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Suggest Treatment For Severe Depression And Anxiety Disorder
Hello, I have had depression and anxiety and ADHD my entire life, but was never treated; due to my family s stigma against mental illness and my own self denial about the need to be medicated. I recently had an extreme life crisis (that caused heartbreak, beginning of new job and moving to the other side of a city in 2 weeks time. It was so traumatic, that it increased the above issues. I had been abusing alcohol for about a year and a half. Then realized I had to stop. (just in the past 3 months), I ceased using alcohol but tried substituting with other medications, including suboxone, percocet, heroin (would never shoot, just orally ingested). I have always had a very high tolerance to these things. Even being prescribed pain killers in the past for a few operations, I would need to take 5 (instead of 1) to relieve pain, the amount of anesthesia it takes to knock me out confuses doctors etc. Even Novocane at the dentist, took 3x more to numb me than average patients. When I took the suboxone for extreme depression and anxiety (before going to a psych doc), I took 8mg (as a person never addicted to opiates) and had no side effects! I was told I should have been vomiting and should have gotten very ill from taking that much for the first time. Since I had gone to see a psych doctor, she prescribed me Celexa (after a month, depression and anxiety didn t change), Neurontin (after 2 days of use, didn t help, even if I took more), Xanax (.25; didn t help, so I HAD to take at least 1.5 or 2mg for my anxiety and depression to subside). Then, after about 2 weeks of taking Xanax, it stopped working!. I am now on Wellbutrin and it is NOT helping. My depression, anxiety and ability to focus is getting WORSE! I have 2 questions: 1) Is there an existing condition where some people are extremely tolerant of medications for no apparent reason (i.e never having been an addict?) I was honest with my psych doctor about abusing the .25 prescription of Xanax, but I was telling truth (and not abusing the drug itself. Meaning, I wasn t getting high or anything). Reluctantly she upped my dose to .5mg. I m going to tell her we need to try other things because I m not getting better. I m just afraid to tell her that I am very tolerant and build tolerance to medications very quickly. I don t want her to think I m a drug seeker, because I m not. I just want to feel normal and get better. 2) Based on my brief description of what I m going through, are there any medication combinations that you could reccomened?
Mon, 17 Aug 2015
Excellent questions. First things first: if you are abusing any substance, whether an illegal drug or prescription medication, this needs to be addressed before anything else. Adding antidepressants will not help you if you are abusing or withdrawing from substances. If this is the case, I recommend detox and rehab before addressing depression, anxiety, or ADHD.
You describe a history of anxiety and depression. We'll leave ADHD aside for a moment. The standard treatment for both depression and anxiety is either an antidepressant, psychotherapy, or both in combination, which is usually the most effective. It sounds like you started taking Celexa, after a month you noticed no change, and Wellbutrin was added. This is a sound strategy. Keep in mind that unfortunately, you may not notice an improvement in symptoms using an antidepressant for 4-6 weeks. It requires some patience to allow time for the medication to work, and if it doesn't work, to increase doses and employ augmentation strategies like adding Wellbutrin to the mix. If you are still not feeling better after 4-6 weeks of maximum dose Celexa + maximum dose Wellbutrin, I would switch to a different antidepressant (Zoloft, Lexapro, Prozac, etc) and give that a try.
I would not under any circumstances ever use Xanax, for a couple reasons. First, benzodiazepines actually do not treat anxiety well in the long term; this is the job of an antidepressant. Second, Xanax is a highly addictive benzodiazepine, which should be avoided at all costs in someone with a history of substance abuse. As you mention, you will habituate (develop tolerance to) this medication quickly, and it will not help you in the long-term.
I would avoid treatment of ADHD until your mood and anxiety disorders are addressed. These are causing you the most trouble, and ADHD treatment is tricky because it also involves amphetamines, which are addictive substances.
In summary, I would avoid benzodiazepines altogether, set aside ADHD for the moment, and focus on depression and anxiety. This involves treatment with an antidepressant and, if possible, psychotherapy. Allow 4-6 weeks of maximum-dose antidepressant to work, and if it doesn't, augment with something like Wellbutrin or lithium, or switch to a different antidepressant. There are many to choose from, so be hopeful. I'm sure with time and patience you will begin to feel better.
Dr. Sheppe
You describe a history of anxiety and depression. We'll leave ADHD aside for a moment. The standard treatment for both depression and anxiety is either an antidepressant, psychotherapy, or both in combination, which is usually the most effective. It sounds like you started taking Celexa, after a month you noticed no change, and Wellbutrin was added. This is a sound strategy. Keep in mind that unfortunately, you may not notice an improvement in symptoms using an antidepressant for 4-6 weeks. It requires some patience to allow time for the medication to work, and if it doesn't work, to increase doses and employ augmentation strategies like adding Wellbutrin to the mix. If you are still not feeling better after 4-6 weeks of maximum dose Celexa + maximum dose Wellbutrin, I would switch to a different antidepressant (Zoloft, Lexapro, Prozac, etc) and give that a try.
I would not under any circumstances ever use Xanax, for a couple reasons. First, benzodiazepines actually do not treat anxiety well in the long term; this is the job of an antidepressant. Second, Xanax is a highly addictive benzodiazepine, which should be avoided at all costs in someone with a history of substance abuse. As you mention, you will habituate (develop tolerance to) this medication quickly, and it will not help you in the long-term.
I would avoid treatment of ADHD until your mood and anxiety disorders are addressed. These are causing you the most trouble, and ADHD treatment is tricky because it also involves amphetamines, which are addictive substances.
In summary, I would avoid benzodiazepines altogether, set aside ADHD for the moment, and focus on depression and anxiety. This involves treatment with an antidepressant and, if possible, psychotherapy. Allow 4-6 weeks of maximum-dose antidepressant to work, and if it doesn't, augment with something like Wellbutrin or lithium, or switch to a different antidepressant. There are many to choose from, so be hopeful. I'm sure with time and patience you will begin to feel better.
Dr. Sheppe
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