![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 35 to 59 of 103. Go back in thread:
Posted by Mitch on December 22, 2001, at 17:06:39
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug?????, posted by MB on December 22, 2001, at 10:34:46
> The nurse called me back and said that the fill-in doc wanted me off the medication, but to titrate down...not to just quit taking it. I was up to 12mg (Thursday night) so last night I took 8mg, and I figure that tonight I'll drop to 4mg and hold it there a few before stopping completely. I haven't been on it more than a week, I figure that won't be too quick. I wonder what the side effects are to withdrawing too quickly. I guess if I have a seizure, I dropped the dose too quickly (LOL)!! An interesting note: before I started this medication, I was getting these weird pressure headaches (more pressure than ache, actually) accompanied by nausea, sensitivity to light, stomach cramps, etc. They usually happend about 2 - 2.5 hrs after jogging or weight lifting. I would usually get extremely spacy during the precipitation workout and see some flashing lights and weird visual effects. I thought these symptoms were totally psychosomatic and that after I got on some meds, they'd go away. When I started the Gabitril, the symptoms got worse, and I, in my infinite paranoia, decided I must have a brain tumor so I went to urgent care at 8pm and the doc told me he thought it was something called a migraine eqivalent (bacically a migraine without the severe headache). He wants me to quit all caffeine and see my regualar doc in a week (ouch on the no caffine). Anyway, the reason I bring this up is that the Gabitril caused me to see the flashing lights even without the the "migraine-like episodes". I wonder if there's some connection here. I'm still worried about a brain tumor (yes paranoia). The urgent care doc looked in my eyes, looked in my throat, listened to my lungs and said, "well, you don't have a brain tumor or anything like that." I felt kind of patrinized. He probably saw "Gabitril" on my chart and figured that since I was "crazy" he should probably do some fluff exam to placate me. This is the medical clinic where it took me A MONTH to find out my foot was broken. It took me almost that long to find out that I actually DID have a tumor in my foot. This was after the doctor told me it was a BLISTER and that it needed to be aspirated. I don't know what the ramifications are of aspirating a tumor, but I don't think they're good. Luckily it was not cancer, otherwise my blood stream probably would have been full of it. Sometimes I get so sick of the medical comminity. If I burst an aneurysm and die, he is *SO* going to be haunted < g >
>
> wow, I really got off topic there, didn't I?
>
>
> peace,
> MBI doubt if you will have a seizure if you stopped taking it abruptly if you are down to 8mg/day anyhow. Believe it or not, people that are taking Gabitril for intractable seizures are taking between 24-56mg/day!
The migraine thing sounds interesting. I don't know if you were aware that Depakote is used for migraines 250-500mg/day. Perhaps Depakote would be a better match for you as a mood stabilizer if you are having troubles with migraines, too. According to what you said previously, your doc wants to find the "right" mood stabilizer first, then add an SSRI (the "right" one I assume), and then a stimulant,correct? Wow, that will take a while, but at least it sounds like a good plan. I wonder if he could work on the SSRI at the same time? It sounds like all of this experimentation has gotten you ruminating a lot. It isn't nice when you are withdrawn from something that didn't work and don't have anything else in place, yet.
Mitch
Posted by MB on December 22, 2001, at 19:31:18
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 22, 2001, at 17:06:39
> I doubt if you will have a seizure if you stopped taking it abruptly if you are down to 8mg/day anyhow. Believe it or not, people that are taking Gabitril for intractable seizures are taking between 24-56mg/day!
YIKES! How do people tolorate it in such high doses? I bet if I were suffering seizures, I would be willing to put up with a lot more in the side effects department.
> The migraine thing sounds interesting. I don't know if you were aware that Depakote is used for migraines 250-500mg/day. Perhaps Depakote would be a better match for you as a mood stabilizer if you are having troubles with migraines, too. According to what you said previously, your doc wants to find the "right" mood stabilizer first, then add an SSRI (the "right" one I assume), and then a stimulant,correct? Wow, that will take a while, but at least it sounds like a good plan.
I think it's a great plan, but the waiting is lame. Comming off the Gabitril doesn't worry me, since it never really did anything for me anyway. What *does* worry me though, is that the doctor didn't think I was going to really feel better until I was on all three medications. That could take a long time, it seems (if my intolorance to antiepileptics is anything like my intolorance to antidepressants). I guess tolorance is related to willingness (i.e., how bad am I willing to feel in exchange for relief of original symptoms). Maybe three years ago when I was taking mushrooms and smoking weed, derealization and depersonalization wouldn't have bothered me. I want a new life though, now, one based on *reality*. I mean, I'd like to finish school and get a job some day. I guess, right now, I'm not willing to put up with feeling very bad at all. If the medication feels like it's hurting my ability (or desire) to live life *in reality* then screw it.The antiepileptic is supposed to increase my tolorance to the AD by "smoothing things out," but the idea of adding Prozac to the mix when I feel the way I do on the Gabitril scares the hell out of me. Also, now it's going to be hard to tell how the Gabitril withdrawal is affecting me because I am also weaning myself off caffeine (I tried cold-turkey and made it about 24 hrs when I said "screw this!"). One thing that is definitely food for rumination (for me) is making a change in more than one area and not knowing *which* change is making me feel the way I do.
> I wonder if he could work on the SSRI at the same time? It sounds like all of this experimentation has gotten you ruminating a lot.
That's an understatement. Also, the length of my posts is starting to scare me. I'm definitely obsessing.
> It isn't nice when you are withdrawn from something that didn't work and don't have anything else in place, yet.
