Mental Health Went to Doc for Lyrica script, got Zoloft instead

[Wake_of_the_Flood]

First post here so I'll explain my situation a bit first. I'm a little over 5 months clean from Suboxone (and everything else besides occasional weed smoking). The first couple months off Suboxone, I dealt with some paranoia, depression and anxiety which I attributed mostly to PAWS but generally I had a good amount of energy, focus and motivation. Lately, I have been much more anxious and depressed and I have gained a fair amount of weight and let my exercise schedule go to shit. My lack focus and motivation are the two things really bothering me at the moment. The anxiety comes in waves and has actually been occurring less frequently and with less intensity than before. Depression is harder for me to analyze, but I'm definitely not living a happy, healthy life and I generally try to avoid social situations and connection with others. I see a counselor every other week for cognitive and behavioral therapy.

I know I won't be scripted anything good because of my history of abuse, and I'm honestly not drug seeking at all. In fact, when I saw my doc a few months ago, he suggested Lyrica and I flipped out and declined because I was too fresh off Suboxone and actually enjoying sobriety too much to consider another intense medication.

Today when I saw my doc, he denied ever bring up Lyrica as a solution, even though I am 100% positive he did and was ready to shell me out a script in April. Instead, I got some speech about serotonin and how my brain chemistry is probably still a little off balanced. So he wrote me a prescription for Zoloft and now I really am unsure how to proceed.

I hate the thought of taking an SSRI, since I feel numb enough already and the fact that no positive results will result for over a week is really a mindfuck to me since I am so accustomed to instant gratification.

I'm extremely tempted to just suck it up and get my ass to the gym and forgetting today ever happened. But I'm also extremely curious if he may be right and depression is really the underlying cause that lead me to self-medicate with opiates and other drugs for so much of my early adulthood. Does anyone have any advice or experience with Zoloft or have any advice for me? I feel like giving me an SSRI was just a cop out for him sensing that I was drug-seeking and looking for something with recreational value with maybe a hint of concern about my fragile mental condition. I just want to do what is best for my recovery and what will keep me from losing my job and being such a fat, lazy, anti-social person.

 

[paranoid android]

I have taken amitriptyline, mirtazapine (remeron) and bupropion (wellbutrin, Zyban) while coming off opiates. Out of those bupropion was the best for helping with the anhedonia and depression of PAWS. However since bupropion is a stimulating anti-depressant as it is a NDRI it can worsen anxiety and insomnia in some people. I have always had to take a anti-psychotic coming off opiates to help with the restlessness and mood swings but i have bipolar disorder so it's a wee bit different for me

SSRI's won't help to balance your brain chemistry or to reset it to it's pre addiction state but it may help your depression and anxiety. Although SSRI's work as bout as well as placebo they do help some people quite abit. Personally i would say maybe trying a tricyclic such as amitriptyline wouldn't be a bad idea. Amitriptyline is a serotonin norepinephrine reuptake inhibitor with strong anti-cholinergic side effects which is what gives it it's knock out effect. I found that it to be the best sleeping pill i ever had actually. It did help with my bipolar depression as well and unlike Effexor it didn't make me feel fucked up or numb.

The best cure to get over the post acute withdrawal syndrome is a healthy diet, exercise and time. Those will help your brain get back to a more balanced state far more then any pill ever will.

 

[pro re nata]

congratulations on being clean and free of suboxone!! that is really great. as you were saying that it has been 5 months so there is the strong chance that you could still be going through PAWS and mentally readjusting. you do have some good thoughts and concerns in looking at under lying mental health issues as it is for sure a reason for many of us addicts to chose and self medicate.

anxiety is a straight bitch and the only real cure for it is to try and pin point it's origins with in. do you think the sessions you are having with your counselor are helping at all in dealing with motivation, depression and your anxiety?? if so maybe try and see them once a week instead of every other week.. i think CBT can be very helpful in dealing with this transitional period. to me a lot of the emotions and lack of focus/engagement is completely typical to be feeling and facing during this time period. whats cool is that you know things that can help you from working out to creating a more balanced schedule to general every day health... with looking at this and realizing these things in a way you are challenging yourself to take steps in reaching and obtaining these totally beneficial measures in building a life style you desire. that is kick ass!! i know the hardest part in making a move is the getting up... so yeah. but the thought is there so there is already some momentum that exist for moving in this positive direction. sounds like it just needs a lill pushhh.. ..

