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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 49 to 73 of 74. Go back in thread:
Posted by KaraS on August 17, 2005, at 14:37:57
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 15, 2005, at 3:43:41
> Hi Ed,
>
> >In my last appointment I told Dr. E. that my resting pulse rate has been in the 80's and 90's so told me he wants me to start on the atenolol (as I knew he would).
>
> Is the tachycardia bothersome? IMHO, sinus tachy can often be left untreated unless it's.......
>
> a) uncomfortableonly occasionally
>
> b) anxiety provoking
I could probably make a case for that. Besides, fear has stopped me from doing so many things. This would prevent that I think.
> or c) severe - severe sustained tachycardia can damage the heart muscle leading to a condition called tachycardiomyopathy, which can cause heart failure. Heart failure due to tachycardiomyopathy can often be reversed by treatment with a beta blocker such as bisoprolol.Reversed? Wow. That's great and hard to believe. I know my increased heart rate is nowhere near the rate required to create tachycardiomyopathy.
> 90bpm isn't really tachycardia. >100bpm is tachycardia.I was doing some research and came across the actual definition so really my doctor is technically incorrect for calling my condition tachycardia.
> I can definately see where your doc's coming from though, it is certainly possible that you'll develop troublesome tachycardia as you increase the dose of Dex. With your family history of heart disease, it makes sense to be extra cautious. IMHO, it would be best to start atenolol at 25mg/day.
I have 25 mg. pills here. I know he wants me to start taking it once a day. Do I eventually take it twice or more a day? How often does one take beta blockers to insure continuous coverage?Also, I think that even if he weren't going to be starting me on a stimulant, that he'd prescribe the beta blocker. He really seems to think that my hyper adrenal (for lack of a better term - maybe hyperadrenalism is better?) is the root of my anxiety and depression.
> >He thinks that the atenolol will solve almost all of my anxiety and depression problems.
>
> It does sometimes help anxiety. I have a friend who finds atenolol very calming, he takes it for Ritalin-induced tachycardia! I've never heard of it helping depression.If you have severe anxiety (which I do when not medicated) then that can lead to depression, right (because your system starts making more cortisol instead of neurotransmitters?). So if an agent were to shut down the anxiety response, then depression is prevented, no?
> >It's difficult for me to believe that a beta blocker alone will give me back my motivation.
>
> It might allow you to tolerate a higher dose of Dex - which may improve your motivation.Very true but I don't think he was seeing it that way.
> >He thinks it would be foolish of me not to take the dexedrine every day. I don't buy this, do you?
>
> It's always surprised me how few docs seem to prescribe 'as required' stimulants. Most people seem to take them every day.It doesn't really surprise me. How often do you not want to think clearly? Or how often do you want to be sluggish and depressed? Did you see the explanation in another thread here where a poster talks about why some doctors prefer that patients take stimulants every day? I was happy to see that since I'd like to believe it's better to take them continuously.
K
xx
Posted by ed_uk on August 17, 2005, at 15:10:27
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 17, 2005, at 14:37:57
Hi K,
>Reversed? Wow.
As far as I know, tachycardiomyopathy is one of the rare types of heart failure which can often be reversed. Most types of heart failure are irreversible.
>I have 25 mg. pills here. I know he wants me to start taking it once a day. Do I eventually take it twice or more a day? How often does one take beta blockers to insure continuous coverage?
Atenolol is usually given once daily, at a dose of 25-100mg/day.... rarely up to ~150mg. It's occasionally given twice daily for angina.
>If you have severe anxiety (which I do when not medicated) then that can lead to depression, right (because your system starts making more cortisol instead of neurotransmitters?). So if an agent were to shut down the anxiety response, then depression is prevented, no?
Makes sense :-)
>How often do you not want to think clearly?
On a Sunday? ;-)
Ed xx
Posted by KaraS on August 18, 2005, at 18:36:03
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 17, 2005, at 15:10:27
> Hi Ed,
> Atenolol is usually given once daily, at a dose of 25-100mg/day.... rarely up to ~150mg. It's occasionally given twice daily for angina.
