![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 10 to 34 of 34. Go back in thread:
Posted by DL on September 10, 1998, at 23:52:15
In reply to Re: Response to Toby, posted by Toby on September 10, 1998, at 16:14:21
Maybe you can guess how much this correspondence has meant to me--but I don't think so. I don't know what drives you to come to this site and volunteer your time and patient expertise--but it has helped to keep me going.. I sense that at sometime in your life you have been some of the painful places I have been or you would not have the understanding you so freely give. If you were within driving distance I would find a way to you.
I think I did write for the EMDR list for NH at some point but I can't seem to find it. I live in seacoast NH and the drive to the MA border is about 30 min. I will write for the list again, but it will take a while to come. If you have names to suggest I will call them. I would like to try it soon. Your descrption has helped me a lot. Beyond the father who came home from WWII and terrorized me, and the physically abusive husband, there have been many other traumas that I have pushed below the surface. I feel like I am trapped by these things and can't find my way out. Just typing this has the tears running slowly down my face.
Thank you for prioritizing the suggestions. It really helped a lot. I have an appt with the psychiatrist on the 21st and then won't see him for another 2 mos probably. I would like to find someone for EMDR soon so I can see if it will help and then know what to say to the MD. Since you suggest not trying any meds till EMDR, I'm not quite sure what to say to him on the 21st. Do psychiatrists do,or know about EMDR? Should I discuss Buspar or Remeron at this time if I haven't found someone for EMDR yet? I always feel that those quick visits are a waste of insurance money. And is everyone equally qualified to do EMDR, or are there diff levels of training?
At one point you mentioned EMDR was not hypnosis. In your experience does hypnosis help people with problems like mine? When I was in the throws of PPdepression 19 years ago the GYN tried to teach me self-hypnosis in a 20 min office visit. I hadn't slept in weeks and I went home more desperate than ever. When I called the next day at the end of my rope, his suggestion was to relax and go have sex with my husband! I will NEVER forget that. I will always remember being ready to really give up and trying to get help--but it was like screaming into an empty world--no one was willing to listen.
Once again, you are a godsend. Reading your messages has helped to crystalize some of the things in me where I might be able to find help.It is now 1AM and I get up at 6AM. Maybe I can sleep....
Posted by Toby on September 11, 1998, at 7:57:53
In reply to You will never know how helpful you have been..., posted by DL on September 10, 1998, at 23:52:15
Since you will be seeing your doctor so soon, it would seem reasonable to talk to him about trying the Buspar. You want to keep the Klonopin on board until the Buspar has a chance to work. You can mention the EMDR to him if you want, but if he rolls his eyes, just drop it. Psychiatrists do EMDR, but it has been primarily in the domain of psychology for most of its existence, so many psychiatrists are either unaware of it or don't believe it's possible for a treatment to work so fast (I'm quite a skeptical person and I thought it was just a scam until I started seeing actual and permanent results from it through one of my supervisors in residency). Now, however, there is scientific research using PET scans and SPECT scans (these are like MRI's except that they show activity of the brain rather than just structure) that is showing that real changes are occuring in the brain during and after EMDR. Anyway, if the doctor agrees to the trial of Buspar and it will be a couple of months before you see him, you may just want to get the prescription and try the EMDR before starting the Buspar. There are 2 therapists is New Hampshire (I looked again at this list and these are instructors so they are highly trained and have been doing it for years; there are sure to be others as well in case these two aren't near you), Debbie Korn, Psy.D. in Nashua (800) 866-9006 ext1806 and Roger Poire, Psy.D. in Gilford and Dover (603) 528-4405 or (603) 749-2729. Hope these numbers are current.
Posted by DL on September 12, 1998, at 12:24:37
In reply to Re: NH EMDR therapists, posted by Toby on September 11, 1998, at 7:57:53
> There are 2 therapists in New Hampshire (I looked again at this list and these are instructors so they are highly trained and have been doing it for years), Debbie Korn, Psy.D. in Nashua (800) 866-9006 ext1806 and Roger Poire, Psy.D. in Gilford and Dover (603) 528-4405 or (603) 749-2729. Hope these numbers are current.>I found my list from EMDR Institute. No one was listed as a facilitator or instructor. There were 9 listed as "level II" in training. Eric Niler PhD (Dover), Edie McCaddin MSW (Durham), Bruce Altman PsyD, Pamela Henry, Mark Moses PhD, Mary Satterthwaite, Judy Albertson MS, Kathryn Driscoll LSW (all Portsmouth) and David Diamond PhD (Rochester). All these places are close, but I am confused about the people with no credentials listed. What does that mean? The person you listed in Dover is listed in my white pages with the same # but is not on the EMDR list sent to me a few months ago. Perhaps if you ask for the list as a professional you get a different list. I saw my therapist today and she said she is going to an EMDR conference at Columbia Portsmouth Hosp (30 min away) next week. I won't see her again until the 26th. I am thinking she may get some helpful info for me but I would like to see someone soon.
