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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on July 31, 2009, at 17:23:18
In reply to do you think the xr version is better?, posted by qbsbrown on July 31, 2009, at 17:01:15
> Would you recommend the XR version over the generic immediate release? You only have to take 2 times a day, as opposed to 3-4 (although dosing at same time as valium was nice), and probably much smoother blood levels.
>
> Thanks for you help.
I haven't read anything about the clinical advantages of using the XR version. I like the idea of keeping blood levels as steady as possible, though.Why don't you stay at 400mg until Tuesday, and not make any decisions until you know how you feel by then.
- Scott
Posted by qbsbrown on July 31, 2009, at 18:11:56
In reply to Re: do you think the xr version is better?, posted by SLS on July 31, 2009, at 17:23:18
Yeah, XR sounds nice, but generic immediate release is dirt cheap, and I like dosing at same time as valium. Gives me some psychosomatic buffer i think lol.
But yeah, after my first 2 doses of 200 yesterday, was really excited felt great. Ready to tackle the world, and thought this might be easier, only to be bit in the *ss by me taking that 3rd dose of 200, totaling 600mgs.
You mean wait til tues to see if im ready to drop valium dose, or to raise to 600mgs?
In your estimation, do you think that i would experience the same dysphoria/depression on 600mgs a week from now, as i did today? Just as i had on 500 of depakote?
That expert did give the range of 200-800 of tegretol to come off. Perhaps I'm in the middle at 400.
Regards,Brian
Posted by qbsbrown on July 31, 2009, at 20:28:25
In reply to Re: do you think the xr version is better?, posted by qbsbrown on July 31, 2009, at 18:11:56
Well I got 50 dollars worth of the xr version, and still have the generic.
Now while i was feeling great on the generic, then why was i frantically calling the doc to call in the xr version? i thought it would make it even easier and smoother
I assume they will both provide the same benefit, perhaps the xr version providing a smoother release and blood levels. The generic was pretty harsh, would feel well for 2 hours, then crash out. But it had a good psychosomatic buffer that i would take it at the same time as my valium doses, 3 times a day.
Being quite agoraphobic right now, being able to take it midday with my midday dose of valium, i felt buffered and not afraid to leave the apartment.If i was only dosing 2 times a day w/ the xr, morning and night, i might be afraid to leave the house during midday. I'm not sure.
Plus i had a great day on the generic, but then why was i trying to change it? Do i listen to that?
Which would you go with?
If generic, should i dose 200-100-100? or 100-100-200? Probably doesn't matter
Regards,
Brian
Posted by qbsbrown on July 31, 2009, at 22:15:49
In reply to It's a tough call, which would you take?, posted by qbsbrown on July 31, 2009, at 20:28:25
fine, i think that i will stick w/ the generic. I'm guessing that my ceiling is 500mgs. I believe that 600mgs of tegretol, is equal to 900 mgs of trileptal, correct me if i'm wrong, and at that dose, it is mimmicing some of the adverse symptoms.
So perhaps 500 is my ceiling. Like i said, i took 200mgs morning and mid day, and was golden. Apparently it was the 3rd 200mg pill that put me over the edge.
Regards,
Bri
Posted by qbsbrown on July 31, 2009, at 22:17:32
In reply to It's a tough call, which would you take?, posted by qbsbrown on July 31, 2009, at 20:28:25
Do you think that i could try 500mgs tomorrow, or is that too much of a gamble? I think it's my ceiling, and i'd go 200-200-100. But probably better to wait at least 3-7 days huh?
Posted by qbsbrown on July 31, 2009, at 23:36:37
In reply to Re: It's a tough call, which would you take?, posted by qbsbrown on July 31, 2009, at 22:17:32
If I tried the XR version for a week, and didn't like it, would that lessen my chance of the generic immidiate version working?
