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Dr. Bob is Robert Hsiung, MD,
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Posted by qbsbrown on August 1, 2009, at 22:24:52
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 1, 2009, at 14:22:58
Ok Scott. I'm gonna go generic immediate release for the next 5 days and let you know from there. I'll go 200-100-100, unless you think it makes any difference to have the big dose at night.
The ER version is simply acting too much like the trileptal that i didn't like.
I was SO excited w/ our initial progress and hope, only to have my symptoms ramped up by me going up too high, too fast, and then mixing er w/ generic.
Hopefully we can get back on track. I'll do 5 days of the 400mgs, then we can assess to go up to 500mgs, or to continue tapering.
Thank you very much for your help.
Regards,
Brian
Posted by SLS on August 2, 2009, at 7:13:03
In reply to Re: Does this sound prudent Scott?, posted by qbsbrown on August 1, 2009, at 22:24:52
> Thank you very much for your help.My privilege.
- Scott
Posted by qbsbrown on August 2, 2009, at 14:45:54
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 2, 2009, at 7:13:03
To a highly kindled system. A jacked up, damaged, compromised CNS. Is a small amount of an antidepressant a dangerous thing to try?
At the beginning of this taper, I even had like 20mgs of tryptophan, and gave me depression.
All of the antidpressants always gave me worse depression, and even more compulsions (paradoxical reactions)
The only antidepressant that ever worked was lexapro. Still some adverse and paradoxical reactions. It would usually work for a week, then turn on me and give me what docs called "mixed mood" episodes, induced mania before, and even screwed up one of my valium tapers once i was down to 1mg (the doc raised the lexapro from 10mgs to 20mgs, sent me through the roof, had to re-instate). Probably too risky huh.
But it usually helped the dysphoria/depression from the anticonvulsants.
Do you think that once my brain/body is accustomed to the tegretol, that it might be worth a shot for gad and panic, anticipatory anxiety? Or is it simply too risky right now at this juncture?
Took 400mgs of tegretol yesterday (ER version, took an er version this morning, but thinking about the generic), went out and about today, everything still felt weird, looked weird, sounded weird, etc. But not absoulte and total dysphoria as i experienced w/ that depakote trial.
Let me know what you think. I greatly appreciate it.
Regards,
Brian
Posted by SLS on August 2, 2009, at 15:20:46
In reply to Re: Does this sound prudent Scott?, posted by qbsbrown on August 2, 2009, at 14:45:54
I'm not sure I would be too worried about having a kindled or damaged CNS. You might be too focused on these things and making them out to be more severe than they really are. That's my hope, anyway.
For now, try not to pay too much attention to what you are feeling, as long as it is tolerable. You might get hit with waves of weird or uncomfortable feelings as your system attempts to find a new equilibrium with the Tegretol. Whatever mild effects this drug has on your mood is acceptable for accomplishing the goal of freeing yourself from the diazepam.
I would stick to the plan and continue to take the Tegretol at 400mg for now. You might want to take your largest dose at night since it might produce some sedation and that there are more hours to cover. I don't think you should raise the dosage until your system stabilizes, and do not even think about reducing the diazepam until you reach that point.
You really need to slow down. I understand your impatience. I am pretty sure that this will all work out for you if you don't rush it. You really need to be evaluating things at weekly intervals, and not at daily or even hourly intervals the way you are doing now.
I am encouraged by what I'm hearing.
- Scott
Posted by qbsbrown on August 2, 2009, at 15:34:19
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 2, 2009, at 15:20:46
> I'm not sure I would be too worried about having a kindled or damaged CNS. You might be too focused on these things and making them out to be more severe than they really are. That's my hope, anyway.
>
> For now, try not to pay too much attention to what you are feeling, as long as it is tolerable. You might get hit with waves of weird or uncomfortable feelings as your system attempts to find a new equilibrium with the Tegretol. Whatever mild effects this drug has on your mood is acceptable for accomplishing the goal of freeing yourself from the diazepam.
>
> I would stick to the plan and continue to take the Tegretol at 400mg for now. You might want to take your largest dose at night since it might produce some sedation and that there are more hours to cover. I don't think you should raise the dosage until your system stabilizes, and do not even think about reducing the diazepam until you reach that point.
