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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by KrissyP on March 7, 2003, at 7:27:34
I took my Effexor-XR at 11pm last night, went to bed at about 12:50AM, and I am up and manic. I don't like this and I can't deal with it. I need a new doc, I don't feel I can call her and tell her, plus, she is never in her office-except for 2 days out of the week. It makes me wonder if she is fully dedicated AND knowledgable in Psychiatry. I am thinking of just stopping the Effexor. I am in a terrible spot. I can try to call around for a new doc-one under my insurance, this is getting unbearable trying to find the right med combo for me. I also took Lamictal 50mg, my usual 100mg Seroquel, 2mg Klonopin, my Stresstab, and Cal-Mag. I woke up with explosive diarrhea (sorry for the truth) and I'm nauseas as heck.
Any help would be greatly appreciated. This is not right.
Kristen
Posted by Ron Hill on March 7, 2003, at 11:27:10
In reply to Please help, it's 5am-effexor mania, posted by KrissyP on March 7, 2003, at 7:27:34
Kristen,
> I took my Effexor-XR at 11pm last night, went to bed at about 12:50AM, and I am up and manic.
Sorry you’re having trouble, but hang in there, this can be fixed. I can not take Effexor or any of the SSRIs. They all push me into hypomania (initially). After that they cause a reduction in dopamine levels resulting in blunted emotions, lack of motivation, anergy, etc.
I subscribe to the position held by Dr. Phelps regarding the use of antidepressants for bipolar patients. He believes that bipolar patients should be treated with moodstabilizers first and foremost. If the depressive phase does not respond to the moodstabilizer (or combination of moodstabilizers) and it is decided that there is no other option but to add an AD, then MAOIs are best suited for the BP patient. Here is a link to his web site. His site is not very user-friendly, but if you click around you will find what I'm talking about. Click on "antidepressant controversy" or something like that. Click through the entire site if you have time.
http://www.psycheducation.com/
Also read the relevant portions of the American Psychiatric Association's document entitled; PRACTICE GUIDELINE FOR THE TREATMENT OF PATIENTS WITH BIPOLAR DISORDER (Revision). Here a link to it.
http://www.psych.org/clin_res/bipolar_revisebook_index.cfm
>I am thinking of just stopping the Effexor
If you do, reduce your dose VERY slowly to reduce the risk of severe withdrawal side effects (including severe dizziness, nausea, etc).
>I also took Lamictal 50mg, my usual 100mg Seroquel, 2mg Klonopin, my Stresstab, and Cal-Mag.
50 mg of Lamictal is nowhere near the therapeutic dose level. You currently have very little mood stabilization on board. Is your pdoc in the process of slowly ramping up the Lamictal?
Your dx is BP II, correct? What is you medication history; how long ago did you start taking meds, for what reason, which meds have you tried and how did each med make you feel?
-- Ron
Posted by Ron Hill on March 7, 2003, at 11:49:34
In reply to Please help, it's 5am-effexor mania, posted by KrissyP on March 7, 2003, at 7:27:34
Kristen,
>>I am thinking of just stopping the Effexor
>If you do, reduce your dose VERY slowly to reduce the risk of severe withdrawal side effects (including severe dizziness, nausea, etc).
If you are at risk of being pushed into a full blown mania by the Effexor, then it may be necessary to discontinue the Effexor ASAP and just put up with the possible withdrawal side effects. The withdrawal side effects, if any, will likely subside in a week or less. Or you might be one of the lucky ones that do not experience the withdrawal effects.
Best wishes.
-- Ron
Posted by KrissyP on March 7, 2003, at 14:18:56
In reply to Re: Please help, it's 5am-effexor mania » KrissyP, posted by Ron Hill on March 7, 2003, at 11:27:10
Ron, I thank you for being so helpful!!!
I am definately going to check out those sites.
Like I said in an earlier post, I NEED A NEW psychiatrist. She has no plans on upping the dose of Lamictal, unless I tell her from my own reaearch-something I pay her for!
I started taking AD because my fiance at the time and I broke up, my dad went to jail for drugs, forgery, and alcohol, and I just got depressed because I didn't know what I wanted to "do with my life". I couldn't handle all this so I started on Prozac. I felt good on that but I GAINED 80 Lbs. and went from Luvox, Paxil, to Zoloft.