i am kind of surprised that you doctor talked about prescribing you lyrica. do you have pain issues or was it just as an anti anxiety/anti depressant?? a medication to call your doctor about and perhaps talk to about in aiding you through this transition is wellbutrin. it is not an ssri or a snri it is a ndri - norepinephrine-dopamine reuptake inhibitor. this medication can be very helpful in dealing with PAWS and its wake. it is an a-typical anti depressant that is used for both long and short term depression with this it is much easier to start and stop taking the medication than a traditional ssri/snri. it is known to help with all of the symptoms you are talking about, it is also a nicotine antagonist aiding in smoking cessation. might be a worth wile phone call as you are on the fence about the zoloft. the wellbutrin should help you with motivation and energy not dull you out.

i think this for a time period could help you with a bit of that "push"... .. are you taking any supplements/vitamins??

it is awesome that you want to do what is best for your recovery and continue to build on all the wonderful strides you have made thus far!! do not even stress for a minute about your doctor thinking you are "drug seeking" be totally honest and real with him about your feeling/concerns and that your recovery is a top priority. he/she should give you much respect for this and if you do not feel so maybe it is time to look for a new doc... important to be proactive with your doctors. keep working at it and moving forward!!

 

[Wake_of_the_Flood]

congratulations on being clean and free of suboxone!! that is really great. as you were saying that it has been 5 months so there is the strong chance that you could still be going through PAWS and mentally readjusting. you do have some good thoughts and concerns in looking at under lying mental health issues as it is for sure a reason for many of us addicts to chose and self medicate.

anxiety is a straight bitch and the only real cure for it is to try and pin point it's origins with in. do you think the sessions you are having with your counselor are helping at all in dealing with motivation, depression and your anxiety?? if so maybe try and see them once a week instead of every other week.. i think CBT can be very helpful in dealing with this transitional period. to me a lot of the emotions and lack of focus/engagement is completely typical to be feeling and facing during this time period. whats cool is that you know things that can help you from working out to creating a more balanced schedule to general every day health... with looking at this and realizing these things in a way you are challenging yourself to take steps in reaching and obtaining these totally beneficial measures in building a life style you desire. that is kick ass!! i know the hardest part in making a move is the getting up... so yeah. but the thought is there so there is already some momentum that exist for moving in this positive direction. sounds like it just needs a lill pushhh.. ..

i am kind of surprised that you doctor talked about prescribing you lyrica. do you have pain issues or was it just as an anti anxiety/anti depressant?? a medication to call your doctor about and perhaps talk to about in aiding you through this transition is wellbutrin. it is not an ssri or a snri it is a ndri - norepinephrine-dopamine reuptake inhibitor. this medication can be very helpful in dealing with PAWS and its wake. it is an a-typical anti depressant that is used for both long and short term depression with this it is much easier to start and stop taking the medication than a traditional ssri/snri. it is known to help with all of the symptoms you are talking about, it is also a nicotine antagonist aiding in smoking cessation. might be a worth wile phone call as you are on the fence about the zoloft. the wellbutrin should help you with motivation and energy not dull you out.

i think this for a time period could help you with a bit of that "push"... .. are you taking any supplements/vitamins??

it is awesome that you want to do what is best for your recovery and continue to build on all the wonderful strides you have made thus far!! do not even stress for a minute about your doctor thinking you are "drug seeking" be totally honest and real with him about your feeling/concerns and that your recovery is a top priority. he/she should give you much respect for this and if you do not feel so maybe it is time to look for a new doc... important to be proactive with your doctors. keep working at it and moving forward!!

Thank you for your incredibly thoughtful and encouraging reply!

After sleeping on it for a night and reading both replies, I have decided to tough it out and not begin an SSRI regiment right now.

I do believe the symptoms I am experiencing are a combination of PAWS, an increasingly sedentary lifestyle, and situational factors involving my job and other personal matters which I will not go into further.

