to think about trying to hang on for months—please don't let that stop you.
Are you still going to therapy every week? Can your therapist put the fear of god into your doctor/receptionist? Because you really need to see your doc ASAP.
posted by heatherann at 9:30 AM on July 15, 2009
I would also encourage you to get on the list for a psych doc. I know it takes months. That's why you need to get on that list sooner than later. I waited longer than I should have because it was depressing to think about trying to hang on for months—please don't let that stop you.
Are you still going to therapy every week? Can your therapist put the fear of god into your doctor/receptionist? Because you really need to see your doc ASAP.
posted by heatherann at 9:30 AM on July 15, 2009
2 things that helped me with some of those same issues was cutting/curbing my sugar/carb intake. The energy crash I would get from those would send me spiraling down. And making sure I was taking the brand name Wellbutrin. The generic cause me to have panic attacks, jittery hands, heart racing ect. Sorry I don't have more for you, I still have alot to work through myself.
posted by meeshell at 12:13 PM on July 15, 2009
posted by meeshell at 12:13 PM on July 15, 2009
Response by poster: meeshell, I wish you hadn't said that. I'd heard about the generic/name brand difference, and tried to switch to the name brand. First I couldn't 'cause i'd started the batch, and over the last month my health provider has stopped covering the name brand altogether.
posted by tigrrrlily at 12:53 PM on July 15, 2009
posted by tigrrrlily at 12:53 PM on July 15, 2009
See a different psychiatrist.
Keep a journal.
Every day, do a small amount of activity, be it walking or stretches or meditation.
Eat fresh foods; vegis are your wonderful friends.
Over time, you may find your meds aren't working. If so, stop taking them.
I have been here, done this.
This was how I fixed it.
I am very, very happy now.
posted by fan_of_all_things_small at 7:04 AM on July 16, 2009
Keep a journal.
Every day, do a small amount of activity, be it walking or stretches or meditation.
Eat fresh foods; vegis are your wonderful friends.
Over time, you may find your meds aren't working. If so, stop taking them.
I have been here, done this.
This was how I fixed it.
I am very, very happy now.
posted by fan_of_all_things_small at 7:04 AM on July 16, 2009
I would like to add that I had depression since I can possibly remember (24 years?) and an anxiety disorder with panic attacks and agoraphobia for 14 years.
I'm a semi-professional musician now.
You can do this.
posted by fan_of_all_things_small at 7:07 AM on July 16, 2009
I'm a semi-professional musician now.
You can do this.
posted by fan_of_all_things_small at 7:07 AM on July 16, 2009
You sound so much like I used to that it makes me sad. Feel free to email me.
posted by fan_of_all_things_small at 7:10 AM on July 16, 2009
posted by fan_of_all_things_small at 7:10 AM on July 16, 2009
This thread is closed to new comments.
when i first started wellbutrin, i had the zoomzoom feeling for about a day and a half. it was awesome, and i hoped that would be what it always felt like. it was not. so, that's not an uncommon side effect of that particular drug, as i know other people experience it as well.
why did you not contact your doctor when the wellbutirin was giving you heart palpitations? why can you not get ahold of her for a few weeks?
as you know, different folks need different meds, and it can take a while to find the right one. so, you were taking a drug that was giving you shitty side-effects for a month, when you coudl have called your doctor on day 2 of heart palpitations (that's one of the ones that's "serious") and gotten on something else for day 2+n.
you either need to get a new psych or talk to your current psych.
posted by misanthropicsarah at 6:27 PM on July 14, 2009