QUESTION:
Dear Doctor,
I was diagnosed many years ago with dysthymia and had severe insomnia. I’ve always been depressed even as a child. I’m 55 years old now. I took 20/40mg of Prozac for about 10 years and it helped tremendously. For about the final 2 years on Prozac, it seemed to “poop out” and fatigue started setting in. All I wanted to do was sleep. I went all the way up on dosage to 80mg/day on the Prozac with no improvement. Feelings of “fear” of job, life, etc., preoccupied my mind.
Not having the money to continue visiting a psychiatrist, I’m trying to solve this problem medically myself. I think I’ve read your entire Website trying to see if the fact that I had no adverse affect with taking Prozac rules out me having the GAD. I haven’t seen that specifically addressed.
As I’ve said, I’ve developed a great “fear” of getting thru life and being able to handle my job. Assuming the constant “fear” may be the GAD, I’m taking 15mg/day of BuSpar and 40mg/day of Paxil. I’ve been on Paxil for 2 months (still having constant fear though it seems to have helped my depression) and just started 15mg of BuSpar for a week now. Do you think I am headed in the right direction? Can the constant “fear” of life be something other than the GAD? The fear seems to be related to anxiety in my view. What would you recommend? Is the BuSpar a waste?
You have a wonderful Website. You have a unique sense of logic that I like being an engineer myself (i.e. SSRI’s increase agitation with the GAD, etc.). You don’t take a shotgun approach to solving mental disorders.
Thank you.
ANSWER:
The two main reasons Prozac “stops working” are the BPD with chronic dysphoria (anxiety, rage, depression and despair) and an imbalance of too much serotonin with a relative lack of dopamine and noradrenaline in the brain. This resolves with the addition of Wellbutrin.
If BPD dysphoria (anxiety, rage, depression and despair) is the problem, the addition of Tegretol usually makes the problem go away.
Not all patients with GAD have their condition worsened by SSRI’s. The main symptoms I look for with the GAD are persistent worry, mind always going, and chronic fear. The GAD is usually genetic. If the GAD is present, BuSpar will make a huge difference.
I cannot overemphasize the importance of making all the diagnoses and treating them comprehensively. The screening test may be of use to you in this regard. The dysthymia you describe is likely what I call “fractured enjoyment” – and used to be called the depressed personality disorder in the 1920’s. Prozac is usually a miracle medicine for these individuals.