![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Amelia_in_StPaul on April 21, 2009, at 13:12:24
Desolation rowers (what a great name by the way),
I am crashing, fast (5 days off fluoxetine for a sleep study--atypical depression getting worse). I need to come up with a regimen that works for me and am hoping that I could get your input. I hope you bear with me as I give you a little history.
I am in my late 30s. In pre-teen years, my father died suddenly in front of me (only me) and I was unable to save him. After, my sister showed signs (unbeknownst to us) of being in the prodromal stages of schizophrenia and, as a result, she was often violent in our home. Looking back, I had periods of melancholy in high school, but nothing too bad until I was 17 and in an abusive relationship with my boyfriend. I tried to kill myself, but my mother found me. I went in hospital for two weeks. They did not want to give me medication b/c my brain was still developing. I had psychotherapy after and then went off to college, which seemed to solve my problems for a couple of years. At 20, I had a melodramatic relationship with a guy whose presence triggered something in me so that he felt like home, he felt like the missing piece, and then when he left me I had a bout of depression. That was the first time I was on Prozac.
Over 15 years I was on and off of it, mostly on. In the meantime, I tried multiple other drugs, but couldn't last a trial b/c of overwhelming side effects (listed below). I never had much of a problem with anxiety, though I was a worrier, and had a bit of a problem with compulsions when I was 7.
Flash forward. My husband and I endured a ton of stress related to our house. Part of it actually collapsed, we ended up almost in bankruptcy, my in-laws gave us some money so we could try to fix the house, contractors created more structural problems--a period of about 9 years of hell, during which time I broke my back, got mono, etc. My relationship with my husband is sometimes bad so that is an ongoing stressor (as is the house--still not finished yet).
In January of 2008, I ended up with anxious depression, something totally new to me. This was after going off of my fluoxetine in April 2007 (with very brief trials of other meds, all failed, after the fluoxetine). I ended up on the couch, unable to move, shaking, not eating, not showering, just waking up and moving to the corner of the couch, where I sat all day, freaking out. I thought I was becoming schizophrenic. I was obsessed with that thought. I went inpatient, ended up being verbally abused by the staff, manipulated and retaliated against when I complained to the hospital ombudsman, and left the hospital worse than when I came in. Spent four weeks in a state of extremely severe anxiety, ironically the only thing that would get me out of my head for seconds at a time was to read, so I read a ton of light novels. Went into a partial hospital program at another hospital, went inpatient for awhile to sort out my sleeping, started the road to healing. 9 months after 20mg of fluoxetine, became severely apathetic, sleepy (in addition to fatigue), amotivated, and again, in periods of depression. I am now back to suicidal ideation and sitting on the couch.
My diagnoses are PTSD, Major Depression recurrent, GAD, OCD, social anxiety, and borderline features (the emotionally labile part), and non-restorative (lack of stage 4) sleep. All of them fit, although my OCD therapist balks at the notion that someone could have so many diagnoses.
Med History-Failed Trials
Effexor (eye dilation, intense nausea, double vision, flu-like symptoms lasting 24 hours)
Serzone (migraine headache)
Paxil (double vision, unable to see/focus)
Zoloft (first trial in 1993, slept for most of the next 72 hours, flu-like symptoms; second trial in 2008, chest paint for four days, sleepy but not helping me sleep)
Elavil (zombie-feeling, bumping into things, unable to concentrate)
Lexapro (eye dilation, woozy, spacey, tried for two days but couldn't take it)
Wellbutrin (as an adjunct to fluoxetine it used to work to wake me up, but then I started to have panic attacks on it; tried it on its own in 2008, on 35mg daily ended up incredibly hostile, angry, climbing walls)
Seroquel (tried in 2003, knocked me out for 13 hours but didn't seem to help with deep sleep, got up and slept most of hte next day. Headache and flu-like symptoms; tried in 2008 in the hospital, ended up with panic attacks, agitation, hyperventilation, and unable to judge accurately the distances between me and objects and the size of some objects)Now Prozac. In the past, trying it at 30mg, I was just dead basically. 20mg always worked, but with fatigue. Now on 20mg, I am totally wiped out, falling asleep during the day etc. My reaction to it seems to have changed. Before hospitalization, I tried to get back on it, twice: the first time, it made me incredibly sleepy, and the second time, it made me absolutely wired, anxious, and agitated, with a resting pulse of 80 (normally more like 50). In hospital, I was also placed on ativan, and then, back on Trazodone, the only thing that has ever worked for deep sleep.