>
> Mitch
Yeah, I want to move on, too. I could possibly tolorate the Prozac without an antiepileptic if I had a benzo (and that would take care of the anxiety there and then without months of waiting) but the doc wants to save that as a last resort because of my history of alcohlism. I agree with him that an AE would probably be best for the rage attacks. Did you experience any discontinuation symptoms from quitting Gabitril?MB
Posted by christophreJMC on December 22, 2001, at 23:20:22
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug?????, posted by MB on December 22, 2001, at 10:34:46
> An interesting note: before I started this >medication, I was getting these weird pressure >headaches (more pressure than ache, actually) accompanied by nausea, sensitivity to light, stomach cramps, etc. They usually happend about 2 - 2.5 hrs after jogging or weight lifting. I would usually get extremely spacy during the precipitation workout and see some flashing lights and weird visual effects.
I sometimes have similar symptoms usually after exercise. Please let me (us) know if you find out anything more about them.
Thanks,
Christophre
Posted by MB on December 22, 2001, at 23:31:54
In reply to migraine equiv. » MB, posted by christophreJMC on December 22, 2001, at 23:20:22
> > An interesting note: before I started this >medication, I was getting these weird pressure >headaches (more pressure than ache, actually) accompanied by nausea, sensitivity to light, stomach cramps, etc. They usually happend about 2 - 2.5 hrs after jogging or weight lifting. I would usually get extremely spacy during the precipitation workout and see some flashing lights and weird visual effects.
>
> I sometimes have similar symptoms usually after exercise. Please let me (us) know if you find out anything more about them.
>
> Thanks,
> ChristophreYeah, I'll let you know when I find out more. Are you taking any medication? Caffeine?
Posted by christophreJMC on December 23, 2001, at 10:10:32
In reply to Re: migraine equiv., posted by MB on December 22, 2001, at 23:31:54
I've had them off and on medication. I don't drink much caffeine, but I can't say for sure if it played a part or not.
Out of curiosity, have you ever had an EEG?
Posted by MB on December 23, 2001, at 10:44:03
In reply to Re: migraine equiv. » MB, posted by christophreJMC on December 23, 2001, at 10:10:32
> I've had them off and on medication. I don't drink much caffeine, but I can't say for sure if it played a part or not.
>
> Out of curiosity, have you ever had an EEG?No, I've never had an EEG. What would it show?
Posted by JahL on December 23, 2001, at 21:03:51
In reply to Re: methadone » JahL, posted by shellir on December 22, 2001, at 16:21:53
Hi Shelli. Hope you're doing OK.
I tried mailing you but apparently yr address doesn't exist. Have you posted it right?
Best,
J.
> jah,
>
> I just put a new message on today re methadone. I detoxed from over 100mg and am now on 10mg. I don't know if it is habituating, like other opiates, etc. Also, of course I don't know how I would get it after the 50 I have now. I'm not sure that knowing how to get it in england would help me in usa, but I'm curious how you get it (stacie1012km@yahoo.com).
Posted by shellir on December 23, 2001, at 22:26:30
In reply to Re: methadone » shellir, posted by JahL on December 23, 2001, at 21:03:51
> Hi Shelli. Hope you're doing OK.
>
> I tried mailing you but apparently yr address doesn't exist. Have you posted it right?
>
> Best,
> J.
>
>
> > jah,woops, I wrote the e-mail address wrong. It's stacey1012km@yahoo.com. Sorry. If you still have the email, please send.
I'm now up to 15mg (x3) of methodone already--looks pretty habituating unfortunately.Do you have brothers and sisters? If so, any relationship with them. Also, have you seen the new doctor again?
Shelli
Posted by Mitch on December 26, 2001, at 18:28:14
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by MB on December 22, 2001, at 19:31:18
> Yeah, I want to move on, too. I could possibly tolorate the Prozac without an antiepileptic if I had a benzo (and that would take care of the anxiety there and then without months of waiting) but the doc wants to save that as a last resort because of my history of alcohlism. I agree with him that an AE would probably be best for the rage attacks. Did you experience any discontinuation symptoms from quitting Gabitril?
>
> MB
Hi, I am back. Been on the road. I had no problems stopping it (Gabitril). I immediately went back to Neurontin, but at a lower dose (300mg/day). I think low-dose Prozac+low-dose Klonopin might work great.Mitch
Posted by MB on December 26, 2001, at 19:07:21
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 26, 2001, at 18:28:14
Well, I tried the Gabitril for a few more days at 12mg just to see (heck, maybe something would have clicked and it would have gotten better). It just got worse so yesterday, I only took 8mg and today I took none. Got the AE switched to Trileptal and will start that tomorrow night. I am in the middle of quitting caffeine so it might get weird differentiating Trileptal side-effects with caffeine withdrawal. I think now is a good time to start keeping a medication journal.
You mention low dose of Prozac, but the doc said he wants me on 60mg minimum for OCD (says higher doses needed for OCD than for depression). This seems really high to me, since I've only taken 20 mg before (when I talked to him the first time, I made a mistake and said I had taken 40 mg before). I guess if it helps with the obsessed thinking, I can put up with no sex life...well, maybe for a while. Do you know if Adderal (as it is a dopaminergic) will help with Prozac induced anorgasmia?
MB
> Hi, I am back. Been on the road. I had no problems stopping it (Gabitril). I immediately went back to Neurontin, but at a lower dose (300mg/day). I think low-dose Prozac+low-dose Klonopin might work great.
>
> Mitch
Posted by Mitch on December 27, 2001, at 15:09:22
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by MB on December 26, 2001, at 19:07:21
> Well, I tried the Gabitril for a few more days at 12mg just to see (heck, maybe something would have clicked and it would have gotten better). It just got worse so yesterday, I only took 8mg and today I took none. Got the AE switched to Trileptal and will start that tomorrow night. I am in the middle of quitting caffeine so it might get weird differentiating Trileptal side-effects with caffeine withdrawal. I think now is a good time to start keeping a medication journal.