I am really stressed now. Tension at home is terrible (going through divorce mediation with an angry, controlling husband) and new job has a director who is controlling and manipulative (most of previous staff have left because of this). It is difficult for me to react to her without lots of internal anxiety. This puts me in a hyperalert state all day. The new career was planned to help me get away from this long term stressful relationship at home but positions in my field are very limited for new grads due to managed care and new Medicare guidelines.--So I felt I had to take this job--full time with benefits. So right now I am pretty desperate. Taking the .5 klonopin and one tablet of kava every night with calming herb tea and calcium. Can't increase the klonopin or before mentioned problems interfere with work. Feeling on the edge all the time.
Thanks for your help.
Posted by DL on September 13, 1998, at 23:27:08
In reply to Re: NH EMDR therapists, posted by DL on September 12, 1998, at 12:24:37
Toby, My PDR family guide lists the following side effects for Buspar: "more common"--dizziness, dry mouth, UNUSUAL EXCITEMENT, NERVOUSNESS, headache, lightheadedness, nausea. (The caps are mine). In your experience does Buspar usually cause nervousness? That is certainly not anything I need.
Posted by DL on September 13, 1998, at 23:41:27
In reply to Side effectts of Buspar, posted by DL on September 13, 1998, at 23:27:08
> Toby, Have you read the current question on this site's RX page? What are your comments? It is on social phobia and meds.
Posted by Toby on September 14, 1998, at 12:34:09
In reply to Side effectts of Buspar, posted by DL on September 13, 1998, at 23:27:08
Buspar generally does not cause nervousness but everyone reacts differently to every different medication. If you start it at a low enough dose and eat a little with it when first starting out, most people tolerate it well and cannot tell they are even taking anything until a couple of weeks later they start to really feel better.
I don't know if the conference your therapist is going to is a training conference or not, but I didn't see Columbia listed as an upcoming training session, so I would assume not. In which case, she won't want to use EMDR until she is actually trained (a couple of lectures just doesn't get it). Regarding the therapists you found that don't have initials after their name, I couldn't tell you what their credentials would be, but you can only get the EMDR training if you are a real therapist and have a licensing board for whatever your training is. Call a few of them and, if several have openings fairly soon, choose based on any feel of good rapport you may get, or if you don't get to talk directly to them, Level II training is better. Don't worry too much about the initials they have after their name.
Regarding the meds for social phobia: I don't have any personal experience with prescribing MAOI's for social phobia. I've used cog-beh therapy, Inderal for performance anxiety, Paxil several times for pervasive anxiety, and EMDR for situational panic attacks. Never had to resort to the MAOI's.
Posted by DL on September 14, 1998, at 20:41:23
In reply to Re: Side effects of Buspar, posted by Toby on September 14, 1998, at 12:34:09
> I don't know if the conference your therapist is going to is a training conference or not, but I didn't see Columbia listed as an upcoming training session, so I would assume not. In which case, she won't want to use EMDR until she is actually trained (a couple of lectures just doesn't get it).
I realize this. I called and it is a one day "conference". I think it is just informational. They will send me a pamphlet. I just thought she might become familiar with the local people who are practiced in it so she could recommend someone. To me it is scary to choose someone from a list and suddenly allow them inside my pain.. I feel safer when I have a recommendation from someone who knows the person. I imagine I won't get to talk to the professionals themselves--perhaps a secretary--that seems to be the way it is now.
.
> You can only get the EMDR training if you are a real therapist and have a licensing board for whatever your training is.That is good to know, thanks.
> Regarding the meds for social phobia:
I wan't really thinking of the other meds. Only the comment that Buspar is of no use--which was emphasized. Buspar seems to be viewed by one group as totally useless and by another group as a drug that is underused and has great potential. Why such a division of opinions?
I have 2 more therapy sessions authorized and then could try to get authorization for a diff therapist. I will call insurance co and see if any of those people are on the list of providers before I call them. Would it be likely that someone trained in cog beh would also be EMDR cert?
Thanks for hanging on with me.
Posted by Toby on September 15, 1998, at 8:36:57
In reply to Re: Buspar, posted by DL on September 14, 1998, at 20:41:23
There are more than 20,000 therapists trained in EMDR now and so it is highly likely that one or more will be on your insurance company's provider list. It's hard to say whether someone trained in cog-beh therapy would be likely to be trained in EMDR, but the reverse is almost sure to be true.
In regard to the Buspar, there are generally two camps of thought on it, as you have seen. Those who tried it early on when it was first released and found that it didn't work because they were using it in patients actively abusing substances or were using it in patients who didn't have the disorder that it is indicated for, which is generalized anxiety (to which I think social phobia is closely related). If they gave up on it at that point and didn't try it again or didn't mend their prescribing ways, they are going to think that Buspar doesn't work at all. Once a doctor gets comfortable with it in generalized anxiety disorder, he can begin to branch out a little in prescribing it for certain other patients for whom other medications don't do much and sometimes the chmistry works just right. These doctors have more confidence in Buspar because they've learned how to channel the medication toward the right patient. And that's more the art of medicine than the science.
