Today I called two psychiatrists – both which have been recommended to me. One is in Warrington, around 30 mins. away, the other is in Philadelphia – around 40 mins. I’m leaning towards the latter – he works with University of Pennsylvania, which BTW has some of the leading psychological thinkers (especially in CBT). It’ll be a hefty cost – the initial 90 minute evaluations are always quite expensive (the Warrington office said $400) and I don’t have insurance (though neither takes insurance anyways). Thankfully, follow-up visits are significantly less expensive ($100 a pop – still not cheap!).
Currently I am taking 200 mg Wellbutrin Extended Release in the morning and 60 mg of Prozac, also in the morning. I am not taking Adderall at all, the last psychiatrist took me off of it.
My hope with the new psychiatrist is to request that they decrease my Prozac to 40 mg, increase my Wellbutrin to 300 mg, and place me back on Adderall XR at 20 mg.
The Prozac primarily treats my OCD. Prozac is also used to treat depression – but the Wellbutrin seems to do a better job at that for me…so, I’m hoping I can reduce the Prozac without seeing a flair up in my OCD symptoms. Wellbutrin is sometimes used to treat OCD as well – so I think it is likely that the combined Prozac and Wellbutrin will keep the OCD subdued.
“But why decrease the Prozac at all?” I’m glad you asked. Because I know that too much Prozac and Wellbutrin in combination results in me experiencing serotonin syndrome – which is not fun and quite dangerous…but I also know that I need the Wellbutrin dose to be upped in order for me to feel the “normalness” I felt in the days leading up to the serotonin syndrome experience I had on the higher Wellbutrin dose.
It is possible that I could stay at 60 mg of Prozac and go up to 300 mg of Wellbutrin Extended Release without issues – when I had the issues I was on 60 mg of Prozac and 300 mg of Wellbutrin instant release.
Finally, I’m hoping to add back in the 20 mg of Adderall XR. The psychiatrist who took me off the Adderall was against it and refused to put anyone on it (not just me). He thought the Wellbutrin would be able to replace the Adderall – but it didn’t. So, adding that back in will make it easier for me to concentrate again (I can concentrate now, it is just more difficult the longer I am doing so, and my brain “overheats” with some regularity and I have to let it “cool down” which is quite annoying).
Turning from the medicines, I’d like to look briefly at what chemicals these medications affect:
- Prozac – Boosts serotonin levels.
- Wellbutrin – Boosts dopamine and norepinephrine.
- Adderall – Boosts dopamine.
The four major neurotransmitters (I am aware of) involved in anxiety, mood, and so on are the three above and GABA. I have never taken any medication which directly and significantly impacts GABA levels.
Someday I hope to go to Amen Clinics and have a SPECT scan done. Right now, guessing which medications and at what levels will best balance my brain chemistry is just that – guessing. A SPECT scan would allow better insight into which areas of my brain are under/overfunctioning and allow for fine-tuned tweaking of medications…but it costs $2500 or $4000 or something like that…so not in my immediate future. 🙂 But they do have a clinic in NYC – so if I get the cash someday, it is near enough by (I know, it is way outside of my usual “comfort zone” for traveling, but I’d be willing to make the sacrifice).
Maybe someday we’ll be able to see exactly what levels of different chemicals are in our brains at all times and they’ll be able to provide medications not only at the correct levels, but also only when necessary (e.g. some days the chemistry may be such that no medication supplement is needed…so why take one?)
I also place some hope in moving to a simple, complete nutrition diet like Soylent. I try to eat healthier (and continue to improve as time passes), but I know I don’t eat healthy enough…Soylent would make this significantly easier, and correct nutritional ratios might improve the balance in these neurotransmitters.
(Though I don’t think that the diet alone causes the neurotransmitters to be out-of-whack except in very extreme cases…I think that one has a brain chemistry issue which can be amplified by poor diet, but which will likely exist whether on a correct diet or not…)