Okay, so in sum, the things that have only ever worked out of these trials:
Prozac/fluoxetine (was on 20mg until 5 days ago)
Ativan (was for a year and half on .5 in morning, 1.5 in evening; I started tapering off and am on .25 in the morning, same evening dose)
Trazodone (but I develop tolerances to it, and then take more, but anything over 25mg just makes me non-functioning the next day, without necessarily keeping me asleep the night before).Family History
Mother - depression
Sister - schizophrenia
Sister - nothing
Father - depression (tried meds in the late 70s, couldn't tolerate them)/fatal heart attack (fit as a fiddle--genetic cholesterol condition)
Grandparents - maternal side, both undx'ed depression
Grandparents - paternal side, one with undx'ed personality disorder
Great-grandparent - maternal, suicideAlthough in females, the timeframe for developing schizophrenia is most commonly 20-35, it is still possible to develop it later in life, especially with hormonal changes. In the last year and a half, I have had what my doctor calls a stress-induced brief hallucination (last summer, after a huge amount of caffeine and lack of sleep), and quasi-hallucinations. I now have hpynogogic and hypnopompic hallucinations (occurs in normal populations, but new to me). All of this was probably brought on by my intense obsessions over fear of becoming schizophrenic, as I would think of all the things I could think or see or hear that would be unreal. I unfortunately have an intimate knowledge of my sister's delusions and hallucinations, and I have absorbed them and obsessed over them.
So I am not psychotic but feel I could tilt that way.
In sum, I am looking for a medication regimen that may have some dopamine but does not carry with it a higher risk of psychosis (as does the TCAs). I am looking for wakefulness without inducing anxiety. I am looking for something to level out my days, whether that be an AD or a mood stabilizer, if that seems appropriate (and sometimes it does).
I am also looking to not be on a medication that carries a risk for metabolic syndrome or high cholesterol, since heart attacks due to high cholesterol is genetic in my family (father and uncle).
I'm not asking too much am I? ;-)
Willing to try proven alternative therapies.
Whew. If you have read through this entire post, d/r, and anyone else, you are a saint.
Desperately yours,
Amelia
Posted by Amelia_in_StPaul on April 21, 2009, at 13:23:49
In reply to d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 21, 2009, at 13:12:24
Posted by garnet71 on April 24, 2009, at 1:50:35
In reply to d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 21, 2009, at 13:12:24
(((((((((((Amelia)))))))))))
I have to be blunt here--you've BEEN_THROUGH_ HELL. That's what the problem is. It's amazing how well you've plowed through all this, it really is.
I'm sorry no one has responded. D/R is mia. Maybe you could post this on the medication board and will get more responses about the medications? People on the psychology board tend to talk a lot more about personal experiences too, and would be most supportive. So you've never taken a mood stablizer? People seem to start out on Lamictal. That's not one I would want to take because of the cognitive problems. Lithium involves your health concerns. My sister takes Lithium and Wellbutrin. She's gained a lot of weight, but she's doing good.
I'm not here to give you medical advice, though, just want to let you know you've been heard, and I feel your pain, and I share your concern about the schitzophrenia. Sometimes I think (intuitively only) there's a wider spectrum than known, like with autism. I've considered it during my own pseudo diagnosis attempts. You don't have to have psychosis to have schitzophrenia, but it doesn't sound like you have that-although I'm just some average person that's read up on it. Yeah, anxiety can lead to self-diagnoses of every illness imaginable. That's what sounds like is going on with you in regard to that.
Since my Grandmother had schitzophrenia, maybe I should share the experience if it could help in any way. My Grandmother was about 35 when her symptoms manifested; when her husband died when he was 35, after coming back from the war, and she had to support 2 kids w/no family help, she had a nervous breakdown severe mania then a catatonic depression--and at that time she got brutal electric shock therapy. It later manifested as psychosis and lots of hallucinations and stuff. This was a few years later, but she would try to exorcise the house and stab devils on the windowsills with forks, that's about all I can remember from when I was a little kid as far as her being ill. She would be obsessed with religion. Sometimes i wonder if it was her meds that caused psychosis back then, and she was really bipolar and not schizophrenic. I'll never know. I know mostly from what parents told me--and she was very agitated and got mean, alternated by laughing, sounds very much like BP1. For at least ten years before she passed away, she seemed perfectly normal-well, showed no symptoms at all, and worked and was strong and stuff. I don't know what meds she took, I had wished I talked to her more about this. I wonder if historically people were misdiagnosed with schitzophrenia back then? I wonder how much was known about BP? Just a thought. Maybe that didn't happen, and they understood schitzophrenia as they do now.
My sister has BP, but this was after her mental breakdown when she quit drugs and alcohol with no help or support. I didn't even know. While on drugs, she tried to kill herself by driving her car head on with a truck years prior, was life flighted to a hospital and almost died. Somehow the nurses/doctors knew she was coming off heroin. She was wheelchair bound for about 6 months. She became addicted to Oxycotin--which transferred again to heroin because it is so much easier to get. Anyway, it wasn't until she quit drugs that she had severe mania and delusions manifest.