Good luck with the Trileptal. It made me pretty nauseous though. It didn't seem to dull my thinking however and seemed to have an antidepressant effect. I am REAL touchy with anything that causes nausea. You might do fine with it, though.
>
> You mention low dose of Prozac, but the doc said he wants me on 60mg minimum for OCD (says higher doses needed for OCD than for depression). This seems really high to me, since I've only taken 20 mg before (when I talked to him the first time, I made a mistake and said I had taken 40 mg before). I guess if it helps with the obsessed thinking, I can put up with no sex life...well, maybe for a while. Do you know if Adderal (as it is a dopaminergic) will help with Prozac induced anorgasmia?
>
> MB
Wow! 60mg! I know that folks with OCD need a pretty high dose. I just wonder if that much would be too destabilizing (worsen cycling). FWIW, I found that Zoloft gave me the least trouble with reduced libido, anorgasmia, etc. It blocks the dopamine transporter a lot more than the other SSRi's. But of course YMMV. Have you ever tried Neurontin for ruminations/OCD?? It helps some people. Maybe you can take Trileptal+Neurontin and not need an SSRI for the OCD? Just a thought.Mitch
Posted by MB on December 27, 2001, at 16:09:56
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 27, 2001, at 15:09:22
> Good luck with the Trileptal. It made me pretty nauseous though. It didn't seem to dull my thinking however and seemed to have an antidepressant effect. I am REAL touchy with anything that causes nausea. You might do fine with it, though.
I hope this works (Trileptal). My stomach seems to do well with medicine that cause nausea. Today is my second day off of the Gabitril and I still feel weird, but I think some of that must be caffeine withdrawal. Today is first day off of all caffeine. I hear day three will be the worst, then it will get better. I thought about waitng until then to start Trileptal, but I want to get up and moving on some kind of regimen; the waves of anxiety/depression are getting so bad. Did you think trileptal had an anti-anxiety effect?
> > You mention low dose of Prozac, but the doc said he wants me on 60mg minimum for OCD (says higher doses needed for OCD than for depression). This seems really high to me, since I've only taken 20 mg before (when I talked to him the first time, I made a mistake and said I had taken 40 mg before). I guess if it helps with the obsessed thinking, I can put up with no sex life...well, maybe for a while. Do you know if Adderal (as it is a dopaminergic) will help with Prozac induced anorgasmia?
> >
> > MB
>
>
> Wow! 60mg! I know that folks with OCD need a pretty high dose. I just wonder if that much would be too destabilizing (worsen cycling). FWIW, I found that Zoloft gave me the least trouble with reduced libido, anorgasmia, etc. It blocks the dopamine transporter a lot more than the other SSRi's. But of course YMMV. Have you ever tried Neurontin for ruminations/OCD?? It helps some people. Maybe you can take Trileptal+Neurontin and not need an SSRI for the OCD? Just a thought.
>
> Mitch
Well, I'll try the Prozac, but I've decided I'm not going to take anything that makes me more uncomfortable than the original symptoms. That's been my experience with the SSRIs in the past. The mood stabalizer is supposed to mitigate the anxiogenic side effects of the Prozac. I'm keeping my fingers crossed.MB
Posted by Mitch on December 27, 2001, at 19:01:58
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by MB on December 27, 2001, at 16:09:56
> I hope this works (Trileptal). My stomach seems to do well with medicine that cause nausea. Today is my second day off of the Gabitril and I still feel weird, but I think some of that must be caffeine withdrawal. Today is first day off of all caffeine. I hear day three will be the worst, then it will get better. I thought about waitng until then to start Trileptal, but I want to get up and moving on some kind of regimen; the waves of anxiety/depression are getting so bad. Did you think trileptal had an anti-anxiety effect?
You are lucky you can handle nausea-provoking meds! Unfortunately, I didn't get too much of an anti-anxiety effect from Trileptal. As far as mood stabilizers that helped with anxiety/agitation I would have to say that Lithium, Neurontin, Depakote, and Topamax worked the best.
> Well, I'll try the Prozac, but I've decided I'm not going to take anything that makes me more uncomfortable than the original symptoms. That's been my experience with the SSRIs in the past. The mood stabalizer is supposed to mitigate the anxiogenic side effects of the Prozac. I'm keeping my fingers crossed.
>
> MB
Well....Prozac tends to provoke more anxiety than the other SSRI's and tends to be the most activating. Also, I haven't found mood stabilizers to "mitigate" adverse effects of antidepressants very well. Then can reduce hypomania and agitation that AD's can cause, but I think all the flak you are going to catch from taking antidepressants is going to have more to do with the AD itself and the dosage used despite whatever mood stabilizers are in place. I think it would be best to find the least destabilizing antidepressant that will help with GAD/OCD sfx, THEN find which mood stabilizer works the best on your cycling. But that's just an opinion.Mitch
Posted by MB on December 27, 2001, at 22:04:47
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 27, 2001, at 19:01:58
< cut >>I think it would be best to find the least destabilizing antidepressant that will help with GAD/OCD sfx, THEN find which mood stabilizer works the best on your cycling. But that's just an opinion.
>
> Mitch
Yeah, I figure once I get on a mood stabilizer that is both tolorable and effective, I'll have to go through the same process with the SSRIs (find one that's tolorable and effective), and then, later, do the same with the stimulants. I've tried all the SSRIs, and I liked Prozac the best (but I was also smoking weed and drinking on it, so I wouldn't have noticed anxiety/rage anyway. I found Serzone the most tolorable. No restlessness, no fatigue, no anxiety, and no anorgasmia. I haven't heard good results of treating OCD with Serzone. Have you? I'll ask my doc about it. Also, do you think the Adderal will counteract the sexual side effects of the Prozac? Just wondered since sometimes Wellbutrin is used for this (both are dopaminergic).Anyway, enough about me. How are you doing on your medications (was it Neurontin, Celexa, Klonopin and Wellbutrin)? The only time I could handle Wellbutrin without rage attacks was with a benzo. Probably the best combo I've been on for anxiety and depression was Xanax and Wellbutrin (did nothing for my OCD though).