That's amazing that just one pill can keep your pulse lower for a whole day. Does it just lower the pulse and/or does it keep it at a steady level? When I exercise will my pusle rate go up at all? If not, then there's no benefit to exercising while on a beta blocker, is there?
This morning my pulse rate was 72. I have a feeling my blood pressure was fairly low too. What will a beta blocker do to me during the times when I'd normally have a low pulse rate and blood pressure? Could the beta blocker lower them to a dangerous level?
I read that insomnia is one of the side effects from them as well. I wonder why that is. I'd have thought that preventing a racing heart would help you sleep.
Posted by ed_uk on August 18, 2005, at 18:48:04
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 18, 2005, at 18:36:03
Hi K,
>Does it just lower the pulse and/or does it keep it at a steady level?
It should prevent 'spikes' in pulse.
>When I exercise will my pusle rate go up at all?
Not as much as normal.
>If not, then there's no benefit to exercising while on a beta blocker, is there?
There's always benefit to exercising :-) The beta blocker won't prevent it from being beneficial.
>What will a beta blocker do to me during the times when I'd normally have a low pulse rate and blood pressure?
It might lower them a bit, but probably not much, especially at 25mg.
>Could the beta blocker lower them to a dangerous level?
It's not likely :-)
>I read that insomnia is one of the side effects from them as well.
Sleep disturbance is more a problem with Inderal, not so much with atenolol. Inderal can cause bad dreams.
Ed xx
Posted by KaraS on August 18, 2005, at 22:59:34
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 18, 2005, at 18:48:04
> Hi Ed,
>
> >Does it just lower the pulse and/or does it keep it at a steady level?
>
> It should prevent 'spikes' in pulse.
>
> >When I exercise will my pusle rate go up at all?
>
> Not as much as normal.
>
> >If not, then there's no benefit to exercising while on a beta blocker, is there?
>
> There's always benefit to exercising :-) The beta blocker won't prevent it from being beneficial.
>
> >What will a beta blocker do to me during the times when I'd normally have a low pulse rate and blood pressure?
>
> It might lower them a bit, but probably not much, especially at 25mg.
>
> >Could the beta blocker lower them to a dangerous level?
>
> It's not likely :-)
>
> >I read that insomnia is one of the side effects from them as well.
>
> Sleep disturbance is more a problem with Inderal, not so much with atenolol. Inderal can cause bad dreams.
>
> Ed xx
Thanks. That's all good to hear. I think I'm ready to start taking it. You can study for your exams now. :-)K
Posted by ed_uk on August 19, 2005, at 9:34:55
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 18, 2005, at 22:59:34
Hi K,
I'm not taking my exams. I'm working in a pharmacy for a year. I might go back to uni next year... but maybe not.
ed xx
Posted by KaraS on August 19, 2005, at 18:04:52
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 19, 2005, at 9:34:55
> Hi K,
>
> I'm not taking my exams. I'm working in a pharmacy for a year. I might go back to uni next year... but maybe not.
>
> ed xx
One more question. Can I have a drink or two if I'm taking a beta blocker and using a stimulant?You must have made your decision not to take your exams very recently. Sometimes a year or so off can be very therapeutic. I took a year off between my sophmore and junior years. It was just what I needed at the time. I hope you go back eventually though. The world needs more good, caring health professionals!
K
xxx
Posted by ed_uk on August 20, 2005, at 10:49:42
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 19, 2005, at 18:04:52
Hi K!
>Can I have a drink or two if I'm taking a beta blocker and using a stimulant?
Yes :-) The alcohol might temporarily reduce your BP a bit, probably not much.
Have you started atenolol 25mg yet? ........and did you get a BP monitor?
>Sometimes a year or so off can be very therapeutic.
I can take a maximum of two years off.
Ed xxx
Posted by alohashirt on August 21, 2005, at 0:04:07
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 20, 2005, at 10:49:42
> Hi K!
>
> >Sometimes a year or so off can be very therapeutic.
>
> I can take a maximum of two years off.
>
> Ed xxxI left my government job in Australia in 1990 for six week's off travelling the world.
