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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by v on July 15, 2001, at 13:15:57
hello eveyone... i'm making myself write this as i have been trying to for some time... i'll try & keep my info down to the most recent to keep this from being too long
i went off my meds sometime last autumn with the usual disastrous results... at the time i was on 20mg ritalin sr, 112.5mg effexor xr and 15mg buspar with valium &/or xanax as needed. my depression was getting worse & i began to hate being dependent on the doctors and the drugs and the whole damn thing!
after spending the winter & much of the spring hovering near suicide, i went back on the meds i had left, went back to therapy and found another pdoc since the last one i had disappeared in august (i showed up for an appointment only to find a note on the door saying the office was closed...i've since discovered that one of the partners committed suicide & that's how it was dealt with)
after the first visit (2 months ago), he "pronounced" me as mostly attention deficit and put me on 18mg concerta, kept my effexor alone, had me drop the buspar & put me on valium. btw, he asked no questions about my meds history, which is quite long. i'm 48yrs old, have ptsd & did, with a history of eating disorders... i'm currently about 25lbs overweight and miserable about it so any med with weight gain side efects is not acceptable
when i went back last month saying i was still depressed he upped the concerta to 36mg, increased the effexor to 150mg, kept the valium & added wellbutrin - 150mg for 4 days then 150mg 2x daily.... but i've only been taking it once as i don't sleep if i take a 2nd dose and taking them together is too much for me (doc's idea not mine)
while i have been quite "stimulated" i have also been a mess... my brain has turned to mush - i now have worse symptoms of add that weren't there before & am still depressed - actually it's more that i am still not functioning - if anything i'm starting to get worse again... frozen in inactivity.... can't go out except when i must - like work - which then takes everything out of me.... i'm just hiding - what good is stimulation if i can't do anything with it? i still have a hard time even brushing my teeth. i was a cyclist before this past bout hit and was just starting to get back on the bike this past month - the last 2 weeks i've had trouble breathing on the bike so i've been riding less & less... i don't know if the breathing problem is anxiety, illness, or med induced.
i have, however, been taking pain killers so i've been wondering what mechanism is being helped by them - they do seem to make me feel alittle better... and yes, i know that self-medicating is not the answer... i'm just trying to fill the holes in me & i do try not to do it too often... certainly i can't take pain killers and ride!
i'm slowly reducing the effexor & am considering dropping it entirely. i am thinking of keeping the concerta & wellbutrin (150 or 300mg) & asking for klonopin... how does this sound? anything else?
any suggestions would be GREATLY appreciated... i need to see the pdoc this week
thanks for taking the time reading this... sorry it's so long... i really tried to keep it succinct
v
Posted by SalArmy4me on July 15, 2001, at 16:30:21
In reply to i need help, posted by v on July 15, 2001, at 13:15:57
What's wrong with the Effexor (why do you want to drop it)? The Wellbutrin SR has to be taken 2 times a day or it will not have any efficacy. Wellbutrin is a good choice for ADHD, by the way. More thoughts later...
Posted by v on July 15, 2001, at 16:49:56
In reply to Re: i need help » v, posted by SalArmy4me on July 15, 2001, at 16:30:21
hi... thank you for replying
> What's wrong with the Effexor (why do you want to drop it)?
i've been using effexor for the past few years now and figure that it just isn't doing enough... at higher doses i fear its great potential for weight gain... and i'm thinking the stupidity that descended upon me might have been a result of the effexor / wellbutrin combination
> The Wellbutrin SR has to be taken 2 times a day or it will not have any efficacy. Wellbutrin is a good choice for ADHD, by the way. More thoughts later...
why must it be taken 2x a day? my pdoc actually told me to take both doses at the same time since i had difficulty sleeping with the 2nd dose
thanks again,
v
Posted by SalArmy4me on July 15, 2001, at 18:40:45
In reply to Re: i need help, posted by v on July 15, 2001, at 16:49:56
Man, you can't worry about weight gain right now with the Effexor. You gotta worry about your own mental health and well-being. I'm on Effexor 600 mg and I still haven't gained weight. I don't understand the "stupidity" part--that's only a valid complaint against tricyclics, phenytoin, and topiramate.