Posted by DL on September 15, 1998, at 22:42:49
In reply to Re: Buspar, posted by Toby on September 15, 1998, at 8:36:57
> There are more than 20,000 therapists trained in EMDR now and so it is highly likely that one or more will be on your insurance company's provider list. It's hard to say whether someone trained in cog-beh therapy would be likely to be trained in EMDR, but the reverse is almost sure to be true.Thanks for the info. The "professional symposium" at the Portsmouth Hosp. is an overview or EMDR 9 only 3 hrs. It is taught by Roger Solomon PhD a member of the EMDR Institute. Objectives are : to understand the model, the research, and how it fits in to a total rx plan. I have the national exam for my profession this Sat for 4 hrs in Boston. Pretty stressful getting ready for it. But I will be checking out EMDR practicioners soon. Thanks agian
Posted by DL on September 21, 1998, at 19:23:16
In reply to Reply, posted by DL on September 15, 1998, at 22:42:49
Toby,
I saw the psychiatrist today. It has been a long time since I saw him. I spoke to him about Buspar and your other recommendations of Remeron and Serzone. I am so glad I had some information to take with me since the visits are so short and he always seems to have to rush somewhere.As you suggested, he brushed past the EMDR. my impression was that he didn't even know what it was.
After I brought it up he talked about Buspar and asked if I had tried it before (I would think he might know since he's the only MD I have seen for mental health). I reminded him he had told me over a year ago that it probably wouldn't help me. He said his opinion was that it was a very mild anxiolytic.
He then took the time to actually ask me what was going on in my life. I told him divorce mediation, atmosphere at home, and work were making me feel like I was only loosely held together with spider web and that I felt constantly at risk of coming apart. I have been routinely crying most of the time while I drive and even wtih other people will hold my breath or swallow or change the subject from me in order not to cry. He suggested I should try Remeron. He knows how terrible the SSRI's were for me more than a year ago but said Remeron should help me sleep and that some people are now using it for that in the same way Trazadone is used.
He gave me a prescription for the 15 mg tabs and said to cut them in half and take it at bed time. He said I could also keep taking the klonopin but to only take a half. Trying to work, mediate and with my sleep deprivation I am really leery of trying it and would like your comment. I asked if he would want me to increase the dose and he said no, to just stay at the 1/2 tab and come back in 6 wks! He always says to call if any problems but he is never available.
Before I knew it the visit was up and I was on my way out! On the way home I realized there was no discussion of Saint John's Wort. I have been taking 4 tablets a day for 3 months. Recently I ran out and only took 2 one day and noticed increased anxiety/racy feeling in the afternoon and evening. Not sure if it was directly related, but the next day I took the 4 agian and felt better. So I wonder if I can taper off while taking Remeron, or still take it also (a number of people take AD's and SJW and do fine (see hypericum.com). Or do I have to suddenly stop? And should I also stop the one tab of kava? He did not address any of these.
I will wait to hear from you or if not I will try to leave a message for him before starting the Remeron. It is a prescription for 15 tabs (30 doses) with 2 refils.
Not sure what to do. Will taking this interfere with EMDR if I find someone? Because I do want to try it? Help. I am not sure what to do here. And I don't want to be any more affected at work than I already am. You can answer to my e-mail if you want. Dotty
Posted by Toby on September 23, 1998, at 13:55:41
In reply to Help!, posted by DL on September 21, 1998, at 19:23:16
Since he gave you a total of 45 pills and you will see him in 6 weeks (about 42 days), and you will be breaking the pills in half (a total of 90 days worth of medication), then there is certainly room to increase to the full 15 mg dose if 7.5 mg is too sedating. The 7.5 mg is not enough to help depression, but getting good rest is a good start. Since he did give you that many pills, my guess is that you could start with the 7.5 mg for about one week to 10 days and if you are being too sedated during the day, call his office and request to increase to the 15 mg dose. You will still have enough medication to last until you see him in six weeks and increasing the dose will relieve the daytime sedation.
The SJW will probably be OK to continue with the Remeron for now since the dose will be so low, but when you see your doctor again, be sure to tell him you are taking the SJW because there can be interactions between it and any other antidepressant (the interaction can be severe and cause high temperatures, seizures and death). We talked about the kava before and I think at the present dose of klonopin it should be OK to continue it as well for now. The only problem I have with herbals is that the dose is not regulated and you never know from dose to dose what milligrams you are getting and how that dose will interact with your other medications.
None of the medications you are taking, nor about to take, will interfere with the EMDR. The only way it won't work is if you go into it while intoxicated. When you go for the session, don't try to "make" anything happen, don't try to "figure things out," because your brain will do all the work automatically and really too quickly for you to ponder over them during the session. Just let things come to mind and leave again on their own. Concentrate on the physical feelings that come up and do what the therapist tells you to do. Be honest with the therapist and yourself. Other than that, your brain will make the connections and adjustments it has been trying to, but has been too overwhelmed to.
Posted by DL on September 23, 1998, at 22:20:10
In reply to Re: Help!, posted by Toby on September 23, 1998, at 13:55:41
THANKS FOR RESPONDING! Where do I find a doctor like you? I'll bet you don't run out the door and hop in your car as soon as your patients leave...The psychiatrist I see is a nice person, but I always feel he just really does not have time for me, and sticks pretty much to what he has always done--not much innovation or individual attention. Perhaps if I see someone for EMDR he/she can suggest another MD if I am still on any kind of med? I will see my therapist this Sat, right after a long mediation session. She will have been to the lecture on EMDR by then and may have suggestions of a person. locally.