I still haven't returned.
Posted by KaraS on August 21, 2005, at 1:46:01
In reply to Time off (Re: Dexedrine update, posted by alohashirt on August 21, 2005, at 0:04:07
> > Hi K!
> >
> > >Sometimes a year or so off can be very therapeutic.
> >
> > I can take a maximum of two years off.
> >
> > Ed xxx
>
> I left my government job in Australia in 1990 for six week's off travelling the world.
>
> I still haven't returned.
>
Maybe your chosen Babble name should have been alohajob... :-)
Posted by ed_uk on August 21, 2005, at 15:25:30
In reply to Re: Time off (Re: Dexedrine update » alohashirt, posted by KaraS on August 21, 2005, at 1:46:01
Hi K,
Did you start atenolol?
Ed xx
Posted by KaraS on August 21, 2005, at 16:33:05
In reply to Re: Time off (Re: Dexedrine update » KaraS, posted by ed_uk on August 21, 2005, at 15:25:30
> Hi K,
>
> Did you start atenolol?
>
> Ed xx
Not yet. cluck cluckK
Posted by KaraS on August 21, 2005, at 16:43:27
In reply to Re: Dexedrine update » KaraS, posted by ed_uk on August 20, 2005, at 10:49:42
> Hi K!
>
> >Can I have a drink or two if I'm taking a beta blocker and using a stimulant?
>
> Yes :-) The alcohol might temporarily reduce your BP a bit, probably not much.Great!
> Have you started atenolol 25mg yet? ........and did you get a BP monitor?
No, I am planning on taking a portion of that today. I had bad allergies the last couple of days so I've been particularly scared to try it.I haven't bought a BP monitor yet either. I don't live far from a drugstore that has one in it so I've been going over there to test my pressure.
> >Sometimes a year or so off can be very therapeutic.
>
> I can take a maximum of two years off.
I am so hoping that you can get better treatment to cover your OCD and yet leave you with some motivation. Prozac sounds like a good place to start. I also hope that working will give you more of an incentive to go back and finish the program.Believe me I know how you're feeling.
k
xxx
Posted by KaraS on August 22, 2005, at 5:39:10
In reply to Re: Time off (Re: Dexedrine update » KaraS, posted by ed_uk on August 21, 2005, at 15:25:30
Ok, I took a quarter of a pill. My pulse rate was 76 before and now it's 64. Unbelievable that such a small amount had so much effect or maybe it would have gone down some anyway.
I'll take this amount for a little while and then go up to 1/2 of a pill.
k
Posted by ed_uk on August 22, 2005, at 15:30:57
In reply to Re: Time off (Re: Dexedrine update » ed_uk, posted by KaraS on August 22, 2005, at 5:39:10
Hi K,
>I took a quarter of a pill.
6.25mg? A 25mg tablet.
I expect you'll only need a micro-dose of atenolol (or none at all) while you're on such a low dose of Dexedrine. You could aim to keep your resting pulse at about 70. You might need a bit more atenolol when you increase the Dex.
Are you taking 2.5mg Dexedrine?
Ed xx
Posted by KaraS on August 22, 2005, at 16:22:04
In reply to Re: Time off (Re: Dexedrine update » KaraS, posted by ed_uk on August 22, 2005, at 15:30:57
> Hi K,
>
> >I took a quarter of a pill.
>
> 6.25mg? A 25mg tablet.Yup.
>
> I expect you'll only need a micro-dose of atenolol (or none at all) while you're on such a low dose of Dexedrine. You could aim to keep your resting pulse at about 70. You might need a bit more atenolol when you increase the Dex.
>
> Are you taking 2.5mg Dexedrine?
>
> Ed xx
I took it at night. I hadn't taken any Dex yesterday. I wanted to see what it would be like on it's own. I'm not going to take any Dex for a few days. This morning I had a half of a cup of coffee and my pulse rate is at 72. I bet that even with the Dex, that I won't need to go higher than 12.5 mg. of atenolol, which is great. It's wierd having a heart that doesn't spike up so quickly. Once my heart rate is firmly under control, I intend to go higher on the Dexedrine until I get a speeded up response and some motivation. That small amount I've tried doesn't even help me think more clearly.