Therapy has been somewhat helpful, although I find the positive effects to wear off after a day or so after the session. I usually walk out of there feeling great though, so it must be doing something beneficial. Since I've decided to go the no medication route, I don't think looking for a new doctor is necessary even though I seriously doubt my current doctor's ability to comprehend what I am going through. He mentioned referring me to a psychiatrist since he admitted he might not be able to properly diagnose me.

I'm going to stick with the natural remedies for at least another month and see how it goes. I've been taking Fish Oil, Vitamin B-Complex, and a Multi-Vitamin and occasionally L-Tyrosine for an extra boost of mental energy, but I've found some negative effects with the L-Tyrosine like increased agitation. I will sometimes take Benadryl or Melatonin for sleep too. I've been sleeping pretty consistently for the last few months however, so I don't think that is the issue.

The "push" to exercise is really the key, since I know that is one of the few things that really helps and it would help considerably with one source of my anxiety which is poor body image and feeling insecure about the weight I have put on.

Thanks ParanoidAndroid for the SSRI recommendations too. I've read the study about the placebo vs. SSRI and that seals the deal for me in terms of my decision to stick with natural remedies. It's not what I am basing my decision on (since it would be absurd to do that from the results of one specific study), but based on reading a lot about other people's experiences, it just doesn't seem like the risk/reward ratio is worth it for SSRIs and they should be used more as a "last resort" imho. I'm going to stick it out until at least the 6 month mark, since that has been a milestone in recovery that I have been looking forward to for a while.

 

[pro re nata]

hey.. .. really great news!! i totally think you have a wonderful mind set for dealing with and yep "pushing" your way through PAWS. by going about things in the natural way you are is going to help you way more than any ssri. plus just cleaner and better for the long haul, you will be able to look back at this and feel so good with how you made it through.

i think the thing with therapy is it kind of just like you described, a subtle process that builds upon itself over time. as time passes by you do not even realize how much progress you are making mostly because it is in small delicate steps. i have found keeping a journal through it is a great record of where things were and where they are going.. such good stuff to be able to look back on especially during tougher times. if you can try and bump up your meeting to once a week.

you have a great list of supplements and vitamins, maybe try and through a potassium boost into the mix. instead of the l-tyrosine you could add a straight vitamin b-12 in along with your b-complex and some extra vitamin c. valerian here and there in helping aid your anxiety at more profound moments.. but yeah exercise and looking at and confronting the underlying issues is always best!

you are doing an amazing job in progressing through this period!! keep up the good work and positive direction the more time passes the better you will feel and it is amazing how nice it does feel to be consistent day in and day out with out a substance... ..

 

[paranoid android]

Thank you for your incredibly thoughtful and encouraging reply!

After sleeping on it for a night and reading both replies, I have decided to tough it out and not begin an SSRI regiment right now.

I do believe the symptoms I am experiencing are a combination of PAWS, an increasingly sedentary lifestyle, and situational factors involving my job and other personal matters which I will not go into further.

Therapy has been somewhat helpful, although I find the positive effects to wear off after a day or so after the session. I usually walk out of there feeling great though, so it must be doing something beneficial. Since I've decided to go the no medication route, I don't think looking for a new doctor is necessary even though I seriously doubt my current doctor's ability to comprehend what I am going through. He mentioned referring me to a psychiatrist since he admitted he might not be able to properly diagnose me.

I'm going to stick with the natural remedies for at least another month and see how it goes. I've been taking Fish Oil, Vitamin B-Complex, and a Multi-Vitamin and occasionally L-Tyrosine for an extra boost of mental energy, but I've found some negative effects with the L-Tyrosine like increased agitation. I will sometimes take Benadryl or Melatonin for sleep too. I've been sleeping pretty consistently for the last few months however, so I don't think that is the issue.

The "push" to exercise is really the key, since I know that is one of the few things that really helps and it would help considerably with one source of my anxiety which is poor body image and feeling insecure about the weight I have put on.

Thanks ParanoidAndroid for the SSRI recommendations too. I've read the study about the placebo vs. SSRI and that seals the deal for me in terms of my decision to stick with natural remedies. It's not what I am basing my decision on (since it would be absurd to do that from the results of one specific study), but based on reading a lot about other people's experiences, it just doesn't seem like the risk/reward ratio is worth it for SSRIs and they should be used more as a "last resort" imho. I'm going to stick it out until at least the 6 month mark, since that has been a milestone in recovery that I have been looking forward to for a while.

