any advice greatly(!) appreciated

[doctordog]

I suffer from very bad OCD, inattentive ADD and some form of depression (atypical.. though suspecting bipolar lately). I also struggle with an addictive personality .. it's never evolved into anything drastic re: narcotics, but I am liable to e.g. compulsively surf the 'net or get hooked on a videogame or whatever.

Was gifted as a child, did well until the age of 19 (when OCD set in) and life has been a basic variation of hell for the past 9 years (recently turned 28). I've been through the gamut of SSRIs, stimulants, benzos, atypicals, TCAs, MAOIs etc. Only avenue unexplored are the more hardline mood-stabilizers like Lamical, Lithium and so on.

Present symptoms are insomnia, cognitive deterioration and depleted attention span, fatigue (unable to exercise), social withdrawal and loss of motivation. What doesn't help is that I live in an extremely noisy household with a family I barely tolerate, but I'm agoraphobic and also don't qualify for any social assistance here.

Now, first up, I know my condition is bad and believe me, it's not from laziness or neglect. I've been through continuous CBT (with measly gains), fought hard to try more unconventional treatments like Memantine or Riluzole (which I launched an internet fundraiser for) etc. I'm just *so* worn out after a decade spent fighting that I can barely muster the hmph to do anything anymore. Suicide has been a constant presence at the fore and background of my mind for the past year and is starting to feel like an inevitable outcome.

Part of the issue is that I'm very sensitive to drugs. I can't recall if this is something that's emerged post-depression or not. Either way, a) benzos spin me out and make me agitated, b) I can take about 2.5mg of Dexedrine (laugh, I know) before I get overstimulated.. I could tolerate more on SSRIs though c) SSRIs give me akathisia and restless legs, d) ditto for atypicals.

I have a couple of questions from this thread:

1) Is it all possible to speculate why Riluzole (glutamate-release inhibitor) would cause *more* anxiety? I was so counting on it being the magic bullet. Could this be related to the paradoxical-benzo thing?

2) Ditto for Memantine .. I know it acts at D2 (though was led to believe its action is negligible) but is there anything potentially anxiogenic about NMDA antagonism?

3) The reason I ask is because I've long been interested in the idea of stimulant-tolerance prevention as a target for ADD/depression. At this point, I feel like I'm so divorced from life that any hope of rebuilding or recovering needs some kind of simultaneous cognitive and hedonic improvement. I recall last year when I was on Dexedrine .. before it turned on me after a few days (I inevitable become strung out and anxious); I read an entire philosophy book in about 3 days (heretofore impossible with ADD) and the feeling of having my brain back, ever so briefly, was amazing. In order to tackle OCD, it would just be so great to have something else going on .. most of the time, when depressed or overmedicated, I feel like a dependent child.

Anyway, I don't know if, given my sensitivity, it might be worth a look revisiting agents like Riluzole or Memantine (still have a supply) together with an AD or if I just need to give up on the idea.

I'm meeting a new psychiatrist soon, in a week or two, and understand the priority is to treat depression/anxiety, so am open to anything he can suggest from conventional psychiatry. Parnate, I should add, has been the best thing to date, but I couldn't sleep and it didn't help anxiety (was good for depression, motivation, ADD though). I'm terrified of a hypertensive crisis though, so would prefer to avoid it.

I just want to keep my ear out for anything else unconventional, whether research chems or whatever, that might be worth pursuing -- though nothing illegal, obviously and nothing that would be a hassle bringing into Australia. I'm poor, but can always find money if it's something that might save my life.

So if anyone has any suggestions, or maybe alternative ways to address the stimulant-tolerance thing, I would appreciate it, and please no flaming, things are hard enough already.

Thank you!

 

[sekio]

NsPD is not a medical advice forum. This would be better off in The Dark Side.

By the way... "inability to exercise" is not going to do you any favours at all. You are only crippling yourself by believing that. Exercise is the number one depression killer for a lot of individuals, and if you stop doing things (exercise, social activity etc) for 9 years, of course you will feel fatigued when you start back up. Not exercising at all is not the solution.

I don't think drugs are going to solve your problems. You need to make major lifestyle changes.

 

[neversickanymore]

Hey dog. Sorry you are struggling. I think your future may look bright though since you haven't tried the lamictal yet. I am not a physician so my advise is not to be taken as such. You seem to be having allot of symptoms just like fibromyalgia. I have a theory about fibro and allot of diseases that have similar symptoms as well as some of the suspected autoimmune diseases. I think they may all better label and treated under pan hypothalamic dysregulation. The Hypothalamus portion of your brain controls so many things and it has control over all of you symtoms. It is responsible for controlling your sleep and wake cycles (insomnia), your energy and fatigue levels, the level of our alertness (cognitive depletion and attention span), social functions (social withdrawal), your emotions (fear and anxiety are emotions so agoraphobia), and your moods (depression and motivation).

