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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3725 to 3749 of 8406. Go back in thread:
Posted by Dr. Bob on July 28, 2003, at 21:55:14
In reply to re: Back at ya!, posted by arrianna on July 28, 2003, at 14:09:51
> This isn't "med" related, so I hope I don't get in trouble.
You're not in trouble, but since this isn't medication oriented, I'd like follow-ups to be redirected to Psycho-Social-Babble. Here's a link:
http://www.dr-bob.org/babble/social/20030727/msgs/246326.html
Bob
Posted by lil' jimi on July 28, 2003, at 22:00:27
In reply to side effects, posted by gamble on July 28, 2003, at 20:19:36
hi gamble,
glad to have you sharing your post with us ... thanks.
diarrhea is a rough SE to endure ... got to watch out for dehydration ... i believe lexapro alone increases your risk for dehydration, diarrhea is another major risk .... .... so drink LOTS of water, and electrolyte replacing fluids ... push fluids and avoid caffeinated-beverages, or at least drink twice as much water as cola/tea/coffee to replace water loss from their diruetic effects ...hang in there and keep us up-to-date ...
TAKE CARE !!
~ jim
Posted by jrbecker on July 28, 2003, at 23:18:20
In reply to Lexapro and dirurnal variation, posted by Bela on July 28, 2003, at 10:05:00
> I have a question for Lexapro users and those that who have experienced the poop-out syndrome with other SSRIs. Over the years of experiencing the SSRI merry-go-round, the main depression symptom I experience when they all quit working, was diurnal variation (DV). DV involves no motivation in the morning, dragging the butt out of bed, etc., with improvement as the day progresses. At present, the Lexapro is working for me and basically eliminated the DV, but I am not optimistic about it working forever. For any of you that have experienced DV, do you have suggestions for psychotherapeutic coping mechanisms? Do any of you know what happens during the night to cause the cycle to repeat itself the next day?
> Bela
>diurnal variation is also a major symptom of my [atypical] depression. My body's natural clock wants me to sleep til noon and stay up past 2am. And taking antidepressants only exacerbates the daytime sleepiness.
The best tips I can give (besides finding the best AD that won't sedate you) are:
1.Take a sleep agent at night if you aren't on one already. Whether it's Ambien, a regular benzo, or something stronger like trazodone, find something that will get you a good night's rest. In some of us, this is just not possible while taking an AD montherapeutically. In my case, even though I'm tired all day, I still won't get a good night's rest -- this is a symptom of the daily phase shift most depressive sufferers exhibit as well the insomnia from the AD. Take a good look at your sleep efficiency: if you can sleep through the night, but sometimes toss and turn and wake-up intermittently, your sleep pattern might be dysfunctional and could probably be made a lot more efficient by the addition of a sleep aid. For a lot of depressed people, this realization isn't always an apparent one, and remains the missing link to getting over a good deal of the daytime sleepiness.
Equally important, make sure that your sleep agent doesn't have too much overhang sedation the next day. Finding the right one for you is the tricky part. A dose of Ambien and some short-acting xanax were a good combo for me (the ambien on its own didn't keep me asleep the whole night). But something like klonopin left me too tired the next day. There is a new sleep med, much like Ambien, but much more potent and with a longer half-life, called Estorra, that is due out near the beginning of '04. There was a lot of great data to show that this will be a better drug -- with no daytime overhang. I suggest you check it out when it surfaces on the market.
2. Take the AD at night if you can. I found that when taking Lexapro, this was possible. The catch-22 is that you might have to take more sleep agent to compensate.
3. Exercise at the peak of your daily schedule. This would be around mid-afternoon for someone's normal sleep-wake cycle. This will definitely put you to sleep earlier and also shift your clock to be arouse earlier in the morning. A more reliable option is that you can try exercising vigorously right as you get up in the morning for more than a half hour. As much as the idea of running right as you first get up strikes you as pleasant, it might just be worth it if it actually keeps you energized the rest of the day.
4. Try B12. Important: make sure it is Methylcobalamin form - this is really the only form that crosses the BBB efficiently. Some people find it to help moderately (for me it probably gives me a 10% overall boost). It helps maintain energy during the early part of the day and helps with getting to bed by inducing the a timely release of melatonin earlier in the evening.
5. Tried light therapy? Take advantage of the summer weather and get as much light as you can throughout the early part of the day.