With Wellbutrin SR, the manufacturer never quite achieved once-a-day dosing. The drug has a half-life of only something like 8 hours.
Posted by shelliR on July 15, 2001, at 19:17:56
In reply to i need help, posted by v on July 15, 2001, at 13:15:57
Hi V.
I disagree with the previous poster who said to forget about weight until you are stabilized. I found that medications that gave me a weight gain tended to destabilize me because the weight gain upset me so much.
As for your plan of going off the effexor and keeping the welbutrin and concerta, you might want to add a mood stabilizer (neuronton, lamictal, etc.) But if I was in your shoes, I'd take the time to find a pdoc who knows my entire history and is willing to make joint decisions with me. I think having a good relationship with a pdoc is a good stabilizer, and then you can work from that. Maybe you can change the relationship with this pdoc by asking more questions, and volunteering more information about your history. Otherwise, I'd find myself a new doctor.
Just an opinion,
Shelli
Posted by JahL on July 15, 2001, at 20:30:32
In reply to Re: i need help » v, posted by SalArmy4me on July 15, 2001, at 18:40:45
> I don't understand the "stupidity" part--that's only a valid complaint against tricyclics, phenytoin, and topiramate.
Not so. Of the 30+meds I've tried Effexor gave me by far the most trouble, cognitively speaking.
J
Posted by Janelle on July 15, 2001, at 21:17:51
In reply to i need help, posted by v on July 15, 2001, at 13:15:57
Hi,
All I can add is that I have had excellent results with Klonopin for anxiety/tension, racing thoughts. However, each person is SOOOOOO different that what works for one often does not for another. It's trial-and-error, working with a pdoc you trust and feel comfortable with.
I've tried quite a few meds and for what it's worth, the only one that seems to stimulate my appetite (which I do NOT want; I just lost weight, still need to lose more and fear gaining any back) is ZYPREXA. However, I won't be on it for long.
Good luck.
-Janelle
Posted by SalArmy4me on July 16, 2001, at 0:58:49
In reply to Re: i need help, posted by JahL on July 15, 2001, at 20:30:32
Just because it happened to you doesn't reflect a general trend. I'm moody tonight!
> > I don't understand the "stupidity" part--that's only a valid complaint against tricyclics, phenytoin, and topiramate.
>
> Not so. Of the 30+meds I've tried Effexor gave me by far the most trouble, cognitively speaking.
>
> J
Posted by v on July 16, 2001, at 6:37:48
In reply to Re: i need help, posted by SalArmy4me on July 16, 2001, at 0:58:49
thank you all so much for replying...
for me, weight gain = depression, depression = wieght gain, it's that simple
how would neurontin figure in my cocktail? what dosage is it usually started at?
would i take concerta, wellbutrin, neurontin & klonopin? could i potentially cut any of them out?what about segligine(sp?) anybody know anything about how it could work for me? what drugs could i cut out?
the issue about the pdoc is a good one but unfortunately, my insurance (dreaded hmo) makes change difficult... we'll see what happens this week...
sorry for asking so many questions... i figure i better know as much as possible...
thanks again & again for being here... to say i feel isolated and alone in all this is an understatement
v
Posted by shelliR on July 16, 2001, at 8:41:51
In reply to Re: i need help, posted by SalArmy4me on July 16, 2001, at 0:58:49
> Just because it happened to you doesn't reflect a general trend. I'm moody tonight!
>
> > > I don't understand the "stupidity" part--that's only a valid complaint against tricyclics, phenytoin, and topiramate.
> >
> > Not so. Of the 30+meds I've tried Effexor gave me by far the most trouble, cognitively speaking.
> >
> > JSal,
It is really not appropriate to tell somewhat that what they have experienced (e.g. stupidity under effexor) is not valid. General trends count for very little when it comes to one person's symptoms. J. was supporting that he also had the same symptoms, so your comment to him was not only rude, but superfluous.
