Chapter 35: FEELING SOME RELIEF! Antidepressant Medications

It has been 9 months since I went to the Amen Clinic in Newport Beach, California.  It has taken this long to make all of the medication changes recommended by my doctor at the clinic.  I am starting to feel better, FEELING SOME RELIEF!  I have an atypical depression that needed to be treated in layers.  The anxiety symptoms needed to be treated first, and I talk more about this in Chapter 9 of my blog.  There is a detailed treatment plan from the Amen Clinic in Chapter 10.

I am now taking 150 mg of Effexor XR in the morning with breakfast.  I have come down from 300 mg because I was not feeling any improvement of depression symptoms, and side effects were not going away.  The higher dose was causing insomnia and anxiety, flushing several times a day, and constipation.  These are the only side effects I have experienced with Effexor XR, and they are just about gone on 150 mg.

 




 

I am also taking generic Luvox, fluvoxamine.  I take 50 mg in the morning and 50 mg in the afternoon.  I was already on this drug when I went to the Amen Clinic and my brain scans showed it was helping to quiet the activity in the deep limbic system; but it was not completely effective.  Depression symptoms originate in the deep limbic system.  I am using fluvoxamine for depression, and I do not have any side effects strong enough to notice.  I have been on fluvoxamine for over a year, and a pharmacist told me the brand Luvox is no longer made. The extended-release capsule is a new medication.

Information on generic Luvox, fluvoxamine from:  PubMed Health - Fluvoxamine

 

Why is this medication prescribed?

Fluvoxamine is used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over) and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Fluvoxamine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs).

 

How should this medicine be used?

Fluvoxamine comes as a tablet and an extended-release capsule to take by mouth. The tablet is usually taken either once daily at bedtime or twice daily, once in the morning and once at bedtime. The extended-release capsule is usually taken, with or without food , once daily at bedtime. Swallow the extended-release capsules whole; do not crush or chew them.

Your doctor may start you on a low dose of fluvoxamine and gradually increase your dose, not more often than once every week, depending on how well the medication works for you and the side effects you experience.  It may take several weeks or longer for you to feel the full benefit of fluvoxamine. Continue to take fluvoxamine even if you feel well. Do not stop taking fluvoxamine without talking to your doctor.

If you suddenly stop taking fluvoxamine, you may experience withdrawal symptoms such as irritability; agitation; dizziness; extreme worry; uneasiness; confusion; headache; tiredness; mood changes; difficulty falling asleep or staying asleep; or pain, burning, numbness, tingling or 'electric shock' sensations in the hands or feet. Your doctor will probably decrease your dose gradually.

 

Other uses for this medicine

*Fluvoxamine is also sometimes used to treat depression. Talk with your doctor about the possible risks of using this medication for your condition.  This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

 

What side effects can this medication cause?

Fluvoxamine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:  drowsiness, difficulty concentrating, dry mouth, headache, nausea, vomiting, diarrhea, stomach pain, constipation, indigestion, gas, change in taste, decreased appetite, weight loss, nervousness, weakness, unsteadiness, and changes in sex drive or ability.

I am taking generic Neurontin, gabapentin, to help calm the activity in the basal ganglia where anxiety begins.  I take a 300 mg capsule four times a day,1,200 mg total.  Neurontin is an anticonvulsant medication the Amen Clinic has found to be effective for anxiety.  I started on this drug as soon as I got home from the clinic to help me get off the drug clonazepam.  I have written quite a bit about clonazepam in Chapter 12 - I Hate Clonazepam and Chapter 15 - Clonazepam The Beast.  (I have been off The Beast for 7 months! =)  My doctor at the clinic chose gabapentin for me because of its low side effect profile, but you will see there are many side effects listed for this drug in the following article.  I did not experience any of these side effects.

Information on generic Neurontin, gabapentin from: PubMed Health - Gabapentin

 

Why is this medication prescribed?

Gabapentin is used to help control certain types of seizures in patients who have epilepsy. Gabapentin is also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain.

 

How should this medicine be used?

Gabapentin comes as a capsule, a tablet, and an oral solution (liquid) to take by mouth. It is usually taken with a full glass of water (8 ounces [240 milliliters]) three times a day. Gabapentin may be taken with or without food. Take this medication at evenly spaced times throughout the day and night; do not let more than 12 hours pass between doses.

If your doctor tells you to take one-half of a tablet as part of your dose, carefully split the tablet along the score mark. Use the other half-tablet as part of your next dose. Properly throw away any half-tablets that you have not used within several days of breaking them.

Your doctor will probably start you on a low dose of gabapentin and gradually increase your dose as needed to treat your condition. If you are taking gabapentin to treat PHN, tell your doctor if your symptoms do not improve during your treatment.

 

Other uses for this medicine

Gabapentin is also sometimes used to relieve the pain of diabetic neuropathy (numbness or tingling due to nerve damage in people who have diabetes), and to treat and prevent hot flashes (sudden strong feelings of heat and sweating) in women who are being treated for breast cancer or who have experienced menopause (''change of life'', the end of monthly menstrual periods). Talk to your doctor about the risks of using this medication for your condition.  This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

   

What side effects can this medication cause?

Gabapentin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:  drowsiness, tiredness or weakness, dizziness, headache, shaking of a part of your body you cannot control, double or blurred vision, unsteadiness, anxiety, memory problems, strange or unusual thoughts, unwanted eye movements, nausea, vomiting, heartburn, diarrhea, dry mouth, constipation, weight gain, swelling of the hands, feet, ankles, or lower legs, back or joint pain, fever, runny nose, sneezing, cough, sore throat, or flu-like symptoms, ear pain, and red, itchy eyes.