1) As far as the Effexor, I only started a little over a week ago, back on it since October 2002.
2) You say>>>" 50 mg of Lamictal is nowhere near the therapeutic dose level. You currently have very little mood stabilization on board"
I SO AGREE.
3)>>>>Your dx is BP II, correct?-Yes I was diagnosed in Nov 1999.>>>> What is you medication history; how long ago did you start taking meds, for what reason, which meds have you tried and how did each med make you feel?
I've tried EVERY SSRI but Zoloft only for a few days all the others NO GO-too many side effects.
Effexor has worked the best on my depression but makes me extremely manic. Do you think that the 50mg Lamictal is adding to this right now? I have also tried Risperdal-couldn't tolerate it-my body is VERY sensitive to a lot of meds:-(
I am on Klonopin-2mg at night and my psychiatrist wants me to start weaning myself to 1mg ONLY.
What, IYO, do you think I should do at this point?
I am puzzled.
I so appreciate your help, did this help any??
Please reply when possible,
Thanks again, Kristen
--------------------------------------------------------------------------------------------------
Sorry you’re having trouble, but hang in there, this can be fixed. I can not take Effexor or any of the SSRIs. They all push me into hypomania (initially). After that they cause a reduction in dopamine levels resulting in blunted emotions, lack of motivation, anergy, etc.
>
> I subscribe to the position held by Dr. Phelps regarding the use of antidepressants for bipolar patients. He believes that bipolar patients should be treated with moodstabilizers first and foremost. If the depressive phase does not respond to the moodstabilizer (or combination of moodstabilizers) and it is decided that there is no other option but to add an AD, then MAOIs are best suited for the BP patient. Here is a link to his web site. His site is not very user-friendly, but if you click around you will find what I'm talking about. Click on "antidepressant controversy" or something like that. Click through the entire site if you have time.
>
> http://www.psycheducation.com/
>
> Also read the relevant portions of the American Psychiatric Association's document entitled; PRACTICE GUIDELINE FOR THE TREATMENT OF PATIENTS WITH BIPOLAR DISORDER (Revision). Here a link to it.
>
> http://www.psych.org/clin_res/bipolar_revisebook_index.cfm
>
> >I am thinking of just stopping the Effexor
>
> If you do, reduce your dose VERY slowly to reduce the risk of severe withdrawal side effects (including severe dizziness, nausea, etc).
>
> >I also took Lamictal 50mg, my usual 100mg Seroquel, 2mg Klonopin, my Stresstab, and Cal-Mag.
>
> 50 mg of Lamictal is nowhere near the therapeutic dose level. You currently have very little mood stabilization on board. Is your pdoc in the process of slowly ramping up the Lamictal?
>
> Your dx is BP II, correct? What is you medication history; how long ago did you start taking meds, for what reason, which meds have you tried and how did each med make you feel?
>
> -- Ron
>
Posted by KrissyP on March 7, 2003, at 14:37:25
In reply to Re: A quick addendum to above post » KrissyP, posted by Ron Hill on March 7, 2003, at 11:49:34
Ron, I am with you on this one. I may just stop the Effexor. It sucks because it DOES help my depression but can't the mania part be controlled at maybe 100mg Lamictal-WITH the 75mg Effexor????
Please-what do you think?
Thanks, Kristen
-------------------------------------------------------------------------------------------------- Kristen,
>>I am thinking of just stopping the Effexor
If you are at risk of being pushed into a full blown mania by the Effexor, then it may be necessary to discontinue the Effexor ASAP and just put up with the possible withdrawal side effects. The withdrawal side effects, if any, will likely subside in a week or less. Or you might be one of the lucky ones that do not experience the withdrawal effects.
Best wishes.
-- Ron
Posted by jay on March 7, 2003, at 15:04:27
In reply to Please help, it's 5am-effexor mania, posted by KrissyP on March 7, 2003, at 7:27:34
Hi Krissy:
I too am a fellow Effexor user. I am likely going to be going through a trial with Lamictal, and have used Seroquel, and do use Klonipin with it.
I am coming into my 5th or so year of Effexor use, and it really is the only antidepressant, as "hellish" as it has been, that works for me. BUT, I am also BP2, so I need to take a mood stabalizer with it.A couple of things regarding your current situation, and I feel for you, believe me..:-(
-the vitamin and mineral suppliment might be best to take either in smaller doses, or in the morning.