I also would have thought that by now you would have realized that weight gain can be a major contributor to depression for some people. When someone says they won't take a med or want to change meds because of weight gain, I wish you would respect that, rather than beating them down for their point of view. One's selection of medication IS their choice, along with their doctor's.
Shelli
Posted by shelliR on July 16, 2001, at 9:04:58
In reply to Re: i need help - all, posted by v on July 16, 2001, at 6:37:48
v,Generally the first mood stabilizer added is lithium, but it does often cause weight gain. I know neurontin makes one less anxious, but I'm not sure if it would be the best to potentiate the serzone to make up for the taking away the effexor. I would probably choose lamictal, but unless your pdoc is familiar with it's use for depression, that may be a tricky request.
So I don't feel comfortable actually recommending any specific mood stabilizer and dosing. Maybe someone else can step in here, with more knowledge of combinations.
Shelli
Posted by JahL on July 16, 2001, at 10:59:23
In reply to i need help, posted by v on July 15, 2001, at 13:15:57
Hi v. Just a coupla thoughts.
> after the first visit (2 months ago), he "pronounced" me as mostly attention deficit and put me on 18mg concerta, kept my effexor alone, had me drop the buspar & put me on valium. btw, he asked no questions about my meds history, which is quite long.Every pdoc I have ever seen has insisted on a full run-down of every drug I've ever tried, including street drugs. I would've thought this is good clinical practice.
> just starting to get back on the bike this past month - the last 2 weeks i've had trouble breathing on the bike so i've been riding less & less... i don't know if the breathing problem is anxiety, illness, or med induced.
Phenelzine rendered me extremely short-breathed; climbing stairs became a huge effort whilst Paroxetine made it impossible for me to go weight-lifting (muscle-fatigue).
I like Shelli's idea of a mood-stabilizer; they were the first thing to dampen down my own suicidal ideation. I take Lamictal but VPA & Olanzapine helped equally. I didn't have much luck with Neurontin & it wasn't great for the thinking side of things. But ymmv & all that.
Good luck,
J
Posted by JahL on July 16, 2001, at 14:26:30
In reply to Re: i need help, posted by SalArmy4me on July 16, 2001, at 0:58:49
Sal,
I think Shelli's pretty much said what needed saying. However I would like to stress the point that one of this site's prime functions is to *validate* sufferers' experiences. Experiences that have been discounted & discredited by pdocs because they do not conform to 'general [in italics] trends'. (& where did I mention these?!)
It's not helpful to dismiss experiences here based on the same reasoning.
Rgds,
J.PS. I'm also moody tonight, as with every night. And day....
=============
> Just because it happened to you doesn't reflect a general trend. I'm moody tonight!
=============
> > > I don't understand the "stupidity" part--that's only a valid complaint against tricyclics, phenytoin, and topiramate.
> >
> > Not so. Of the 30+meds I've tried Effexor gave me by far the most trouble, cognitively speaking.
> >
> > J
Posted by MB on July 16, 2001, at 15:48:20
In reply to Re: i need help, posted by SalArmy4me on July 16, 2001, at 0:58:49
> > > I don't understand the "stupidity" part--that's only a valid complaint against tricyclics, phenytoin, and topiramate.
> >
> > Not so. Of the 30+meds I've tried Effexor gave me by far the most trouble, cognitively speaking.
> >
> > J> Just because it happened to you doesn't reflect a general trend. I'm moody tonight!
Just because it's not a general trend doesn't mean it's not a valid complaint. To the individual who suffers it, it is VERY valid.
Posted by tina on July 16, 2001, at 20:30:04
In reply to Re: i need help, posted by v on July 15, 2001, at 16:49:56
Don't have any advice for you hun. I just wanted to say welcome back and you were missed.
I hope things get better really soon.
Sending hugs
Tina> hi... thank you for replying
>
> > What's wrong with the Effexor (why do you want to drop it)?
>
> i've been using effexor for the past few years now and figure that it just isn't doing enough... at higher doses i fear its great potential for weight gain... and i'm thinking the stupidity that descended upon me might have been a result of the effexor / wellbutrin combination
>
> > The Wellbutrin SR has to be taken 2 times a day or it will not have any efficacy. Wellbutrin is a good choice for ADHD, by the way. More thoughts later...
