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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Problem With Sleep And Gastrointestinal Issue. Taken Desvenlafaxine And Tried Duloxetine. Anxiety, Depression And Adult ADHD. Smoking. Suggestion?

Hi, My name is Mark. I am a 24 year old male. My height is 187cm and I weigh around 80kgs. 3 years ago I started treatment for anxiety and depression. After having trialled desvenlafaxine for around 6 months without significant effect I opted to try duloxetine 60mg once daily as an alternative. Additionally 1 and a half years ago I was diagnosed with adult adhd and was started on dexamphetamine 30mg/day. In addition to treatment with medication I began seeing a counsellor, whom I saw for the next 2 years.

Since around the age of 21 I have also been a frequent marijuana user.

Last year I travelled with friends to Nepal for 3 months. While there I was arrested for smoking marijuana and spent a week in a local jail. Since returning home I have found myself unable to cope with the anxiety and depression and my marijuana use has increased significantly to compensate. I have found myself smoking up to almost an ounce a week since then.I am aware that this is likely contributing significantly to the anxiety and depression and I wish to try and stop smoking. I also smoke tobacco, around 3-5 cigarettes a day.

I have attempted to quit before unsuccessfully and I was hoping to please get some advice doing so. I have particular issues with sleep and gastrointestinal disturbances when I dont smoke in addition to feeling extremely depressed and anxious.

Wed, 9 Oct 2013
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Addiction Medicine Specialist,  's  Response
Hi,

Since you have multiple issues, try tackling each one at a time. For example, do not try to quit both marijuana and tobacco simultaneously. First try to quit marijuana as it significantly worsens your anxiety and depression. Keep tobacco for later. In my opinion, you will benefit from addition of either buspirone or buupropion to your treatment regimen. Buspirone will reduce marijuana craving and bupropion reduces tobacco craving. Both will reduce your anxiety and depression. You can discuss this with your doctor and choose one.

Hope this helps you. Best wishes.
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Problem With Sleep And Gastrointestinal Issue. Taken Desvenlafaxine And Tried Duloxetine. Anxiety, Depression And Adult ADHD. Smoking. Suggestion?

Hi, Since you have multiple issues, try tackling each one at a time. For example, do not try to quit both marijuana and tobacco simultaneously. First try to quit marijuana as it significantly worsens your anxiety and depression. Keep tobacco for later. In my opinion, you will benefit from addition of either buspirone or buupropion to your treatment regimen. Buspirone will reduce marijuana craving and bupropion reduces tobacco craving. Both will reduce your anxiety and depression. You can discuss this with your doctor and choose one. Hope this helps you. Best wishes.