-Possibly think of adding a second mood stabalizer, especially one like Depakote/Epival.
-For sleep, until things get smoother also, possibly try a small dose of Remeron.
-Melatonin, which you can buy at health food stores, is popular also as a sleep aid. You just have to use it with caution and not over-use it, as it is a powerful hormone.
-Consider stocking up on Dramamine (Gravol in Canada)as it is great for all stomach/nausea pain and problems. I find this alone makes for such great relief, and it majorly helped when I first started Effexor.
It's very rough at first, but once your body gets a bit more adjusted to the meds, and you get in a regular cycle, I think you will find so much more peace.
Please keep posting...as we are all here to help. Best,
Jay
Posted by KrissyP on March 7, 2003, at 15:10:33
In reply to Re: Please help, it's 5am-effexor mania » KrissyP, posted by jay on March 7, 2003, at 15:04:27
Hi, Thank you so much for your support. Needless to say, I went back to sleep and slept, not too soundly though, and woke up about 4 hours later.
I am here for you too and thanks, I will definately look into what you speak of here.
All the best and keep posting,
Kristen------------------------------------------
Hi Krissy:
I too am a fellow Effexor user. I am likely going to be going through a trial with Lamictal, and have used Seroquel, and do use Klonipin with it.
I am coming into my 5th or so year of Effexor use, and it really is the only antidepressant, as "hellish" as it has been, that works for me. BUT, I am also BP2, so I need to take a mood stabalizer with it.
A couple of things regarding your current situation, and I feel for you, believe me..:-(
-the vitamin and mineral suppliment might be best to take either in smaller doses, or in the morning.
-Possibly think of adding a second mood stabalizer, especially one like Depakote/Epival.
-For sleep, until things get smoother also, possibly try a small dose of Remeron.
-Melatonin, which you can buy at health food stores, is popular also as a sleep aid. You just have to use it with caution and not over-use it, as it is a powerful hormone.
-Consider stocking up on Dramamine (Gravol in Canada)as it is great for all stomach/nausea pain and problems. I find this alone makes for such great relief, and it majorly helped when I first started Effexor.
It's very rough at first, but once your body gets a bit more adjusted to the meds, and you get in a regular cycle, I think you will find so much more peace.
Please keep posting...as we are all here to help. Best,
Jay
Posted by Ron Hill on March 7, 2003, at 16:59:31
In reply to Re: Please help, it's 5am-effexor mania » Ron Hill, posted by KrissyP on March 7, 2003, at 14:18:56
Kristen,
> What, IYO, do you think I should do at this point?
I'll be happy offer my layman opinion, for what its worth, but first I need to ask another question. Have you ever had a psychotic episode? If not, why was the 100 mg/day of Seroquel added to your cocktail?
-- Ron
Posted by noa on March 7, 2003, at 17:37:54
In reply to Please help, it's 5am-effexor mania, posted by KrissyP on March 7, 2003, at 7:27:34
Is it regular effexor or effexor xr?
Regular effexor, I found, had to be taken in very regular doses, no varying of times. And for me, not anywhere near bedtime.
Now I take Effexor xr. Always in the morning, as early as possible (except when my entire day's rhythm is off, which has been happening lately). I find effexor very activating.
Posted by dreamerz on March 7, 2003, at 17:45:48
In reply to Re: Please help, it's 5am-effexor mania, posted by noa on March 7, 2003, at 17:37:54
I find effexor very activating.
I find it the most sedating AD I've taken..just shows how different we are
Posted by KrissyP on March 7, 2003, at 21:12:46
In reply to Re: Please help, it's 5am-effexor mania » KrissyP, posted by Ron Hill on March 7, 2003, at 16:59:31
LOL Okay, You helped me enough, I thank you.
What really IS a psychotic episode? If it means intense anger-YES. If it means getting angry-yes-but like once every few months, if that. I have NEVER been given a diagnosis of Psychotic OR Schizophrenia. The 100 mg/day of Seroquel added to my cocktail was for sleep ONLY.
Thanks again for your help,
All the best, Does this help?
Kristen:-)-------------------------------------------------------------------------------------------------- Kristen,
What, IYO, do you think I should do at this point?
I'll be happy offer my layman opinion, for what its worth, but first I need to ask another question. Have you ever had a psychotic episode? If not, why was the 100 mg/day of Seroquel added to your cocktail?