>
> why must it be taken 2x a day? my pdoc actually told me to take both doses at the same time since i had difficulty sleeping with the 2nd dose
>
> thanks again,
> v
Posted by dove on July 16, 2001, at 22:34:17
In reply to Re: i need help--Hi V, posted by tina on July 16, 2001, at 20:30:04
Alrighty, you've done your fair share of med trials and now your new p-doc is doing *their* thing with your mind, and I feel for you big-time!!!
I have done an Adderall, Wellbutrin, Prozac, Amitriptyline combo and almost went over the edge. I got rid of the Prozac, and some stability returned but I was all full of nerves, nervous energy with no drive or ambition to actually *do* anything. It drove me nuts, and I became very angry with myself.
So, I got rid of the Wellbutrin and found myself in a much better place. From there we added Serzone. It smooths but doesn't jump-start. It is very-very difficult to pinpoint what it does for me other than helping my libido and smoothing some rough edges here and there. However, if I forget to take it I get very nauseous and queasy.
From there we added Neurontin to the mix. Right at first I felt super-great, like a new lease on life. Unfortunately, within 6 weeks that wore off and lowering or increasing the dosage made no difference. Neurontin also seems very much like the Serzone, there are no surprises just subtleties that prove it's doing something or other.
Next addition: Klonopin. Only 1.5 mgs per day and it has made such a dent in both my depression and anxiety/panic attacks that it is quite amazing. I never knew there was a med that works well without the ups-and-downs of meds like Ativan.
However, over time, I seem to have lost my motivation yet again and have added Prozac back into the picture. I've had a hard time wiht Prozac in the past, but I started slower and lower this time and there haven't been any big surprises (like wanting to throw myself out the window.).
Current cocktail: Amitriptyline, Serzone, Adderall, Klonopin, Neurontin, and Prozac. I feel better than in the past, and have been hammered by some big personal family stuff besides and I think I'm doing much better. The one med that really didn't agree with me was the Wellbutrin, which surprised my doc's, they were so sure that this would be their final success for stabilizing me, they were wrong.
There are lots of meds to look at, and you already have experience and knowledge. What your instincts tell you should not be discounted! And klonopin was very different from all the other benzo's I've had experience with, as well as all those mood-stabilizers. It is nothing like Tegretol, or even Neurontin. If you feel in your gut that you should give it a go, then ask your doc and go for it!!!
Best of luck to you :o)
dove
Posted by v on July 17, 2001, at 5:43:14
In reply to Re: i need help--Hi V, posted by tina on July 16, 2001, at 20:30:04
oh tina - how wonderful to hear from you!!!
thank you so much for stopping in.. :)
i hope all is going well...
love
v> Don't have any advice for you hun. I just wanted to say welcome back and you were missed.
> I hope things get better really soon.
> Sending hugs
> Tina
Posted by v on July 17, 2001, at 5:54:09
In reply to Re: i need help » v, posted by JahL on July 16, 2001, at 10:59:23
thank you so much for replying... i've been berating myself over this breathing thing... telling myself i'm making it up, having anxiety, not trying hard enough...
the pdoc knows something of my history with street drugs as i think that came out in the conversation... actually, i think one of the reasons he diagnosed me as primarily add was over my early "drugs of choice"
are you able to work out now? i need to get back in the weight room as much as i need to ride... but i need the ability to do so... now that sounds so stupid to me... even i can hear the voice that says "so just do it" and how paltry the excuse of mine that says "i can't'... yet that is how it is... i live with this big "NO" in my head
sorry for rambling... i'm feeling soooo frustrated by all this
thanks again,
v> Hi v. Just a coupla thoughts.
>
> > after the first visit (2 months ago), he "pronounced" me as mostly attention deficit and put me on 18mg concerta, kept my effexor alone, had me drop the buspar & put me on valium. btw, he asked no questions about my meds history, which is quite long.
