Anxious Depression -- Medication?
Jul 4, 2012
In my last post, I reviewed the recommendations of Saveanu and Nemeroff (2012).
Today, I'd like to briefly discuss one of them:
- Pharmacotherapy that will be effective in quieting the body’s hyper-responsiveness to stress and reverse epigenetic modifications induced by trauma and stress
The "standard" drugs used to treat PTSD / trauma are the SSRI anti-depressants. These rarely work all that well, at least in my experience. The most "success" I've had is with a combination of Venlafaxine (Effexor) and Buproprion (Zyban) -- the latter being "good" due to its managing the anxiety symptoms I suffer. Generally, though, my attitude tends to be the same as that of my fellow blog writer John on "Storied Mind" -- [LINK] -- "stay off 'em if you can".
One of the changes being considered for the next edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) Version 5 is the introduction of a mixed anxiety / depression disorder -- [LINK]. The recommended diagnostic criteria for this disorder include: "The patient is not suffering from any other mental disorders recognised by DSM-5" This is farily standard diagnostic practice, but does little, really, except help serve one of the possible uses of DSM-5 -- produce relatively "pure" groups for research.
However, during one of my previous stays in the local "Mental Health" acute unit, the psychiatric registrar suggested, and I started taking, "prn" (as needed) Quetiapine, "to help me sleep" -- it helped, although taking it "too late" at night left me feeling too sedated the next day.
Now, in the latest issue of the journal Depression and Anxiety, Thase et al -- [LINK] -- discuss the use of extended release Quetiapine in patients suffering from depression, some of whom also suffered high levels of anxiety symptoms, though they DID NOT use the recommended DSM5 criteria. As they put it: "Quetiapine XR monotherapy improved symptoms of depression in patients with higher and lower levels of anxiety."
One caution, the last time I was in hospital the psychiatric registrar at that time was not in favour of prescribing Quetiapine -- "I generally don't prescribe "anti-psychotics" (my quotes) to people not suffering psychosis" -- well,, sorry to say, thare are NOT such things as "anti-psychotics" -- biological psychiatrists have long been in search of this Holy Grail, but it's simplistic to describe the drugs given to patients with psychosis as "anti-psychotics" -- mostly, they are major tranquillizers, some with effects on both physical and cognitive symptoms. So, my recommendation, if you wish to try this medication out -- bring this information to the attention of your treating doctor, and simply explain that, for you, symptoms of BOTH anxiety and depression are being experienced and are problematic.
I have requested the Thase et al article from the author and will make it available for you to provide your doctor as soon as I have it -- contact me at AdultSurvivors.org.nz if you'd like to have a copy for yourself.
All the above "technical" considerations need to take place, in the making of a decision between your medical care provider and yourself of all the other "non-specific" factors relevant to treatment including (but not limited to): the need for a collaborative partnership the two of you, including that a clear and full discussion is held about options available, and the possible need to "stage" different treatments for different times -- perhaps medication immediately, then medication PLUS counselling, then moving on to counselling alone at some future time; the need for "titration" of the dosage taken -- carefully monitoring effects of dosage, starting on a small dose, altering dose depending on improvement in symptoms versus cost in side effects; incorporating drug treatment and counselling in a mix of other "interventions" or lifestyle changes, including peer support from those with similar problems -- for general tips see here -- [LINK] and try the other resources here -- [LINK]- good luck, good health, let me know how you get on!