I read yesterday that Lance Armstrong's resting pulse rate is 32-34. Can you imagine?k
xx
Posted by ed_uk on August 22, 2005, at 17:05:15
In reply to Re: Time off (Re: Dexedrine update » ed_uk, posted by KaraS on August 22, 2005, at 16:22:04
Hi K!
>I read yesterday that Lance Armstrong's resting pulse rate is 32-34. Can you imagine?
Mine is about 95.
Dose the atenolol to keep your resting pulse at 60bpm or above.
Ed xxxx
Posted by Sarah T. on August 22, 2005, at 23:05:20
In reply to Re: Dexedrine update » ed_uk, posted by KaraS on August 19, 2005, at 18:04:52
Hi Kara,
How've you been? I was wondering whether you're still on Doxepin? I'm sorry I haven't read the entire thread. It looks as if you're off Doxepin.
Sarah
Posted by KaraS on August 22, 2005, at 23:46:01
In reply to Re: Time off (Re: Dexedrine update » KaraS, posted by ed_uk on August 22, 2005, at 17:05:15
> Hi Ed!
>
> >I read yesterday that Lance Armstrong's resting pulse rate is 32-34. Can you imagine?
>
> Mine is about 95.I know one of the things that Dr. E. would prescribe for you! (You'd also get to try stimulants I bet.)
> Dose the atenolol to keep your resting pulse at 60bpm or above.
>
> Ed xxxx
OK. Sounds like a good plan. Tonight it's in the mid 70's but I haven't taken any more of the atenolol yet.k
xxx
Posted by KaraS on August 22, 2005, at 23:49:43
In reply to Re: Dexedrine update » KaraS, posted by Sarah T. on August 22, 2005, at 23:05:20
> Hi Kara,
>
> How've you been? I was wondering whether you're still on Doxepin? I'm sorry I haven't read the entire thread. It looks as if you're off Doxepin.
>
> Sarah
Hi there,No, I'm still taking 12.5 mg. of doxepin but I'm going to try to cut it in half and then get off of it as I increase the atenolol a little bit. It feels so wierd not having my heart race at the slightest provocation. It's a nice peaceful feeling though. Shortly I'll try adding in the Dex again and I'll be able to increase it until I get some stimulation (hopefully).
How about you? How are you doing? I did more research on the night guards so please take a look on the health board when you get a chance.
K
Posted by Sarah T. on August 25, 2005, at 0:33:35
In reply to Re: Dexedrine update » Sarah T., posted by KaraS on August 22, 2005, at 23:49:43
> > > > No, I'm still taking 12.5 mg. of doxepin but I'm going to try to cut it in half and then get off of it as I increase the atenolol a little bit. It feels so wierd not having my heart race at the slightest provocation. It's a nice peaceful feeling though. Shortly I'll try adding in the Dex again and I'll be able to increase it until I get some stimulation (hopefully).> >
Hi Kara,
Is the doxepin you take in tablet form so you can cut it? For some reason, I thought doxepin was either in capsule or liquid.Is the atenolol responsible for alleviating the racing heart? I'm sorry if you've already explained this. I know (or I think) atenolol is a blood pressure medication. Was it rx'd specifically so that you wouldn't get rapid heart beats on the dexedrine + doxepin combination?
>>How about you? How are you doing? I did more research on the night guards so please take a look on the health board when you get a chance.K>
> > >Oh, I guess I'm hanging in there. Thank you so much for doing all that research on the mouth guards. I read what you posted on the health board and I've bookmarked it. Even though I'm not on an SSRI and will probably never taken an SSRI again, I still need to use a night guard. It was the SSRI's, especially Zoloft, that made me start grinding. It got so bad that I would grind even during the day. I've been off of Zoloft for five or six years now, and the grinding and chewing have finally subsided; however, every once in a while, I find myself doing it again, usually in response to stress, and I'm pretty sure, based on what my dentist says, that I must grind at night.