>
> You really need to slow down. I understand your impatience. I am pretty sure that this will all work out for you if you don't rush it. You really need to be evaluating things at weekly intervals, and not at daily or even hourly intervals the way you are doing now.
>
> I am encouraged by what I'm hearing.
>
>
> - ScottOk, I hear ya. man, some/any sedation would be welcome. Jesh, if I could just have that drunk feeling the whole time, that's be nice. Maybe phenobarbiol is my way lol.
Well my sleep is gonna be crap regardless. I feel some sort of psychosomatic buffer i think if i go 200-100-100. I believe that i will continue the generic tomorrow and stop the ER version.
Ya know, after my first 200mg dose, i felt some dysphoria while teaching online, i should have gone 200-100-100 that day in hindsight.
Perhaps once i go 200-100-100, and no longer feel the dysphoria, then i could bump up 100mgs, or if it's been 1 week. 200-200-100. The day i went 200-200-200 it was great. Time went by, didn't think about my dosing, things slowed down, didn't even worry about taking my last dose of both vailum and tegretol at bedtime.
I hope we can get that back. I believe we can, simply that i went up too fast to 600mgs.
Thanks,
Brian
Posted by qbsbrown on August 2, 2009, at 18:11:54
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 2, 2009, at 15:20:46
So are you saying that now isn't a good time to mess around w/ a small dose of an antidepressant? Lexapro 2.5-5mgs? Considering that i have intrusive/racing/obsessive/bad memories 24/7, might not be a great idea huh? In the past it seemed to induce more racing thoughts, so might not be that great of an idea.
Regards,
Brian
Posted by qbsbrown on August 2, 2009, at 19:34:29
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 2, 2009, at 15:20:46
> I'm not sure I would be too worried about having a kindled or damaged CNS. You might be too focused on these things and making them out to be more severe than they really are. That's my hope, anyway.
>
> For now, try not to pay too much attention to what you are feeling, as long as it is tolerable. You might get hit with waves of weird or uncomfortable feelings as your system attempts to find a new equilibrium with the Tegretol. Whatever mild effects this drug has on your mood is acceptable for accomplishing the goal of freeing yourself from the diazepam.
>
> I would stick to the plan and continue to take the Tegretol at 400mg for now. You might want to take your largest dose at night since it might produce some sedation and that there are more hours to cover. I don't think you should raise the dosage until your system stabilizes, and do not even think about reducing the diazepam until you reach that point.
>
> You really need to slow down. I understand your impatience. I am pretty sure that this will all work out for you if you don't rush it. You really need to be evaluating things at weekly intervals, and not at daily or even hourly intervals the way you are doing now.
>
> I am encouraged by what I'm hearing.
>
>
> - ScottMan, my WD symptoms are totally revved up. Probably from taking 600mgs (that alone would make it worse for a few days), took 500mgs, and the er version are bad for me, acting like trileptal. So all of those things are going to rev up symptoms for a while, and i just have to accept that.
I REALLY hope that i can tolerate 400mgs and that it doesn't make things worse. This seemed really like the break i was praying for.
You think it's better to stay at 400mgs than 300mgs right (i do)? I think i can tolerate it, and as long as i stay at the exact dose, with the exact generic, i hope that this will settle down in 5-7 days.
And oh yeah, an AD is totally out of the question for now:)
Brian
Posted by qbsbrown on August 2, 2009, at 23:37:36
In reply to Re: Does this sound prudent Scott?, posted by qbsbrown on August 2, 2009, at 19:34:29
Yeah, they all suck and have adverse/paradoxical reactions in me. How long do you think i might have to be on tegretol before i tried (if needed, it might not be), like a minute, 2.5mgs of lexapro?
Anxiety so bad that it's hard to eat sometimes because I'm afraid that i will choke on the food. Then again, i ate a ton of food yesterday. A lot of this could be benzo wd flare up. All the other ADs give me worse depression, minus lexapro. But with my already racing thoughts and insomnia, lexapro kinda scares me. I was once able to get all the way down to 1mg of valium on lexapro, only to have the doc raise it from 10 to 20mgs, making me manic, and having to re-instate everything.