Brian
Posted by SLS on August 1, 2009, at 6:27:06
In reply to Re: It's a tough call, which would you take?, posted by qbsbrown on July 31, 2009, at 22:15:49
> fine, i think that i will stick w/ the generic. I'm guessing that my ceiling is 500mgs. I believe that 600mgs of tegretol, is equal to 900 mgs of trileptal, correct me if i'm wrong, and at that dose, it is mimmicing some of the adverse symptoms.
>
> So perhaps 500 is my ceiling. Like i said, i took 200mgs morning and mid day, and was golden. Apparently it was the 3rd 200mg pill that put me over the edge.Just remember, Tegretol induces its own metabolism. You might have to raise the dosage at some point just to compensate for the reduction in blood levels.
I would remain at 400mg for another 5 days and not reduce the diazepam.
- Scott
Posted by SLS on August 1, 2009, at 6:31:15
In reply to Re: It's a tough call, which would you take?, posted by qbsbrown on July 31, 2009, at 23:36:37
> If I tried the XR version for a week, and didn't like it, would that lessen my chance of the generic immidiate version working?
>
> BrianI very much doubt it.
What can lessen your chances is too rapid a taper of diazepam. The more you allow the forest to burn (kindling), the harder it will be to put the fire out. I wouldn't begin tapering until the Tegretol puts out the fire that is currently burning.
There really is no rush.
- Scott
Posted by qbsbrown on August 1, 2009, at 11:05:33
In reply to Re: It's a tough call, which would you take?, posted by SLS on August 1, 2009, at 6:31:15
Well it seems that the XR version really mimics a lot of the same things as the trileptal, which is both good and bad. Made the day seem SO slow (which is normal during wd, but worse w/ trileptal, and apparently this xr version). I would look at the clock, and it'd say only 4 pm, and i'd be like, are you serious. With trileptal, i couldn't wait til my 6-7 pm dose, as then things would seem normal, i could watch tv, and fall asleep naturally.
Then it also allowed me to be able to watch tv at night, which I usually can't do, due to concentration problems with the wd. And I got a little naturally tired, and slept pretty well, which i usually don't get naturally tired one bit, so that was nice.
That said, with generic, i was improving with every dose. Time was going by faster, i had high hopes that the taper would eventually be easier. Even though i wasn't sleeping well, didn't get tired, couldn't watch tv, my mood was improving with every dose (until i tried 600mgs). Plus had the psychosomatic buffer of taking at same time as diazepam (there might be something to that seeing that they are both immediate releasing, right?).
So weighing those positives and negatives, which would you go with? I'm leaning towards the generic. Plus i think that it would be easier to add 100mgs when needed, and that coming off in smaller incriments would be easier, correct?
God I hope that we can get this gravy train back on board Scott.
Regards,
Brian
Posted by qbsbrown on August 1, 2009, at 11:19:17
In reply to Re: It's a tough call, which would you take?, posted by qbsbrown on August 1, 2009, at 11:05:33
The first day, i went 100-100-100, and felt improvement in mood, concentration etc. Second day was 200-200-200.
After the first 200mg on the second day, i did feel some dysphoria. But time did not go so slow, after second dose, things finally slowed down a little bit, was ready to go out, got a rocking headache, took the third, then really bad dysphoria/depression/revved up symptoms the next day.
That said, I could hold 200-100-100, either until 5-7 days have passed, or when that dysphoria passes from the first dose has past, which i think it has? Then I could add another 100mgs, 200-200-100. How does that sound?
Do you think that there is something to be said about taking it at the same time as valium, as they are both immediately released?
Regards,
Brian
Posted by qbsbrown on August 1, 2009, at 12:16:33
In reply to Does this sound prudent Scott?, posted by qbsbrown on August 1, 2009, at 11:19:17
Do you think that 500mgs is too much for now? 200-200-100. As I felt so great after those first 2 200mg doses.
Or play it safe, and stay at 400?
Brian
Posted by SLS on August 1, 2009, at 14:22:58
In reply to Re: Does this sound prudent Scott?, posted by qbsbrown on August 1, 2009, at 12:16:33
> Do you think that 500mgs is too much for now? 200-200-100. As I felt so great after those first 2 200mg doses.
