I think I'm Depressed (and Have Anxiety), Med Options to Discuss with Doctor?

[Monica70]

Hello, I've frequently visited the anxiety forum, but I think I'm depressed too (because I've had suicidal ideations--again) and I'd like to discuss antidepressant, medication options with my psychiatrist.

I've been on a low dose of Seroquel (25 mg) for about six months or so because of anxiety and my general doctor felt that I needed a mood stabilizer, as she called it. The truth is, I showed up at her office, unannounced, in a frenzy (I know). I also told her that I had been having suicidal ideations at least twice per month for two months. The Seroquel has calmed me down, tremendously, although my general doctor also recommended that I see a psychiatrist. I did.

I told the psychiatrist that the Seroquel has worked for me, so he saw no reason to change it. I also told him that every now and again I have a "melt down," which is usually attributed to PMS, so he prescribed me 5 mg of Valium to take as needed.

The thing is, though, I've thought about suicide, again, about two days ago and this scares me. Perhaps my Seroquel dosage needs to be increased, or I need antidepressants. A friend of mine is on Celexa and she said it works for her, but she sometimes feels like she's bouncing off walls because she's so happy. She said, "I can't stop laughing." I have anxiety and I need to *calm down* not be "bouncy" or I'm liable to freak out on someone. I need to be un-sad, if that makes sense. In fact, if I can take an antidepressant "as needed," that would be even better.

Do you have any recommendations for antidepressants that I can discuss with my psychiatrist that does not cause weight gain or make me too giddy. I quit smoking a year ago and already gained 10 pounds, which I have accepted, but I think anything more might cause me more anxiety and body-image issues. I just want to be okay living life. I don't want to die. It's just sometimes my life feels hopeless. By the way, I will also find a psychologist for talk therapy, but I need immediate intervention because my mind can sometimes take me to dark places.

Thanks in advance!

[Monica70]

Just to follow up,

I see my psychiatrist tomorrow (it sounded like he was going to have a melt down over the phone when I told him I had suicidal ideations!) and we're going to talk about Wellbutrin (or other things, but I brought this one up).

I also asked my pharmacist if Wellbutrin would be okay with my current cocktail and he said it shouldn't be a problem (I have a good relationship with my pharmacist).

Plus, I have an appointment with a psychologist on Friday for talk therapy. Interestingly, she mentioned Wellbutrin before I even brought it up. She said her clients do well with it. In fact, I asked her if she was comfortable with me being on medication because one therapist I talked to earlier was not interested in medication for her patients. At all. But the one I'm seeing on Friday said she was okay with it. In fact, she said her patients open up better with it.

But I have to tell you, the psychologist wants to see me once per week and I told her since I have anxiety, that would put a lot of pressure on me (I'm a full-time student). I will see her twice a month for two months, but after that, once a month would be better for me (preferably when I'm PMSing).

[whodunnit]

Hi again,

As a male it's impossible for me to say anything about PMS, except as someone who witnessed partners who suffered it. I have had a number of partners over the years and some reacted not at all and one was a real she devil when it hit.

How they actually felt they never said and wouldn't talk about it and I certainly wasn't going to ask!! Males tend to avoid problems at those times as we have no idea at all what is happening to our lady friends.

You ask is thinking suicide normal at such times. Well, you clearly suffer worse than most females and it is a big range of reactions. Just luck of the genes I think. But of course any awful feelings, pain, negative thoughts and much, much more cause our minds to turn to suicidal thoughts.

It's simply our mind looking for previous experiences to find a solution for us and in these cases where it finds no solution comes up with the only way to stop the pain and suffering. Which is simply reflective of our own life and our limited experience in dealing with pain and the like.

I've been through the suicidal throes a few times and know now I won't succumb to it but my mind still turns to that when things get bad, thankfully not too often these days. You see our brain hasn't got an experience that demonstrates  precise way to stop the pain quickly. If we had a pill we could take that stopped it immediately then our brain would say "What about that pill" instead of "Why not die?".

You follow? It's trying to help but that thought does not help any of us. Our brains and bodies still react in a very primitive way really. Like fight or flight reactions. We don't get attacked by a lot of sabre toothed tigers today but our body still reacts the same if we hear a Police siren don't we? Thinking we've done something wrong.

This is where I believe our medical researchers are failing us. They are trying to find things to deal with the modern thoughts and theories but we still have bodies and minds built how many millenia ago? Like having a T Model Ford and a computer mechanic trying to fix it. No chance right?

Good idea keeping with the talk therapy. No matter what we do in life there are things we need to resolve or they'll eventually eat us up in some ways. Do persist though with the physical tests via your doc as it may be there's more to it than you know just yet. It could be there's something affecting your PMS reaction, who knows?

Good luck and do well, you deserve it.

[Monica70]

I looked at the calendar and indeed I am PMSing. I told my psychiatrist about my monthly melt downs. That's why he prescribed me Valium. I don't know if people know that they are as bad as they are, though, with the mood swings.