> The 7.5 mg is not enough to help depression, but getting good rest is a good start. Since he did give you that many pills, my guess is that you could start with the 7.5 mg for about one week to 10 days and if you are being too sedated during the day, call his office and request to increase to the 15 mg dose.I think he prescribed the small dose because of my reactions to tiny doses of other AD's in the past. I was surprised he did not suggest increasing the amount at some point though. Would the 15 mg be enough to affect depression or would I probably need more if I could tolerate it?
> The SJW will probably be OK to continue with the Remeron for now since the dose will be so low. We talked about the kava before and I think at the present dose of klonopin it should be OK to continue it as well for now.
When I could not get the MD by phone--and did not want to talk to one I did not know, I did check one other place. My sister is a nurse and knows a very knowledgeable Pharm D at the Veterans Hospital in Manchester NH. When I talked to her by phone this week (and I was at a breaking point...........) she suggested I e-mail him and ask about the SJW and Kava. He did reply and suggested I taper off the SJW over a few days then start the Remeron. So I took only 3 on Tue and only 2 this morning. So perhaps I should be courageous and take the Remeron tonight......He also suggested I not stop the klonopin till I found out if the Remeron helps me. And he agreed with you that the one tab of kava would be OK.
But he did suggest I have baseline WBC and LFT tests and again after 2-4 weeks since a small percentage of people have problems with Remeron. I don't know what LFT is, but I do know that in past blood tests ( 1 1/2 yrs ago and 3 yrs ago) I was told my WBC was slightly below the span of normal each time. Any comments on the above? What is LFT? And should I request these tests? THe psychiatrist never had blood tests done except once when I took Pamelor 2 yrs ago only to check its level. This person also commented I should watch what I eat since a significant # of people have weight gain on Remeron.
QUESTION: Do AD's really work for some people? I mean do they say, wow I really feel better? Because I just seem to hear about the ones who have all the side effects and problems...
The only problem I have with herbals is that the dose is not regulated and you never know from dose to dose what milligrams you are getting and how that dose will interact with your other medications.
The SJW I was taking was the KIRA brand that comes from Germany and was used in the published studies. The Kava had a standardized amount of kavalactones which are supposed to be the active ingredient
.
> None of the medications you are taking, nor about to take, will interfere with the EMDR. The only way it won't work is if you go into it while intoxicated. When you go for the session, don't try to "make" anything happen, don't try to "figure things out," because your brain will do all the work automatically and really too quickly for you to ponder over them during the session. Just let things come to mind and leave again on their own. Concentrate on the physical feelings that come up and do what the therapist tells you to do. Be honest with the therapist and yourself. Other than that, your brain will make the connections and adjustments it has been trying to, but has been too overwhelmed to.Thank you for the very humanistic explanation. It helps to put me at ease about EMDR. Even if I have to find the money without insurance coverage I will see someone. I used to dirink a glass of wine occasionally but it has been a few years since I have been able to. Even though sometimes it would relax me for a few hours, I would have a backlash after that similar to coffee and SSRI's--I would wake up and feel racy and stay awake. THe last time I tried a glass of wine I started to feel that way within 30 min. I hope the therapist is good at disconnecting me from the defenses I have used for years. I have become very good at canceling pictures and thoughts from my past.--because when I allow myself to think into myself the tears well up and I feel so fragile..
QUESTION: I have been taking a low dose of natural hormones (estradiol and micronized progesterone) to see if that will help. When I had a recent test done through Madison Womens Pharmacy, the nurse there called and said my estradiol level had shot way up to high levels even though I was only taking a tiny dose. She said this frequently happens when there are thyroid problems. She is going to call my GYN to suggest I have a thyroid antibody test done. A few times in the past diff Drs during regular check ups have had TSH done since my thyroid area seems somewhat enlarged. But I was told each time it came out within the normal range. Is this something that can affect depression or anxiety? I know that thyroid problems are fairly common after birth in women but when I had problems years ago I don't think it was checked.
Thanks again for hanging on for me. After the last few years it's nice to know there are a few MD's out there who care.
Dotty
Posted by Toby on September 24, 1998, at 10:27:52
In reply to Remeron, posted by DL on September 23, 1998, at 22:20:10
15 mg of Remeron does work in some people and I have several patients who have gotten relief with 15 mg alone, but many people need to go on up to 45 or 60 mg per day. Weight gain can be a problem at the low doses, not so much at doses above 30 mg, and it is mostly because of some increased craving for sweets and carbohydrates, so watch those. LFT's are "Liver Function Tests." In the clinical studies, 2% of patients had elevations in one of the enzymes that the liver makes; in most of these patients, the enzyme returned to normal and the patients did not have any symptoms of liver trouble. You probably don't need blood work done specifically for starting Remeron. Every patient should have baseline blood work done at the very beginning of treatment for depression or anxiety so that medical causes of depression can be ruled out. If that was done for you when you first started seeking treatment, you probably don't need to repeat most of it. However, the thyroid situation is interesting (if you'll pardon that word). Even if the blood work shows normal or borderline normal levels of thyroid hormone, if you clinically show evidence of hypothyroidism, a small dose of Cytomel (NOT Synthroid) may be very helpful in treating your depression. As far as the CBC goes, stress can cause drops in the white count but it is also a normal finding in about 20% of the population. If there was nothing else suspicious in your CBC, it is probably normal for you. Bottom line, unless it has been several years since you have had any routine blood work done for general health reasons, the only test I would recommend that you really should get for now would be the TSH and the thyroid antibody test.