MB
Posted by Mitch on December 27, 2001, at 22:48:33
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by MB on December 27, 2001, at 22:04:47
> Yeah, I figure once I get on a mood stabilizer that is both tolorable and effective, I'll have to go through the same process with the SSRIs (find one that's tolorable and effective), and then, later, do the same with the stimulants. I've tried all the SSRIs, and I liked Prozac the best (but I was also smoking weed and drinking on it, so I wouldn't have noticed anxiety/rage anyway. I found Serzone the most tolorable. No restlessness, no fatigue, no anxiety, and no anorgasmia. I haven't heard good results of treating OCD with Serzone. Have you?
You are kind of begging your own question there! :) You found Serzone the most tolerable and you must have noticed its effect on your OCD-you said "no anxiety".
You may already have found your "SSRI". Serzone is a weak SSri-BTW. It just also happens to antagonize 5-HT2a receptors.
> I'll ask my doc about it. Also, do you think the Adderal will counteract the sexual side effects of the Prozac? Just wondered since sometimes Wellbutrin is used for this (both are dopaminergic).It might. But, I have found that switching the med that is causing the problem is a superior solution to finding an additional med to "reverse" side-effects.
> Anyway, enough about me. How are you doing on your medications (was it Neurontin, Celexa, Klonopin and Wellbutrin)? The only time I could handle Wellbutrin without rage attacks was with a benzo. Probably the best combo I've been on for anxiety and depression was Xanax and Wellbutrin (did nothing for my OCD though).
>
> MBThat's my combo. I "like" Zoloft better than the Celexa and I have added back a little Zoloft lately. But the sertraline just shreds my guts (IBS probs). I have also heard that Zoloft can be effective for depersonalization/derealization and I get that sfx from other meds easily-that might explain why I respond to sertraline better than the other SSRi's. The Wellbutrin is there just because of seasonal depression. Things would be pretty black right now if it wasn't for the WB. But, I am getting headaches, elevated heart rate, blurry vision (worse than nortripytline), and it doesn't help with ADHD as well as the Zoloft+nortripytline combination (both very low dose). To be honest, I think after this seasonal spell starts diminishing (in 3-4 weeks)I will probably be back on Neurontin+Klonopin+Zoloft+Nortriptyline.
Mitch
Posted by MB on December 28, 2001, at 0:44:40
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 27, 2001, at 22:48:33
> > Yeah, I figure once I get on a mood stabilizer that is both tolorable and effective, I'll have to go through the same process with the SSRIs (find one that's tolorable and effective), and then, later, do the same with the stimulants. I've tried all the SSRIs, and I liked Prozac the best (but I was also smoking weed and drinking on it, so I wouldn't have noticed anxiety/rage anyway. I found Serzone the most tolorable. No restlessness, no fatigue, no anxiety, and no anorgasmia. I haven't heard good results of treating OCD with Serzone. Have you?
>
> You are kind of begging your own question there! :) You found Serzone the most tolerable and you must have noticed its effect on your OCD-you said "no anxiety".
> You may already have found your "SSRI". Serzone is a weak SSri-BTW. It just also happens to antagonize 5-HT2a receptors.
>
>
> > I'll ask my doc about it. Also, do you think the Adderal will counteract the sexual side effects of the Prozac? Just wondered since sometimes Wellbutrin is used for this (both are dopaminergic).
>
> It might. But, I have found that switching the med that is causing the problem is a superior solution to finding an additional med to "reverse" side-effects.
>
> > Anyway, enough about me. How are you doing on your medications (was it Neurontin, Celexa, Klonopin and Wellbutrin)? The only time I could handle Wellbutrin without rage attacks was with a benzo. Probably the best combo I've been on for anxiety and depression was Xanax and Wellbutrin (did nothing for my OCD though).
> >
> > MB
>
> That's my combo. I "like" Zoloft better than the Celexa and I have added back a little Zoloft lately. But the sertraline just shreds my guts (IBS probs). I have also heard that Zoloft can be effective for depersonalization/derealization and I get that sfx from other meds easily-that might explain why I respond to sertraline better than the other SSRi's. The Wellbutrin is there just because of seasonal depression. Things would be pretty black right now if it wasn't for the WB. But, I am getting headaches, elevated heart rate, blurry vision (worse than nortripytline), and it doesn't help with ADHD as well as the Zoloft+nortripytline combination (both very low dose). To be honest, I think after this seasonal spell starts diminishing (in 3-4 weeks)I will probably be back on Neurontin+Klonopin+Zoloft+Nortriptyline.
>
> Mitch
Wellbutrin made my eyes blurry too...maybe anticholinergic action? I guess when I said "no anxiety" with the Serzone, I should have said "no increased anxiety," which is still really important. I'll talk to the doc before it's time to start the SSRI and see what he says. So you take the Wellbutrin for seasonal depression? Interesting. I remember that in the early nineties, the consensus was that SAD had something to do with the short days affecting seratonin production (or something like that) and that SSRIs were supposed to be the best for that. Has the consensus changed? I guess it just goes to show that what *works* is more important than whatever psychobiological theory is popular at the time.That's great that the Neurontin works for you. I took it for restless leg syndrom and found no side effect (but no wanted effect either).
Oh wait, maybe I missed something. Does your seasonal depression have to do with the stress of the holidays or because of the limited daylight?
MB
Posted by Elizabeth on December 28, 2001, at 14:29:55
In reply to Re: methadone » JahL, posted by shellir on December 22, 2001, at 16:21:53
> I don't know if it is habituating, like other opiates, etc.
