POZ Community Forums
Meds, Mind, Body & Benefits => Mental Health & HIV => Topic started by: Miss Philicia on February 15, 2008, 02:40:23 am
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... here's the deal folks. As you know, today I introduced the board to my Jewish therapist, Mr. Ginsberg. You have yet to meet my fabulous Sri Lankn psychopharmacologist, Dr. Sivakantha. A most pleasant young man, with more mental issues than myself... but I digress. Dr. Siva, as he is known more commonly, seemingly disappeared for an extra two weeks after the recent Christmas holidays, and got in trouble with the administration of COMHAR (http://www.comhar.org/) consequently receiving the ole heave-ho. My last visit with him was in mid-January and he gave me one set of refills and pseudo-dished about his situation, so my next visit in mid-March will be with an entirely new doctor who, as yet, has not even been hired so I couldn't even schedule an appointment.
Anyway, that's neither here nor there really, but I kind of grew to like the man. I still managed to squeeze a decent 60mg of klonopin out of him monthly, though when I first saw him it was 90mg and he balked -- I'd been getting that from the kindly Quaker hippy chick who departed suddenly to run an orphanage in the Nepalese countryside. At one time I was regularly receiving 120mg from a goatee'd French man in Manhattan (he was VERY cute too, but straight). It's amazing how some people dole that stuff out . As many of you know by now, Philicia likes her sedatives and tends to go to town when she gets her monthly bottle, so I'm pondering taking advantage of the situation of a new psychopharmacologist and proposing a complete cessation of my pesky, secretive med abuse which has gone on for... oh, a good seven years now. le sigh... seriously, google "klonopin + Stevie Nicks" and you'll see what I've been dealing with. You don't even want to know how much of it I can digest at once and still function. I'm like a horse.
So, at the same time my game plan is also to propose wiping my system of ALL psycho meds, which I've already privately done and just not told Dr. Siva. All of these retarded doctors INSIST on having me take SSRI anti-depressants. My first doctor, the gay Jew with the zen garden on the Upper East Side, diagnosed me in 2000 with generalized anxiety disorder, which I think is correct. But he also gave me an SSRI prescription because he said it would make the Social Security/Disability Gods happier people, and for me just to not really take them. This was all after attempting both Prozac and Zoloft, both which were either like being on speed or a water pill, neither helping me in any manner. Then due to changes in insurance I had to leave the gay Jew and see the straight cute French man, who made me try Effexor. That only aggravated my already overly intense Kaletra diarrhea, making me go up to 20mg of loperamide DAILY while doing nothing for the depression. I started to learn just to act like I took the stuff and then collect it in a box and donate it somewhere. Trust me when I say I *never* play doctor like this with HIV meds... never.
So I've also done Wellbutrin (dreadful) and Cymbalta (gave me high blood pressure... had to stop). Too make a long story shot the past 7 years of all of this, combine with other wretched personal issues so dreadful that I never discuss them in public on AIDSmeds, have made for a rather tortuous existence.
SO FELLOW BOARD MEMBERS I ASK YOU FOR HELP
Sorry this is SO long winded. Frankly I'd not read it myself if I were you. I detest long ass posts on web forums, but in this case the background information is important. I just get NOTHING from the SSRI meds, and after I clear out my body for 2 months I will ponder attempting something else, because quite frankly I *do* have severe depression. I'm actually a rather cheery, non-depressed sounding person if you encounter me in person... but TRUST I have all of those symptoms you read about in the confines of my residence. You know the drill.
So, please tell me what you take as long as it's not an SSRI. I also have insomnia issues and may consider Trazadone which I think many of you take, so was wondering how that will help my anxiety/depression issues all in one swoop.
Thanks.
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The answer is simple.
It's time Philodendron for you to consider embracing the wonderful world of Tri-Cyclic Antidepressants. These are good old fashioned psych pills which have kept a million housewives supple, subserviant and oh so compliant.
TCA's (such as doxepin) have a sedating effect. Granted they have a few nasty side-effects such as dry mouth and occasionally urinary retention requiring catheterisation, but I'm figuring that would be probably be a kick for you, doll.
Seriously, years back when Matty the Damned had a brush with the Black Dog he was treated with a course of TCAs, finally settling on a delightful number called imipramine which, incidentally, is used to treat bedwetting in children. 18 months later he felt fine and was gradually withdrawn and has never had a day's real misery since.
TCAs can be mixed (carefully!) with benzodiapenes (oxazepam is a good one) or even high-powered antihistamines such as doxylamine succinate.
One word of caution. In overdose TCAs are bad news (or good news depending on one's perspective) as they are absorbed quickly. They bind strongly with protein and that makes dealing with overdose toxicity very difficult. So if your prone to dark thoughts of ending it all, they may not be for you.
Just offering some food for thought.
MtD
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Oh, I should have been more clear with my initial post: in no way have I ever been prone to thoughts of suicide. Fortunately, it's not at all in my nature. I'm much too much of a big ole sissy to contemplate something like that.
I've heard you reference this class of meds, MtD -- so I'll be sure to bring it up. However, I'm not at all familiar with them and, in fact, I think I've only ever heard of them from you, so I wonder if it's something widely used here in the Land of the FreeŠ ... guess we'll see.
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Not suggesting that you are prone to stepping into the den with a revolver dear, but with TCAs it needs to be mentioned.
They're a rather old fashioned style of anti-depressant and have been used widely everywhere in the civilised world.
And also in Canada.
Of late they've been displaced by the SSRI class due to pansy arsed concerns about "side effects". Given your record of dealing with ARV side effects, I'd wager that TCAs would offer you little problems.