>
> -- Ron
Posted by KrissyP on March 7, 2003, at 21:15:59
In reply to Re: Please help, it's 5am-effexor mania, posted by noa on March 7, 2003, at 17:37:54
Hi noa, It is Effexor-XR, because it is also helping me with my GAD. Wow, I always took Effexor in the AM and decided after I read a post, that I started taking it at night-now for 3 nights. Maybe I'll switch back to taking it in the AM.
Take care,
Kristen:-)
-------------------------------------------------Is it regular effexor or effexor xr?
Regular effexor, I found, had to be taken in very regular doses, no varying of times. And for me, not anywhere near bedtime.
Now I take Effexor xr. Always in the morning, as early as possible (except when my entire day's rhythm is off, which has been happening lately). I find effexor very activating.
Posted by ace on March 7, 2003, at 21:26:33
In reply to Please help, it's 5am-effexor mania, posted by KrissyP on March 7, 2003, at 7:27:34
> I took my Effexor-XR at 11pm last night, went to bed at about 12:50AM, and I am up and manic. I don't like this and I can't deal with it. I need a new doc, I don't feel I can call her and tell her, plus, she is never in her office-except for 2 days out of the week. It makes me wonder if she is fully dedicated AND knowledgable in Psychiatry. I am thinking of just stopping the Effexor. I am in a terrible spot. I can try to call around for a new doc-one under my insurance, this is getting unbearable trying to find the right med combo for me. I also took Lamictal 50mg, my usual 100mg Seroquel, 2mg Klonopin, my Stresstab, and Cal-Mag. I woke up with explosive diarrhea (sorry for the truth) and I'm nauseas as heck.
> Any help would be greatly appreciated. This is not right.
> Kristen
Kristen - GET HELP NOW. GO TO DOC'S AND LOWER THE DOSE OF EFFEXOR. YOU DO NOT DESERVE THIS DARLING. CALL FAMILY AND FRIENDS AND SAY YOU NEED HELP NOW! I WILL TELL YOU HEAPS ABOU NARDIL BUT THIS IS NOT THE TIME. YOU MUST BE STABILIZED.
SO, PLEASE, PLEASE GET TO THE DOC . TELL THEM EXACTLY HOW YOU FEEL. ONE OF THE DRUGS MIGHT BE REACTING TO ANOTHER OR IS NOT APPROPRIATE.YOU WILL HEAR FROM ME SOON. BUT YOU MAKE SURE YOU GET HELP.
LOVE ANDREW. (ACE)
Posted by ace on March 7, 2003, at 21:28:32
In reply to Please help, it's 5am-effexor mania, posted by KrissyP on March 7, 2003, at 7:27:34
Posted by Ron Hill on March 7, 2003, at 22:17:40
In reply to Re: Please help, it's 5am-effexor mania » Ron Hill, posted by KrissyP on March 7, 2003, at 21:12:46
Kristen,
Perhaps I gave you the wrong impression. I asked if you had experienced a psychotic episode because Seroquel is an antipsychotic medication and I was trying to determine the reason it has been added to your cocktail. The primary use of Seroquel is in the treatment of schizophrenia, but some pdocs use a low dose of an antipsychotic as an add-on medication in the treatment of bipolar disorder.
So rest assured Kristen, your posts do not sound delusional or psychotic, if that's where you thought I was coming from.
-- Ron
------------------------------------> LOL Okay, You helped me enough, I thank you.
> What really IS a psychotic episode? If it means intense anger-YES. If it means getting angry-yes-but like once every few months, if that. I have NEVER been given a diagnosis of Psychotic OR Schizophrenia. The 100 mg/day of Seroquel added to my cocktail was for sleep ONLY.
> Thanks again for your help,
> All the best, Does this help?
> Kristen:-)
>
> -------------------------------------------------------------------------------------------------- Kristen,
> What, IYO, do you think I should do at this point?
>
> I'll be happy offer my layman opinion, for what its worth, but first I need to ask another question. Have you ever had a psychotic episode? If not, why was the 100 mg/day of Seroquel added to your cocktail?