During the EMDR, you want to try really hard to bring up that painful physical feeling you get in your throat and chest. Think about whatever you have to to keep that feeling going. That will help you to keep from blocking out the pictures. And it doesn't really even matter if the pictures are present before your eyes (with the eye movements, most people can't "see" the pictures well anyway), as long as you "just think about the event" and keep that physical feeling going, your brain will be processing things. And suddenly, that feeling will decrease in intensity, and the event won't hold as much power anymore. From there, it gets progressively easier and easier. And what you process during the session, stays processed; in other words, you don't just get temporary relief, it's permanent. You can try, but the feeling will not be able to get back to the same intensity as it was before, in which case your brain will view that event as "not very important anymore." That's the part that's hard to understand until you experience it because of course those terrible experiences are important and they do matter, but they are stuck in the kind of feeling that "it's still happening, I can't get away" and that causes them to be important in a destructive way and not allow you to grow past them. When your brain experiences them as "not important anymore" the events become important as a learning experience and possibly as a way to galvanize you into age-appropriate action to take care of yourself, but no longer "important" in an overwhelming, frozen-in-time kind of way. You just have to experience it to really get it, but you probably already know that that's kind of the way you want it to be, you just can't get there. Well, good luck on Sat.
Posted by DL on September 24, 1998, at 16:33:23
In reply to Re: Meds, posted by Toby on September 24, 1998, at 10:27:52
> 15 mg of Remeron does work in some people and I have several patients who have gotten relief with 15 mg alone, but many people need to go on up to 45 or 60 mg per day.Last night I took the half tablet of Remeron (7.5), a half tablet of klonopin (.25mg) and one tablet of kava. I did sleep differently--seemed to be deeper. My alarm woke me and it was very difficult to get up. I would have liked to stay in bed and sleep longer. This is strange for me because I always wake before the alarm and this is ususally about 5 hrs after I go to bed. But I had to go to work.
However, the feeling hung on all day. I couldn't shake it. Even eating some chocolate didn't cause the hyper feeling it usually does. I think I could have fallen asleep at my desk--which is VERY different for me. Right now I am home between work and an evening meeting. I am wondering how I will stay awake at the meeting. Should I try to stop the klonopin and also stop the kava? Perhaps they are increasing the effect of the Remeron? Or is this normal for Remeron? Or is this my overreactive system again? I am a little worried about driving more tonight due to this. Perhaps going to bed earlier will help. I usually don't because then I wake up so early in the morning.
Is there anything I can do to cope with this feeling? although it is nice that the racy feeling is not there, it is not so great to be so sedated either. It also helps me to see that I was not sabotaging my own tx. I was told at one time that the AD's caused these symptons because I didn't really want to get better!
> Weight gain can be a problem at the low doses, not so much at doses above 30 mg
With my sensitive system and all this drowsiness, do you think I could take more, and how quickly should I titrate up? I can call the MD and ask him about this if you think it would help the drowsiness. Actually it I didn't have to go to work and look for a place to live I would just sleep for days and no one would appreciate it more! Sleep has been elusive for me for years.
However, the thyroid situation is interesting (if you'll pardon that word). Even if the blood work shows normal or borderline normal levels of thyroid hormone, if you clinically show evidence of hypothyroidism, a small dose of Cytomel (NOT Synthroid) may be very helpful in treating your depression.MD's office has not called me so I will have to check with them about the tests. They did a "hyperthyroid screen" almost a year ago and told me results were within normal spans but I did not see the results. Before that TSH had been tested by PCP and then GYN at various times.
I thought HYPOthyroid meant too much sleep and slowing down, not anxiety symptoms and lack of sleep?
> During the EMDR, you want to try really hard to bring up that painful physical feeling you get in your throat and chest.
Thanks again for the GREAT explanations. I will find a way to try this out.
This feeling from the Remeron just won't leave. I wish I could just go to sleep now. And I actually think I could!!! It has been years since I could sleep during the day....But, sleeping all day is not too functional either.
Well, good luck on Sat.
THANKS! There haven't been a lot of supportive comments in my marriage in years. I guess I have made it the "status quo" and accepted it. I look forward to being able to talk to you. I wish the MD's were more available. I feel so much more supported when I can get my questions answered.
Sincerely, Dotty
Posted by DL on September 24, 1998, at 22:51:06
In reply to Started Remeron, posted by DL on September 24, 1998, at 16:33:23
I am now home from the meeting. I had to stop and get coffee. I never drink coffee. Within the last few years it has sent me into orbit. But I didn't know what else to do to counter the sedated feeling for my meeting. The coffee did not wire me. Rather it just evened out the sedation. I made it through the meeting OK and drove home. Actually felt OK.. Could have just been that the Remeron wore off by then though (18 hrs). Now I have taken the second dose of a half tablet but NO klonopin or kava. Hopefully I will still sleep but not be as sedated tomorrow. Not feeling as small and fragile and lost as I was. Perhaps just having someone respect my knowledge and experience and situation is having an effect? Dotty
Posted by Toby on September 25, 1998, at 8:43:28
In reply to Re: Started Remeron, posted by DL on September 24, 1998, at 22:51:06
I would definitely say to increase the Remeron to 15 mg since 7.5 mg made you so sedated and it hung on throughout the next day. You may still feel some sedation during the day at 15 mg because your body will need to get used to it, but since the weekend is here that will buy some time. If you still feel sedated during the day by Tuesday at 15 mg, call the doc and get permission to increase to 30 mg. That will mean you will run out of medication early, so he may need to call in a new prescription (or give yousamples to tide you over if he has any) if your insurance company won't pay for a refill in the same month. Stopping the kava and klonopin is fine. Give your body these next few days to adjust to all the changes.