>
> Or play it safe, and stay at 400?
>
> BrianI feel strongly that you should remain at 400mg for at least 5 more days.
Try not to look at things so microscopically all day long. Just take the drug and try to relax. Things might get a little weird at first. It is difficult to predict how your system will react to the exposure to a new drug. It is likely much of what you are experiencing is startup side effects that will disappear with time.
Let's see how you feel after five days at 400mg.
Good luck.
- Scott
Posted by qbsbrown on August 1, 2009, at 15:55:15
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 1, 2009, at 14:22:58
Thanks Scott. And yes, a HUGE part is my fault. 300 first day, 600 second, 500 3rd (2 XRs, and 1 regular; stupid), and will go 400 today (2 XRs). Basically suicide lol. These changes and additions to my already super delicate brain.
Today i am taking 2 xr's and will decide tomorrow which one to continue with, generic or XR, and STICK with it.
So most of this is my fault. I was feeling better with every pill i was taking. So the obvious more is better mentality set in.
I have a bad history, of raising lowering, adding/changing meds, hence me needing to get off of them.
I'll take the 400 mgs today, and assess tomorrow to stick w/ the generic (dirt cheap), or the MUCH more expensive XR version.
Thanks Scott.
Brian
Posted by qbsbrown on August 1, 2009, at 19:59:13
In reply to Re: Does this sound prudent Scott?, posted by qbsbrown on August 1, 2009, at 15:55:15
Hey Scott. Is the Tegretol habit forming? Or tolerance building? I know it's not addictive addictive, but i noticed that at the beginning that it made me feel better, and the wd easier, so i couldn't wait til the next dose. A great welcome relief.
One could argue that all psychotropic meds are addictive, and tolerance building (as does Peter Breggin). Like i remember that during a benzo wd, a doc gave me an antidepressant that made my depression worse, and believe it or not, my obsessions and compulsions worse.
But she gave me 5mgs of zyprexa for the flight home from china to the US. It knocked me out for the entire flight. Then came home, and slept for 20 hours straight.
Needless to say, i ended up taking 30mgs zyprexa (that's beyond me) for my racing thoughts, just to be able to drive long distances, and would take when i came home from work, and it wouldn't make me tired. The racing thoughts all along have been benzo wd.
Anyway, well the tegretol xr i took this morning, gave me a kinda pleasurable euphoric drunk feeling (I'm an alcoholic who hasn't drank in a year, so it felt good). To where it was making me crave my next dose. You did say that you need to raise the dose because it begins to metabolize itself quicker, right? Plus I'm a very fast med metabolizer, so i might even have to take this med 3 times a day, same as it's derivitive trileptal.
Today will be my 3rd day at 400mgs or higher. I've seen that this med is usually raised every week, but i've seen publications that said 2-5 days.
Just let me know what you think.
I greatly appreciate it.
Brian
PS-If you think that we should email personally, I'm [xxx] at [xxx]
I always look forward to hearing from you
Posted by qbsbrown on August 1, 2009, at 22:24:52
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 1, 2009, at 14:22:58
Ok Scott. I'm gonna go generic immediate release for the next 5 days and let you know from there. I'll go 200-100-100, unless you think it makes any difference to have the big dose at night.
The ER version is simply acting too much like the trileptal that i didn't like.
I was SO excited w/ our initial progress and hope, only to have my symptoms ramped up by me going up too high, too fast, and then mixing er w/ generic.
Hopefully we can get back on track. I'll do 5 days of the 400mgs, then we can assess to go up to 500mgs, or to continue tapering.
Thank you very much for your help.
Regards,
Brian
Posted by SLS on August 2, 2009, at 7:13:03
In reply to Re: Does this sound prudent Scott?, posted by qbsbrown on August 1, 2009, at 22:24:52
> Thank you very much for your help.My privilege.