So we can see if the tegretol keeps working, and re-*ss*s in a week.
Posted by SLS on August 3, 2009, at 6:56:05
In reply to Question about an AD scott, posted by qbsbrown on August 2, 2009, at 23:37:36
> Yeah, they all suck and have adverse/paradoxical reactions in me. How long do you think i might have to be on tegretol before i tried (if needed, it might not be), like a minute, 2.5mgs of lexapro?
It is difficult to know for sure how an antidepressant would affect you right now. I guess I am in favor of letting your system settle right now. If you do go to Lexapro, I advocate starting at 10-20mg. I think that very low dosages might actually make you feel worse. I can't prove it, but I suspect that such low dosages produce a reduction in the synthesis and release of serotonin without a comparable stimulation of postsynaptic receptors. Lexapro can produce anxiety early in treatment, so I wouldn't recommend starting it at this point. It would be difficult evaluate your withdrawal symptoms with the additional anxiety.
How much diazepam are you taking right now?
Have you ever tried Lyrica (pregabalin)?
I still like the Tegretol right now. I would stay at 400mg for the next few days to see what happens. Perhaps you will need to take a higher dosage. I don't think it is out of the question to work up to 800mg. It will be necessary to exercise self-discipline and logic.
Continue to post. However, I would NOT look at Tegretol to be the culprit in your periodic worsenings. I think they would have happened anyway.
- Scott
Posted by qbsbrown on August 3, 2009, at 10:16:42
In reply to Re: Question about an AD scott, posted by SLS on August 3, 2009, at 6:56:05
> > Yeah, they all suck and have adverse/paradoxical reactions in me. How long do you think i might have to be on tegretol before i tried (if needed, it might not be), like a minute, 2.5mgs of lexapro?
>
> It is difficult to know for sure how an antidepressant would affect you right now. I guess I am in favor of letting your system settle right now. If you do go to Lexapro, I advocate starting at 10-20mg. I think that very low dosages might actually make you feel worse. I can't prove it, but I suspect that such low dosages produce a reduction in the synthesis and release of serotonin without a comparable stimulation of postsynaptic receptors. Lexapro can produce anxiety early in treatment, so I wouldn't recommend starting it at this point. It would be difficult evaluate your withdrawal symptoms with the additional anxiety.
>
> How much diazepam are you taking right now?
>
> Have you ever tried Lyrica (pregabalin)?
>
> I still like the Tegretol right now. I would stay at 400mg for the next few days to see what happens. Perhaps you will need to take a higher dosage. I don't think it is out of the question to work up to 800mg. It will be necessary to exercise self-discipline and logic.
>
> Continue to post. However, I would NOT look at Tegretol to be the culprit in your periodic worsenings. I think they would have happened anyway.
>
>
> - ScottI agree with you about not taking an AD at this point. And yes, there is/was already start up anxiety w/ lexapro. And risking any type of mania and/or worse racing thoughts isn't worth it.
I have taken lyrica, even doses up to 900mgs. Felt pretty stoned, super social, an extremely high sense of well being, derealization, edema.
But I do not have insurance, and it'd be very hard for me to obtain.
I think we're on the right track.
I went back to the generic tegretol this morning (200mgs), and it feels much more fitting, much better, a big difference.
How do we know when to raise it?
Today would be day 4 of 400mgs or more.
By the night yesterday, the dysphoria finally seemed to be wearing off. The ER version was acting WAY too much the trileptal was, in the good and bad ways, and i'd like to steer clear of that
I am at 16mgs of diazepam.Well I can tell that tegretol is part of the periodic worsenings, it is/was the culprit. I mean to feel that depression and dysphoria, which i never had tapering by itself. And when that happens, it's bound to raise my symptoms for a few days. So that's just part of the cycle.
So I say that we continue to raise when we think I'm ready. Do you think that 100mg incriments are more appropriate for me than 200?
It's easy for me to observe how i feel, it hits me right away.
But when to raise it, i don't know.
Thanks for the help.
Regards,
Brian
Posted by qbsbrown on August 3, 2009, at 10:44:38
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 10:16:42
Perhaps 200mg incriments would be fine, unless we think 100mgs is safer. I think my error was going from 300mgs on the first day, to 600 on the second.