Posted by DL on September 25, 1998, at 18:16:46
In reply to Re: Started Remeron, posted by Toby on September 25, 1998, at 8:43:28
> I would definitely say to increase the Remeron to 15 mg since 7.5 mg made you so sedated and it hung on throughout the next day.Today I was still very sedated. Had another cup of real coffee on way to work since I was so out of it. That helped some but by afternoon I was back in the same place again. I again felt un safe on the road. Perhaps the klonopin still needs to wash out of my system some. I will try the 15mg tonight but am afraid with the mediation session at 9 AM tomorrow morning that I won't be able to attend and take part fully.
> If you still feel sedated during the day by Tuesday at 15 mg, call the doc and get permission to increase to 30 mg.
I will keep this in mind if I can make it through the weekend. I may have to make some important decisions about my life in mediation and with real estate this weekend so I hope I can think straight.
My GYN doctor called in an order for thyroid tests to the lab. For TSH and Thyroid antibodies I think. I will have them done before mediation tomorrow morning. I hope the Remeron does not affect that test. I will ask for a copy of the results from this and previous test from the MD.
What should I say to the psychiatrist if I call in for increase in prescription? Should I just tell him what you said about decreased sedation?
'
How long will it take before I should expect results from the Remeron other than sedation, and what should I notice?Thank you for checking in.....Dotty
Posted by DL on September 27, 1998, at 19:29:33
In reply to Second day on Remeron, posted by DL on September 25, 1998, at 18:16:46
Yesterday, after taking the 15 mg (I didn't call and ask the Doc since there is only emergency on call nights and weekends) and no klonopin I was a little less sedated but still shouldn't have been driving. More foggy/slow thinking compared to the heavy sedation of the previous 2 days. BUT, my sleep at night returned to the "just under" light sleep I usually have--in fact worse than usual. Now I wish I could have taken those first 2 days off from work when I was so drowsy and just slept. It would have been such a treat for me --you can't even imagine!
I made it through the mediation session Sat. but later at my counseling session the therapist said she was worried about me because of the sedation. After the session I sat in my car in the parking lot for about 2 hours--in and out of a very light sleep. I was off and on aware of the clock and noises, but was startled when the therapist woke me on her way home. She was worried about me driving and stayed with me for about 10 min until I got her to believe I was OK.
I again took the 15 mg last night but was in need of sleep so I took 1/2 the klonopin tablet also. But I still had that same "just under" non dreaming sleep. I remember seeing the clock many times during the night. Is it the Remeron that is causing this? And will I continue to have this kind of sleep? I am pretty confused and don't know whether to take the klonopin or not at this point. Should I continue to take the Remeron? What should I expect if I continue to take it? What should I be looking for to know if it is helping me or not?
Sat. I felt some of the physical tension and hyper feelings I used to have--but under the blanket of sedation. That, and sleep changes prompted me to take the small dose of klonopin. Perhaps tonight I will take the .5 klonpin and see if I sleep better. Any suggestions? You were right that the sedation decreased some, with a larger dose but the sleep did not get better. I may be going to a 2 day conference on Fri and Sat and hope by then to be alert but rested. [Yes know this is probably asking too much considering how my system reacts to drugs]
Do you think changing Docs would be a good idea? The therapist said I should consider that as an option if I feel the one I have is not helpful to me. I am just so tired of the work of life---I just want some peace--
The therapist said she thinks my problems stem more from anxiety than depression and that the depression is probably related to the anger I have pushed back inside related to physical/mental abuse from my husband--and to the stress I have at work and home daily. With the divorce almost all set and the house almost sold I will be out on my own soon--scary after 20 years, but perhaps I will find some peace somewhere--
Do you still think the Buspar is something to try? In case I do switch Docs? I need some guidance on how long to try the Remeron and what I should expect to see if it is working.
As always thank you. I wish my MD here could be available and knowledgeable enough to discuss this with me as you have done. I feel pretty low on his list of priorities. And pretty lost also. Dotty
Posted by DL on September 28, 1998, at 22:13:48
In reply to Foggy and confused, posted by DL on September 27, 1998, at 19:29:33
This is Monday. Last night I took the 15mg Remeron and .25 klonopin and 1 tablet of kava. I slept better--not yet a really restful sleep, but better than the last few nights. And, I did not feel as sedated today. It was easier to get through the day. I feel a little bit more in control of my mind and body. I have no idea if this will continue. I never before made it to a point that I could actually tolerate even the starting dose of an AD. So this surprises me. I will wait to hear from you before I contact the doc about dosage and prescriptions.
When the divorce goes through I will have to join a diff insurance company (HealthSource). They have lists of generic, preferred and non-preferred drugs. Their only "preferred" AD's are Paxil, Zoloft and Prozac. Everything else is non-preferred and costs $25 per script! It's pretty sad when someone at an insurance co is deciding what to prescribe---Is there any way to get more at a time if it turns out the Remeron might help me?
