Age: 61. Sex:Female. Diagnoses: Major depressive disorder, severe, recurrent without psychotic features (2 episodes: 2003-2004 and 2007-2008); surgeries include hemithyroidectomy (2004), total hysterectomy (2001); family history includes severe heart disease and Parkinson's disease (father), depression (mother), AML (sister). Current meds & daily dosages: Synthroid 50 mcg; Climara 0.0375 mg patch (weekly application; simvastatin 10 mg; sertraline 125 mg (in process of reducing from 200 to 100); buspirone 60 mg (30 x 2).
History: 2 episodes of MDD 2003-04 and 2007-08. Successful with 100 mg sertraline and CBT first episode. 2nd episode had to increase to 200 mg and also used diazepam 5-10 mg/night temporarily for severe anxiety & insomnia until sertraline took effect. Initial tremors subsided after a few months. Depression & anxiety gone. OK for about 1yr. Then noted "Unintential but not Involuntary" rhythmic foot-tapping movements, increased to including jaw clenching/tooth grinding. Started buspirone a couple of months ago, increased to current dose. No effect on bruxism (or anything else) so far. Dentist noted broken tooth & displacement of front teeth; he's making a "deprogrammer" for me. Psychiatrist & FNP concurred: reduce sertraline dose 25 mg increments every 2-4 wks & stay on buspirone; currently at 125 mg sertraline. No ill effects.
Question(s): How long do I wait for buspirone to work? Should I take more of it or something else? I just read about propranolol as a possibility, what do you think of buspirone vs propanolol? Should I give up medications as a solution & just wait until I find my "maintenance dose" of sertraline & see if it goes away and just protect my teeth with the deprogrammer? Will this make it more likely that the akathisia will become permanent?
Thank you for your help.