- Scott
Posted by qbsbrown on August 2, 2009, at 14:45:54
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 2, 2009, at 7:13:03
To a highly kindled system. A jacked up, damaged, compromised CNS. Is a small amount of an antidepressant a dangerous thing to try?
At the beginning of this taper, I even had like 20mgs of tryptophan, and gave me depression.
All of the antidpressants always gave me worse depression, and even more compulsions (paradoxical reactions)
The only antidepressant that ever worked was lexapro. Still some adverse and paradoxical reactions. It would usually work for a week, then turn on me and give me what docs called "mixed mood" episodes, induced mania before, and even screwed up one of my valium tapers once i was down to 1mg (the doc raised the lexapro from 10mgs to 20mgs, sent me through the roof, had to re-instate). Probably too risky huh.
But it usually helped the dysphoria/depression from the anticonvulsants.
Do you think that once my brain/body is accustomed to the tegretol, that it might be worth a shot for gad and panic, anticipatory anxiety? Or is it simply too risky right now at this juncture?
Took 400mgs of tegretol yesterday (ER version, took an er version this morning, but thinking about the generic), went out and about today, everything still felt weird, looked weird, sounded weird, etc. But not absoulte and total dysphoria as i experienced w/ that depakote trial.
Let me know what you think. I greatly appreciate it.
Regards,
Brian
Posted by SLS on August 2, 2009, at 15:20:46
In reply to Re: Does this sound prudent Scott?, posted by qbsbrown on August 2, 2009, at 14:45:54
I'm not sure I would be too worried about having a kindled or damaged CNS. You might be too focused on these things and making them out to be more severe than they really are. That's my hope, anyway.
For now, try not to pay too much attention to what you are feeling, as long as it is tolerable. You might get hit with waves of weird or uncomfortable feelings as your system attempts to find a new equilibrium with the Tegretol. Whatever mild effects this drug has on your mood is acceptable for accomplishing the goal of freeing yourself from the diazepam.
I would stick to the plan and continue to take the Tegretol at 400mg for now. You might want to take your largest dose at night since it might produce some sedation and that there are more hours to cover. I don't think you should raise the dosage until your system stabilizes, and do not even think about reducing the diazepam until you reach that point.
You really need to slow down. I understand your impatience. I am pretty sure that this will all work out for you if you don't rush it. You really need to be evaluating things at weekly intervals, and not at daily or even hourly intervals the way you are doing now.
I am encouraged by what I'm hearing.
- Scott
Posted by qbsbrown on August 2, 2009, at 15:34:19
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 2, 2009, at 15:20:46
> I'm not sure I would be too worried about having a kindled or damaged CNS. You might be too focused on these things and making them out to be more severe than they really are. That's my hope, anyway.
>
> For now, try not to pay too much attention to what you are feeling, as long as it is tolerable. You might get hit with waves of weird or uncomfortable feelings as your system attempts to find a new equilibrium with the Tegretol. Whatever mild effects this drug has on your mood is acceptable for accomplishing the goal of freeing yourself from the diazepam.
>
> I would stick to the plan and continue to take the Tegretol at 400mg for now. You might want to take your largest dose at night since it might produce some sedation and that there are more hours to cover. I don't think you should raise the dosage until your system stabilizes, and do not even think about reducing the diazepam until you reach that point.
>
> You really need to slow down. I understand your impatience. I am pretty sure that this will all work out for you if you don't rush it. You really need to be evaluating things at weekly intervals, and not at daily or even hourly intervals the way you are doing now.
>
> I am encouraged by what I'm hearing.
>
>
> - ScottOk, I hear ya. man, some/any sedation would be welcome. Jesh, if I could just have that drunk feeling the whole time, that's be nice. Maybe phenobarbiol is my way lol.
Well my sleep is gonna be crap regardless. I feel some sort of psychosomatic buffer i think if i go 200-100-100. I believe that i will continue the generic tomorrow and stop the ER version.
Ya know, after my first 200mg dose, i felt some dysphoria while teaching online, i should have gone 200-100-100 that day in hindsight.
