what will i be prescribed - Social Anxiety Forum
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post #1 of 22 (permalink) Old 01-09-2011, 08:16 PM Thread Starter
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what will i be prescribed


hi everyone um this is my first post and i have a question ... i was diaagnosed with MAJOR,RECURRENT,DEPRESSION and also ATTENTION DEFICIT HYPERACTIVITY DISORDER COMBINED TYPE ANXIETY just the other day ... and i have an appointment wit my doc in 4 days to get meds .... im just curious as to any ideas as to what i will most likely be prescribed for this ? and also what could i say to him to maybe pursuade him "if you will " on giving me a benzo along with these meds i will be getting because i just want them for once in a while in anxiety inducing type outings ....
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post #2 of 22 (permalink) Old 01-09-2011, 08:27 PM
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SSRI+Amphetamine seems the most logical thing, to thread the anxiety, depression and ADHD, i recommend lexapro as first SSRI.

Disclaimer: I am not a professional, all my advice is based on my own research and experiences.

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post #3 of 22 (permalink) Old 01-09-2011, 08:29 PM
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Amphetamine works for anxiety, it will most likely work better for you then a benzo for SA as you have comorbid ADHD, for me amp works best for SA.

Disclaimer: I am not a professional, all my advice is based on my own research and experiences.

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post #4 of 22 (permalink) Old 01-09-2011, 08:54 PM Thread Starter
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ok thnx just curious tho , why would you recommend lexapro ,, or wouldnt atypical antidepressants be better because they affect dopamine also so to me that seems like i would get just an overall better mood
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post #5 of 22 (permalink) Old 01-09-2011, 08:57 PM
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Originally Posted by californiakid18 View Post
ok thnx just curious tho , why would you recommend lexapro ,, or wouldnt atypical antidepressants be better because they affect dopamine also so to me that seems like i would get just an overall better mood
Stay away from antipsychotics wich are BERY dangerous, you will risk permanent braindamage and parkinson like symptons (tardive dyskinesia wich my mum months later still suffers from).

Also they do the exact opposite of what we want for social anxiety! Antagonize 5HT2A and dopamine, we want more dopamine!

Old post of me:

Refuse neuroleptics for 3 reasons:

1) Incosistent evidence based on small pilot study's wich hasnt been replicated in bigger study's AFAIK, as an example:
Quote:
J Clin Psychiatry. 2005 Oct;66(10):1289-97.
Olanzapine/fluoxetine combination for treatment-resistant depression: a controlled study of SSRI and nortriptyline resistance.
Shelton RC, Williamson DJ, Corya SA, Sanger TM, Van Campen LE, Case M, Briggs SD, Tollefson GD.

Department of Psychiatry, Vanderbilt University, Nashville, TN 37212, USA. [email protected]
Comment in:

Evid Based Ment Health. 2006 May;9(2):42.
Abstract
BACKGROUND: This 8-week, double-blind, multicenter study was undertaken to replicate, in a larger sample of patients with treatment-resistant major depressive disorder (MDD; DSM-IV criteria), the results of a pilot study of the olanzapine/fluoxetine combination.

METHOD: The study was begun in August 1999. The primary entry criterion was a history of failure to respond to a selective serotonin reuptake inhibitor (SSRI). Patients (N = 500) who subsequently failed to respond to nortriptyline during an open-label lead-in phase were randomly assigned to 1 of 4 treatment groups: olanzapine (6-12 mg/day) plus fluoxetine (25-50 mg/day) combination, olanzapine (6-12 mg/day), fluoxetine (25-50 mg/day), or nortriptyline (25-175 mg/day). The primary outcome measure was baseline-to-endpoint mean change in score on the Montgomery-Asberg Depression Rating Scale (MADRS).

RESULTS: At the 8-week study endpoint, MADRS total scores decreased by a mean 8.7 points from baseline (28.5) with the olanzapine/fluoxetine combination, 7.0 points from baseline (28.4) with olanzapine (p = .0, 8.5 points from baseline (28.4) with fluoxetine (p = .84), and 7.5 points from baseline (28. with nortriptyline (p = .30), with no significant differences among the therapies. The olanzapine/fluoxetine combination was associated with significantly (p < or = .05) greater improvement (decrease) in MADRS scores than olanzapine at weeks 2, 4, 6, and 7; than fluoxetine at weeks 2 through 5; and than nortriptyline at weeks 1 through 4. A post hoc analysis of a subgroup of patients who had an SSRI treatment failure during their current MDD episode (N = 314) revealed that the olanzapine/fluoxetine combination group had a significantly (p = .005) greater decrease in MADRS scores than the olanzapine group at endpoint. Safety data for the olanzapine/fluoxetine combination were similar to those for its component monotherapies.