I guess mental health professionals now call it a mental breakthrough-something sets off your underlying tendancies. Who knows what the theories are, but I think being proactive is imperative in preventing somethinglike that from happening, and that is exactly what you are doing. I mean, if my grandmother and sis didn't have all those environmental factors, I wonder if they would have ever had such severe illnesses. But see, they didn't research mental illness or read about it-didn't have the tools or will or whatever to try and prevent it. Well you do.
From anxiety, I, too, fear "losing it". Well, I had these thoughts the other day and once before. It is scary, I know. I think its important to try to stay away from those anxiety/OCD thoughts about illnesses. It's difficult, I know.
But what did you mean, more specifically, when you felt you were "freaking out" before you went to the hospital? Interesting you were able to read. Yeah, I spent lots of time at the mental hospital (took half dozen trips before my sister was admitted when she had her breakdown). It was a horrible experience. I had to almost threaten w/ a lawsuit before they gave her meds to stabilize her w/rapid cycling BP, delusions, thinking she was God, screaming if I went near the computer because it was bugged by our mother, not letting me sleep for days and I had to occupy her around the clock by agreeing to "type" her book she was writing about out mother and family (all during final exams week at school..lol). I mean how else to you occupy someone w/severe delusions and mania? I would calmly tell her "sis, this is a symptom of your illness and is not real". She would always say "sis, I know these are only delusions and not real, but then this that...and describe the whole world-wide delusion to me again and how everyone in our life fits in the story about God....This went on and on because doctors would not prescribe her one single pill to stop it despite she was like this for 2 weeks by this point. They wrote in the medical records later (you could tell they added it) that she could have been "acting". OMG her mania was so severe and she was staying with me as I was taking care of her, and she didn't sleep for days straight. After trip 5 or whatever, and still no drug prescribed to stablize her, I asked them if they were comfortable taking responsibility if she were to jump the roof of my house thinking she could fly because she thought she was God, and because I could not 'watch' her 24/7. I can't believe every time we went to the mental hospital ER--they refused to give her meds to stablize her. The PDOcs were sooo mean. We told them she had quit heroin and everything 2 months prior. I asked for something to "sedate" her, not using the correct term, not knowing anything about BP1. Each trip to the ER, they said they could not prescribe meds. Yet, they'd take her in this room with students and a PDoc and talk to her for what seemed like hours-observing her under a camerea. I was uncomfortable with this so I said I want to be in the room, while the nurse practically pushed me away and yelled at me. I had to chase down the doctor to tell him I wanted to be by her side, and he said I was allowed in the room. All of the sudden, after I asked them if they were willing to take responsbilitly for what happend to her in her mania/paranoid delusions--they prescribed meds. So from that I can conclude 1) many doctors first thoughts revolve around "drug seeking behavior" and 2) their second thoughts revolved around a lawsuit. I cannot believe how cruel they were...then in the hospital w/all the shots of Halidol and everything else..I had never seen my sister soooo messed up. From this experience, I'm a lot smarter about using lawsuit implications now. I think the treatment of my sister equated to cruel and unusual punishment, not to mention the safety risk. So I guess you can see that I can understand your anger and frustration with your hospital experience.
So I answered your story with a story..lol. I just want to let you know I can relate to some of your experiences, even if only in some small way, and it you've been through sooo much pain and are very resilient. And you're going to be ok. You are a remarkable woman there Amelia!!!
Posted by garnet71 on April 24, 2009, at 2:02:10
In reply to d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 21, 2009, at 13:12:24
Amelia, I forgot to say...please read up on PTSD some more. I can't explain it, but having PTSD has more variables involved. It can definitely make you feel like you're going crazy. Maybe people on the psychology board can help you with that. I think Scott/SLS posted some articles about it and Rskontas did on the medical board too.
My first diagnoses was PTSD w/severe depression, though it seemed at the time that I was slowly going crazy, if that makes any sense. Thankfully I first had an awesome therapist. He passed away though, but those few sessions w/him meant the world to me. I was led to him for help-he was an angel. Angels manifest as 'regular' people to help us through hard times. If you look close enough, angel radar, I bet an angel will emerge that will be working for you too. :-)
Hang in there Amelia!!!!!! You will be ok!!!!
Posted by Amelia_in_StPaul on April 24, 2009, at 17:31:53
In reply to Re: d/r + experts - desperate for help w/my meds » Amelia_in_StPaul, posted by garnet71 on April 24, 2009, at 1:50:35
Dear Garnet,
Oh my gosh, thank you so much for your extremely kind response. I really needed for someone to "hear" me and understand and I so appreciate that you did that. Sometimes, "helping" professionals end up treating us as specimens, and after an awful experience at my psychiatrist's office the other day (he clearly does not understand OCD), I really needed to be heard; I really needed for my words and experiences to be heard.
I am so sorry that you have been through hell too--to have gone through so much with your sister as well. For her to have almost died. And for her to have been treated dismissively and with cruelty. She is extremely lucky to have you. My husband--some issues I have with him revolve around his passivity. When about half my rights were violated, similarly to your sister, he did nothing. He was paralyzed by anxiety and conflict. I cannot forgive him, sometimes, for that.