Perhaps once i go 200-100-100, and no longer feel the dysphoria, then i could bump up 100mgs, or if it's been 1 week. 200-200-100. The day i went 200-200-200 it was great. Time went by, didn't think about my dosing, things slowed down, didn't even worry about taking my last dose of both vailum and tegretol at bedtime.
I hope we can get that back. I believe we can, simply that i went up too fast to 600mgs.
Thanks,
Brian
Posted by qbsbrown on August 2, 2009, at 18:11:54
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 2, 2009, at 15:20:46
So are you saying that now isn't a good time to mess around w/ a small dose of an antidepressant? Lexapro 2.5-5mgs? Considering that i have intrusive/racing/obsessive/bad memories 24/7, might not be a great idea huh? In the past it seemed to induce more racing thoughts, so might not be that great of an idea.
Regards,
Brian
Posted by qbsbrown on August 2, 2009, at 19:34:29
In reply to Re: Does this sound prudent Scott?, posted by SLS on August 2, 2009, at 15:20:46
> I'm not sure I would be too worried about having a kindled or damaged CNS. You might be too focused on these things and making them out to be more severe than they really are. That's my hope, anyway.
>
> For now, try not to pay too much attention to what you are feeling, as long as it is tolerable. You might get hit with waves of weird or uncomfortable feelings as your system attempts to find a new equilibrium with the Tegretol. Whatever mild effects this drug has on your mood is acceptable for accomplishing the goal of freeing yourself from the diazepam.
>
> I would stick to the plan and continue to take the Tegretol at 400mg for now. You might want to take your largest dose at night since it might produce some sedation and that there are more hours to cover. I don't think you should raise the dosage until your system stabilizes, and do not even think about reducing the diazepam until you reach that point.
>
> You really need to slow down. I understand your impatience. I am pretty sure that this will all work out for you if you don't rush it. You really need to be evaluating things at weekly intervals, and not at daily or even hourly intervals the way you are doing now.
>
> I am encouraged by what I'm hearing.
>
>
> - ScottMan, my WD symptoms are totally revved up. Probably from taking 600mgs (that alone would make it worse for a few days), took 500mgs, and the er version are bad for me, acting like trileptal. So all of those things are going to rev up symptoms for a while, and i just have to accept that.
I REALLY hope that i can tolerate 400mgs and that it doesn't make things worse. This seemed really like the break i was praying for.
You think it's better to stay at 400mgs than 300mgs right (i do)? I think i can tolerate it, and as long as i stay at the exact dose, with the exact generic, i hope that this will settle down in 5-7 days.
And oh yeah, an AD is totally out of the question for now:)
Brian
Posted by qbsbrown on August 2, 2009, at 23:37:36
In reply to Re: Does this sound prudent Scott?, posted by qbsbrown on August 2, 2009, at 19:34:29
Yeah, they all suck and have adverse/paradoxical reactions in me. How long do you think i might have to be on tegretol before i tried (if needed, it might not be), like a minute, 2.5mgs of lexapro?
Anxiety so bad that it's hard to eat sometimes because I'm afraid that i will choke on the food. Then again, i ate a ton of food yesterday. A lot of this could be benzo wd flare up. All the other ADs give me worse depression, minus lexapro. But with my already racing thoughts and insomnia, lexapro kinda scares me. I was once able to get all the way down to 1mg of valium on lexapro, only to have the doc raise it from 10 to 20mgs, making me manic, and having to re-instate everything.
So we can see if the tegretol keeps working, and re-*ss*s in a week.
Posted by SLS on August 3, 2009, at 6:56:05
In reply to Question about an AD scott, posted by qbsbrown on August 2, 2009, at 23:37:36
> Yeah, they all suck and have adverse/paradoxical reactions in me. How long do you think i might have to be on tegretol before i tried (if needed, it might not be), like a minute, 2.5mgs of lexapro?