I will call tomorrow to see what the results are on the thyroid tests. How is thyroid antibodies shown on a lab form? It doesn't seem to be written out on any of the screens. Is that what FTI is? What would I see as symptoms if some sub-clinical thyroid problem was an issue? I seem to recall that depression can be a symptom of both hyper and hypo thyroid. But about a year ago the GYN's office did a "hyperthyroid screen" and told me all was OK. I will ask for copies of that test and this one.
Hoping can give me some guidance.
Posted by Toby on September 29, 1998, at 16:12:47
In reply to A little better?, posted by DL on September 28, 1998, at 22:13:48
Remeron does require a little patience since it is so sedating at first and can make you feel strange as a result. If you continue to slowly improve regarding the grogginess (which is typical) and sleep well with the klonopin and kava together, keep it up. I think I said something about going up on the dose if you are still really groggy by Tuesday (today) and that is still what I would recommend if you aren't greatly improved, but if you can tell that it is still getting better, then maybe wait another day or two before increasing. Part of depression itself can disrupt sleep so perhaps getting some benfit from the medication regarding that will also help the sleep. I think your therapist is probably right about the anxiety and that your depression has probably followed the anxiety (due to your system getting exhausted from being in a constant state of stress).
Prescriptions can always be appealed to get the insurance company to pay for them, especially if you can demonstrate that you did not tolerate the preferred ones or that they did not work. If you cannot afford the large copay for remeron, your doctor may be able to get samples for you. The tablets come in a 30 mg size also which can be cut in half if the 15 mg tablet works out. Also, he should be writing for a 1 month supply per prescription so that you don't have to pay 25 bucks for each refill.
If the thyroid is subclinical, then you won't see any symptoms of thyroid disease, but depression can be a symptom of hypo thyroid, and anxiety can be a symptom of hyper thyroid. The level will be very close to the extreme ranges of normal on the lab work if indeed there is a problem there. When that is the case, often nothing is done because it is "within normal limits" but when the level is very close to the extreme limits, sometimes it is worth a trial of medication just to see if it affects the mood. If the level is about in the middle of the range, then thyroid generally won't do much for the mood.
Posted by DL on September 29, 1998, at 20:07:40
In reply to Re: A little better?, posted by Toby on September 29, 1998, at 16:12:47
> I think I said something about going up on the dose if you are still really groggy by Tuesday (today) and that is still what I would recommend if you aren't greatly improved, but if you can tell that it is still getting better, then maybe wait another day or two before increasing.Today I was not quite as even and alert as yesterday. I don't know if it is because I slept less than the night before or due to the Remeron. Again I felt "nervous/on edge" during the day, but under somewhat of a fog. Sedation was worse in the afternoon. I had a real struggle concentrating and by afternoon when I was shopping I found the time just slipping away. It bothered me that I was staring at the same things for a long time and aimlessly wandering the aisles forgetting what I was looking for. I will try one more day before calling the doc. I will get to bed early and give myself a chance to sleep for a length of time in case I can--then see how the day goes.
If the grogginess continues, should I increase to 30mg? Is that an effective dose for depression? Is 15mg effective for depression?
Will Remeron help with the anxiety? Can Buspar be used with Remeron and would you suggest it?
As REmeron is titrated up what are the common side effects--since the sedation and appetite should decrease. (Yes, I have noticed some increased craving for carbohydrates)
Do you think the anxiety is just me, the lower dose of klonopin (I have only used .25mg since starting Remeron) or related to the Remeron?
For a while I was feeling a little more sturdy in relation to dealing with aggressive and controlling people. It was while I took the SJW but I don't know if it was related or coincidental.
> Part of depression itself can disrupt sleep so perhaps getting some benfit from the medication regarding that will also help the sleep.
At what dose and at what point in taking Remeron should I hope for some improvement here?
> Prescriptions can always be appealed to get the insurance company to pay for them, especially if you can demonstrate that you did not tolerate the preferred ones or that they did not work.
I never thought of this--perhaps just another struggle to add to the list? If I hear from you that I should try to increase the dose from 15 mg, I will call the doc and ask about a new prescription. If it works I can fill the refills before the end date to save some money. Then I will check on the appeal process or samples.
THANKS AGAIN. I know I must seem like quite a bother with all these conversations. But I feel quite alone and unsupported at the same time I am feeling very vulnerable and "controlled" by a drug. And my MD is not available to me. I feel I am "disconnected" from my brain and floating off at times--loosing a few seconds at a time--almost like a petit mal seizure. Will check in tomorrow evening again. Dotty
Posted by Toby on September 30, 1998, at 11:09:31
In reply to Re: A little better?, posted by DL on September 29, 1998, at 20:07:40
if the grogginess continues, I would recommend you call your doctor and see about going on up to 30 mg. That is an effective dose for depression in many patients, whereas 15 mg is sometimes effective, but usually only when it is added to another antidepressant to aument it. Remeron is designed specifically to help anxious depression, panic, insomnia. Once the dose is increased, the side effects generally stop (the sedation and carb cravings) and no new ones start. Buspar can be used with Remeron and I do use that combination but you should probably hold off on trying that combo until after the EMDR in case you don't need anything extra after that. With Remeron, improvement generally begins within 2 weeks (faster than with other antidepressants) and certainly begins to kick in at 30 mg within a week or so.