As you say, look 'em up.
MtD
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Hello Philly,
Please be careful with getting off from such high doses of clonazepam due to seizure risks. It will need to be weaned carefully. That in itself would be a huge task to undertake, most preferrably with the doc's supervision.
The unusual response that you have to SSRI's (i.e., feeling like you're on speed) makes me wonder if there is an underlying diagnosis other than just depression (and anxiety)? That might be something to keep in mind and discuss with the psychiatrist.
Gerry
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Oh yeah gerry, I totally know that routine. When I've gone down a milligram previously in dose it's been totally supervised a tapered, but I've had no problems at all.
You know, my first shrink seemed to think that perhaps I lacked some needed enzyme to tolerate SSRI's, but by the time we arrived at that I'd had to switch doctors. And seeing as how I'm about to be on my fifth psychopharmacologist in the span of 7 years obviously things have fallen through the crack. It's hard to get them up to speed with my situation when they all keep quitting on me :(
I think I should write down a page of information and just fork it over during my first visit this time. I have a month to collect my thoughts, and include any suggestions from this thread.
I'm just frustrated with the situation, and in fact have just come to the conclusion that I will just have to adjust and live with it, that it's in fact not solvable. I'm not sure I should think like that, but seriously after only mild improvement (all only from cognitive therapy, NOT from any of these meds) what else can I do? I'm just over it. And obviously every time I start a different SSRI, and I've cycled though about six of them, it's like getting on a long roller-coaster. I'm really worn out from it.
It's really, really TIRED that here I am, having fought like hell with my HIV treatment, and gone from an AIDS diagnosis with under 200 cd4s and now have had +1,000 for the past year (granted that covers a span of 15 years) but if my mind is so utterly fucked then something is missing.
Basically at this point I just don't believe in psychotropic meds and view them as some sort of questionable voodoo.
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Recedite yourself, imperator!
Here's a possibility to throw into your basket: an anti-psychotic, like Seroquel. You may have been misdiagnosed. You're certainly manic here on the site and within 500 feet of a Dominican; it's frankly depressing to think you're cowering within the cobwebs of Miss Havisham's bed chambers when you're alone in your dungeon. Could it be that you're actually bi-polar?
Besides, drugs like Seroquel are used off-label for many purposes these days. I use Seroquel for my severe insomnia, as do many others. (However, I'm also on Celexa and 1 measly mg. of Klonopin daily "to take the edge off"--and I have to beg my tight-assed MD for that.) If you tried Seroquel for your insomnia problems, you might find it works for other things as well. But you've also got to try to stop being a pill-hound and using them all at once.
As they say, just sayin'....
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Well, I've certainly brought up the BP issue and it's been religiously shot down now by 3-4 psychiatrist spanning 7 years of treatment. Gerry was nice enough to PM me about this thread, and I went into a little more depth with the underlying things that have happened to me in the past 10 years which seem to have specifically triggered all of this depression. You know, the first 5-6 years of my diagnosis I was perfectly fine mentally... no problems at all. Got over the bad news in a week or two and just got down to business.
One of my closest friends is BP and I don't even see myself quite like that, but hey I'm no doctor.
And my Dominican mania predates my HIV diagnosis dear... let's not go there.
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Hi Philly,
Ed is correct in saying that atypical antipsychotics (Abilify, Seroquel, Risperdal, Zyprexa, Geodon) are being used more and more (although off-label) in treatment-resistant depression. However, most literature that report this use them as an augmentation to SSRIs. Your main issue is you cannot tolerate SSRIs. So perhaps an adequate trial of tricyclics (amitriptyline, doxepine, etc) or tetracyclics (trazodone, Remeron) may be something to consider. These meds also improve sleep. I have not seen studies that combine both tricyclics/tetracyclics with atypicals. Also, I have not seen studies that say using atypicals alone are effective in treatment of unipolar depression. They do sedate as well so they can help with sleep problems.
The other thing to be careful about use of atypicals is metabolic side effects, including weight gain and alterations in blood sugars and cholesterol, and that may be an issue if you are already taking PIs that also cause similar side effects (on blood sugars and cholesterol).
Just some additional food for thought...
Gerry
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Yes, I think I told you in my last PM that I took Remeron for 3-4 years. I totally liked it and tolerated it well, but mostly for it's help in my insomnia. I don't feel it really did anything for my depression, but it certainly was not bad. Also the metabloic stuff was beneficial at the time, because in 2002 I had my most severe wasting where I went from 170 > 140 lbs, and just looked atrocious.
In '05 I went off it when I bloated up to 185 from 165 in the span of a few months and my blood pressure sky-rocketed, and I've been on Diovan ever since. I'm around 180 now and I really do NOT want something where I gain weight.
Otherwise I'm on the following combo if that helps: Preszista, Norvir booster, Isentress, Truvada.
Like I said, it's quite clear I need to write a lot of things down for this new person, as my medical history with all of this is so fucking contorted that I actually pity someone making sense of it. There's such a lack of continuity as I've had to shuffle from doctor to doctor for reasons of insurance changes and moving from NY to Philadelphia. None of that has helped, and it was enough for me considering my HIV med resistance issues to focus first on my HIV treatment (obviously).
Thanks to all of you for these suggestions. It's times like these that one realizes the marvelous beneficial nature of this board.
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Yes, unfortunately, weight gain is a big issue for Remeron. Trazodone or tricyclics might be reasonable alternatives if you haven't tried them before, though weight gain is still listed as a side effect (but not as bad as Remeron).
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I think Lexapro is generic in Canada. Why dont you order it online? Or is that illegal?