>
> Every pdoc I have ever seen has insisted on a full run-down of every drug I've ever tried, including street drugs. I would've thought this is good clinical practice.
>
> > just starting to get back on the bike this past month - the last 2 weeks i've had trouble breathing on the bike so i've been riding less & less... i don't know if the breathing problem is anxiety, illness, or med induced.
>
> Phenelzine rendered me extremely short-breathed; climbing stairs became a huge effort whilst Paroxetine made it impossible for me to go weight-lifting (muscle-fatigue).
>
> I like Shelli's idea of a mood-stabilizer; they were the first thing to dampen down my own suicidal ideation. I take Lamictal but VPA & Olanzapine helped equally. I didn't have much luck with Neurontin & it wasn't great for the thinking side of things. But ymmv & all that.
>
> Good luck,
> J
Posted by v on July 17, 2001, at 6:19:13
In reply to Re: i need help--Hi V, posted by dove on July 16, 2001, at 22:34:17
thank you so much for your post...
it's incredible to me that hearing (well, reading, but i feel as if i "hear" these posts) some of the same things as i'm experiencing really does lessen this isolation i'm all wrapped up in..in the past, reaching out, hasn't always helped so i'm wondering if somewhere in this quagmire of drugs, i'm actually getting some benefits that are hard to distinguish.. like even though i still feel like crap, i'm not thinking about suicide... i'm used to comforting myself with the knowledge that i have an out from all this & that option doesn't feel available to me right now...
knowing that is confusing me even more... i am feeling incredibly frustrated about this whole damn thing.. i hate taking meds... i hate having to find combinations - all the trial & error while i flounder - i especially hate feeling as if someone (pdocs) & something (meds) have all this control over me
i want you to know how much your post has helped me... you validated not only some of my feelings & experiences but reminded me that in the middle of my insanity... with all my fragments running around... someone, somewhere inside me sees the big picture... now if i could only hear her... :)
blessings,
v> Alrighty, you've done your fair share of med trials and now your new p-doc is doing *their* thing with your mind, and I feel for you big-time!!!
>
> I have done an Adderall, Wellbutrin, Prozac, Amitriptyline combo and almost went over the edge. I got rid of the Prozac, and some stability returned but I was all full of nerves, nervous energy with no drive or ambition to actually *do* anything. It drove me nuts, and I became very angry with myself.
>
> So, I got rid of the Wellbutrin and found myself in a much better place. From there we added Serzone. It smooths but doesn't jump-start. It is very-very difficult to pinpoint what it does for me other than helping my libido and smoothing some rough edges here and there. However, if I forget to take it I get very nauseous and queasy.
>
> From there we added Neurontin to the mix. Right at first I felt super-great, like a new lease on life. Unfortunately, within 6 weeks that wore off and lowering or increasing the dosage made no difference. Neurontin also seems very much like the Serzone, there are no surprises just subtleties that prove it's doing something or other.
>
> Next addition: Klonopin. Only 1.5 mgs per day and it has made such a dent in both my depression and anxiety/panic attacks that it is quite amazing. I never knew there was a med that works well without the ups-and-downs of meds like Ativan.
>
> However, over time, I seem to have lost my motivation yet again and have added Prozac back into the picture. I've had a hard time wiht Prozac in the past, but I started slower and lower this time and there haven't been any big surprises (like wanting to throw myself out the window.).
>
> Current cocktail: Amitriptyline, Serzone, Adderall, Klonopin, Neurontin, and Prozac. I feel better than in the past, and have been hammered by some big personal family stuff besides and I think I'm doing much better. The one med that really didn't agree with me was the Wellbutrin, which surprised my doc's, they were so sure that this would be their final success for stabilizing me, they were wrong.
>
> There are lots of meds to look at, and you already have experience and knowledge. What your instincts tell you should not be discounted! And klonopin was very different from all the other benzo's I've had experience with, as well as all those mood-stabilizers. It is nothing like Tegretol, or even Neurontin. If you feel in your gut that you should give it a go, then ask your doc and go for it!!!
>
> Best of luck to you :o)
>
> dove
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