Do people usually contemplate suicide when they are PMSing? Should I even bring this up to my doctor again? I was going to call him Monday morning.

Interestingly, before I was diagnosed as having anxiety (I had it for a long time, just wasn't diagnosed), I had the same monthly meltdowns and I was researching medications, but never saw a doctor; this was years ago, but my mood swings were affecting my relationships. I figured that's what most women go through. In fact, every boyfriend I ever had, I broke up with him while I was PMSing.

I'm still moving forward with the talk therapy, no matter what happens.

[whodunnit]

I must comment on some things you've written. Firstly, psychopharmacologists. I've never heard of them, in decades of being involved with a full range of docs and specialists no one has ever mentioned these people. Why would that be do you think?

Having just Googled the term I find that firstly they do not need a degree in anything at all, just schooling in related fields, no mention of success at that schooling at all. The same web page states that these people are generally employed by drug companies and/or for research, which again is usually a drug company.

I strongly challenge your assertion that such people would have any more knowledge than an experienced psychiatrist. There is no way that these people could have the wide experience of a psychiatrist as they are likely to have worked on a specific drug for a long period ( and likely with rats ) and maybe a number over a career. Whereas a psychiatrist uses most of them for their entire career and gets direct feedback from live, angry or happy patients.

This sounds very much like a side issue and I could not agree it would be worth pursuing at all. Having Googled them for the city I live in here in Australia there are none advertising at all. The only ads that come up are for the US. That tells me a lot.

Then your statement that a lot of anxiety can be mania. I disagree entirely. Mania is typified by the opposite, confidence, extreme energy, extremely fast thought and speech, errant behaviour such as spending and promiscuity but the absolute key to mania being defined as mania is the confidence and self belief that you can do basically anything.

In what way would mass anxiety fit with that requirement for a diagnosis of BP, particularly mania? In absolutely no way at all frankly.

Where did you get these ideas from? The anxiety may certainly be part of bi polar but not the mania part. It's the down period of bp that deep depression and anxiety dominates, not mania at all.

If you are confused then please Google it and check the facts as I cannot see any understanding of BP in what you write at all.

As to weight gain it is basically the same as gaining weight when not depressed. You can only gain weight if your intake of fat and protein etc exceeds your body's requirements. A particular drug does not cause weight increases at all in itself. It is our behaviour that causes it, as I wrote above a depressive lifestyle tends to be sedentary, overeating and no thought of exercise. I include mnyself and have no qualms about saying that.

You will find reports everywhere of people stating drug x or y causes weight increase but really the most they can ever do is stimulate appetite. If you don't eat more than you did the weight gain is nil. Unless you eat mountains of a med of course.

To Monica,

I am BP2 and frankly I see little in what you write to indicate bp. Except that your doc prescribed a mood stabiliser. Lithium is prescribed for non BP and so may other mood stabilisers but the doc would tell you if you were bp before prescribing.

The way you talk about this issue it really does sound at least vaguely hormonal although twice a month is a query. But depression, and bp, does not come one or two days a month. It comes and stays full time until you recover. So if you are not full time depressed or manic you are unlikely to be in the throes of a depressive episode as such. It feels the same of course for the time you feel it but rather than start thinking you have bp (Believe me you'd know if you were) or other depressive illnesses I'd ask the doc to explore more physical cuases. A good doc should do this early on anyway.

Hope this clarifies things a bit.

Hey Hensley,

Yeah, I think it kicks it off alright as anxiety is what causes us to lie there all night thinking through things and predicting bad news. Which can become D really easily and most of us don't know it's happening until it's got us by the throat do we? It's such an insidious illness. Why doesn't it give us spots or something so we know?????

And, like you, once we're in the mire I can agree too that I can't tell which is driving, the chicken or the egg. Keep at it mate, we'll all get there, particularly if we speak honestly to each other. Even if it hurts sometimes, none of us is immune to that hey?

[Monica70]

I wouldn't be surprised in the least bit if I were told that I have bipolar. I spend a lot of time in that forum reading (and also the divorce forum, but that's a different story).

I've been crying for two days and I didn't go to the gym at all this week because I didn't feel like it, which is unusual for me. I just don't have the energy, nor wherewithal to do anything. But today I want to go for a walk.

I wanted to wait to hear from the new psychologist before I called my psychiatrist because he responds fast. I think an increase on the Seroquel might do. But I don't know what I need. I need to feel happy and stop thinking about taking my life because it ***** with my husband. I feel trapped, like a caged bird. I can't leave him until next year, though, so I've got to hang in there.

I have been researching these drugs last night: Wellbutrin, Effexor, Desyrel and Serzone. I'm going to bring up Wellbutrin to the doctor, but I'm not sure if it will play well with Seroquel. I NEED to stay calm. I freak out very easily over the littlest things. The Seroquel has given me the ability to "shake it off" or walk away from potential blow-outs, something that I've never been able to do in my entire life.