In the darker/colder months, get outside around noon and catch the sun at its zenith -- take a walk or something. This will help wake you up.Good luck
Posted by Donia on July 29, 2003, at 0:24:16
In reply to Re: Lexapro and dirurnal variation, posted by Bela on July 28, 2003, at 15:39:33
I was on xanax for a while when first starting zoloft. My doctor does not think long term benzo use is a good treatment. Do doctors treat with long term use of benzo? Do you become addicted and just need more and more? I will admit the xanax has made me feel better than zoloft or lexapro, but I am afraid of the long term use of them?
Posted by Donia on July 29, 2003, at 0:29:29
In reply to Re: Lexapro and dirurnal variation, posted by Bela on July 28, 2003, at 16:53:46
Hello, I have never heard the term dirurnal variation, but it sounds like something I experience. I can be doing great for a few days and then, bam. I have never had a constant sleep pattern,or mood for more than a few days. Even in high school, it was terrible. I have been better with mood swings on the lex, but mornings are tough. I dont think mine is caused by AD's because I would not take them for many years.
Posted by Donia on July 29, 2003, at 0:33:34
In reply to Re: dirurnal variation » Bela, posted by jrbecker on July 28, 2003, at 23:18:20
Thanks jrbecker, good post!!
Posted by BekkaH on July 29, 2003, at 0:43:18
In reply to Re: dirurnal variation » Bela, posted by jrbecker on July 28, 2003, at 23:18:20
Hi jrbecker,
How much B12 do you take, and when do you take it? Do you take it only in the morning or throughout the day?
Thanks.
Bekka
Posted by jlo820 on July 29, 2003, at 0:57:26
In reply to Re: Lexapro and dirurnal variation/Benzo use, posted by Donia on July 29, 2003, at 0:24:16
WIth respect to tolerance of the benzodiazepines, more tolerance develops for the sedative/hypnotic, muscle relaxant, and anticonvulsant effects. There is less tolerence for the anxiolytic (anti-anxiety) and anti-panic effects.
For example, many people take the same dosage of Klonopin or Valium for years for anxiety. However, if you are using benzodiazepines to help you sleep, they usually loose their effectivness in 7-10 days.
PL
Posted by vandy on July 29, 2003, at 6:51:35
In reply to Re: dirurnal variation » Bela, posted by jrbecker on July 28, 2003, at 23:18:20
Boy, is that ever a great post! Full of good information, hope and stuff to try. Thank you!
Posted by mph-speedy on July 29, 2003, at 7:22:57
In reply to Re: dirurnal variation » Bela, posted by jrbecker on July 28, 2003, at 23:18:20
To JR re: a.m. exercise.
I'm been on Lex (first time on AD) for about a month. I was on running program before and that is what kept me from falling apart before Lex(obsessive/compulsive running habit I could count on). I've always run first thing in the a.m. (6:00 a.m.) and continue to do so. Have only minimum daytime tiredness, and since I have always been an insomniac don't see much difference there except sometimes have to get up to go to the bathroom more often. Regular exercise helps all around I believe.
One more thing that has helped me deal with my insomnia - my mom always told me - "you sleep more than you actually think you do". I know that sometimes I dream I'm awake - so many times I don't worry about it if it's just a day or two and the anxiety of not sleeping passes and then I'll get a good night's sleep. Just another coping mechanism, but hey!
Also, had started to sleepwalk occasionally before Lex (would wake up in another room of the house -- freaky). No more of that since on meds.
Posted by Bela on July 29, 2003, at 10:15:33
In reply to Re: dirurnal variation » Bela, posted by jrbecker on July 28, 2003, at 23:18:20
> > I have a question for Lexapro users and those that who have experienced the poop-out syndrome with other SSRIs. Over the years of experiencing the SSRI merry-go-round, the main depression symptom I experience when they all quit working, was diurnal variation (DV). DV involves no motivation in the morning, dragging the butt out of bed, etc., with improvement as the day progresses. At present, the Lexapro is working for me and basically eliminated the DV, but I am not optimistic about it working forever. For any of you that have experienced DV, do you have suggestions for psychotherapeutic coping mechanisms? Do any of you know what happens during the night to cause the cycle to repeat itself the next day?
> > Bela
> >
>
> diurnal variation is also a major symptom of my [atypical] depression. My body's natural clock wants me to sleep til noon and stay up past 2am. And taking antidepressants only exacerbates the daytime sleepiness.