I just fear the worsening of symptoms, and the dysphoria/depression that it might induce.
But then again, i felt great after my first 2 200mg doses, and should have stopped there that night.
Let me know what you think.
Regards,
Brian
Posted by qbsbrown on August 3, 2009, at 13:34:31
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 10:44:38
what day do you say i give 500-600 a go? Today is 400, but basically starting over w/ 200-100-100. Although last 2 days have been 400 of er versions, they act and are totally different.
Regards,
Brian
Posted by SLS on August 3, 2009, at 17:14:46
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 13:34:31
> what day do you say i give 500-600 a go? Today is 400, but basically starting over w/ 200-100-100. Although last 2 days have been 400 of er versions, they act and are totally different.
>
> Regards,
>
> BrianI think the main thing that you should be looking for is stability. I don't think you have been on 400mg long enough to justify an increase. If you had been on a steady dosage for a week, I would say that it was time to go up to 600mg. Since you have not established an equilibrium at 400mg yet, I would suggest that you wait another 3-5 days before moving up. Since you have observed a worsening of your condition in association with Tegretol dosing, I think it makes sense to wait 5 days. What you do now at 400mg might determine how effective the BZD withdrawal strategy is. My advice is to wait 5 days and then try going up to 600mg. In the meantime, do not try to lower your dosage of diazepam, or else you defeat the purpose.
When do you take your doses of diazepam? Do you take the Tegretol and the diazepam together? I'm just curious.
- Scott
Posted by qbsbrown on August 3, 2009, at 17:45:34
In reply to Re: Question about an AD scott, posted by SLS on August 3, 2009, at 17:14:46
> > what day do you say i give 500-600 a go? Today is 400, but basically starting over w/ 200-100-100. Although last 2 days have been 400 of er versions, they act and are totally different.
> >
> > Regards,
> >
> > Brian
>
> I think the main thing that you should be looking for is stability. I don't think you have been on 400mg long enough to justify an increase. If you had been on a steady dosage for a week, I would say that it was time to go up to 600mg. Since you have not established an equilibrium at 400mg yet, I would suggest that you wait another 3-5 days before moving up. Since you have observed a worsening of your condition in association with Tegretol dosing, I think it makes sense to wait 5 days. What you do now at 400mg might determine how effective the BZD withdrawal strategy is. My advice is to wait 5 days and then try going up to 600mg. In the meantime, do not try to lower your dosage of diazepam, or else you defeat the purpose.
>
> When do you take your doses of diazepam? Do you take the Tegretol and the diazepam together? I'm just curious.
>
>
> - Scott
>Yeah, I agree. It has helped many things, much less paranoia, and i was able to eat many foods that i feared (i thought they were worsening symptoms), it allowed me to go to the gym for the first time in more than 2 months. So I have seen the benefits for sure. It was me messing around w/ the dosing that screwed me up. Yesterday was better than the day before, today is better than yesterday etc. So I hope that the storm is calming.
I dose diazepam 3mgs 6am, 3mgs 2pm, 10mgs, 10pm. I am dosing the tegretol at the same time, and I think it is to much benefit. Right now it's 200-100-100.
Regards,
Brian
Posted by qbsbrown on August 3, 2009, at 18:02:39
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 17:45:34
We could shoot for Friday as the test/trial date for 600mgs. It's a good day, because i don't teach on saturdays, i am supervised by my roommate in case i react badly etc. If I have a bad depressive/dysphoric reaction to it, and it worsens wd symptoms, then I could make it 500mgs.
What do you think?
My brain is so dead and fried from all of this. It literally needs a jump start lol. They only thing i could think of is lexapro, but given it's history of making me more anxious for a couple of days, give me insomnia, which i already have, induced mixed mood episodes, some dysphoria, worse racing thoughts etc, it's best to steer clear.
Probably best to just be retarded until all of this is over. The exercise will help much as long as i can continue, and it doesn't rev up symptoms. And if i can eat regular/normal foods, instead of a very restricted diet, then that should help much as well.
Thanks for the help Scott.