My favorite website to learn about medications is Crazy Meds! The Good, The Bad, and The Funny.  It will tell you about uses, pros and cons, effects, side effects, and stuff your doctor usually won't tell you.  "Crazy Meds Suck Donkey Dong"  If that quote is offensive to you, you may not like this site.

I hope you are FEELING SOME RELIEF from your antidepressant medication, or will be soon!!

Chapter 13: My Brain Scans; Inside Active View

I have been off clonazepam for 15 days.  I am still taking extra Neurontin for the anxiety, I am more irritable, but I am sleeping well.  I visualize my brain healing, and I am starting to get excited about being able to start the last part of my medication treatment plan.  As soon as the anxiety calms down I will begin taking Wellbutrin.  It is important for me to wait until the anxiety calms.  The 100 milligrams of Luvox I am taking per day is helping to calm the increased activity in the deep limbic system.  The 1200 milligrams of Neurontin per day is helping calm the anxiety in the basal ganglia.  Wellbutrin will help increase the activity in my prefrontal cortex.

Here are SPECT scans of a healthy brain when it is active.  This is a 3D Active rendering, looking at the most active 15% of the brain where fluid (Ceretec) injected into an artery reached the tissues.  A normal scan shows increased fluid in the tissues of the cerebellum, with all else being relatively quiet.  Pictures are from the Amen Clinic.
                                    

                                    

                   Here are my SPECT 3D Active rendering scans after rest:  R=rest.

These are my SPECT 3D Active rendering scans after concentration:  C=concentration

                           

                                                                           

My SPECT Study Findings Report from the Amen Clinic is 4 pages long.  Here is a brief overview of what was found on my scans.  The most significant finding is decreased activity bilaterally (both sides) of the temporal lobes on the rest and concentration studies. 

Decreased activity was found in the following areas:

• Bilateral inferior orbital prefrontal cortex, worse at rest.
• Bilateral parietal lobes, worse at rest.
• Medial parietal lobe, on both studies.
• Left and medial dorsal prefrontal cortex, at rest.
• Bilateral occipital lobes, at rest.
• Anterior medial prefrontal cortex pole, on both studies.
• Internal cerebellar activity, worse at rest.

Increased activity was found in the following areas:

• Thalamo-limbic system, worse on concentration.  The basal ganglia are a group of large nuclei that partially surround the thalamus.
• Anterior cingulate gyrus, on both studies.

Below are pictures of the anatomy of the brain.  PFC=prefrontal cortex; FC=frontal cortex; TL=temporal lobe; PL=parietal lobe; OL=occipital lobe; BG=basal ganglia; ACG=anterior cingulated gyrus; PCG=posterior cingulate gyrus; R=right; L=left.  These photos were included in my notebook from the Amen Clinic.

                                                              

I am not well yet, but I am making progress toward feeling better.  Having SPECT scans done did not cure anything, but they gave my psychiatrist at the Amen Clinic more information which helped him write a treatment plan that is working for me!

Chapter 9: Three Days At The Amen Clinic

Wednesday morning I had my first SPECT brain scan.  The IV was inserted with ease and I had no bruising later.  The concentration scan is done first and I did an activity to get my brain focused.  The radioactive isotope was put into my IV during the activity.  I did not have any sensation in my body when it was injected.  After the activity I laid down on my back on the scanning machine.  I needed to hold still, but the the time went quickly; it took about 15-20 minutes.  A band was wrapped around my forehead to help me keep my head still.  The scanning machine made a noise, but it wasn't irritating.  Part of the machine went around my head, but I did not feel claustrophobic like I have during an MRI.

Wednesday afternoon I had an appointment with one of the historians.  She had read my intake questionnaire and asked me questions to clarify, or give her more details on my answers.  This was a calm, deliberate process. She gave me plenty of time to add any information to what was included in the questionnaire. She compiled a well written history for the psychiatrist I had an appointment with later in the week.

Thursday morning I had my second SPECT brain scan.  After the IV was in place I was taken to a dim lit room to prepare for the resting scan.  I was asked to let my mind wander or daydream, but not to think about any specific subject, meditate, or fall asleep.  A short time into my resting the isotope was injected.  There was an interesting rug in the room with geometric shapes on it.  I wanted to see how the pattern repeated itself, but I didn't, I kept resting.  There was also a picture of Dr. Amen with information about his work in brain imaging I wanted to look at.  I didn't, I kept resting. After 15-20 minutes, I laid down on the scanning machine for my second scan.

On Thursday afternoon, my husband and I had a delectable seafood lunch at a restaurant called Rusty Pelican.  It is on 2735 West Coast Highway, Newport Beach, CA 92663-4798, (949) 642-3431.  http://www.rustypelican.com/

On Friday afternoon I met with a psychiatrist.  He showed me my brain scans and went over what was found on them.  It was awesome to see the scans!  He showed me rippling, called scalloping, on the surface of my brain.  For me, it is probably caused by taking the drug clonazepam. I have not abused or been exposed to drugs, alcohol, or environmental toxins. I have used this drug for approximately 8-10 years and the Amen Clinic uses it only for short periods of time for severe cases of anxiety.  I am in the process of coming off clonazepam so the scalloping on my brain can heal!

Other Findings:

1. Luvox has been helping calm the activity in my deep limbic system; where depression originates. 
2. There is too much activity in my basal ganglia; causing anxiety. 
3. I have an atypical depression needing to be treated in layers.  This is why I haven't achieved a more complete remission of symptoms in the last year and a half.  The basal ganglia (anxiety) must be calmed down first. 
4. My prefrontal cortex is not functioning effectively.  After the anxiety is calmed down I will need to take a drug to stimulate the prefrontal cortex.  If I take this drug too soon, it will over stimulate the basal ganglia and cause too much anxiety.

I now have an extensive treatment plan giving me hope I can get feeling better!