I just can't believe how expensive the dentist-made mouth guards are. All they do is put a mould in your mouth for a few minutes and send the impression off to a lab. The lab makes up some plastic-like guard, and the dentists charge anywhere from $400 - $600 for it. What a racket!Oh, well, enough ranting for tonight. Again, thanks so much for your help.
S.
Posted by KaraS on August 25, 2005, at 12:12:02
In reply to Re: Dexedrine update » KaraS, posted by Sarah T. on August 25, 2005, at 0:33:35
> > > > > No, I'm still taking 12.5 mg. of doxepin but I'm going to try to cut it in half and then get off of it as I increase the atenolol a little bit. It feels so wierd not having my heart race at the slightest provocation. It's a nice peaceful feeling though. Shortly I'll try adding in the Dex again and I'll be able to increase it until I get some stimulation (hopefully).> >
Hi Sarah,> Is the doxepin you take in tablet form so you can cut it? For some reason, I thought doxepin was either in capsule or liquid.
It's in capsule form. I meant that I would be cutting the dose in half. (I open the capsules and pour some into an empty capsule.)
> Is the atenolol responsible for alleviating the racing heart? I'm sorry if you've already explained this. I know (or I think) atenolol is a blood pressure medication. Was it rx'd specifically so that you wouldn't get rapid heart beats on the dexedrine + doxepin combination?
Yes, atenolol lowers the heartrate and also prevents the sharp spikes. It's harder to raise the pulse rate when you're taking it and it doesn't raise as much as it would normally when encountering stress. My doctor prescribed it to help prevent the dexedrine and doxepin from making my pulse rate even faster but he would have prescribed it for me even if I weren't taking dexedrine or doxepin. He thinks that for me a large part of my anxiety problem is tied in with my fast heart rate. He believes that causes or is a symptom of a hyper adrenal situation in my body which creates the extreme anxiety and depression. I do feel calmer on atenolol but I find it hard to believe that the atenolol alone would be enough for me in terms of anxiety and depression prevention.
> >>How about you? How are you doing? I did more research on the night guards so please take a look on the health board when you get a chance.K>
> > > >
>
> Oh, I guess I'm hanging in there. Thank you so much for doing all that research on the mouth guards. I read what you posted on the health board and I've bookmarked it. Even though I'm not on an SSRI and will probably never taken an SSRI again, I still need to use a night guard. It was the SSRI's, especially Zoloft, that made me start grinding. It got so bad that I would grind even during the day. I've been off of Zoloft for five or six years now, and the grinding and chewing have finally subsided; however, every once in a while, I find myself doing it again, usually in response to stress, and I'm pretty sure, based on what my dentist says, that I must grind at night.
> I just can't believe how expensive the dentist-made mouth guards are. All they do is put a mould in your mouth for a few minutes and send the impression off to a lab. The lab makes up some plastic-like guard, and the dentists charge anywhere from $400 - $600 for it. What a racket!I wonder if you'd need a nightguard at all if you never took an SSRI. I added an update to that research on night guards last night so hopefully you read that update as well. It really is a racket that the d*mn things cost so much for so little work and product.
k
> Oh, well, enough ranting for tonight. Again, thanks so much for your help.
>
> S.
>
>
Posted by Sarah T. on August 28, 2005, at 12:31:15
In reply to Re: Dexedrine update » Sarah T., posted by KaraS on August 25, 2005, at 12:12:02
> > > > > > > Yes, atenolol lowers the heartrate and also prevents the sharp spikes. It's harder to raise the pulse rate when you're taking it and it doesn't raise as much as it would normally when encountering stress. My doctor prescribed it to help prevent the dexedrine and doxepin from making my pulse rate even faster but he would have prescribed it for me even if I weren't taking dexedrine or doxepin. He thinks that for me a large part of my anxiety problem is tied in with my fast heart rate. He believes that causes or is a symptom of a hyper adrenal situation in my body which creates the extreme anxiety and depression. I do feel calmer on atenolol but I find it hard to believe that the atenolol alone would be enough for me in terms of anxiety and depression prevention. > >> > >>
Hi Kara,
That's very interesting that your doctor thinks your anxiety stems from the rapid heart rate and not the other way around! You mentioned a hyper-adrenal problem. Do you have elevated cortisol, either elevated urinary, salivary or plasma cortisol?
