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Paradoxical drug reactions
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Paradoxical drug reactions

Hi,

I am 24yrs old male. I have a very complicated case of Depression in comorbidity withGeneralized anxiety disorder and all options seem to have exhausted.

I have
1. GAD with obsessional pattern anxiety thoughts
2.OCD (currently under control)
3. Major Depressoin.

Been on almost all SSRIs, Benzos and SNRIs.

Complication- PARADOXICAL Reactions.
With all the SSRIs and SNRIs, i start to have chronic depression with obsessional regrets, suicidal ideation, excessive sleep (18-20hrs), excessive dreams. Due to this have to stop the medication before it even reaches the therapeutic dose.
It is very puzzling.

Shrinks here are unable to diagnose it, they keep jumping me from one med to another with the same results.

Does anyone have an idea of what this depression/obsessional regrets is?

Even CBT didnt help much. Would be very grateful for any helpful info.

Thanks
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Hello, Maza.

I'm not sure what depression/obsessional regrets are. It sounds like you do things during either depression or periods of OCD that you regret.  Just a guess.  Did you ask your doctor what this means?

Trust me, paradoxical reactions to medications happens a lot.  I had them severly with a couple of drugs that put me in the hospital with suicidal ideation.  I had the paradoxical reaction with opioid medications too.  They made me alert and function at a high level yet still killed the pain.  I was on heavy pain killers yet came up negative on urinalysis tests.  That blew my MD away.

Anyway, dealing with anti-depressants is a hit or miss thing.  Try one, see how it works, etc.  It's a frustrating process because eveyone is slightly different.  One possibility is that you are undiagnosed bi-polar which would change the picture entirely.  Bi-polar is very under diagnosed and the average is for someone to suffer from it for 7 - 10 years before it is diagnosed.  Other than trying more meds, looking at bi-polar, looking at medical conditions, the last option is electro-shock therapy (ECT).  There are a number of websites that discuss this form of treatment.  

For me, no medication ever worked.  I changed my psychiatrist with the thought that this would be the last try.  She thinks outside the box and when I told her that no medication had worked, she asked me about sleep apnea - how tired I was during the day, did nmy wife notice I would stop breathing in the middle of the night, etc.  I knew I had sleep apnea but never equated depression and apnea.  I went for a sleep study that confirmed the apnea.  I am being treated with a CPAP machine and started to feel a little better.  And then, my second med she tried was much better than anything before.

Think hard about your fatigue and sleep patterns, do a little research on apnea.  Perhaps there is a link for you too.

Best of luck!

Curt
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ECT is a last resort for treatment resistant depression. If a person has tried everything and has continuing suicidal ideations then it is sometimes tried. Otherwise the long term effects of cognitive confusion and memory loss (which is usually short term but in some cases long term) outweigh the good. For more information on all forms of treatment for depression and mood disorders in general look up "Depression Central" and this site
has up to date information on all mood stabilizers and anti-depressents:
http://www.psycheducation.org/index.html
I went through 30 mood stabilizers before I found one that worked. Its hard to treat but not impossible. Its not a reason to give up but to advocate to get onto new treatments, many of which are available as prescriptions but used off label as mood stabilizers and anti-depressents. If your psychiatrist is unfamiliar with these medications, a referral to a mood disorders specialist would be helpful as they would be.
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Have you tried an MAOI such as Nardil?  While there are dietary restrictions, it might be worth a try since you haven't achieved full remission with SSRIs, SNRIs, or benzos.
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This is a very old (5 years) thread, so I don't know if you're even still reading or following MedHelp.  

I am sympathetic with your problems.  My situation is quite different but I offer it because of the ol' "Mystery Diagnosis" category of illnesses.  

While I do not discount that their are many illnesses of the brain & its associated chemistry, the brain primarily reacts to the overall condition of the body and how well the various systems of the body are functioning.  In other words, if something is messed up in your body, it can affect your brain functions, e.g. cognitive functioning, mood, including sometimes thoughts, such as of suicidal ideations.

I'm 67 years old, so I've got lots of years on you.  I've been predominantly a very healthy person (except for one bout of a major depressive episode at about age 42) until about 5 years ago.  While it began with a seemingly legitimate episode of Post Traumatic Stress Disorder (PTSD - I won't waste time explaining why), it progressed to extreme fatigue.  Docs, including specialists, ran about every test known to them - all negative.