I think you said about the most reassuring and supportive thing anyone's every said to me when you said: "I wonder if they would have ever had such severe illnesses. But see, they didn't research mental illness or read about it-didn't have the tools or will or whatever to try and prevent it. Well you do." That is so insightful, so smart, so important for me to hear. I hope you remember that too, in times of anxiety or crisis.
I guess by "freaking out" I meant that I had stopped functioning--I had stopped eating, was barely sleeping. [Warning: the following might be triggering--it's about anxiety and panic] During the day, my brain was zoned out, was blank, but every nerve was on overdrive--sounds hurt my ears, lights hurt. At night, my mind was on fire, and I would try to sleep but have--well, its embarrassing to say, but I would wake up thinking I heard my husband ask for a cookie. Or I would fall asleep hearing a radio playing. Or I would hear a doctor's voice as I drifted in and out of sleep. I know now that those were hypnogogic and hypnopompic hallucinations, pretty normal stuff, esp. with anxiety or with narcolepsy, but I had no idea--sounds scary, right? So during the day, I was scared and I was listening to everything to check if it was real, looking at everything to see if I saw it. At night, I didn't get any sleep.
I didn't want to go to the hospital, but I also didn't want to exist like that. When I left the hospital, I had all the symptoms of PTSD, reactivated. I experienced a total dissociative state. I didn't recognize any houses on my block--I couldn't tell where we were when my husband drove me home. Those f%ckers. The governor of my state let a bill expire that required that inpatient facilities have trained staff--so that now, completely untrained "staff" can be in charge of patients. I had no idea. I thought it was like 20 years ago, the one and only other time I had been in a hospital--nurses only on staff, kind people who gave me homework to do during the day and who listened to what was going on with me.
Anyway, now I'm going on and on...
I can never tell you how much I appreciate your virtual hug and your support. Thank you so much, kind, wonderful
((((((((((Garnet))))))))))))
-Amelia
Posted by Amelia_in_StPaul on April 24, 2009, at 17:34:54
In reply to Re: d/r + experts - desperate for help w/my meds » Amelia_in_StPaul, posted by garnet71 on April 24, 2009, at 2:02:10
Thank you Garnet, I will look up those posts. You have PTSD too? Oh, I'm sorry. You HAVE been through so much. And yes, it COMPLETELY makes sense that you felt you were slowing going crazy. I do too!
Wow, it sounds like you had a great therapist. It's wonderful that you can appreciate the few sessions you had with him, despite that it couldn't last...he sounds like a special person.
Thank you again Garnet. You're an angel!!!!!!!
> Amelia, I forgot to say...please read up on PTSD some more. I can't explain it, but having PTSD has more variables involved. It can definitely make you feel like you're going crazy. Maybe people on the psychology board can help you with that. I think Scott/SLS posted some articles about it and Rskontas did on the medical board too.
>
> My first diagnoses was PTSD w/severe depression, though it seemed at the time that I was slowly going crazy, if that makes any sense. Thankfully I first had an awesome therapist. He passed away though, but those few sessions w/him meant the world to me. I was led to him for help-he was an angel. Angels manifest as 'regular' people to help us through hard times. If you look close enough, angel radar, I bet an angel will emerge that will be working for you too. :-)
>
> Hang in there Amelia!!!!!! You will be ok!!!!
Posted by desolationrower on April 24, 2009, at 21:30:47
In reply to Re: d/r + experts - desperate for help w/my meds » garnet71, posted by Amelia_in_StPaul on April 24, 2009, at 17:34:54
hey, i'll try to respond. i'm probably not much use with hugs. and its a grass=greener, but i don'tn really experience 'breakdown', i just feel kind of dead, and kind of wish i had something to say other than 'i sat around, not doing much, and was sad'. so anyway, what i mean is that even though it takes me a while to read through, i did find your story interesting. i did have a 'am i schizophrenic' moment, woke up with lots of jamais vu, and had to call my old man.
about TCAs, they are preferred for psychotic depression (+an antipsychotic). they won't help much with OCD, but they are effective for panic, at least once you get to a good dose and are there for a bit. perhaps a low dose of an sri would be worth trying, once you're on a good dose ofa tca.
if traz. helps but gives you a hangover, try something with a shorter half life maybe. cyproheptadine or low dose risperdone. probably gabapentin/pregabalin. i just realized i said this to you before i think/?
so i guess i'd say get some nortryptaline. oh, i see you've tried amytryptaline. could you say more about it you didn't like? maybe you're sensitive to antimuscarinic effects. maybe some huperzine would be helpful?
also, read the post i made for zana, i think that has about everything relevant to alternative (but not including herbal ADs) as far as nutrition and its pretty much the same thing for health. do'nt take a statin, though.
inositol (titrating up to 15-20g/d range) and modafinil might help too.
also, things like 2-day trials of meds isn't necessarily indicative of how they will be long-run, make sure you don't start off too high and so get a bad reaction to a drug. things like nausea from ADs usually go away; its the side effects like sexual disfunction that don't.
maybe try NAC for the OCD? could try memantine too, but its DX and more $.
oh, i like reading to distract myself too. or video games, i did that thsi last week and just now am emerging.