>
> The best tips I can give (besides finding the best AD that won't sedate you) are:
>
> 1.Take a sleep agent at night if you aren't on one already. Whether it's Ambien, a regular benzo, or something stronger like trazodone, find something that will get you a good night's rest. In some of us, this is just not possible while taking an AD montherapeutically. In my case, even though I'm tired all day, I still won't get a good night's rest -- this is a symptom of the daily phase shift most depressive sufferers exhibit as well the insomnia from the AD. Take a good look at your sleep efficiency: if you can sleep through the night, but sometimes toss and turn and wake-up intermittently, your sleep pattern might be dysfunctional and could probably be made a lot more efficient by the addition of a sleep aid. For a lot of depressed people, this realization isn't always an apparent one, and remains the missing link to getting over a good deal of the daytime sleepiness.
>
> Equally important, make sure that your sleep agent doesn't have too much overhang sedation the next day. Finding the right one for you is the tricky part. A dose of Ambien and some short-acting xanax were a good combo for me (the ambien on its own didn't keep me asleep the whole night). But something like klonopin left me too tired the next day. There is a new sleep med, much like Ambien, but much more potent and with a longer half-life, called Estorra, that is due out near the beginning of '04. There was a lot of great data to show that this will be a better drug -- with no daytime overhang. I suggest you check it out when it surfaces on the market.
>
> 2. Take the AD at night if you can. I found that when taking Lexapro, this was possible. The catch-22 is that you might have to take more sleep agent to compensate.
>
> 3. Exercise at the peak of your daily schedule. This would be around mid-afternoon for someone's normal sleep-wake cycle. This will definitely put you to sleep earlier and also shift your clock to be arouse earlier in the morning. A more reliable option is that you can try exercising vigorously right as you get up in the morning for more than a half hour. As much as the idea of running right as you first get up strikes you as pleasant, it might just be worth it if it actually keeps you energized the rest of the day.
>
> 4. Try B12. Important: make sure it is Methylcobalamin form - this is really the only form that crosses the BBB efficiently. Some people find it to help moderately (for me it probably gives me a 10% overall boost). It helps maintain energy during the early part of the day and helps with getting to bed by inducing the a timely release of melatonin earlier in the evening.
>
> 5. Tried light therapy? Take advantage of the summer weather and get as much light as you can throughout the early part of the day.
> In the darker/colder months, get outside around noon and catch the sun at its zenith -- take a walk or something. This will help wake you up.
>
> Good luck
>
>
JrBecker,
I concur with others; your advice is very helpful. Thank you for such an informative message. In response to some of your points, I have taken various sleep agents over the past few years and Ambien worked well for me most of the time and so did Seroquel. The hangover from both was minimal at low doses. Several weeks ago I ordered an herbal remedy called "GreatNightSleep" and it has worked surprisingly well for me. I was dubious at first and have been pleasantly surprised. No hangover. My wife took it one night and got zero benefit, so its effectiveness obviously varies from individual to individual. It is only $19.95 for a month's supply.I do exercise religiously. Aerobic exercise, as everyone says, is of paramount importance for fighting depression and just about every other medical problem.
I have not tried B12, but will. In the winter, I have found light therapy works wonders for Seasonal Affective Disorder.
Bela
>
Posted by jrbecker on July 29, 2003, at 16:48:49
In reply to Re: dirurnal variation - jrbecker, posted by BekkaH on July 29, 2003, at 0:43:18
I take 5,000 mcg of methylcobalamin B12 in the form of a sublingual lozenge (dissolves within a minute under the tongue) at breakfast. I'd recommend trying 2,000 mcg to see if it has any benefit. The reason I take 5,000 is only because the tablet comes in that dosage. I have thought of experimenting with a second dose at lunch, but have not gotten around to it yet. It's not stimulating at all, so you shouldn't have any concern with taking too much, your body will just get rid of the excess anyways (since it's water-soluble).
Posted by Capri on July 29, 2003, at 17:44:05
In reply to re: .... how are We ? » Capri, posted by lil' jimi on July 28, 2003, at 21:47:19
Hi Jim,
I started 7.5 mg last Friday. Since the increase I have the tiredness and dizziness but the headache is gone. I see my doc Friday. Wait til he finds out I'm not taking 10 mg like he suggested. We'll see.
Do you think I still need to give the Lex some time? Been taking it almost 6 weeks this Friday.
Still have some anxiety, etc. I can't say I'm cured.Thanks for responding. You're a great help to this board!
Feel good,
Capri
Posted by gamble on July 29, 2003, at 18:19:22
In reply to re: .... how are We ? » lil' jimi, posted by Capri on July 29, 2003, at 17:44:05
Capri, I would give it some time yet. Everyone is different and it takes some people longer than others. I don't think your doctor should be too disappointed because you are gradually getting up to the prescibed dosage and are staying with the program. I wish you the best of luck!
