Confused about current med switch

Dear Expert, I was diagnosed with GAD and OCD in July, 1997, and have been treated both biologically (medications) and psychologically (Gestalt therapy, interpersonal therapy, and CBT) for the past nine years. I have come to the painful conclusion that, despite my best efforts at therapy, and succeses therein (i.e. dealing with childhood trauma, dysfunctional family of origin issues, etc.), at times the only thing that provides consistent symptom relief is medication.

That said, I have been fairly med sensitive, in terms of getting nearly all the major side effects (i.e. weight gain, sexual dysfunction) on Paxil, Prozac, Celexa, Effexor, and even Lexapro. This winter, after having been treated successfully with 5mg of Lex, I weaned myself off, and then put myself back on 5mg, as I had no psychiatrist and had been med-free for the previous year. Well, I soon was referred to a p-doc, and he slowly added generic Serzone, starting with 25mg a day for a month, all the way up to 200mg, beginning in February. I ultimately got a second opinion from another psychiatrist, because he (previous doc) was unapproachable, and seemed unwilling to help me find more relief, despite my strong commitment to the CBT work and other non-pharm inventions (exercise, eating right, etc.). When I asked him at our last visit, if he would be willing to raise the Lex to 5mg and the Serzone to 250, as he had suggested during our previous June appointment, he said, "there's no problem, but I'll have to deal with you." I felt quite dismissed.

Anyway, my new p-doc, very kind and compassionate, asked me to drop the 2.5mg of Lex, and move up to 250mg of Serzone, with the goal of reaching 400mg of Serzone. I am a bit afraid, and have been obsessive over whether I did the right thing in seeking the second opinion. The first week off Lex has been tought, and I am worried I will have bad withdrawals, as I did experience some wooshy feelings in my head, felt groggy, and a minor return of some obsessions. My fear now is, will this ever get better? Is it possible to get relief medication wise from the Serzone alone (up to 400 mg is the eventual goal)? Is this a reasonable try? Is there a way to ameliorate the side effects (grogginess, feeling a bit in a fog, etc.)?

I am also dealing with some difficulties within my family (i.e. wife's chronic pain, inability to resolve relationship difficulties with inlaws, stress from a second job, etc.) I am just looking for a 'third' opinion, I guess. Specifically:

1). Did I do the right thing in getting a second opinion?
2). Is the OCD, etc. exacerbated by underlying anxieties?
3). Is it possible to get relief from Serzone alone (minus the 2.5mg Lex)?
4). Are there any other combinations that might work?

I understand the answer to the question is merely for informational purposes only.

Thank you very much!!!



Sincerely,

A Roy

[Roger Gould, M.D.]

I think you did the right thing in getting a second opinion but I must tell you that finding the right combination of medications is essentially a guessing game for you, and is best done with one psychiatrist you trust who can work with you and his or her knowledge of you to find that combination. there are so many factors to consider, including the amount of current distress.  Serzone is very good, and may work, but I am not sure that you want to have any target dose in mind in the beginning, work up to what works.

[ABCMomof3]

I just wanted to let you know that I took serzone for a long time (for my first depressive episode) and when I had my 3rd depression, I started out on serzone and then switched to effexor xr (my dr. talked me into switching). I really liked the serzone and it worked really well for me. I slept good at night too. And I found it really helped with my obtrusive thoughts of *having depression and never getting better and what if it gets worse or comes back* I had those bad thoughts all the time, but the serzone really worked and took all those thoughts away. I took 250 mgs a day.

I've been medication free and depression/anxiety free for 6 months now and counseling really helped me; what I needed the most was reassurance and I got that from my counselor. I handle things so easily now, I amaze myself sometimes.

I know you'll feel better soon.
prayers are with you.