-d/r
Posted by Amelia_in_StPaul on April 25, 2009, at 14:30:55
In reply to Re: d/r + experts - desperate for help w/my meds, posted by desolationrower on April 24, 2009, at 21:30:47
hey, d/r!! thanks so much for responding!!! its okay you don't do hugs--every one of us has something to contribute, and you obviously do us all such a favor by using your huge smarts to help us out. so I thank you, from the bottom of my heart.
some responses in text...
> hey, i'll try to respond. i'm probably not much use with hugs. and its a grass=greener, but i don'tn really experience 'breakdown', i just feel kind of dead, and kind of wish i had something to say other than 'i sat around, not doing much, and was sad'. so anyway, what i mean is that even though it takes me a while to read through, i did find your story interesting. i did have a 'am i schizophrenic' moment, woke up with lots of jamais vu, and had to call my old man.old man=psychiatrist? I'm confused--and I'm abashed to admit this, as it means that for all my feminism, I am sexist, but I thought you were/are a guy?
about jamais vu--you wouldn't happen to have temperoal lobe epilepsy, would you? that can happen without it being clear that you have seizures (you probably already know this). things like jamais vu and a lot of deja vu are often signs of TLE.
> about TCAs, they are preferred for psychotic depression (+an antipsychotic).
I'm confused. Why do so many of them have a side effect as inducing schizophrenia, as opposed to the MAOIs and SRIs?
>they won't help much with OCD, but they are effective for panic, at least once you get to a good dose and are there for a bit. perhaps a low dose of an sri would be worth trying, once you're on a good dose ofa tca.
>
> if traz. helps but gives you a hangover, try something with a shorter half life maybe. cyproheptadine or low dose risperdone. probably gabapentin/pregabalin. i just realized i said this to you before i think/?I think so. Are you in favor of low-dose antipsychotics even in absence of a psychotic disorder? I looked up cyproheptadine--how do you know about this stuff? my pdocs have never even mentioned this medication. it looks promising, from what I've read, in terms of increasing non-rem sleep (which I need).
> so i guess i'd say get some nortryptaline. oh, i see you've tried amytryptaline. could you say more about it you didn't like? maybe you're sensitive to antimuscarinic effects. maybe some huperzine would be helpful?
>
I remember that it didn't really put me or keep me asleep any better than not having meds, but that I was quite out of it the next day, bumping into things and unable to focus--even on objects--as though I could see, but not really see. I don't know how to describe that. I could see objects, but couldn't precisely judge their location in space, so I'd bump into them.I think you may be right about anticholergenic drugs (their antimuscarinic effects--whew, I'm googling like crazy), if Effexor would be considered one of them. Are there classes of drugs that are anticholergenic, like SNRIs? Is Seroquel one of them, or no?
> also, read the post i made for zana, i think that has about everything relevant to alternative (but not including herbal ADs) as far as nutrition and its pretty much the same thing for health. do'nt take a statin, though.
>OK, will do.
> inositol (titrating up to 15-20g/d range) and modafinil might help too.
It's funny. I had my first dose of GNC women's multivitamin, which has excesses of some B vitamins, and has iron, and I was SO ALERT--not right away, but maybe 5 hours later. I couldn't sleep last night, didn't fall asleep until 2:00 (my usual is 12:00) and had a fitful sleep. I took the multi too late--at 3:00 PM. I am supposed to take them b/c I am on borderline deficiency with iron and B12.
>
> also, things like 2-day trials of meds isn't necessarily indicative of how they will be long-run, make sure you don't start off too high and so get a bad reaction to a drug.OK. I think that is what has happened in the past!!
> things like nausea from ADs usually go away; its the side effects like sexual disfunction that don't.
>is eye dilation a troubling sign? Or double-vision--should I withdraw after only two days if that happens? Nausea I've been able to work with, like when I'd start Wellbutrin (back when it didn't make me into a bit of a maniac), and just push through.
> maybe try NAC for the OCD? could try memantine too, but its DX and more $.
WOW, I have NEVER heard of these things, things like NAC. THANK YOU! What an encyclopedia your mind is. Methinks you are a pharmacist or doctor??
>
> oh, i like reading to distract myself too. or video games, i did that thsi last week and just now am emerging.Ahhhhhhhh yessssss. My distractions are word games online. I wonder, though, isn't that a sign of perhaps some sort of dopamine deficiency, since gaming taps into the reward center of the brain?
d/r thank you. thank you. thank you. I have learned so much in the 20 minutes that I've read and processed your post.
sounds like maybe you were down last week if you were gaming? if so, i'm very sorry to hear it.
