- Why Do I Feel Worse On Ritalin, Zoloft And Buspar?
QUESTION:
Dr. Heller,
I wrote you last week with a question concerning my problems with figuring out the chemical imbalance I am having. I would like to say that I have taken the advice you gave me in adding the BuSpar again. I have just started it yesterday at only half the dosage of a whole pill in the morning because I take .25 Xanax at night before bed. I think it is 7.5 mg. of BuSpar. Furthermore, I did not take my Zoloft today at all. I also have cut the dosage of Ritalin to just 5 mg. upon waking.
Today, (Christmas Day) I felt the most focused and calm I have felt in a long while. My mind hardly raced at all either. I told you that I have been diagnosed OCD. Well, in reality, it is only suspicion. I have only been officially diagnosed as ADHD, and GAD, with a heavy emphasis on the social aspect of anxiety. Sorry if I confused things. I just assumed I am OCD because a few doctors have said so, but I suspect that this Zoloft is making my mind race so fast and clouding it up so bad that I am obsessing a lot more.
Since the start of the Ritalin, I have not obsessed nearly to the extent I was before. So here is my 2-part question:On the Zoloft, I am very perfectionistic. I always feel like something is on my clothes, or in my hair, etc. So I will keep checking it to make sure. Would this likely be just an increase in the GAD and ADHD from the Zoloft causing me to do these things, or some other problem? The second part to the question: Could it be possible that my serotonin levels are fine, and maybe even a bit high in places like you said, and my dopamine levels and norepinephrine levels are low causing the hyperactivity and GAD problems? I can only figure this because of my response to these meds. I am scheduling an appointment with my G.P. in a few days, and I was thinking of recommending Effexor XR to replace the Zoloft. I know this is serotonin based too, but it seems that it is good for GAD, from what I hear and read.
I would appreciate any response to these questions sir.
ANSWER:
You likely have overactive serotonin 1 (GAD) and serotonin 2 (PTSD) receptors. Ritalin and Zoloft worsen the anxiety of the GAD, sometimes of PTSD. BuSpar lowers the overactivity of serotonin 1, but in many patients makes PTSD worse. The medication I use for people like you is to add Remeron – which lowers the serotonin 2 overactivity. The combination you’re on plus Remeron could be extremely effective.
From what you wrote, I suspect the OCD and/or OCPD are likely present as well – worsened by your current combination of medications. It is common for people to have multiple diagnoses.
Effexor may work in high doses. Some physicians and patients get good results on high doses (300-600mg daily). I haven’t seen many benefits; both side effects and withdrawal symptoms are of concern, and a problem for most patients.
