Likewise, don't feel required to be my personal disgruntled ex-shrink and read my posts and respond. I realize I prattle some, but it's because the field of psychology interests me, my awareness really interests me, and well, I'm a verbose fuck. (Page down for proof.)
Well that sucks big ass. A couple of weeks ago I finally discovered the one word that could describe my depression: anhedonia. I'm not sad, like most depressed people, I just can't feel pleasure. Nothing interests me, excites me, or motivates me because I don't get pleasure out of things. That'll be a big factor when deciding on the next meds.
Why's that? I do have a large anxiety component to my depression (mostly precipatory anxiety), but it seems to go away on Zoloft and return when I stop taking it.
Boy is that an understatement. :) When I hit a certain dosage of Adderall it was like a fog lifted. It was like up to that moment I had been watching my life on the TV and suddenly I wasn't. It helps me to concentrate, and allows me to get pleasure out of things. Unfortunately, it also worsens my anxiety.
That's the crux of my dilemma -- For anxiety, people usually get prescribed a sedative or an SSRI. For concentration problems people usually get prescribed a stimulant, dopaminergic, or an SSRI. For anhedonia, people usually get prescribed an SSRI, or a dopaminergic. So, if:[list][*]I take a sedative for my anxiety, I'll be hurting my concentration
[*]I take a stimulant for my concentration, I'll be hurting my anxiety
[*]An SSRI looks like a good choice, but though it helps my anxiety, it does nothing for my concentration, and little for my anhedonia.
[*]A dopaminergic seems like a good choice for my anhedonia and concentration, but I've never heard of a dopaminergic being used to treat anxiety. (Have you?)
[*]The NARIs are really new (I don't even think there's one out yet, though Eli Lilly's Atomoxetine is *expected* to have FDA approval by the end of the year), so not much research exists on them. I've had such amazing results with the psychostimulants though, which (I believe) influences noradrenaline (which itself influences dopamine), that I really want to give the new Noradrenaline drugs (NARIs, SNRIs, NaSSas) a shot.[/list]
Adderall helps my concentration and mood IMENSELY, but at 120 mg a day. This is pretty high, but on a mg/kg basis still within recommended dosages since I weigh a small buffalo. However, since Adderall is made up of 4 amphetamine salts (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate, and Amphetamine Sulfate) I'm wondering if the reason my dosage is so high is because just one (or two) of those salts is really what's helping my mood and my concentration. If so, then if I just take one of those salts (such as Dextroamphetamine), my required dosage will drop.
Also, I've noticed that the required dose of Adderall to attain the same mood effects (but not concentration effects) lowers when I'm off the Zoloft, which makes sense now that I know that SSRIs have a tendency towards anhedonia. Maybe then it's just a matter of taking enough SSRIs to curb anxiety and psychostimulants to overcome the anhedonia exacerbated by the SSRIs. That's pretty much what I'm doing right now with 200mg Zoloft a day and 120mg AdderallXR a day. It works great, though inconsistently. I'd try to iron out the inconsistencies rather than explore new drugs if it wasn't for my concern over long-term psychostimulant use.
I'm glad you did. I've always had a problem with my weight (I've probably lost 30 or more pounds 5 times in my life just to gain it back and more) and I finally decided to have my thyroid checked after an insanely fast weight gain. (200 pounds in 3 years.) The results came back that my thyroid was fine, however. I was really surprised by that, so maybe my HMO screwed up the test, maybe the test itself wasn't specific enough, or maybe my thyroid is fine. Regardless, this time I'll let an endocrinoligist decide. Any recommendations on what they should test for? (To test for anhedonia and lethargy more than weight gain, since I'm finally getting a handle on the latter.)
[quote]If you sat down in my office (assuming my office was in the Phoenix area, and I was still a therapist), and you told me you were depressed, I would ask about certain things:
* Daily activities-- are you working like a 9-5 job or anything?...
* Social supports-- who do you talk to every day?...
* Self-care-- food and all that.[/quote]I don't mind answering these, but I don't think they factor in. My depression isn't the sad variety, it's the anhedonic type. I know the difference because I used to have the sad, suicidal type. Then my daily activities, and social supports (and self-care as an indicator) did contribute to my depression, not causually, but sustaining it.
But now, it just isn't true. I can't feel pleasure no matter what my daily activities. (I have the same emotional response to going to school as to going on vacation.) I am pretty happy with my social supports to in that I never feel something's missing. I have a couple of friends in town, family in the area, and all you cyber friends. I want to meet a buddy in town who digs computers like I do. (I'm just getting into tweaking, programming, cracking, hacking, and the like, a grouping I've affectionately named Bone Throwing.) But I've always made friends easily because of my sense of humor, so that's not a problem. As for self-care, I've lost 85 pounds, quit smoking, quit chewing, quit caffeine, quit carbonated drinks, and dropped 24 points in cholesterol, all in less than 10 months. My self-care 10 months ago was ass. Now, it rocks.
Not that I don't have issues. I'm overly compettitive, always looking ahead or behind rather than being in the moment, a pain avoider rather than a pleasure seeker (or rather than a combination), I care WAY too much what people think about me, I'm passive aggressive, and I tend to change how I remember an event if it makes me appear in a better light. So I have issues, but all are realized and being worked on.
So mine is the two-barrel approach proven most effective - I'm working on my ideation process and I'm getting medicine. It's just difficutlt to find a medicine (or combination of medicines) that treat concurrent anhedonia, concentration, and anxiety since the medicine that normally helps one of these, hurts another.
I'm seriously not as fucked up as I sound. :)
---
I ate a hooker half a bottle of knife.