Posted by desolationrower on April 27, 2009, at 0:25:59
In reply to Re: d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 25, 2009, at 14:30:55
ha. emotional support seems more human. i think i'd ratehr do that, although pharm advice make my brain more occupied.
> old man=psychiatrist? I'm confused--and I'm abashed to admit this, as it means that for all my feminism, I am sexist, but I thought you were/are a guy?hm, englishi is your first language? i called my father. and i am a guy, you gueessed right.
no epilepsy (that i know of, i guess i don't have an 'epilepsy-free' certificate). thi sonly happened once.
> > about TCAs, they are preferred for psychotic depression (+an antipsychotic).
>
> I'm confused. Why do so many of them have a side effect as inducing schizophrenia, as opposed to the MAOIs and SRIs?
>
i don't remember ever seeing that written before...> I think so. Are you in favor of low-dose antipsychotics even in absence of a psychotic disorder? I looked up cyproheptadine--how do you know about this stuff? my pdocs have never even mentioned this medication. it looks promising, from what I've read, in terms of increasing non-rem sleep (which I need).
not often, they're quite overused, but i'm not totally against (and i was rec'ing a lower dose than the usual 'low dose').
not sure where i first read of cypro. i have enough trouble remembering what drugs do, let alone a personal intellectual history. i don't think i've really thought of any unique drug uses. there is a huge gap between research and average clininc.
> >
> I remember that it didn't really put me or keep me asleep any better than not having meds, but that I was quite out of it the next day, bumping into things and unable to focus--even on objects--as though I could see, but not really see. I don't know how to describe that. I could see objects, but couldn't precisely judge their location in space, so I'd bump into them.
>
> I think you may be right about anticholergenic drugs (their antimuscarinic effects--whew, I'm googling like crazy), if Effexor would be considered one of them. Are there classes of drugs that are anticholergenic, like SNRIs? Is Seroquel one of them, or no?yeah taht sounds like anticholinergic effect. effeoxor doesn't have much of this. well 'anticholinergic drugs' are the class that are anticholinergic. http://en.wikipedia.org/wiki/Muscarinic_antagonist (wiki is occasionally wrong, and drug summaries often incomplete, but it has some good info too). there is disagreement on if quetiapine is significant M blocker. i'm not sure how acetylcholine (natural agonist for muscrainic and nicotinic receptors) works, if it has significant reuptake or not.
>
> is eye dilation a troubling sign? Or double-vision--should I withdraw after only two days if that happens? Nausea I've been able to work with, like when I'd start Wellbutrin (back when it didn't make me into a bit of a maniac), and just push through.i think muscarinic effects reduce with time, not totally sure though.
> WOW, I have NEVER heard of these things, things like NAC. THANK YOU! What an encyclopedia your mind is. Methinks you are a pharmacist or doctor??nah, just a combination of social anxiety and adhd that keeps me from doing much else.
> Ahhhhhhhh yessssss. My distractions are word games online. I wonder, though, isn't that a sign of perhaps some sort of dopamine deficiency, since gaming taps into the reward center of the brain?most games give frequent feedback which people with ADHD need to keep doing something
> d/r thank you. thank you. thank you. I have learned so much in the 20 minutes that I've read and processed your post.
>
> sounds like maybe you were down last week if you were gaming? if so, i'm very sorry to hear it.
>
hm. i'm not sure 'down' is how i'd think of it. other than a year or two when i was depressed, failure to self-regulate isn't something that i feel as a 'hurt'. thanks though.-d/r
Posted by desolationrower on April 27, 2009, at 14:36:21
In reply to Re: d/r + experts - desperate for help w/my meds, posted by desolationrower on April 27, 2009, at 0:25:59
hm, i read some more of your posts, sounds like anger/ptsd is some of the problem? valproate or guanfacine might be worth trying too, although neither is likely to be very helpful for depression...also compassion meditation is probably good if you can do it for a while.
-d/r
Posted by ricker on April 27, 2009, at 16:43:24
In reply to d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 21, 2009, at 13:12:24
You may try clomipramine, titrate very slow, 25mg every 7 - 10 days. Clonazepam, 0.5mg - 3x/day to help with clomipramine start up and long-term maintenance. Lamictal could be added if need be.
Just my thoughts from past experience,All the best, Rick
Posted by Amelia_in_StPaul on April 27, 2009, at 17:45:05
In reply to Re: d/r + experts - desperate for help w/my meds, posted by desolationrower on April 27, 2009, at 14:36:21
d/r, thank you! yes, ptsd and anger related to that is definitely a problem. hey, guanfacine is for adhd too! hope it doesn't lower blood pressure too much as I am low already, but would love to try that (versus valporate). do you have some kind of mondo drug book? you are a whiz. thanks for your thoughtfulness in regards to all this.