You can guess the next conclusion.  Although, at first, they gave me a "working diagnosis" of Chronic Fatigue Syndrome (CFS - a real disorder that is called a "syndrome" because it's has a poorly defined set of symptoms and usually [not always] ultimately is identified as some other known medical disorder 5 - 15 years later), when I changed PCPs, my new doc quickly (and so typically) latched on to,

    "Well, I think patients I've treated who have symptoms similar to yours respond well to the anti-depressant category of medications.  I'd like to try you on one."  To which, I reply,

    "Doc, are you suggesting that I'm depressed?"

You know the rest.  I reluctantly went along with his folly.  The first he prescribed was Celexa.  For your condolences, I got suicidal ideations within 48 hours - strong ones.  Fortunately, that is totally out-of-character for me and I told my wife immediately, stopped the meds, & contacted the doc on Monday morning.  

Next was Wellbutrin, a "very-well tolerated medication", he said.  Good thing: no suicidal ideations.  Bad thing:  It made my CFS symptoms worse by 2X or 3X - I was, like you, then SLEEPING 18 - 22 hours per day, unable to much of anything the rest - totally unacceptable!  I called his office, told him the symptoms, and let HIM make the big call to cease the meds.  Next O/V, I took my wife in with me and we both eloquently argued why I did not REALLY present appropriate symptoms for a diagnosis of depression, that I had previously experienced it, my wife helped me through the 18 - 24 months of it, and I could not possibly have GREAT days, fully functional, sometimes (1 or sometimes 2 per week) and be totally incapacitated the rest.  

Yep, you guessed it.  The PROUD doc was still unconvinced.  He had latched onto "depression" and was hangin' on like a junkyard dog.  He suggested that maybe it might be more appropriate if I sought a second opinion from a psychiatrist.  So I did.  The psychiatrist, who also knew me well from treating our special-needs children, confirmed my history as I related it to him, and also confirmed that I did NOT have depression.  He did say that he thought my sleep apnea and "excessive daytime sleepiness" (EDS - both sleep apnea & EDS were officially diagnosed by a real sleep disorder clinic) was exacerbating my condition but he felt it HAD to be some underlying medical issue.

Ultimately went to my GI doc, since I had been experiencing pain after eating.  He's a great doc so I begged him to think if there were ANYTHING medically he could think of.  Well first order, after running a HIDA scan on my gall bladder (no gall stones), was to get my gall bladder removed.  Done laproscopically, it was a pretty easy surgery.  I was hoping my problems would be over . . . BUT . . . No.

Oh & by the way, during this time, I had lost weight (good thing) from 235 to 158 pounds (too low) without ANY dieting or special eating habits.  Told each of my docs and showed this graph charts with the adding of a critical fact - my CFS was being treated by one of my specialists with Prednisone, an oral steroid known for . . . . weight . . . . GAIN (NOT Loss).  Never mind all those facts which the docs literally shuddered and refused to look at, no diagnosis.

Back to my good ol' GI doc, after continuing problems I experienced, did more testing - blood tests, abdominal CT scan which revealed that I had an enlarged bile duct and common bile duct with a size up to 30mm (4X - 5X normal size).  He then ordered an MRI which confirmed the situation.

He wisely referred me to a regional hospital part of a medical school for a surgical procedure called ERCP (too long to write out - look it up).  Basically, we all have sphincter muscles at various places in our body.  The Sphincter of Oddi is at the end of the common bile duct where the combined liver bile and pancreatic enzymes are dumped into the duodenum area of the small intestine the cause proper digestion.

Laymen's Version:  No digestive juices, little to no digestion ==> causing, indigestion, vacillating diarrhea and constipation, BUT, more importantly, lack of nutrition means inability to thrive - i.e. starving to death.  When one is starving, believe me, you have a wide variety of mental thoughts, moods, etc. - many of which would be fodder for any shrink to diagnose and treat with more meds that also will not be properly digested and assimilated in your system.  Oh yes, and by the way, if you're starving to death, you problem are kind of fatigued, suffering from malaise, etc.  Yep, your heart doesn't even seem to beat right, giving cause for genuine anxiety (GAD???) and feelings of doom (yep, that happens during hunger strikes not of your own doing).

Long post for a poor soul who I hope & pray might already be doing better.  My advice to you is there are a bunch of GI things (Crone's Disease, etc.) that can cause some bizarre symptoms that the average PCP doc will simply miss.  You MUST be your own advocate, your own record keeping, and your NEVER take anything your told for granted - check it out and verify the benefits vs risks.  

maza2106, if you're still around & reading, let us know how you're doing.

Wish you the best!
Redshirt58
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