Yes, methadone is a full opioid receptor agonist, and it can be really hard to come off of it if you're on a high dose. Withdrawal from methadone can be especially hard because, although withdrawal symptoms don't hit as hard as they do if you're coming off of, say, heroin, they last much longer.
> I have just gotten out of four hospitals, forced by handcuffs when my friend took me to the emergency room and I was sent to a prison-looking hospital in washington, d.c.
A lot of state psychiatric hospitals have that requirement, that patients be restrained while they're being transported there. State hospitals do often get patients who are violent, but I think it's terrible that they insist on treating everybody that way.
> Then I've been at supposedly the best psychiatric hospital in pennsylvania, and I know you'll love this--they told me I need extensive therapy and discharged me.
*sigh* I'm sorry you're having such a time getting decent care, Shelli. People with histories
of abuse or trauma often need talk therapy, but that doesn't mean that they should be deprived of medication. Also, if you've tried lots of different talk therapies without success, you shouldn't be expected to continue regardless of your diagnosis. And nobody should ever be forced or coerced into talk therapy.You have my best wishes and hopes, as always.
-elizabeth
Posted by Mitch on December 28, 2001, at 18:07:22
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by MB on December 28, 2001, at 0:44:40
> Wellbutrin made my eyes blurry too...maybe anticholinergic action? I guess when I said "no anxiety" with the Serzone, I should have said "no increased anxiety," which is still really important. I'll talk to the doc before it's time to start the SSRI and see what he says. So you take the Wellbutrin for seasonal depression? Interesting. I remember that in the early nineties, the consensus was that SAD had something to do with the short days affecting seratonin production (or something like that) and that SSRIs were supposed to be the best for that. Has the consensus changed? I guess it just goes to show that what *works* is more important than whatever psychobiological theory is popular at the time.
Well, what I "heard" about seasonal affective disorder is that the "activating" SSRi's tend to be most effective (Prozac/Zoloft). I took Prozac for several years and it would be very helpful. The trouble is I can't tolerate anything close to a "standard" dose with an SSRI, due to hypomania, GI distress, and insomnia/agitation. I took Adderall two years ago at this time and poof!, no depression at all but I was very edgy, cool, aloof, robotic, etc. Pstims and stim-like AD's work the best for the seasonal depression for me-probably because I can tolerate them a little better. Also, the more sedative SSRi's and TCA's tend to make me very melancholic-very, very blue. Wow, if I could get the effectiveness of Adderall for seasonal depression (and its lack of cycling)without increasing anxiety I would have it made. I would really prefer to not have to take any AD's at all. Just a mood stabilizer and a stimulant. I have thought about Provigil. I wonder if Neurontin+Provigil would be enough? If I can get off AD's my cycling almost quits entirely.
>
> That's great that the Neurontin works for you. I took it for restless leg syndrom and found no side effect (but no wanted effect either).
>
> Oh wait, maybe I missed something. Does your seasonal depression have to do with the stress of the holidays or because of the limited daylight?
>
> MBI really can map it by how much light there is. I am depressed now, I am just not ruminating and agitated about it. I am just not interesting in doing much of anything. The presence of the holidays makes it worse because there is more stufff to do that I normally would be interested in doing and I don't give a damn. I guess with meds in place it is more of a mild dysthymia/anhedonia thing. Hey, it beats a full-blown depressive episode by a whole lot-I am not going to gripe much. Things have been a whole lot worse than this!
Mitch
Posted by MB on December 28, 2001, at 23:14:07
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 28, 2001, at 18:07:22
> Well, what I "heard" about seasonal affective disorder is that the "activating" SSRi's tend to be most effective (Prozac/Zoloft). I took Prozac for several years and it would be very helpful. The trouble is I can't tolerate anything close to a "standard" dose with an SSRI, due to hypomania, GI distress, and insomnia/agitation. I took Adderall two years ago at this time and poof!, no depression at all but I was very edgy, cool, aloof, robotic, etc. Pstims and stim-like AD's work the best for the seasonal depression for me-probably because I can tolerate them a little better. Also, the more sedative SSRi's and TCA's tend to make me very melancholic-very, very blue. Wow, if I could get the effectiveness of Adderall for seasonal depression (and its lack of cycling)without increasing anxiety I would have it made. I would really prefer to not have to take any AD's at all. Just a mood stabilizer and a stimulant. I have thought about Provigil. I wonder if Neurontin+Provigil would be enough? If I can get off AD's my cycling almost quits entirely.
What about Neurontin + Adderal and just increase your Kolopin dose until the anxiety from the Adderall is tolorable? Or does increasing the Klonopin too high cause other problems? Klonopin can make you depressed, can't it?
> > That's great that the Neurontin works for you. I took it for restless leg syndrom and found no side effect (but no wanted effect either).
> >
> > Oh wait, maybe I missed something. Does your seasonal depression have to do with the stress of the holidays or because of the limited daylight?
> >
> > MB
>
> I really can map it by how much light there is. I am depressed now, I am just not ruminating and agitated about it. I am just not interesting in doing much of anything. The presence of the holidays makes it worse because there is more stufff to do that I normally would be interested in doing and I don't give a damn. I guess with meds in place it is more of a mild dysthymia/anhedonia thing. Hey, it beats a full-blown depressive episode by a whole lot-I am not going to gripe much. Things have been a whole lot worse than this!
>
> Mitch
Yeah, I am starting to pull out of a very depressed place. My cycling seems to have periods of three days or less (is that possible, or is rapid cycling like that merely situational?) I'm feeling much better now. The caffeine withdrawal is subsiding. I can already tell that this Trileptal is going to be better than the Gabitril. Although I'm only at 100 mg at night (for the time being) I think I can tell it's more tolorable. I'm almost thinking it might have some AD properties...although this morning I was afraid it was making me crash. Maybe I'm just cycling. Hmmm. At least I don't feel like I'm on PCP with my head in a cocoon!!MB
Oh, by the way, what do you mean about the Adderall making you robotic?