> hm, i read some more of your posts, sounds like anger/ptsd is some of the problem? valproate or guanfacine might be worth trying too, although neither is likely to be very helpful for depression...also compassion meditation is probably good if you can do it for a while.
>
> -d/r
Posted by Amelia_in_StPaul on April 27, 2009, at 17:51:33
In reply to Re: d/r + experts - desperate for help w/my meds, posted by ricker on April 27, 2009, at 16:43:24
Hi Ricker, all suggestions welcome. Thank you! Clomipramine is Anafril? Wait, it's used for both OCD and ADHD? That sounds like a possibility. Oh great--a side effect is fatigue and somnolence? Looks very common. Do you know, if one takes something like that at night, do they feel fatigued and somnolent the next day?
> You may try clomipramine, titrate very slow, 25mg every 7 - 10 days. Clonazepam, 0.5mg - 3x/day to help with clomipramine start up and long-term maintenance. Lamictal could be added if need be.
> Just my thoughts from past experience,
>
> All the best, Rick
Posted by Amelia_in_StPaul on April 27, 2009, at 17:59:51
In reply to Re: d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 27, 2009, at 17:51:33
Posted by ricker on April 27, 2009, at 20:08:07
In reply to Re: d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 27, 2009, at 17:51:33
> Oh great--a side effect is fatigue and somnolence? Looks very common. Do you know, if one takes something like that at night, do they feel fatigued and somnolent the next day?
I was on Anafranil - 150mg for ten years along with the clonazepam. It was some what of a struggle to get use to the drug.... 2 attempts actually, but it was the best drug for my symptoms which are very similar to yours. That's why I recommend taking the clonazepam during start up to help alleviate some of the side effects.
I experienced some tremor and a slight increase in anxiety for a month. It was well worth it... I've yet to achieve that sense of well-being to date. My wife often questions me as to why I haven't went back on it earlier...very good question.I may have experienced some day time drowsiness in the beginning but that quickly passed.
I can appreciate your anxiety related to side effects and all, a challenge with most meds I would think..... short term pain for long term gain!I'm currently taking zoloft/nortriptyline/clonazepam..... if things don't improve I will be going back on anafranil.
I was stable ten years ago when my p/doc decided to see how I would do on the "new and improved" ssri's????? big mistake on my part.I believe many people have prematurely ended med trials due to start up side effects, myself included. My first trial with anafranil lasted 10 days and I dumped it. Second trial was in hospital with excellent nursing staff and p/doc. I still experienced some side effects but the clonazepam helped dramatically.
When we are suffering, one day can seem like an eternity and that feeling from hell often clouds our ability to persevere with a med that could potentially provide years of stability.
I hope you find success with your treatment, you have lots of options so try and remain positive.
Regards, Rick
Posted by Chairman_MAO on May 14, 2009, at 16:06:37
In reply to d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 21, 2009, at 13:12:24
I only had time to skim your post, but I'd
look into selegiline, tranylcypromine, or
d-amphetamine, increasing the lorazepam as necessary.
Posted by TriedEveryDrug on June 13, 2009, at 12:08:41
In reply to d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 21, 2009, at 13:12:24
So you said prozac works, except you get heavy fatigue?
Have you tried prozac + provigil to fight off the fatigue?
Maybe your anxiousness lately is from tapering your ativan?
Also, have you tried consistent aerobic exercise?
Posted by Amelia_in_StPaul on June 16, 2009, at 12:17:47
In reply to Re: d/r + experts - desperate for help w/my meds » Amelia_in_StPaul, posted by TriedEveryDrug on June 13, 2009, at 12:08:41
Hey there, for awhile my doc switched me to prozac at night, which was great--I actually had energy during the day, and with Trazodone, was able to sleep at night. But the same thing happened that happens with Prozac--it poops out after awhile, or situational factors overwhelm my ability to cope and Prozac doesn't provide enough of a buoy. Increasing it just means more side effects. My P450 2D6 enzymes are a little off. Prozac seems to build up in my system.
I have begged for provigil and never got it from my old doc. My new doc tells me to ask my gp for it, b/c she's a specialist in fibromyalgia. Which brings me to your last question--have tried, yes. I have to make a choice every day: use my brain or my body. My fibro involves pain, but more than that, exercise intolerance. I crash after aerobic exercise, can't think, can't concentrate, am exhausted. It has been that way ever since I can remember. So I can't really get to the level of intensity I should if I want to have a thinking life, and I do, as I am a writer.
I haven't continued to taper off Ativan. I've stayed at the same dose since I initially started to taper--.25 in the morning, 1.5 at night. Oddly, even though Prozac has such a long half life, I found that when I took it at night, I would get severely anxious by evening. That didn't happen when I took it in the morning. Knowing what I know about Prozac, that doesn't make a lot of sense, but nonetheless...