> >
> > -- Ron
>
>
Posted by viridis on March 7, 2003, at 22:34:13
In reply to Re: Please help, it's 5am-effexor mania » Ron Hill, posted by KrissyP on March 7, 2003, at 21:12:46
"Psychosis" indicates a break with reality -- hearing voices (and believing them), imagining people and things that aren't really there, and so on. It doesn't sound like that's what you're experiencing, so I wonder why you're taking an antipsychotic (AP) drug like Seroquel. I have no experience with APs, since I've never had a psychotic episode, but my understanding is that there are risks of movement disorders etc, with this class of meds. And, although I've never used Effexor, I definitely know the bizarre side effects that can occur with the related SSRIs, and can't tolerate them at all.
It sounds like you need a new psychiatrist, however much trouble that may be.
Posted by KrissyP on March 7, 2003, at 22:43:16
In reply to Re: Please help, it's 5am-effexor mania » KrissyP, posted by Ron Hill on March 7, 2003, at 22:17:40
Nooooooo Of course not Ron:-) I had a long day taking care of my grandmother.
I understand what you were asking and yes I think that the Seroquel was added on for treatment of my bipolar. I knew, as I posted earlier in the week, that Seroquel is used for schizophrenia and psychotic episodes.
I am so sorry if I came across as harsh-that was not my intention at all *embarrassed*
Nope, even if my posts do sound delusional or psychotic, that's what the boards for eh? LOL
Take care:-)
Kristen
-------------------------------------------------Kristen,
Perhaps I gave you the wrong impression. I asked if you had experienced a psychotic episode because Seroquel is an antipsychotic medication and I was trying to determine the reason it has been added to your cocktail. The primary use of Seroquel is in the treatment of schizophrenia, but some pdocs use a low dose of an antipsychotic as an add-on medication in the treatment of bipolar disorder.
So rest assured Kristen, your posts do not sound delusional or psychotic, if that's where you thought I was coming from.
>
> -- Ron
Posted by KrissyP on March 7, 2003, at 22:53:51
In reply to Re: Please help, it's 5am-effexor mania » KrissyP, posted by viridis on March 7, 2003, at 22:34:13
Yeah, I do need a new psychiatrist, but I'm going to see if it gets better with her. Use of AP's have the risk of developing Tardive something-that's the movement disorder you were talking about-I don't want to worry now-but maybe I should-that's why I am trying to wean myself down on the Seroquel. 2 docs have told me I don't need it-but I feel like I do---solely to get to sleep-and it does help me to sleep.
We'll see.............
Take care Ron
Kristen-------------------------------------------------------------------------------------------
"Psychosis" indicates a break with reality -- hearing voices (and believing them), imagining people and things that aren't really there, and so on. It doesn't sound like that's what you're experiencing, so I wonder why you're taking an antipsychotic (AP) drug like Seroquel. I have no experience with APs, since I've never had a psychotic episode, but my understanding is that there are risks of movement disorders etc, with this class of meds. And, although I've never used Effexor, I definitely know the bizarre side effects that can occur with the related SSRIs, and can't tolerate them at all.
It sounds like you need a new psychiatrist, however much trouble that may be.
Posted by KrissyP on March 8, 2003, at 0:21:38
In reply to Re: Please help, it's 5am-effexor mania » KrissyP, posted by jay on March 7, 2003, at 15:04:27
Posted by KrissyP on March 8, 2003, at 1:25:35
In reply to Re: Please help, it's 5am-effexor mania » KrissyP, posted by ace on March 7, 2003, at 21:26:33
Ace, thanks. I spent the day helping out my grandmother-she needed my support. Her doc is putting her on Zoloft.
The day was spent doing that. If this gets worse (see my MANY posts), I am going to call my psychiastrist Monday!!!! I am smoking like a fiend.
Tell me about Nardil when you can-I am ready to hear.
Love ya-Thanks so much!
Hope to hear from you soon.
Kristen
-------------------------------------------------
Kristen - GET HELP NOW. GO TO DOC'S AND LOWER THE DOSE OF EFFEXOR. YOU DO NOT DESERVE THIS DARLING. CALL FAMILY AND FRIENDS AND SAY YOU NEED HELP NOW! I WILL TELL YOU HEAPS ABOU NARDIL BUT THIS IS NOT THE TIME. YOU MUST BE STABILIZED. SO, PLEASE, PLEASE GET TO THE DOC. TELL THEM EXACTLY HOW YOU FEEL. ONE OF THE DRUGS MIGHT BE REACTING TO ANOTHER OR IS NOT APPROPRIATE.