Posted by Mitch on December 29, 2001, at 8:36:28
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by MB on December 28, 2001, at 23:14:07
> What about Neurontin + Adderal and just increase your Kolopin dose until the anxiety from the Adderall is tolorable? Or does increasing the Klonopin too high cause other problems? Klonopin can make you depressed, can't it?
You bring up something that I had thought about since that experiment. I was just taking Neurontin+Adderall (nothing for panic). It seems that everytime I try to get off a serotonergic med I start getting very, very, anxious. And that anxiety keeps me so preoccupied (OCD-like), I become somewhat socially chilly and unspontaneous. Then, that sets the stage for panic to creep back in. Everything else is just fine however. I slept excellent-not too much or little, no interrupted sleep. I was focused all day long and not drowsy, yawning, forgetting where I was at work, etc. Everything was just a bunch of little tasks to complete, one at a time-no procrastinating. Time even had this very discrete "unitized" feel about it-I did't have any *big* ideas really, just a lot of smaller task-oriented ideas-no hypomania or grandiosity. I didn't experience *any* mood cycling at all. Ordinary everyday events didn't seem *boring* any more-it was just stuff to do. That's when my pdoc was convinced I had ADHD (but still believed I was also atypical bipolar). The problem is I need some form of serotonergic med for my anxiety probs., but antidepressants trigger cycling. I wonder if Neurontin+pstim+Klonopin (mildly serotonergic) or Neurontin+pstim+Lithium would do the trick??> Oh, by the way, what do you mean about the Adderall making you robotic?
That is a term I picked up from reading about ADHD and children taking stimulants for it. It is a mild form of "sterotyped" behavior. It is somewhat "tic-like" in the sense that you "go through the motions" in a very literal deliberate way that doesn't seem "normally spontaneous". But, without the pstim I would often start several different things at once and be stopping, and starting them all to try to get them done and fail at most of them, and then forget half of what I was going to accomplish! (that would be an ineffecient silly form of spontaneity-the opposite).
> Yeah, I am starting to pull out of a very depressed place. My cycling seems to have periods of three days or less (is that possible, or is rapid cycling like that merely situational?) I'm feeling much better now. The caffeine withdrawal is subsiding. I can already tell that this Trileptal is going to be better than the Gabitril. Although I'm only at 100 mg at night (for the time being) I think I can tell it's more tolorable. I'm almost thinking it might have some AD properties...although this morning I was afraid it was making me crash. Maybe I'm just cycling. Hmmm. At least I don't feel like I'm on PCP with my head in a cocoon!!
>
> MB
>My mood cycling is approximately 20 days. There are people that have cycles in less than 48 hrs (ultra-rapid cyclers). As far as the situational element of it goes-you can figure that out by mood-charting (faithfully). You will see the pattern emerge. I thought a lot of my cycling was situational-but when I got the paper and pencil out and start keeping track-a very persistent pattern emerged. That is an entity that is separate from the seasonal depressions. It still happens-it is just the "baseline" drops considerably.
I definitely experienced an AD+improved attentional effect from the Trileptal. That "crash" is probably the short half-life of the Trileptal (you need to take it two-three times a day to keep a fairly steady level). Go slow on the titration! It sounds like your pdoc has figured out that you are going to be a little med-sensitive-that's a good sign.
good luck,Mitch
Posted by MB on December 30, 2001, at 20:59:36
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 29, 2001, at 8:36:28
> > What about Neurontin + Adderal and just increase your Kolopin dose until the anxiety from the Adderall is tolorable? Or does increasing the Klonopin too high cause other problems? Klonopin can make you depressed, can't it?
>
>
> You bring up something that I had thought about since that experiment. I was just taking Neurontin+Adderall (nothing for panic). It seems that everytime I try to get off a serotonergic med I start getting very, very, anxious. And that anxiety keeps me so preoccupied (OCD-like), I become somewhat socially chilly and unspontaneous. Then, that sets the stage for panic to creep back in. Everything else is just fine however. I slept excellent-not too much or little, no interrupted sleep. I was focused all day long and not drowsy, yawning, forgetting where I was at work, etc. Everything was just a bunch of little tasks to complete, one at a time-no procrastinating. Time even had this very discrete "unitized" feel about it-I did't have any *big* ideas really, just a lot of smaller task-oriented ideas-no hypomania or grandiosity. I didn't experience *any* mood cycling at all. Ordinary everyday events didn't seem *boring* any more-it was just stuff to do. That's when my pdoc was convinced I had ADHD (but still believed I was also atypical bipolar). The problem is I need some form of serotonergic med for my anxiety probs., but antidepressants trigger cycling. I wonder if Neurontin+pstim+Klonopin (mildly serotonergic) or Neurontin+pstim+Lithium would do the trick??
Yeah, Maybe the benzo/AE/pstim (Klonopin/Neurontin/Adderall) would work to fix cylcing, anxiety and attention problems...but you did mention that your anxiety was "OCD-like" for which an SSRI might do better than Klonopin (but, like you said, you risk cycling with the SSRI). Neurontin/pstim/Li? Does the lithium have an anti-anxiety effect for you? Would the weight gain issue with litium worry you?
> My mood cycling is approximately 20 days. There are people that have cycles in less than 48 hrs (ultra-rapid cyclers). As far as the situational element of it goes-you can figure that out by mood-charting (faithfully). You will see the pattern emerge. I thought a lot of my cycling was situational-but when I got the paper and pencil out and start keeping track-a very persistent pattern emerged. That is an entity that is separate from the seasonal depressions. It still happens-it is just the "baseline" drops considerably.