CONCLUSIONS: The olanzapine/fluoxetine combination did not differ significantly from the other therapies at endpoint, although it demonstrated a more rapid response that was sustained until the end of treatment. The results raised several methodological questions, and recommendations are made regarding the criteria for study entry and randomization.
2) Long term risks, wich includes a permanent movement disorder wich is no joke.
Quote:
Tardive dyskinesia and new antipsychotics.
Correll CU, Schenk EM.

The Zucker Hillside Hospital, North Shore Long Island Jewish Health System, Glen Oaks, NY 11004, USA. [email protected]
Abstract
PURPOSE OF REVIEW: To provide an update on tardive dyskinesia rates in patients treated with first-generation or second-generation antipsychotics in studies published since the last systematic review in 2004. RECENT FINDINGS: Across 12 trials (n = 28 051, age 39.7 years, 59.7% male, 70.9% white, followed for 463 925 person-years), the annualized tardive dyskinesia incidence was 3.9% for second-generation antipsychotics and 5.5% for first-generation antipsychotics. Stratified by age, annual tardive dyskinesia incidence rates were 0.35% with second-generation antipsychotics in children, 2.98% with second-generation antipsychotics versus 7.7% with first-generation antipsychotics (P < 0.0001) in adults, and 5.2% with second-generation antipsychotics versus 5.2% with first-generation antipsychotics (P = 0.865) in the elderly (based almost exclusively on one retrospective cohort study). In four adult studies (n = 2088, age 41.2 years, 71.2% male, 62.0% white), tardive dyskinesia prevalence rates were 13.1% for second-generation antipsychotics, 15.6% for antipsychotic-free patients, and 32.4% for first-generation antipsychotics (P < 0.0001). SUMMARY: Current evidence supports a lower tardive dyskinesia risk for second-generation antipsychotics than for first-generation antipsychotics. Tardive dyskinesia incidence was higher with second-generation antipsychotics than previously reported, possibly due to recent studies with relatively short mean durations and use of nonstandard tardive dyskinesia definitions.
3) Possibility of even higher risk when those drugs are being used offlablel, still need to check the full text of this one:
Quote:
Curr Drug Saf. 2010 Jul 2;5(3):263-6.
Safety considerations of the use of second generation antipsychotics in the treatment of major depression: extrapyramidal and metabolic side effects.
DeBattista C, DeBattista K.

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA. [email protected]
Abstract
Second generation antipsychotics (SGAs) are increasingly employed in the treatment of depression. Adjunctive aripiprizole and olanzapine/ fluoxetine combination (OFC) have been approved in the US in the treatment of depression. Quetiapine also appears to be poised for an FDA approval as an adjunctive treatment for resistant depression. Historically, first generation antipsychotics were thought to carry an enhanced risk of certain side effects in the treatment of mood disorders, including an enhanced risk of extrapyramidal symptoms (EPS). The second generation antipsychotics are also known to be associated with a variety of metabolic side effects. The use of SGA in a depressed population may pose risks that differ from use in other conditions such as bipolar disorder and schizophrenia. In this paper, the risk of extrapyramidal and metabolic side effects is reviewed in depressed patients treated with second generation antipsychotics.

Disclaimer: I am not a professional, all my advice is based on my own research and experiences.

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-Lenin


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post #6 of 22 (permalink) Old 01-09-2011, 08:58 PM
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Reasening behind lexapro:
http://www.socialanxietysupport.com/...e-ssri-105131/

Disclaimer: I am not a professional, all my advice is based on my own research and experiences.

"A lie told often enough becomes the truth."
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post #7 of 22 (permalink) Old 01-09-2011, 09:17 PM Thread Starter
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oh **** ur right i thought drugs like wellbutrin would increase dopamine but guess it doesnt
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post #8 of 22 (permalink) Old 01-09-2011, 09:20 PM
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oh **** ur right i thought drugs like wellbutrin would increase dopamine but guess it doesnt
Not very significant, but you can get amphetamine's with a ADHD diagnosis.