Brian
Posted by SLS on August 3, 2009, at 18:27:47
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 18:02:39
> We could shoot for Friday as the test/trial date for 600mgs. It's a good day, because i don't teach on saturdays, i am supervised by my roommate in case i react badly etc. If I have a bad depressive/dysphoric reaction to it, and it worsens wd symptoms, then I could make it 500mgs.
>
> What do you think?
Perfect!!!
- Scott
Posted by qbsbrown on August 3, 2009, at 21:13:15
In reply to Re: Question about an AD scott, posted by SLS on August 3, 2009, at 18:27:47
I've read that magnesium is one of the only minerals/vitamins/supplements that might provide some relief, especially muscular.
I was in great shape when i begun this. Now total muscle wastage, muscle spasms, pretty bad stuff.
Does/will magnesium interfere/compete for any of the neurotransmitters?
Regards,
Brian
Posted by qbsbrown on August 3, 2009, at 22:52:41
In reply to Magnesium Scott?, posted by qbsbrown on August 3, 2009, at 21:13:15
I was wondering about Neurontin for anxiety and insomnia during benzo wd.
Now lyrica was the 2nd most difficult drug to come off of after benzos, but i don't remember a problem w/ neurontin
Of course we'll go one step at a time w/ the tegretol, and i don't know if you can mix those 2 anticonvulsants at the same time, or is a good idea anyway.
It does scare me that neurontin gave me suicidal ideation out of no where a couple of times, for no reason. But other than that, it was more like being social and high.
But i don't know how the whole gaba part interacts w/during the benzo wd.
Regards,
Brian
Posted by SLS on August 4, 2009, at 6:35:32
In reply to Magnesium Scott?, posted by qbsbrown on August 3, 2009, at 21:13:15
> Does/will magnesium interfere/compete for any of the neurotransmitters?
The reason I have suggested magnesium to a couple of people is that it *theoretically* would compete with glutamate for binding to the NMDA receptor, the result of which might be to tone down neuronal excitability. Many people feel calmer with magnesium and sometimes use it as a sleep aid. You don't want to take too much, though. It can act as a laxative.
- Scott
Posted by SLS on August 4, 2009, at 6:37:22
In reply to Neurontin?, posted by qbsbrown on August 3, 2009, at 22:52:41
You can take Neurontin with Tegretol, but I wouldn't recommend adding it at this juncture. It can be somewhat unpredictable.
- Scott
Posted by qbsbrown on August 4, 2009, at 9:04:02
In reply to Re: Neurontin?, posted by SLS on August 4, 2009, at 6:37:22
Well a few wd symptoms that I was absolutely thrilled that it began to alleviate was; extreme sound and noise sensitivity. I would have to sleep w/ ear plugs and eye masks, and STIll, the smallest shade of light coming in the window would wake me up.
That is now back the past 2-3 days. Are you guessing that is because i went up to fast and aggrivated my wd symptoms, and the original ones came back, and/or that it's now metabolizing itself quicker, and that i need to raise the dose?
There are a couple other things that have come back as well.
I don't want to go too quick and too fast, as we saw where that landed me last time.
Stick to the original plan of Fri?
Regards,
Brian
Posted by qbsbrown on August 4, 2009, at 9:07:13
In reply to Re: Magnesium Scott?, posted by SLS on August 4, 2009, at 6:35:32
Can you recommend how much magnesium to take? MGS, and times per day?
Posted by qbsbrown on August 4, 2009, at 9:16:17
In reply to Re: Magnesium Scott?, posted by qbsbrown on August 4, 2009, at 9:07:13
Someone on the alternative board said that the magnesium can be stimulating. That kinda scares me. Don't know how my body will react to it at this juncture.
Is it worth the risk for sleep, calm, and muscle spasms?
Brian
Posted by qbsbrown on August 4, 2009, at 9:26:54
In reply to Tegretol, posted by qbsbrown on August 4, 2009, at 9:04:02
Perhaps a 4 day flare up is expected after my 600mg night experience huh
Posted by SLS on August 4, 2009, at 11:58:06
In reply to Re: Tegretol, posted by qbsbrown on August 4, 2009, at 9:26:54
> Perhaps a 4 day flare up is expected after my 600mg night experience huh
It is hard to say.
Friday is just a few days away.
You'll make it.
- Scott
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Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
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