Journaling or charting is hard for me. First of all, focussing is hard, and then, when I *do* focus, I obsess over the perfection of the chart...as if a mistake is going to be the end of the world. For now, my poor friends can be my journal. I babble at manic length about where my mind is and what meds I'm on...then I ask them later what I said. Very inaccurate, but if they make a mistake I can get mad at them instead of myself < g > heh heh heh...
> I definitely experienced an AD+improved attentional effect from the Trileptal. That "crash" is probably the short half-life of the Trileptal (you need to take it two-three times a day to keep a fairly steady level). Go slow on the titration! It sounds like your pdoc has figured out that you are going to be a little med-sensitive-that's a good sign.
> good luck,
>
> Mitch
Yeah, I though Trileptal was screwing with my concentration, but it was the caffeine withdrawal. I ran into a stressful social situation (resulting in a 4 hr drive) so I slipped off of the coffee wagon . The concentration returned (but so did the anxiety). I start my caffeine detox again tomorrow so I can enjoy the leveling effects of trileptal without the caffeine anxiety. On the trileptal, my chronic negativity and cynicism are gone (only at 150 mg), but there is still a painful dysphoria. I guess the AD and pstim will help with that. Amphetamine still seems scary to me. Did you find Adderall addictive at therapeutic doses? I was addicted to crank as a kid. I told my doctor that (that I was scared) and he said that at therapeutic doses I wouldn't be getting "high" and would have no desire to abuse it. Do you think that is true?MB
Posted by leonard60 on December 30, 2001, at 21:43:39
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by MB on December 30, 2001, at 20:59:36
is GABITRIL any thing like gabapentin
Posted by Mitch on December 30, 2001, at 22:11:15
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » Mitch, posted by MB on December 30, 2001, at 20:59:36
> Yeah, Maybe the benzo/AE/pstim (Klonopin/Neurontin/Adderall) would work to fix cylcing, anxiety and attention problems...but you did mention that your anxiety was "OCD-like" for which an SSRI might do better than Klonopin (but, like you said, you risk cycling with the SSRI). Neurontin/pstim/Li? Does the lithium have an anti-anxiety effect for you? Would the weight gain issue with litium worry you?
Yes, the Lithium does have something of an anxiolytic effect. I was on lithium monotherapy for many years. It is just during the seasonal depressions I would get so tired... and the lithium didn't address that very well. Not that I ever wasn't at "high-enough" doses. I was up to 1500mg/day for a few months (about 1.2 blood level-wise). I never found more than 600mg/day to be of any additional benefit. I never experienced any major weight gain from Lithium. Depakote was a different story, though (but that was still about 15-20lbs. at most).
As far as the "OCD-like" quality to anxiety-I really think it would be more accurate to say it was GAD-like "ruminations". The "OCD-likeness" of it had mostly to do with the repetitive (and "stuck") aspect of it. I don't *do* rituals (checking-counting, etc.)-I would obsessively worry about situations-what I said-what was said in return-what I plan to say later-like a negative rehearsal of sorts-a waste of time that just makes you feel crappy. Also, a lot of "catastrophic thinking" which is typical of people with GAD. But, I don't feel uncomfortable looking at it as related to OCD-because I think it is.
> Journaling or charting is hard for me. First of all, focussing is hard, and then, when I *do* focus, I obsess over the perfection of the chart...as if a mistake is going to be the end of the world. For now, my poor friends can be my journal. I babble at manic length about where my mind is and what meds I'm on...then I ask them later what I said. Very inaccurate, but if they make a mistake I can get mad at them instead of myself < g > heh heh heh...Yep, you have got that "stuck switch" situation that SSri's help. It is interesting that people with ADD hyper-focus and get "stuck" like folks with OCD (getting fussy and perfectionistic). Also social anxiety is related to perfectionism, too (evaluation anxiety). I am starting to see this type of symptom complex emerge the more I read and post here-this blend of bipolar, SP, ADHD, OCD/GAD. I am just hypothesizing here, but I think (my opinion!), this is all an information processing problem that involves major structures in the brain simultaneously underfunctioning and overfunctioning. I think at bottom it results in some form of an "attentional syndrome" that can manifest as over-focusing (GAD/OCD/SP), and also a lack of focus (BP, ADHD). The negative emotional "fallout" is a result of screwed-up information sharing between different functional and structural parts of the brain.
> Yeah, I though Trileptal was screwing with my concentration, but it was the caffeine withdrawal. I ran into a stressful social situation (resulting in a 4 hr drive) so I slipped off of the coffee wagon . The concentration returned (but so did the anxiety). I start my caffeine detox again tomorrow so I can enjoy the leveling effects of trileptal without the caffeine anxiety. On the trileptal, my chronic negativity and cynicism are gone (only at 150 mg), but there is still a painful dysphoria. I guess the AD and pstim will help with that. Amphetamine still seems scary to me. Did you find Adderall addictive at therapeutic doses? I was addicted to crank as a kid. I told my doctor that (that I was scared) and he said that at therapeutic doses I wouldn't be getting "high" and would have no desire to abuse it. Do you think that is true?
>
> MB
Well, I was only on Adderall for a couple of months. It was very effective-and at only 5mg/day. I never wanted to take more of it. I got a little euphoric the first day or two on it-then I was just alert and slept ok. As far as abuse goes-all you can do is try it and see. If you find that you are focused and alert and still want to take *more* to get a buzz-then that would probably be a danger sign. I never liked "speed" that much. If I was going to get "addicted" to something, opiates would be the most likely thing for me (I "liked" pain killers after surgery-etc. probably a little *too* much).Mitch
Posted by Mitch on December 31, 2001, at 10:33:01
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug?????, posted by leonard60 on December 30, 2001, at 21:43:39
> is GABITRIL any thing like gabapentin
In short no. Gabitril helps prevent GABA from being scavenged (blocks reuptake). Levels of GABA then build up and since it is an inhibitory neurotransmitter, this can help "stabilize" neuronal firing and help control seizures.