Funny you mention L-Tyrosine because i took that with wellbutrin a few times to get myself out of a horrible depressive funk. I figured that since L-Tyrosine is converted to Levodopa and is thus a precursor to dopamine which is then converted into norepinephrine that adding it to a norepinephrine and dopamine reuptake inhibitor like bupropion would boost the effects. As it turns out it worked a little to good . I don't know if it's just because i have bipolar disorder or if there was just too much dopamine and norepinephrine floating around in the old synapses but it basically triggered off a manic episode that lasted a few months. I was so manic that i was getting at the very most 2 hours of sleep and my dad would start with doing some running on the treadmill for maybe a hour, lifting weights and then i would go clean the house from top to bottom. I was so manic that i just could not sit still and even about 2-4mg's of risperidone, 300-400mg's of seroquel and 4-6mg's of clonazepam a day had a real hard time calming me down. It was the longest manic episode i ever had i think. So i became abit more then agitated

Good idea on laying off the SSRI's. The only reason these drugs are pushed so hard is because pharm reps have beaten it into doctors heads that they are the answer to all of life's problems. Well SSRI's and SNRI's anyway. Basically they have just been making different drugs that affect the same goddamn receptors even since Prozac came on the market. I don't know why they have neglected poor old dopamine so much. It must feel like the most left out neurotransmitter ever . There are better anti-depressants on the market then SSRI's anyway and bupropion not only has a much more favorable side effect profile and boosts your sex drive as opposed to killing it but unlike SSRI's and SNRI's there is basically no withdrawals when you stop taking it. So if it doesn't work for you you can always drop it with a very quick taper. I have stopped taking it cold turkey at various times over the years with no withdrawal symptoms.

But diet,exercise and time are the best cure for the PAWS. However if you start to loose the plot i would suggest going to a doctor and getting something to help you. I found the PAWS to cause anhedonia and a overall feeling of nihilism for lack of a better term to the point where it almost drove me completely over the edge. But it seems like you are doing pretty damn good considering so keep up the good work and remember that you will start to feel better as everyday passes

 

[Wake_of_the_Flood]

You guys are both fucking awesome! I hope you can feel some of the good karma from helping me way more than anyone on the internet ever has before...seriously. This place rocks! I hope I can contribute to a thread sometime soon and keep the wheel turning so to speak and help somebody in need of advice as badly as I was.

Oddly enough I feel great today! I'm sure the fact that it's a Friday evening isn't hurting the cause though. My Zoloft script is tucked away in a drawer never to see the light of day again, haven't felt it necessary to throw it out yet just in case.

PAWS are so strange. I feel like I've gotten a preview of just about every mental illness out there in these past 5 months except maybe some of the really crazy ones

Then some days I feel completely normal and I convince myself I'm just being overly sensitive on the bad days.

I'm definitely going to look into the Wellbutrin some more in case the "natural way" runs its course and this cycle keeps repeating until I can't mentally do it anymore. The "ups" are definitely getting better again, and the "downs" are getting less frequent. This week as a whole was pretty bad to be honest. It feels like last Monday was a month ago.

Music helps me a lot too, some days I will listen to 10 hours of music, and one of the few "social" activities I have engaged in has been seeing live music and those nights I felt high on life just like the good old days pre-drugs.

Also going to look into adding some vitamins to my list as you suggested above, and I agree the L-Tyrosine is probably something to stay away from. It also makes it tough for me to sleep now that you mentioned it, those were usually the nights I needed an extra boost for sleep. I've also been listening to this tape most nights before I go to bed:

Hemi-Sync Gateway experience from the Monroe institute

It's been more than helpful in getting a restful sleep and stopping the racing thoughts and anxiety before bed. I highly recommend checking it out if you've been having sleeping/anxiety problems. I doubt it would help someone with really bad sleep problems much, but it can't hurt that's for sure!

Thanks again...really glad I decided to come here and post this thread!

 

[cbtodacb]

find a new doc bro. if you need lyrica for your anxiety you need to get it. find a doc who understands anxiety. My doctor was the one who actually mentioned lyrica and put me on it. i had never heard of it before he mentioned it.