So now I am on (as of today) Pristiq. I am wired and tired after my first dose. Hope it goes better after...
> So you said prozac works, except you get heavy fatigue?
>
> Have you tried prozac + provigil to fight off the fatigue?
>
> Maybe your anxiousness lately is from tapering your ativan?
>
> Also, have you tried consistent aerobic exercise?
Posted by Amelia_in_StPaul on June 16, 2009, at 18:50:27
In reply to d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 21, 2009, at 13:12:24
after all your suggestions, my psychiatrist put me on pristiq. why? I don't know. I know, but it still doesn't seem like a great choice. and it didn't help my confidence that she had piles of samples right there as though a drug rep had just stopped by (but hey, maybe she got them out in anticipation of our appt--I can try to be optimistic).
my psychiatrist--new psychiatrist--also said I read too much and that while having no knowledge is not a good thing, having a lot of knowledge isn't so hot either. and psychiatry isn't my field. well, duh.
d@mn, I am just not finding anybody I can jive with. then again, the last person I liked did squat for me, just allowed me to do whatever I wanted, including stop taking my meds, which is how I landed in hell. and I had to pay out of pocket for the pleasure.
eh, feeling down. today is my first day of pristiq. waves of different side effects--1st hour, wired and tired, 2nd hour, face flushed and feeling nausea, nausea continued for hours, and now, I'm just feeling wired. what a m&ndf^ck. someone tell me there's a light at the end of the tunnel and all that....
Posted by Amelia_in_StPaul on June 17, 2009, at 15:01:09
In reply to thanks everyone, the end result is pristiq, posted by Amelia_in_StPaul on June 16, 2009, at 18:50:27
Flushing (heat, swelling--presumably) of one's private parts? Anyone experience that? Well I did!! Too much information but, um, man doctors, when I tell you I am sensitive to medications, I fr*gg*ng mean it. But my sweet psychiatrist said this morning that she was sorry, and that I should stop the pristiq and come in tomorrow. I'm going to reread the posts above and come in with some ideas. I am thinking that polypharmacy, with low doses of a few things, is best.
> after all your suggestions, my psychiatrist put me on pristiq. why? I don't know. I know, but it still doesn't seem like a great choice. and it didn't help my confidence that she had piles of samples right there as though a drug rep had just stopped by (but hey, maybe she got them out in anticipation of our appt--I can try to be optimistic).
>
> my psychiatrist--new psychiatrist--also said I read too much and that while having no knowledge is not a good thing, having a lot of knowledge isn't so hot either. and psychiatry isn't my field. well, duh.
>
> d@mn, I am just not finding anybody I can jive with. then again, the last person I liked did squat for me, just allowed me to do whatever I wanted, including stop taking my meds, which is how I landed in hell. and I had to pay out of pocket for the pleasure.
>
> eh, feeling down. today is my first day of pristiq. waves of different side effects--1st hour, wired and tired, 2nd hour, face flushed and feeling nausea, nausea continued for hours, and now, I'm just feeling wired. what a m&ndf^ck. someone tell me there's a light at the end of the tunnel and all that....
Posted by zzzz7 on June 22, 2009, at 5:58:19
In reply to d/r + experts - desperate for help w/my meds, posted by Amelia_in_StPaul on April 21, 2009, at 13:12:24
Some thoughts without reading other people's posts.
1) Are you sure you're not withdrawing from the Prozac and/or lorazepam? Why not take as much lorazepam as you need to alleviate your anxiety? That may help with sleep, too.
2) Maybe a small dose (3.75mg--get a pill cutter if you don't have one) of Remeron at bedtime for AD effects and sleep. I suggest this because of the response to Trazodone.
3) How quickly have you gone on meds? Titrate super-slowly.
4) Get empty gelatin capsules for taking small does of drugs.
5) Try adding modafinil 100mg in the morning. It will help to keep the Prozac from pooping out, and it will help to wake you up.
6) The best AD we have is clomipramine. Try adding 25mg to your Prozac regimen. Do that slowly (you may have to dump the power out and put it in a gelatin capsule).
So, overall thought:
Remeron 3.5mg for sleep.
As much Ativan as you need to feel less anxious. Don't underdo it.
Prozac 20mg, slowly titrating.
Clomipramine 25mg, slowly titrating (will help with sleep, too).
Modafinil 100mg in morning. Start at 25mg or so. Take the minimum you need to wake up.
I'll be away for the next few days, probably, but send me a Babblemail if you'd like.
Good luck.
z
Posted by zzzz7 on June 22, 2009, at 6:00:05
In reply to And now the end result is NOT pristiq, posted by Amelia_in_StPaul on June 17, 2009, at 15:01:09
What dosage of Pristiq did you start on? You should start very, very low given how sensitive you are, and your pdoc should know this. I hope she didn't drop you on at the maintenance dose.
This is the end of the thread.
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