Does the atenolol have noticeable side effects? If so, what are they? I know that some of the older blood pressure medications can cause depression (just what we need!) and fatigue.
> >> I wonder if you'd need a nightguard at all if you never took an SSRI. I added an update to that research on night guards last night so hopefully you read that update as well. It really is a racket that the d*mn things cost so much for so little work and product. > > k>>Yes, I did read your update on the health board. Thank you again for doing all that work. I definitely need to replace my current mouth guard, and your research has been a great help.
Have a good Sunday!
S.
Posted by Paulbwell on August 28, 2005, at 21:34:37
In reply to Re: Dexedrine update, posted by Sarah T. on August 28, 2005, at 12:31:15
> > > > > > > > Yes, atenolol lowers the heartrate and also prevents the sharp spikes. It's harder to raise the pulse rate when you're taking it and it doesn't raise as much as it would normally when encountering stress. My doctor prescribed it to help prevent the dexedrine and doxepin from making my pulse rate even faster but he would have prescribed it for me even if I weren't taking dexedrine or doxepin. He thinks that for me a large part of my anxiety problem is tied in with my fast heart rate. He believes that causes or is a symptom of a hyper adrenal situation in my body which creates the extreme anxiety and depression. I do feel calmer on atenolol but I find it hard to believe that the atenolol alone would be enough for me in terms of anxiety and depression prevention. > >> > >>
>
> Hi Kara,
>
> That's very interesting that your doctor thinks your anxiety stems from the rapid heart rate and not the other way around! You mentioned a hyper-adrenal problem. Do you have elevated cortisol, either elevated urinary, salivary or plasma cortisol?
>
> Does the atenolol have noticeable side effects? If so, what are they? I know that some of the older blood pressure medications can cause depression (just what we need!) and fatigue.
>
>
> > >> I wonder if you'd need a nightguard at all if you never took an SSRI. I added an update to that research on night guards last night so hopefully you read that update as well. It really is a racket that the d*mn things cost so much for so little work and product. > > k>>
>
> Yes, I did read your update on the health board. Thank you again for doing all that work. I definitely need to replace my current mouth guard, and your research has been a great help.
>
> Have a good Sunday!
>
> S.
>
>Inderal (Propranolol) causes more CNS depression As it enters the BBB-blood brain barrier-more, i'v taken it, and Atenolol, and Atenolol is WAY more cardio-selective at decreasing somatic overactivity.
Cheers
Posted by KaraS on August 28, 2005, at 23:54:39
In reply to Re: Dexedrine update, posted by Sarah T. on August 28, 2005, at 12:31:15
Hi Sarah,
> That's very interesting that your doctor thinks your anxiety stems from the rapid heart rate and not the other way around! You mentioned a hyper-adrenal problem. Do you have elevated cortisol, either elevated urinary, salivary or plasma cortisol?
I've never had cortisol tests. I'd like to but I don't have health insurance right now so I haven't been able to. I suppose if the beta blockers work as the Dr. intends, that will bolster his theory though without the need for cortisol tests.
> Does the atenolol have noticeable side effects? If so, what are they? I know that some of the older blood pressure medications can cause depression (just what we need!) and fatigue.No side effects yet but I'm still on a small dose. It should have less potential for causing depression since it's more cardio selective. I'm also thinking that I won't be on a big enough dosage to cause fatigue but who knows. Time will tell soon enough whether it causes me more depression or fatigue.
> > >> I wonder if you'd need a nightguard at all if you never took an SSRI. I added an update to that research on night guards last night so hopefully you read that update as well. It really is a racket that the d*mn things cost so much for so little work and product. > > k>>
>
> Yes, I did read your update on the health board. Thank you again for doing all that work. I definitely need to replace my current mouth guard, and your research has been a great help.
>
> Have a good Sunday!
>
> S.
I'm going to order the cheap StressGard this week so I'll be able to report back on that one shortly.Take care,
K
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