Posted by cache-monkey on October 7, 2004, at 15:15:19
Hey folks,
So, I'll give my history/dx up front. This might be kind of long, but it's relevant to a decision on medications I'm making. If you have time, I'd appreciate your input.
__Mental History__
I've had GAD, social phobia, obsessionality and probably cyclothymia for much of my adult life. The cyclothymia isn't extreme; I think of it as close to normal mood fluctuations. The underlying problem for me seems to be anxiety. The kind with racing intrusive thoughts.When I'm in a good mood it manifests itself as excitement and giddiness, but with an obsessive component. Even during the good times it's hard for me to focus and concentrate on thought-intensive tasks. So maybe there's a component of ADD, but this could be a function of the anxiety also.
When I'm in a bad mood it turns into obsessional introspection and self-criticism. I've also slipped into anxious depression a couple of times. The sort of thing where everything seems meaningless, uninteresting and painful. To the point where all I can think about is how bad I feel, and the thought of work destroys me.
When I'm in a neutral mood, I feel very unmotivated and mentally empty. I tend to become ritualistic, feel bored, snack a lot a lot, particularly on simple carbs. I also have difficulty concentrating.
I started smoking about 10 years ago and that seemed to give me some sort of a kick into mental activity and focus. It has also been a big anxiety reliever for me, which is probably related to more focused mental activity. Every time I've tried to quit smoking I've headed into either deep anxiety or anxious self-judgemental depression.
__Medication History__
In oder, I've tried Wellbutrin, Wellbutrin+Celexa, Wellbutrin+Lexapro, Serzone, Serzone+BuSpar, BuSpar, and BuSpar+Cymbalta.I'm just going off of Cymbalta right now, after a trial in which I got progressively more anxious and jittery, with maybe one decent day in the middle of 18 bad ones. (And that was at a max dose of 30 mg/day.)
My experience seems to indicate that norepinephrine makes me more obsessional and driven in an edgy kind of way. Serotonin seems to make me more anxious and head toward mania.
So, I feel like maybe I'm not one of the people for whom the two "magic bullets" of NE and 5-HT is suited. I've felt the best so far on BuSpar alone. Mostly kind of calm, but a bit unmotivated and with break-through anxiety a few days a week, especially in social situations. But I still felt like each cigarette was kind of keeping my from sliding off of some sort of anxiety edge.
__Medication Future?__
Thing is that BuSpar seems to decrease 5-HT and possible increase dopamine. So I'm thinking right now that maybe dopamine is my issue. That might explain the anhedonia, lack of focus and drive toward reward. It also helps to explain my cigarette addiction and a previous obsession with sex. It might also have something to do with the need for cheap carbs. I.e. simple carbs ~= sugar => dopamine surge. For a number of years I also engaged in binge-drinking, which could yield a similar reaction.Does this seem resonable?
I met with my pdoc yesterday. Upon my suggestion, he agreed to let me try Selegiline at 5mg/day. (I'm an intermediate CYP-2D6 metabolizer, so it's probably better to start with a very low dose.) I feel like this might help for the reasons I mention above, but from stuff I've been reading on this board and elsewhere, it might lead to increased *anxiety* in addition to increased energy. Any thoughts?
Also, I've heard that it is most effective when couple with DL-phenylalanine. Does anyone have experiences with taking selegiline with and with DLPA? Should I try the selegiline alone first, or start off with the DLPA also?
I'm also considereing adding l-glutamine during the day to keep my blood sugar up and the dopamine pumping during the day. I feel like this might help with the smoking cessation, since nicotine has been shown to increase l-glutamine in the brain. Any issues with this?
Final thing: I'm worried about how this might affect my sleep. I've always had problems falling asleep and am concerned about additional problems from selegiline. Would taking a GABA supplement at night help with this? Or should I maybe look to a something prescription-based GABA analogue, like Neurontin or something?
Ok, so this has been long and if you're reading down this far, thanks. As usual, any advice would be greatly appreciated.
Peace,
cache-monkey
poster:cache-monkey
thread:400043
URL: http://www.dr-bob.org/babble/20041007/msgs/400043.html