The anxiety may be due to the decrease in Klonopin, but because you only take it at night, I would think that would not be the primary cause. It may the a combination of decreasing the Klonopin, the incredible stress you are under with the mediation etc, and the anticipation of possibly starting to work on the past in a dramatic way with the EMDR. It's probably not an effect of the Remeron since that's not a side effect and generally acts to relieve anxiety (won't kill situational anxiety because that is a "life-preserving" emotion).
Posted by DL on September 30, 1998, at 21:38:04
In reply to Remeron, posted by Toby on September 30, 1998, at 11:09:31
Your explanations are always so clear, patient and respectful of my knowledge and present status. I think you should teach a course in doctor/patient communication! This is one area where so many MD's could expand their skills. I realize managed care and present restrictions affect care, but physicians should still be able to maintain connections with their patients. Perhaps if I had received adequate care and evaluation 2 1/2 yrs ago I could have saved the insurance company the cost of many fruitless visits.....
> if the grogginess continues, I would recommend you call your doctor and see about going on up to 30 mg.
I will call tomorrow. It is incredibly difficult to actually get him on the phone. I will try leaving a message with his secretary.
I did actually sleep about 7 1/2 hours last night which is a record for me. I did wake a few times but went back to sleep. I did not have that "just under" feeling where I seem to remember most of the night. But I did have to use some coffee to decrease that "dazed' feeling. It is especially scary in the car since I seem to lose concentration easily and find my self drifting away from a focus on the road. I drive from home to home for therapy visits so I am on the road a lot. If this is part of the "grogginess" that will be decreased by raising the dose, I will try it.
Buspar can be used with Remeron and I do use that combination but you should probably hold off on trying that combo until after the EMDR in case you don't need anything extra after that.
Would love to go for EMDR now, but I may have to wait till I have to switch insurance. The new insurance will cover 15 therapy visits per year IF they deem them necessary. That may be a good time to choose a therapist who is also qualified in EMDR? My present therapist will have to ask for more sessions after my appt in 2 weeks. I could call the present insurance (Blue Cross) to approve a diff therapist and see what happens. I will try to find time to call some of the therapists on the list soon.
> The anxiety may be due to the decrease in Klonopin, but because you only take it at night, I would think that would not be the primary cause
You may be right, but when that was all I took for a long time, I would keep trying to stop taking it. I could always skip one night and sleep some, but the next night I would be unable to sleep at all. Charts I have seen show klonopin with a pretty long half life--like 40 hrs. It was the only thing I was given that had any effect on the constant hyperalert state. Even a short trial on Ativan did not seem to affect it.
. It may be the combination of decreasing the Klonopin, the incredible stress you are under with the mediation etc, and the anticipation of possibly starting to work on the past in a dramatic way with the EMDR.
Thank you for recognizing and validating the stress. I myself minimize its effects and ask too much of myself. It seems that I am always doing more than my cohorts think I need to at work. I am sure this is related to the never ending attempts to please my father who was never satisfied unless I was perfect--but, at the same time I think this background has given me an iron will and the determination that have kept me alive through some incredibly traumatic times. Instead of a sudden overwhelming tornado or attack, I have lived through long term chronic abuse neglect....
(won't kill situational anxiety because that is a "life-preserving" emotion).
Apparently this "life preserving emotion" has been trying to tell me something for years and I have been unable to listen......
In case you disappear from my life (and many stable and good things have seemed to) I want you to know that without your support I may not have been here now. There is only so much stress a soul can take.....And, I have persevered for years while protecting my children and maintaining a 'front" for the world. I realize it was not the right path, but "pretending for the world" is a structure I was thoroughly taught as a child and young adult.
----As a child I was not allowed to have novocaine with dental work. I was told it would "build up my pain tolerance". I remember sitting for a half hour of drilling about 40 years ago--holding onto the chair arms till my knuckles turned white. Long stretches of my life have seemed to be like that......holding on in pain--waiting for it to stop. I needed to stand up and walk away--and I am working on that now.
Posted by Ruth on January 29, 2000, at 3:10:28
In reply to Re: Thanks Toby!, posted by Toby on September 4, 1998, at 15:29:09
My husband cannot figure out what is making him so
restless at work. He said he'd been taking those
packs of vitamins they sell at check stands everyday.
Could this be the culprit. He's not been able
to sleep during the night either.
Posted by jd on January 30, 2000, at 3:45:39
In reply to Re: Hyper honey, posted by Ruth on January 29, 2000, at 3:10:28
Ruth,
You bet this could be the culprit. You ought to check what's in those so-called "vitamin packs", since it could be a whole lot more than vitamins! (I've seen some things at store counters that I couldn't believe was legal to package that way.) Even things labelled "natural" or "herbal" can mess some people up pretty good--many of these substances are basically undertested drugs and should be considered as such. So my advice is basically to find out just WHAT he's been taking every day...
best,
jd
> My husband cannot figure out what is making him so
> restless at work. He said he'd been taking those
> packs of vitamins they sell at check stands everyday.
> Could this be the culprit. He's not been able
> to sleep during the night either.
This is the end of the thread.
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