[frannigan]

I'm a social worker who suffers from depression. I would advise you to see a psychopharmacologist if you can afford one. They specialize in psych meds.

The weight gain varies from person to person For some prozac causes weight gain for other weight loss. It's a good med.to start with..and it's cheap Wellbutrin doesn't cause gain but I think it can be stimulating.

The old line antidepressants (Tricyclics) cause the most weight gain. The newer SSRI's are better. It's a **** shoot though. You are a guinea pig until you find something that works. Lamictal is good for stabilizing moods. I would guess that your anxiety is a symptom of your depression and when that is treated the anxiety will fade.

You may want to pinpoint whether you have bipolar disorder or straight depression. If you have a lot of anxiety, it can be mania in disguise. So you may want to be cautious about taking Wellbutrin or an SSRI.  A mood stabilizer may be a good way to go.

There are A LOT of meds out there though.Don't give up. I've had suicidal thoughts myself. Life can be really difficult and I think it's not uncommon to want out sometimes.

Best of luck.

[Hensley258]

I would agree. Many years ago my symptoms first started with anxiety. Many months later I became depressed because the anxiety was taking such a toll on my mind.

Now that my condition is many years advanced the opposite has happened. I notice that my depression is now driving my anxiety. It's like the two traded spots or something.

[whodunnit]

Anxiety is a part of depression in my opinion, the illness that starts depression really.

25 mgs of Seroquel is a very small dose and if it helped you at that level then it is likely to help more with a larger dose. I take 50 mgs per night simply to get to sleep and it does that brilliantly.

5 mg tabs of valium for "melt downs" really isn't terribly helpful. Valium generally works for 2 or three days and then cuts out unless you increase the dose. That is a big no no as it becomes an addiction quickly and cannot be supported. I'd be looking more to long term meds for relief, A/D's which help with depression and anxiety.

I won't suggest any particular one as I don't know your background well enough and I'm no doctor. The way to make it work is to be fully open and honest and tell your docs all that is going on. Don't hide things and never lie. That way they have a shot at helping us.

Ignore your friends advice. Nobody bounces off walls with hapiness because of an anti depressant. They don't work that way and are not "happy" pills. Rather, what your friend describes sounds more like bi polar. Mania or hypomania but don't you tell her that. Get her to ask her doc why she is so up and you are not. Telling her she may be BP can be a shock and I am likely to be way wrong.

Your request for meds that do x, don't do y and z is based on a false premise.

The total focus of A/D's must be your mental health. If other issues arise then you can review with your doc but as soon as you put other issues first I'd suggest you are not serious about your mental health. No offence but mental healyj must be first, always. Weight etc are side issues we can deal with.

[Monica70]

Thanks for your comments.

As far as the weight-gain issue, diabetes runs in my family. Plus, I'd have to buy an entire new wardrobe (again, after I had already gained the 10 pounds a few months ago), which will cause more stress in my marriage, as my husband always points out how much money I spend on clothes (or anything for that matter). And my husband is the main cause of my depression, but I can't leave him right now.

I called a nearby hospital and asked if they take mental-health walk-ins and they said no, so I called two psychologists and I'm waiting for them to call me back. In the meantime, I reached out to a friend and we talked on the phone, so I feel better right now, but tomorrow is a new day.

I do have a psychiatrist though, but all he does is pill management. I may need talk therapy. I have insurance, so they will cover it and I have unlimited visits. But if talk therapy doesn't work, I may need medication, so I'm looking for options to discuss.

Thanks again!

[Hensley258]

Often times with many of us that suffer major Depression or Bi-polar dissorder, we also have anxiety dissorder.

Anxiety dissorder is kind of the evil by-product of depression. I know some people with anxiety dissorder that do not have depression, but I almost never hear of a depression sufferer that does not have anxiety dissorder.

I agree with you. Some of your anxiety may be getting spawned by your un-diagnosed depression. A good antidepressant could help enough that you could get off that Seroquel.

[j7653]

If you have consistant thoughts about suicide then you need to speak with someone right away.  Please let your family and friends know what you are going thru and get yourself some help.

I take Zoloft which I believe is normally prescribed for combination depression and anxiety.  I dont know if it would be best for you.

A lot of people attribute Zoloft to weight gain.  I have not gained any weight from it that I am aware of.  But now that I am not depressed I can exercise again.  So perhaps one balances the other out.  You have to "weigh" the benefits of being pleasant and plump vs. suicidal and thin.  I believe that Prozac could fall into the same family of drugs if you want to look into it.

I dont think that there are any anti-depression meds. that you can take as needed.  I think you really need to take them on a regular basis for many months to see results.  But you should take them in conjunction with regular talk-therapy.  That is the best way to help yourself get over or thru your problems.

I also started meditating and exercising regularly and I think it helps a lot too.

Good luck.