I had a whole bunch of these symptoms and some other ones and the drs keep trying to treat with all kinds of shit and nothing worked.. after years of suffering and spending a fortune all I had gotten from the medical community was a huge opiat addiction. I had had enough and read through all my medical records from all, and there was thousands of pages as I was really sick, and researched everything about everything.. It is then that I started to look at what was going on with me in a different way then the doctors were. I started to look at it as pan hypothalamic dysregulation and theorized that my hypothalamus was as sorts of outa wack and needed to return to a proper homeostasis. Given the variety of my symptoms and the fact that this system was obviously all jumbled up I cam to the conclusion that trying to manipulate individual neurochemicals was not going to fix this and may even make it worse, kinda the idea of if you want a system to return to a proper state then quit fucling with individual parts as this would likely lead to more problems as the the brain is complex and all interrelated. So if we look at the brain as a rubix cube then trying to solve it or return it to homeostasis by just focussing on one or two of the colors will never work. I feel this is what allot of the psych drugs do.. the manipulate one are two of the neurotransmitters in a complex system and thus can be compared to trying to manipulate one or two colors of the cube and expecting to solve it.

So researched all the ways to promote neurochemical stabilization. On a medication level Lamictal is the choice I made as this drug has been shown to work wonders on many symptoms associated with the hypothalamus. I decided to get off almost all other medications to try and stop messing individually with a system I was looking to stabilize as all the neurotransmitters are interrelated and when you try and stabilize just one it may dysregulated another. I also promoted the most healthy sleep I could manage as sleep is so important in neurochemical regulation and may likely be the underlying cause of your problems. I also used a stimulant to fight through the fatigue and help regulate good sleep wake habits. With some relief from the fatigue I was then able to exercise.. and I know what real fatigue is it was buy far the worst symptom for me.. I could have lived with the rest but when you have to psych yourself up to pick up car keys you dropped because it seems to take such an ungodly amount of effort life is about as terrible as I have experienced. So I forced myself to exercise.

With in a year of limiting my stress, promoting sleep and exercise, and three and a half weeks after begining the lamictal.. I woke up and felt 10,000 times better. for the next five months I I fluctuated with some of the symptoms.. but after that day I felt soooooooooooo much better and now I am completely healed and have no symptoms except a wake sleep cycle.. left to my own I would go to bed at four am and get up at eleven am.. thats just my natural sleep cycle.

Here is a thread that I you should look through as it covers more about this. the thread begins with a different subject but flows into what we are talking about.

An article I wrote on help with withdrawal, inspired by the Thomas Recipe

Hope this helps and my very best wishes.. don't give up I almost did

 

[doctordog]

Just wanted to say thank you for your help, neversickanymore. I don't really have the mental energy to write a long reply, but Lamictal is pretty much at the top of my list at the moment as far as treatment options go, so the success you had is very encouraging.

Just out-of-interest : I noticed in the linked thread that you were taking it with Ritalin at one point. Did you find the Ritalin more tolerable with Lamictal? I find stimulants impossible to use as monotherapy.

 

[neversickanymore]

I very much did. Also as it took a combination of changing my behavior as far as the sleep and exercise combined with the medication and it did take some time, so I would not lose heart if this doesn't work immediately and I would give it the time it may need to help the hypothalamus regulate itself. Also another positive is that the lamictal is usually a really side effect free medication for most people and was by far the best psych medication I was ever on as far a feeling like I was still me if that makes any sense. with the addition of the Ritalin you may likely find relief from the mental fog as well as the fatigue and with the lamictal on bored it could prove to be allot more tolerable. what was the issue you have with the stimulants that made their use impossible for you?

 

[doctordog]

I find my threshold to becoming overstimulated and worn out is really fragile .. so they worked very erratically and might increase my fatigue some days, overstimulate me others etc. They also made me more irritable with time. I've suspected a possible Bipolar aspect to my depression, since Lithium Orotate makes stimulants like caffeine and nicotine more tolerable (haven't tested scheduled stims).

 

[neversickanymore]

Makes allot of sense to me as Bi polar is commonly treated by the lamictal and I feel Bi polar two may be another manifested symptom of the more comprehensive underlying problem. I think you have a very good chance of finding the relief you desire. Please dont put your faith alone in the medication, You may have far better results when it is combined with the correct sleep hygiene and a good aerobic exercise routine. Also since you have had an uncomfortable reactions to the stimulants before.. then if you and your doctor agree I would start these after you have begun the lamictal as it has a good chance of preventing these symptoms but allowing the stim to promote a more mental and physical alertness which hopefully can aid you with the fatigue and mental clarity.