Gabapentin's molecule "looks like" the inhibitory neurotransmitter GABA, but its mechanism doesn't appear to be "GABA-ergic". Evidently, there are specific sites in the hippocampus where it acts as a selective calcium-ion channel blocker which also "stabilizes" neuronal firing but in a more selective region of the brain.
Posted by MB on January 1, 2002, at 15:22:34
In reply to Re: GABITRIL (tiagabine) new anti-anxiety drug????? » MB, posted by Mitch on December 30, 2001, at 22:11:15
> > Yeah, Maybe the benzo/AE/pstim (Klonopin/Neurontin/Adderall) would work to fix cylcing, anxiety and attention problems...but you did mention that your anxiety was "OCD-like" for which an SSRI might do better than Klonopin (but, like you said, you risk cycling with the SSRI). Neurontin/pstim/Li? Does the lithium have an anti-anxiety effect for you? Would the weight gain issue with litium worry you?
>
> Yes, the Lithium does have something of an anxiolytic effect. I was on lithium monotherapy for many years. It is just during the seasonal depressions I would get so tired... and the lithium didn't address that very well. Not that I ever wasn't at "high-enough" doses. I was up to 1500mg/day for a few months (about 1.2 blood level-wise). I never found more than 600mg/day to be of any additional benefit. I never experienced any major weight gain from Lithium. Depakote was a different story, though (but that was still about 15-20lbs. at most).
I'm pretty obsessive about not gaining weight. 20 lbs would freak me out. When you gained weight on the Depakote, was it because the Depakote made you hungrier? I gained 20 lbs on Paxil, but I was exercising and eating the same amount of food. That freaked me out (I wasn't over eating and I still got fat).
> As far as the "OCD-like" quality to anxiety-I really think it would be more accurate to say it was GAD-like "ruminations". The "OCD-likeness" of it had mostly to do with the repetitive (and "stuck") aspect of it. I don't *do* rituals (checking-counting, etc.)-I would obsessively worry about situations-what I said-what was said in return-what I plan to say later-like a negative rehearsal of sorts-a waste of time that just makes you feel crappy. Also, a lot of "catastrophic thinking" which is typical of people with GAD. But, I don't feel uncomfortable looking at it as related to OCD-because I think it is.
What you described is EXACTLY the kind of ruminating I go through. I *do* have a few weird rituals, though. For example, after I flush the toilet, I can't be standing on tile (I have to be standing on carpet) when the toilet is finished filling back up. This is a modification of one I've had since third grade: I had to be in bed and under the covers before the bathtub was done draining or it meant I'd have to sell my soul to Satan. Now where in the hell did a third grader come up with *that* one? Pretty bizzare. As I've gotten older, the rituals have gotten fewer, but the ruminating (e.g., having fight in my head with people that I plan to see later that day, etc.) hasn't changed and it reminds me exactly of what you described above.
> > Journaling or charting is hard for me. First of all, focussing is hard, and then, when I *do* focus, I obsess over the perfection of the chart...as if a mistake is going to be the end of the world. For now, my poor friends can be my journal. I babble at manic length about where my mind is and what meds I'm on...then I ask them later what I said. Very inaccurate, but if they make a mistake I can get mad at them instead of myself < g > heh heh heh...
>
> Yep, you have got that "stuck switch" situation that SSri's help. It is interesting that people with ADD hyper-focus and get "stuck" like folks with OCD (getting fussy and perfectionistic). Also social anxiety is related to perfectionism, too (evaluation anxiety). I am starting to see this type of symptom complex emerge the more I read and post here-this blend of bipolar, SP, ADHD, OCD/GAD. I am just hypothesizing here, but I think (my opinion!), this is all an information processing problem that involves major structures in the brain simultaneously underfunctioning and overfunctioning. I think at bottom it results in some form of an "attentional syndrome" that can manifest as over-focusing (GAD/OCD/SP), and also a lack of focus (BP, ADHD). The negative emotional "fallout" is a result of screwed-up information sharing between different functional and structural parts of the brain.
>
> > Yeah, I though Trileptal was screwing with my concentration, but it was the caffeine withdrawal. I ran into a stressful social situation (resulting in a 4 hr drive) so I slipped off of the coffee wagon . The concentration returned (but so did the anxiety). I start my caffeine detox again tomorrow so I can enjoy the leveling effects of trileptal without the caffeine anxiety. On the trileptal, my chronic negativity and cynicism are gone (only at 150 mg), but there is still a painful dysphoria. I guess the AD and pstim will help with that. Amphetamine still seems scary to me. Did you find Adderall addictive at therapeutic doses? I was addicted to crank as a kid. I told my doctor that (that I was scared) and he said that at therapeutic doses I wouldn't be getting "high" and would have no desire to abuse it. Do you think that is true?
> >
> > MB
>
>
> Well, I was only on Adderall for a couple of months. It was very effective-and at only 5mg/day. I never wanted to take more of it. I got a little euphoric the first day or two on it-then I was just alert and slept ok. As far as abuse goes-all you can do is try it and see. If you find that you are focused and alert and still want to take *more* to get a buzz-then that would probably be a danger sign. I never liked "speed" that much. If I was going to get "addicted" to something, opiates would be the most likely thing for me (I "liked" pain killers after surgery-etc. probably a little *too* much).
>
> Mitch
Yeah, I figure the first few days I'll give the Adderall to a friend and have them give me my doses so if I *do* get a craving to use more I won't me able to. This is what I have to do with Vicodin when I get hurt. Last time I was in charge of my own Vicodin I went through 20 in a 24 hr period. I wonder how addictive personality fits into this strange spectrum of mood/attention/obsession problems. The more I hang out here, the more it seems these things are not discrete disorders, but inextricably related in some fashion.MB
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