Posted by lil' jimi on July 29, 2003, at 18:53:28
In reply to re: .... how are We ? » lil' jimi, posted by Capri on July 29, 2003, at 17:44:05
hi Capri,
you posted ;
> I started 7.5 mg last Friday. Since the increase I have the tiredness and dizziness but the headache is gone. I see my doc Friday. Wait til he finds out I'm not taking 10 mg like he suggested. We'll see.
>
> Do you think I still need to give the Lex some time? Been taking it almost 6 weeks this Friday.
> Still have some anxiety, etc. I can't say I'm cured.
>
> Thanks for responding. You're a great help to this board!
>
> Feel good,
> Capri... aaahh, i ain't nothing but a cheerleading menance here ... but it's kind of you, and it lifts the spirits ... thanks ...
.. ... .. and you want my opinion? ... well, you're getting what you pay for ... ... HA!
i'd gently suggest that perhaps you might try working yourself up to 10mg and see how you feel after a few ... weeks? ... ... maybe?
hey, but i'm not one of our anxiety suffers, so i think we should get Wayne's expertise ... ...
(Wayne's my expert on panic/anxiety and Lexapro) ...i am glad we can support each other here, and i have worried about lex SEs with your anxiety ... ... i'm proud of you for making this far ... . i know it can't have been easy ... 6 weeks! ... remember counting the days of your first week?
.. .. i'll give Wayne a shout and ask him for his recommendation(s) ... .. (Please, Wayne?)
... did you know it's my tribute to Wayne? evertime i close with ...
TAKE CARE !!!!
~ jim
... i got 'take care!' from him ... ~ j
Posted by Peter S. on July 29, 2003, at 19:47:20
In reply to Re: Lexapro to 30mg or higher anyone?, posted by pasdenom on July 28, 2003, at 18:19:08
Thanks for your experience pasdenom! I'm really glad it's working for you. It's very encouraging and I may be bumping up soon.
Best,
Peter
> >
> > I've been on Lexapro for about 7 weeks with not a lot of benefit. I increased to 20 mg last week and noticed a slight increase in mood, but now it seems to be dissipating. I'm wondering if others have gone beyond 20mg and whether this has worked.
> >
> > My pdoc has talked about examples of people not responding fully to Prozac until they got up to 80mg. Maybe Lex has the same effect- I've seen research that indicates that there isn't a whole lot of difference between 10 and 20mg, but it's such a new drug and there are so many individual differences about how people respond to meds.
> >
> > Thanks for any responses!
> >
> > Peter
> >
> >
> >
> > Hi Peter,
> I am on Lexapro 30 mg and it did take this dosage to bring me out of my depression.
> I am also on Effexor XR 140 mg and Lamictal 100mg.
> I hope everything works out for you.
>
>
Posted by BLKVETTES on July 29, 2003, at 19:49:23
In reply to re: Hey, Wayne! re: how are We? » Capri, posted by lil' jimi on July 29, 2003, at 18:53:28
> hi Capri,
>
> you posted ;
> > I started 7.5 mg last Friday. Since the increase I have the tiredness and dizziness but the headache is gone. I see my doc Friday. Wait til he finds out I'm not taking 10 mg like he suggested. We'll see.
> >
> > Do you think I still need to give the Lex some time? Been taking it almost 6 weeks this Friday.
> > Still have some anxiety, etc. I can't say I'm cured.
> >
> > Thanks for responding. You're a great help to this board!
> >
> > Feel good,
> > Capri
>
> ... aaahh, i ain't nothing but a cheerleading menance here ... but it's kind of you, and it lifts the spirits ... thanks ...
>
> .. ... .. and you want my opinion? ... well, you're getting what you pay for ... ... HA!
>
> i'd gently suggest that perhaps you might try working yourself up to 10mg and see how you feel after a few ... weeks? ... ... maybe?
>
> hey, but i'm not one of our anxiety suffers, so i think we should get Wayne's expertise ... ...
> (Wayne's my expert on panic/anxiety and Lexapro) ...
>
> i am glad we can support each other here, and i have worried about lex SEs with your anxiety ... ... i'm proud of you for making this far ... . i know it can't have been easy ... 6 weeks! ... remember counting the days of your first week?
>
> .. .. i'll give Wayne a shout and ask him for his recommendation(s) ... .. (Please, Wayne?)
