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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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I am currently on .125mg per day of klonipin and 100mg per

Customer Question

I am currently on .125mg per day of klonipin and 100mg per day of zoloft. I am still feeling anxiety when I get up in the morning but I dont want to increase either drug. I went to a psychiatrist who prescribed depakote at a low dose and upping my dosage of zoloft to 150mg per day. When I go up even 12.5mg increment of zoloft I start to feel anxiety kick in. I am not bipolar, just suffered from depression most of my life. I have been on zoloft for about 12 years from 25mg per day up to 100mg per day with no problems. This year after my dad died I had all kinds of problems with adjusting my zoloft as I began to have this anxiety component which I had never had before. Should I follow the psychiatrist advice with these drugs? He feels that since I suffer from ocular migraines that it is sort of kicking in the anxiety somehow.
Submitted: 6 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 6 years ago.
Hello. I believe I can be of help to you with this issue.

I am not your doctor so I cannot prescribe any course of action; I can merely offer academic information. It is curious that you were prescribed depakote; one speculation is that your psychiatrist feels that it would dampen your anxiety, which he/she is conceptualizing perhaps, as a mood swing (depakote is prescribed as a mood stabilizing agent in bipolar disorder). Now, interestingly, one of the side effects of zoloft in some people is anxiety. Yes, it is prescribed for anxiety disorders and depression, but it causes anxiety in some patients. One hypothesis is that when you are experiencing anxiety with an increase in your zoloft dose, it actually is a sign that you are exceeding an optimal dose---going above your optimal dose brings on an anxiety side effect. If this hypothesis is correct, you would quite reliably experience anxiety whenever you bumped your dose up a bit too far. Now, what about the migraines and anxiety? The migraines per se are probably not 'causing' an automatic anxiety reaction; however, we know that people anticipate having migraines and at the first preliminary symptoms that a migraine might be coming on, they experience a learned, or conditioned anticipatory anxiety response. Yes, people learn to experience anxiety i.e., an anxiety episode can become intimately associated or connected, through learning with external, situational factors. So for instance, we might have an anxiety reaction when we see someone with whom we've had a difficult history; women experience conditioned, anticipatory anxiety when they see a man who raped them, for instance. People have a conditioned or learned anxiety reaction sometimes, when they get into a car to drive, after they've been in a recent car accident. So one hypothesis is that you are indeed, experiencing anticipatory anxiety associated with migraine symptoms. If this hypothesis is valid, you would have an anxiety reaction fairly early on in the development of migraine symptoms and you'd have the anxiety reaction quite consistently.

You say you are seeking counseling but I'm wondering if you have historically, ever had regular, serious psychotherapy involving cognitive behavioral therapy, with a clinical or counseling psychologist who specializes in mood disorders. I have to ask this because you have been on medications for many years and you continue to have challenges adjusting to them, especially when situational mood regulation challenges confront you. I'm concerned about your general life situation over the past 10 years or so, e.g., the quality and intimacy of your relationships and social support network, your satisfaction with work and stresses you experience. It sounds trite, but I'm wondering if you have a well-rounded, situationally happy life, or if you are feeling isolated, lonely, struggle forming and maintaining intimate relationships, etc. These are all issues that can be causal of depression and help maintain it over time. What do you think?
Customer: replied 6 years ago.
Thank you for your response. I must say that I have really never addressed my depression issues long term with cognitive therapy or even with a psychologist. I have been to psychiatrists (25 or so years ago) over relationship issues but they always put me into group therapy which just made the relationship issues worse! None of them ever suggested medication. My family doctor first prescribed the zoloft and I had no problems with it for years until recently with the death of my father, whom I cared for at my home until he died. This was traumatic for me as I lost my mother at the age of seven and my autistic brother when I was in college. That left me with me and dad, then he died. I am married and have a beautiful teenage daughter. My relationship with my husband is difficult as was all of my relationships with men, but I stuck this marraige out for my daughters sake and becuase of religious beliefs. The marriage brings me little satisfaction, although my husband is a good man. I have also had difficulties in general with social settings (I eat lunch by myself at work) and with other women. I am well liked, but I keep people at arms distance. I am afraid of them getting to know me (?) maybe they will think I am wierd (?). the latter is a carryover from childhood as I always felt different from other kids because my mom died so young,, my brother was autistic and institutionalized, and after my dad remarried the typical stepmother from hell, I had no siblings as she was unable to concieve. I am currently waiting for a phone call from a therapist, I just called the counseling center yesterday... because I realize that I do need the counseling, and it is long overdue! And I know that I dont want to get into more medications with more side effects than I need to. By the way I was all the way down to 25mg per day of zoloft when my dad died and that is when the medication issue went haywire, and to make matters worse the doctor who had prescribed it and who I trusted decided to leave private practice for financial issues and go into the corporate setting, so I couldnt really work with him at the time that I needed him the most, to help adjust my medication. Hope this additional information helps.
Customer: replied 6 years ago.
Just to let you know I will be in work soon and may not be able to get back to you until after 5pm. thanks.
Expert:  Dr. Michael replied 6 years ago.
Your life situation does suggest that you lack real intimacy in your life. You don't have a true 'best friend' or 'soul mate' relationship, and such a relationship is a tremendous protective factor against depression. In fact it can dramatically reshape our personality over time, across years, for the 'better'. So this is clearly one issue---lack of true intimacy in your life. Your core beliefs about yourself (and here is where cognitive-behavioral therapy would come in), are that you are doomed to be a non intimate-aloof-generally isolated person and you have acclimated to this, but are still yearning for something more. You also believe you lack enough personal strength and coping skills to fully protect yourself from threats of loss. This threat of loss is a real area of perceived, self-vulnerability for you. Another core belief you hold is that you really, deep down inside, believe you cannot completely, fully trust others. You cannot risk allowing them to get to know you because of course, they probably wouldn't really like you once they got to know you deeply, or they'd discover a flaw eventually and leave----and you'd suffer another loss. Anyway, these are some speculations about your sense of self, your core beliefs that a cognitive behavioral therapist would assist you with. Very gradually changing these beliefs, doing 'experiments' to take more risks with people, and facing the irrational aspects of your core beliefs would be therapy 'tasks' or the work of therapy, if these speculations about your are accurate. Changing core beliefs and one's 'self view' in turn, changes how we act toward others, and actually, it can change how we feel.

I wish you luck with the counseling. You ARE on the right track with this and I applaud your initiative and willingness to look at your depression from the angle of 'multiple causes' or contributions, rather than simply, medication. Please let me know if I have overlooked any aspect of your original question. Please click on the green Accept button at the bottom of the screen. Thanks.
Dr. Michael and other Mental Health Specialists are ready to help you
Customer: replied 6 years ago.
Thanks so much for your insights, and I appreciate the promptness and detail that you provided. Reading your reply really lifted my spirits!
Expert:  Dr. Michael replied 6 years ago.
My best to you!