It is difficult to know for sure how an antidepressant would affect you right now. I guess I am in favor of letting your system settle right now. If you do go to Lexapro, I advocate starting at 10-20mg. I think that very low dosages might actually make you feel worse. I can't prove it, but I suspect that such low dosages produce a reduction in the synthesis and release of serotonin without a comparable stimulation of postsynaptic receptors. Lexapro can produce anxiety early in treatment, so I wouldn't recommend starting it at this point. It would be difficult evaluate your withdrawal symptoms with the additional anxiety.
How much diazepam are you taking right now?
Have you ever tried Lyrica (pregabalin)?
I still like the Tegretol right now. I would stay at 400mg for the next few days to see what happens. Perhaps you will need to take a higher dosage. I don't think it is out of the question to work up to 800mg. It will be necessary to exercise self-discipline and logic.
Continue to post. However, I would NOT look at Tegretol to be the culprit in your periodic worsenings. I think they would have happened anyway.
- Scott
Posted by qbsbrown on August 3, 2009, at 10:16:42
In reply to Re: Question about an AD scott, posted by SLS on August 3, 2009, at 6:56:05
> > Yeah, they all suck and have adverse/paradoxical reactions in me. How long do you think i might have to be on tegretol before i tried (if needed, it might not be), like a minute, 2.5mgs of lexapro?
>
> It is difficult to know for sure how an antidepressant would affect you right now. I guess I am in favor of letting your system settle right now. If you do go to Lexapro, I advocate starting at 10-20mg. I think that very low dosages might actually make you feel worse. I can't prove it, but I suspect that such low dosages produce a reduction in the synthesis and release of serotonin without a comparable stimulation of postsynaptic receptors. Lexapro can produce anxiety early in treatment, so I wouldn't recommend starting it at this point. It would be difficult evaluate your withdrawal symptoms with the additional anxiety.
>
> How much diazepam are you taking right now?
>
> Have you ever tried Lyrica (pregabalin)?
>
> I still like the Tegretol right now. I would stay at 400mg for the next few days to see what happens. Perhaps you will need to take a higher dosage. I don't think it is out of the question to work up to 800mg. It will be necessary to exercise self-discipline and logic.
>
> Continue to post. However, I would NOT look at Tegretol to be the culprit in your periodic worsenings. I think they would have happened anyway.
>
>
> - ScottI agree with you about not taking an AD at this point. And yes, there is/was already start up anxiety w/ lexapro. And risking any type of mania and/or worse racing thoughts isn't worth it.
I have taken lyrica, even doses up to 900mgs. Felt pretty stoned, super social, an extremely high sense of well being, derealization, edema.
But I do not have insurance, and it'd be very hard for me to obtain.
I think we're on the right track.
I went back to the generic tegretol this morning (200mgs), and it feels much more fitting, much better, a big difference.
How do we know when to raise it?
Today would be day 4 of 400mgs or more.
By the night yesterday, the dysphoria finally seemed to be wearing off. The ER version was acting WAY too much the trileptal was, in the good and bad ways, and i'd like to steer clear of that
I am at 16mgs of diazepam.Well I can tell that tegretol is part of the periodic worsenings, it is/was the culprit. I mean to feel that depression and dysphoria, which i never had tapering by itself. And when that happens, it's bound to raise my symptoms for a few days. So that's just part of the cycle.
So I say that we continue to raise when we think I'm ready. Do you think that 100mg incriments are more appropriate for me than 200?
It's easy for me to observe how i feel, it hits me right away.
But when to raise it, i don't know.
Thanks for the help.
Regards,
Brian
Posted by qbsbrown on August 3, 2009, at 10:44:38
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 10:16:42
Perhaps 200mg incriments would be fine, unless we think 100mgs is safer. I think my error was going from 300mgs on the first day, to 600 on the second.
I just fear the worsening of symptoms, and the dysphoria/depression that it might induce.
But then again, i felt great after my first 2 200mg doses, and should have stopped there that night.
Let me know what you think.
Regards,
Brian
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Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
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