>
> ... did you know it's my tribute to Wayne? evertime i close with ...
>
> TAKE CARE !!!!
> ~ jim
> ... i got 'take care!' from him ... ~ jHi, move up to 10mg I guess you have nothing to lose. You can always move back. But you just started 7.5mg and I stand by the link below. Start low and go slow!!!! When one withdrawals the same thing very slow!!!! GOOD LUCK CAPRI!!!
TAKE CARE!!!!
WAYNE>>>>>>>>>>>>>>>>>>>HI JIM!!!!
http://panicdisorder.about.com/features/blmed1.htm
Posted by BLKVETTES on July 29, 2003, at 20:00:18
In reply to re: Hey, Wayne! re: how are We?, posted by BLKVETTES on July 29, 2003, at 19:49:23
Hi, found these to be interesting!!!!!
WAYNE
http://www.bayarea.com/mld/mercurynews/6325166.htmhttp://aolsvc.health.webmd.aol.com/content/article/66/79883.htm?cobrand=aol
http://aolsvc.health.webmd.aol.com/content/article/60/67172.htm
Posted by lil' jimi on July 29, 2003, at 20:09:22
In reply to re: Hey, Wayne! re: how are We?, posted by BLKVETTES on July 29, 2003, at 19:49:23
Posted by sandiegogal on July 29, 2003, at 20:28:22
In reply to re: how are We? Thanks Wayne !! (nm) » BLKVETTES, posted by lil' jimi on July 29, 2003, at 20:09:22
I am on day 8 and i am now taking 5mg of lexapro. I feel spacey and tired and also i have very little appetite. I have been reading all your postings and the links to websites with info on depression and anxiety. I just wanted to say thanks for all of your input. It has helped me to convince myself to stay with this for atleast a few weeks to see if things change. I still have the depression but the anxiety is definately lowered. I am a little leary of going to 10mg because of the tiredness though. Does anyone know if 5 can be a therapeutic dose?
Posted by vandy on July 29, 2003, at 21:44:00
In reply to ANXIETY AND DEPRESSION INFO, posted by BLKVETTES on July 29, 2003, at 20:00:18
Hey, that first link reminded me of that old question: "How can you tell a boy chromosome from a girl chromosome?"
answer: "Easy, look in its genes!"
Posted by Capri on July 29, 2003, at 22:06:21
In reply to re: how are We? Thanks Wayne !! (nm) » BLKVETTES, posted by lil' jimi on July 29, 2003, at 20:09:22
Posted by BLKVETTES on July 29, 2003, at 22:42:09
In reply to 8 days and counting, posted by sandiegogal on July 29, 2003, at 20:28:22
> I am on day 8 and i am now taking 5mg of lexapro. I feel spacey and tired and also i have very little appetite. I have been reading all your postings and the links to websites with info on depression and anxiety. I just wanted to say thanks for all of your input. It has helped me to convince myself to stay with this for atleast a few weeks to see if things change. I still have the depression but the anxiety is definately lowered. I am a little leary of going to 10mg because of the tiredness though. Does anyone know if 5 can be a therapeutic dose?
Hi there, you can stay there until your side effects are to your liking and move up another 2.5mg and so forth. Yes, 5mg has helped others. I take 7.5mg and that seems to be my magic dose. Some take as much as 30mg. We are all so different. TAKE CARE!!!
WAYNE
Posted by BLKVETTES on July 29, 2003, at 22:52:17
In reply to Re: ANXIETY AND DEPRESSION INFO, posted by vandy on July 29, 2003, at 21:44:00
> Hey, that first link reminded me of that old question: "How can you tell a boy chromosome from a girl chromosome?"
>
> answer: "Easy, look in its genes!"My My the lexapro must have been very very good to you. But Im sure that all jokes should be redirected the psycho babble comedy link if there is one. Im sure JIM would know!!! HA!! TAKE CARE!!!
WAYNE
Posted by BekkaH on July 30, 2003, at 0:00:04
In reply to Re: dirurnal variation - jrbecker » BekkaH, posted by jrbecker on July 29, 2003, at 16:48:49
Thank you for the information on B12. Have you ever taken Melatonin at night? Did it help to correct your phase shift? I've read that the "natural" melatonin tablets should be avoided because they are made from ground up pineal glands of sheep and cows, and they might be infected with prion or viral diseases. I've also read that the amount of melatonin that is helpful in inducing sleep is much less than what is commercially available. I think 0.3 mg is the maximum recommended dosage. I'm interested to hear what you have to say about melatonin.
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