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Author Topic: May be adding a new med next month, thoughts welcome  (Read 109 times)

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Offline AncientMelody

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May be adding a new med next month, thoughts welcome
« on: July 04, 2014, 04:09:10 PM »
Last visit. we decreased my prozac dose from 40 mg to 20 mg due to persistent GI effects. My psychiatrist was hesitant as I've just started a new job and she saw how the prozac has benefitted me (I agree) but I couldn't really tolerate the level of side effects any more. My anxiety has not been terrible but it's been a lot of "work" to keep myself on an even keel.

We talked about adding another medication to augment the lowish dose of prozac at the next appointment if I need to and I am leaning towards that option. She personally likes Remeron which I am open to. However, here is a thought and I was curious what your experiences or opinions were. I want to get her opinion on considering adding wellbutrin. I know it's preferred generally more for depressived symptoms rather than anxiety. However fatigue is a huge problem for me. I need naps, I get drowsy driving more than twenty minutes. That's been preexisting before the anxiety. And the fatigue itself can be a trigger that makes me feel panicky. I'm thinking maybe the "activation" of the wellbutrin could be helpful towards the fatigue.

What are your thoughts?  I'm going with whatever my psych discussed because I have a lot of faith in her judgement, but it is something I wanted to discuss with her.  I know Remeron can be sedating, though I know she thinks having me sleep more would be a benefit too which I'm sure that would do.
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Re: May be adding a new med next month, thoughts welcome
« Reply #1 on: July 04, 2014, 06:32:54 PM »
However fatigue is a huge problem for me. I need naps, I get drowsy driving more than twenty minutes. That's been preexisting before the anxiety. And the fatigue itself can be a trigger that makes me feel panicky. I'm thinking maybe the "activation" of the wellbutrin could be helpful towards the fatigue.

....I know Remeron can be sedating, though I know she thinks having me sleep more would be a benefit too which I'm sure that would do.

So the fatigue is mostly because you don't get enough sleep? If so then Remeron would be the better bet. Wellbutrin can be highly stimulating which may counter the fatigue in the short-term, but may exacerbate the insomnia. It might also significantly increase anxiety levels.

On the wider question, wouldn't it be better to dump the Prozac for an antidepressant you can tolerate at an effective dose, than sticking with it and adding other meds to get a result?

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline AncientMelody

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Re: May be adding a new med next month, thoughts welcome
« Reply #2 on: July 04, 2014, 06:51:36 PM »
Sorry to be confusing, no the fatigue is not just a sleep issue. I can wake exhausted after  nine hours of sleep. I function better with more sleep, but even then it's a rare day where I don't feel
noticeably tired. And it's not just secondary to unmanaged anxiety, it's been a long term issue for me, one I will be evaluating with my family doc in the fall too.

Re: one higher dose med versus two, I understand what you're saying and that may well be an option two. However I've had dose limiting side effects with everything so far. Prozac is the first daily med that's helped me and I've been treated for 11 months now..... We're both therefore hesitant to give up on the Prozac completely
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Re: May be adding a new med next month, thoughts welcome
« Reply #3 on: July 04, 2014, 08:29:41 PM »
Prozac is the first daily med that's helped me and I've been treated for 11 months now..... We're both therefore hesitant to give up on the Prozac completely

Okay, understood. Perhaps consider also adding Buspar (buspirone). It has the ability to extract more out of the SSRIs, basically the SSRI version of turbo charging. It may also ease some SSRI side-effects too.
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

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