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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by BrittPark on September 12, 2002, at 21:17:16
My diagnosis since I was in my early 20s is Major Depressive Disorder Recurrent (Melancholic type). For years I've had an average of 1 major episode a year, usually of short duration (2-6 weeks), and have been taking imipramine more or less continuously and xanax and or klonopin for associated anxiety when needed. Usually my episodes were triggered by events in my life. (Girl friend breaking up with me. Physical illnesses. Separation from my wife for short periods. Anything that triggers separation anxiety has been able to start me on a severe but short-lived depressive episode.)
In the last two years, however, I've had several depressive episodes with no obvious external trigger, and in the last 6-9 months I've been experiencing on and off depressive episodes which are less severe and less melancholic but disturbing because different from what I'm used to and because they keep breaking through the measures my psychiatrist and I have implemented. Currently I'm in another break through episode, whose character is marked by quite marked agoraphobia.
I find myself taking a veritable Merck index of drugs:
300mg imipramine
50mg desipramine
(I'm a powerful TCA metabolizer and am smack dab in the middle of the therapeutic range)
30mg remeron
7.5 mg zyprexa
1mg klonopin
4mg xanax
.5mcg cytomel
30mg ritalin in the day
5mg vicodin in the evening
50mg lamictal (titrating up at 25mg increase every two weeks)You should see my pill box;)
I find the ritalin effective but see-sawish, vicodin very effective (my evenings are usually quite comfortable) and unsure about the rest.
I guess what I'm looking for (besides sympathy--always appreciated) is any suggestions about changing the mix that might improve things.
As further background here are some other drugs I've taken in the past.
Paxil (Not effective and made me jittery).
Risperdal (miraculously effective but faded after 6 months or so)
Modafinal (Spectacularly effective for about 2 1/2 weeks and then nothing.)
Wellbutrin (Not a proper trial. I took one dose in the middle of a severe episode and was made so anxious that I discontinued.)Britt
Posted by sleepy lizard on September 12, 2002, at 22:45:17
In reply to Not doing too well but in a new and different way., posted by BrittPark on September 12, 2002, at 21:17:16
That is a hell of a load of medication. How did you get to be using so many? That vicodin is great, but kinda addicting, huh. My doctor was going to get me onto Remeron. He said the only reason he doesn't prescribe it more is because people complain about weight gain of aprox. 10 lbs. That anxiety is a tough one. I never found anything that would completely eliminate it for me. I'm wondering if your symptoms are getting closer together because some of the medications are not as effective anymore. What do you think? Hope you can get some resolution to the delima.
Posted by McPac on September 13, 2002, at 16:40:46
In reply to Not doing too well but in a new and different way., posted by BrittPark on September 12, 2002, at 21:17:16
BrittPark,
You are on too many different drugs!
It would be impossible to tell exactly which ones are working and which ones aren't (or, are making things worse).
I'm wondering if your 'depression' is bipolar?
Posted by nikioct73 on September 13, 2002, at 18:41:42
In reply to Not doing too well but in a new and different way., posted by BrittPark on September 12, 2002, at 21:17:16
i agree with the other folks....Your on too many med's!!!..are they all prescibed but the same Doc?...I have no idea how you are able to funtion on all these med's ...it could be your new issues are related to major drug interactions and side effects...your liver will thank you kindly to cut down to maybe a single AD..with a single Benzo..and a single Stim for day and a single Som for sleep... if you need all that to begin with...I myself had to finally take a Drug holiday because I was on too many from too many different docs it really sucked getting off all that crap..it took a whole month to feel like myself again..(I'm not too chipper but healthy.)I hope you find what your looking for..good luck..really though..too many med's.....
Niki
Posted by BrittPark on September 13, 2002, at 19:14:33
In reply to Re: Not doing too well but in a new and different way., posted by McPac on September 13, 2002, at 16:40:46
I've never had the slightest symptom of bipolar disorder. My "normal" state is mildly disthymic. I have to agree that I take too many drugs. The difficulty is I'm disinclined to make things worse when I'm in a bad state. My current meds give me a certain amount of shelter so that some of the rain is kept out. I have been trying to dismantle the shelter but four weeks ago having stopped ritalin completely and being down to 2.5 mg xanax, I went into a steep mood decline.
I'm inclined to believe that the remeron and the extra 50mg of desipramine are unneccessary. The ritalin, benzos, and vicodin are ameliorative. If the lamictal starts to work I can go back to getting rid of the superfluous pharmaceuticals. If it doesn't we'll move on to something different. Effexor is one possible next choice. Buprenorphine is another since the vicodin seems to be so effective for me and the buprenorphine is less likely to build tolerance. Does anybody have other suggestions (If the lamictal doesn't pan out)?
Posted by BrittPark on September 13, 2002, at 21:50:06
In reply to Re: Not doing too well but in a new and different way. » BrittPark, posted by nikioct73 on September 13, 2002, at 18:41:42
> i agree with the other folks....Your on too many med's!!!..are they all prescibed but the same Doc?...I have no idea how you are able to funtion on all these med's ...it could be your new issues are related to major drug interactions and side effects...your liver will thank you kindly to cut down to maybe a single AD..with a single Benzo..and a single Stim for day and a single Som for sleep... if you need all that to begin with...I myself had to finally take a Drug holiday because I was on too many from too many different docs it really sucked getting off all that crap..it took a whole month to feel like myself again..(I'm not too chipper but healthy.)I hope you find what your looking for..good luck..really though..too many med's.....
>
> NikiThanks for taking the time to comment. I appreciate your advice but don't see any practical way to follow it. My doctor and I are carefully trying to find the thing that will work. Everything I'm taking had a greater or lesser positive effect at one time. Since I don't suffer from any side effects from what I'm taking, (and blood tests say that my liver is quite well ;) my doctor and I see no reason to take things any other way than slowly. Over the last year we've had partial success after partial success, and are now only trying substitutions. Whenever I've been close to stably just below euthymic we've backed off one medication at a time, slowly.
I've been on complete drug holidays in the past and done fine for some number of months only to be visited by severe depression. I finally learned my lesson about 5 years ago. I'm going to have to be on medication for the rest of my life or until research comes up with a treatment to cure recurrent depression.
This is the end of the thread.
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