YOU WILL HEAR FROM ME SOON. BUT YOU MAKE SURE YOU GET HELP.
LOVE ANDREW. (ACE)
Posted by noa on March 8, 2003, at 10:51:43
In reply to Re: Please help, it's 5am-effexor mania, posted by dreamerz on March 7, 2003, at 17:45:48
Yup. It is amazing how differently different people can be affected by the same meds!
Posted by noa on March 8, 2003, at 10:53:46
In reply to Re: Please help, it's 5am-effexor mania » noa, posted by KrissyP on March 7, 2003, at 21:15:59
Yes, it seems some of us find it extremely activating, and some find it extremely sedating. Whether you find it sedating or activating would help determine what time of day to take it. Try to pick a time and stick to it, though. I have gotten inconsistent lately in taking it on time, and it makes me feel a little "off".
Posted by KrissyP on March 8, 2003, at 14:17:11
In reply to Re: Please help, it's 5am-effexor mania » KrissyP, posted by noa on March 8, 2003, at 10:53:46
I hear ya here when you say, "Try to pick a time and stick to it". I am trying. WHen do you take it? Thanks to everyone for understanding my posts lately. I am just getting used to being back on meds and I hope I stabilize soon LOL
Kristen
------------------------------------------------- Yes, it seems some of us find it extremely activating, and some find it extremely sedating. Whether you find it sedating or activating would help determine what time of day to take it. Try to pick a time and stick to it, though. I have gotten inconsistent lately in taking it on time, and it makes me feel a little "off".
Posted by noa on March 8, 2003, at 20:51:29
In reply to Re: Please help, it's 5am-effexor mania » noa, posted by KrissyP on March 8, 2003, at 14:17:11
Well, the way I do it is that when I wake up, which is usually very early M-F, I first take my adderall, so I can wake up, along with the meds that have to be taken on an empty stomach. Then, at least an hour later, I take the meds that have to be taken with food, including the Effexor. Problem is, my morning routine has been very inconsistent of late, so the time I take the Effexor varies. I was experimenting with taking the food meds first, and save the non-food meds for mid morning. If I have an appetite in the early am, that works., although I then often forget the take my non-food meds later. But lately, I've had a number of days when I forget the take the food meds, inc. effexor, until very late--like early afternoon--once as late as 3:30 pm. I don't like when this happens--I feel "off". I've been trying to buy these drinkable yogurts so that I can take my food meds with the yogurt, if I am on the run and/or not up for eating yet in the morning.
I need to work on getting back into a good routine.
BTW, I once forgot to take my meds all day. I remembered by early evening, but thought I should just wait until the next day. Big mistake. I felt very wierd all night and most of the next day. Kind of ill.
Posted by KrissyP on March 8, 2003, at 21:33:38
In reply to Re: Please help, it's 5am-effexor mania, posted by noa on March 8, 2003, at 20:51:29
Hi noa, Thanks for this:-)
Those "Nouriche" yogurts-on-the-go are wonderful. Please..don't forget your meds again-I did the same thing, actually with the Klonopin about 2 weeks and landed in the ER (I posted, I think) I have learned, after a long time, that these meds are very important not to play with.
Take care you:-)
Kristen
--------------------------------------------------------------------------------------------------
> Well, the way I do it is that when I wake up, which is usually very early M-F, I first take my adderall, so I can wake up, along with the meds that have to be taken on an empty stomach. Then, at least an hour later, I take the meds that have to be taken with food, including the Effexor. Problem is, my morning routine has been very inconsistent of late, so the time I take the Effexor varies. I was experimenting with taking the food meds first, and save the non-food meds for mid morning. If I have an appetite in the early am, that works., although I then often forget the take my non-food meds later. But lately, I've had a number of days when I forget the take the food meds, inc. effexor, until very late--like early afternoon--once as late as 3:30 pm. I don't like when this happens--I feel "off". I've been trying to buy these drinkable yogurts so that I can take my food meds with the yogurt, if I am on the run and/or not up for eating yet in the morning.
>
> I need to work on getting back into a good routine.
>
> BTW, I once forgot to take my meds all day. I remembered by early evening, but thought I should just wait until the next day. Big mistake. I felt very wierd all night and most of the next day. Kind of ill.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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