Disclaimer: I am not a professional, all my advice is based on my own research and experiences.

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post #9 of 22 (permalink) Old 01-09-2011, 09:24 PM Thread Starter
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yes i hope so because last time i went i got strattera which absolutely sucks balls because it treats adhd but it also isnt a stimulant . so im gonna say those didnt work wich they didnt and hope for a ritalin or more amphetamine type stimulant
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post #10 of 22 (permalink) Old 01-09-2011, 09:27 PM
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yes i hope so because last time i went i got strattera which absolutely sucks balls because it treats adhd but it also isnt a stimulant . so im gonna say those didnt work wich they didnt and hope for a ritalin or more amphetamine type stimulant
Keep saying it doesnt work untill you get a good stim, with ADHD there isnt much to try so that will be soon.

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post #11 of 22 (permalink) Old 01-09-2011, 09:38 PM
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As crayzyMed said, you'll almost inevitably, as a matter of seeming course, be prescribed an SSRI. Ask for Lexapro, as he also mentioned, if you can. The combination of that with a stimulant would be good. You could also try combining Wellbutrin with a stimulant, but that might be too activating/anxiogenic. You may also be prescribed a mood stabilizer, if the doc is progressive enough, based on the early onset and recurrence of your depression.

Wellbutrin + Lamictal + Adderall + Klonopin might be good, or substitute Lexapro for Wellbutrin.
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post #12 of 22 (permalink) Old 01-09-2011, 09:52 PM
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probably some dumb SSRI that will have minimum effects. But who knows, everyones different. Probably lexapro or cymbalta. But if you have lots of sex, prepare for a rude awakening. Im on 30mg of lexapro for depresssion
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post #13 of 22 (permalink) Old 01-09-2011, 10:03 PM Thread Starter
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my ideal combonation would be wellbutrin instead of an ssri , ritalin , and klonopin/xanax to settle the anxiety from those two.... idk well see .. anything to stay away from an ssri , i need more effect thenn wut ssri's can provide
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post #14 of 22 (permalink) Old 01-09-2011, 10:07 PM
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ya. ask about klonopin if your jumping off the walls. It makes me tired, philosophical and obnoxious. And it makes me love everything...
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post #15 of 22 (permalink) Old 01-09-2011, 10:09 PM Thread Starter
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probably some dumb SSRI that will have minimum effects. But who knows, everyones different. Probably lexapro or cymbalta. But if you have lots of sex, prepare for a rude awakening. Im on 30mg of lexapro for depresssion
lol thats one reason i want to stay away from ssri's and on the other hand wellbutrin raises youre sex drive wich is why i want it ...... and hows the lexapro work , nd is it anxiolitic for u
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post #16 of 22 (permalink) Old 01-10-2011, 12:07 AM
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I do recommend the addition of 2,5mg lexapro added to amphetamine, unless you still want to use MDMA, it will potentiate the anxiolytic effects with barely any side effects.

I do consider SSRI's on their own fairly useless for SA, but they are good augmenters in low doses.

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post #17 of 22 (permalink) Old 01-10-2011, 12:19 AM Thread Starter
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I do recommend the addition of 2,5mg lexapro added to amphetamine, unless you still want to use MDMA, it will potentiate the anxiolytic effects with barely any side effects.

I do consider SSRI's on their own fairly useless for SA, but they are good augmenters in low doses.
saying it will potentiate , that in itself intriugess mehh ... but im mostly stick with thc . beleive it or not because yes it does increase my anxiety greatly but yet i still love it for some reasonn .
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post #18 of 22 (permalink) Old 01-10-2011, 05:04 AM
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but yet i still love it for some reasonn .
Ah, we are simular minds eh? I do dislike weed but i have my own favorite high's haha.

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post #19 of 22 (permalink) Old 01-10-2011, 05:05 AM
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SSRi's are known to block weed increased anxiety btw, yet another reason to take a low doses of one!

Disclaimer: I am not a professional, all my advice is based on my own research and experiences.

"A lie told often enough becomes the truth."
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post #20 of 22 (permalink) Old 01-10-2011, 07:04 AM
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or wouldnt atypical antidepressants be better because they affect dopamine also so to me that seems like i would get just an overall better mood
I take it by atypical antidepressants your referring to Wellbutrin, Remeron etc. These may indeed increase dopamine a bit, but to nowhere near the extent that a psycho stimulant would.
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