Posted by tonyz on June 19, 2009, at 22:55:43
In reply to Re: Question about med combinations, posted by desolationrower on June 19, 2009, at 18:49:00
Thanks d/r, you are really up on the different meds. What you are suggesting makes sense, I just get a bit nervous combining too many different drugs.
Insomnia and lack of concentration/depression are the problems. The lack of sleep adds to the anxiety and depression, memory is severely effected. I have trouble remembering what I did for the day.
I try to get exercise every day and I think that is helping. When I had tapered off of everything except the valium (I was down to 2.5mg) I was sleeping 3-4 hours a night but I was much more focused and alert during the day.
So it is hard to evaluate if ramping up on all the meds has caused the state of confusion now or the insomnia just caught up with me. My biggest concern is the neuroleptics - I understand they can be very effective when paired with an anti-depressant but they just scare the hell out of me. That is just me - they are fine for some people.
When I started back on the meds 7.5 of remeron with the 2.5mg of valium seemed to be working but then things started going downhill. I had seen another doctor in the same office though and she had indicated that remeron in small doses can be effective with insomnia. That is an option but I don't want to add too much stuff now. I've got the three: Nortiptyline (150mg) Seroquel (which I am reducing by 25 mg every night or two) I have only been taking since mid May and ramped up t0 200mg and was back to 0mg by June 4. On June 5 I started back with a low dose of 25mg and have been incresing last night was 200, tonight its 175 on the seroquel and 17 on the valium. I will reconsider the remeron because it seemed to have a good effect initially, but I had stopped the NTP at the time and that may have caused the depression to relapse.
I'm flying blind here and my pdoc doesn't seem to want to make too many changes at once so it leaves it to me to tweak things a bit which I am not real comfortable with but I feel I don't have a choice.
The fact that I was a hell of a lot better even getting little sleep with very few meds tells me something. Last year when I was on 20 mg of valium when I went into the hospital I reduced by 2.5mg every week and the last week 2,5mg every other day. When I was at 12,5mg I added 1500 mg of l-tryptophan. Checking drug interactions that is kind of a no-no for the current dosage of valium but when I reduce further I will be adding that again.
I've had the best response w/ Amitriptyline in the past although the side effects are awful and Blueberry had a very goint point about the serotonin potentially being absent. Maybe all I need is a little serotonin in the mix and scaling back on the NTP and adding some Amitriptyline may be just the ticket.
As I mentioned when I was treated as an outpatient in a hospital I was on amitriptyline and was having severe constipation. How can I put this politely - normally my body is very efficient at processing food. He suggested ducosate sodium which did nothing for me. The current doc told me about miralax and that is just a super laxative for me. Others may have different experiences. I suppose it is also possible that the side effect profile may diminish over time. Notriptyline is easier in terms of constipation, occular pressure, blood pressure changes, for me tremors may be about the same (don't remember).
Anyway, you guys are really great to keep responding to my postings. You have given me a lot of support which I haven't been able to get elsewhere and I continue to be very thankful. I hope we all find something that has a minimum side effect profile and works for all of us.
> The big problem here is insomnia?
>
> I think for bad insomnia, you should try to cover most of the neurotrasnitters implicated in arousal. So an antihistamine like low dose mirtazipine or high dose of cyproheptadine. a gaba drug like a benzo. a andrenergic drug like clonidine. etc.
>
> i also wonder if using a stimulant to both wake you up during the day, and cause rebound fatigue at night could be beneficial. i'd be interested in hearing from anyone who has tried taht.
>
> -d/r
poster:tonyz
thread:901793
URL: http://www.dr-bob.org/babble/20090611/msgs/902179.html