![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Ame Sans Vie on April 15, 2003, at 16:11:33
I started all three of these meds just within the past two weeks and now take 20mg Flexeril three times a day, 20mg Lexapro, and 150mg Elavil before bed. I also take 15mg Tranxene twice a day, 350mg Soma four times a day, 20mg Inderal as-needed and 100mg Ultram as-needed. This is all to combat social anxiety/agoraphobia, dysthymia, panic disorder, and fibromyalgia/chronic fatigue syndrome. I'm 20 years old, yet I sort of feel like a little old lady sorting out my vast array of pills for the next day before going to bed. Oh well.
I'm just a bit concerned the Elavil, Lexapro, and Flexeril (which is essentially a tricyclic, with muscle-relaxant properties) may have a little (or a lot) too much effect on serotonin. I haven't been on any of these long enough to really tell if there are any adverse effects (except the painfully obvious dry mouth with the Flexeril), but should I be concerned about having all this serotonergic action going on in my head?
Also, is it common to be on this many meds for FMS/CFS? It sure seems like there's a lot of overlap in the symptoms the meds are supposed to treat... TIA
Posted by Dragonslayer on April 15, 2003, at 16:34:31
In reply to Elavil, Lexapro, and Flexeril--serotonin overload?, posted by Ame Sans Vie on April 15, 2003, at 16:11:33
Probably only time will tell. I assume the same doc prescribed or knows of the number and types of stuff you're on. The amature and pro psychopharms on this site will be able to give you more, I'm sure. Rough combo of things you're dealing with. CFIDS/FM folks can be on alot of stuff because the array of symptons are varied and you are just treating the symptoms. Have you ever done research on quifenisin
(? spelling)? some say it's quack, others say it works.
Has what you are doing seemed to help so far? Or too early to tell? True seritonin syndrone is a pretty serious deal. Be careful with yourself.
Posted by Snoozy on April 15, 2003, at 16:45:51
In reply to Elavil, Lexapro, and Flexeril--serotonin overload?, posted by Ame Sans Vie on April 15, 2003, at 16:11:33
For the chronic fatigue, have you had a tilt table test?
> I started all three of these meds just within the past two weeks and now take 20mg Flexeril three times a day, 20mg Lexapro, and 150mg Elavil before bed. I also take 15mg Tranxene twice a day, 350mg Soma four times a day, 20mg Inderal as-needed and 100mg Ultram as-needed. This is all to combat social anxiety/agoraphobia, dysthymia, panic disorder, and fibromyalgia/chronic fatigue syndrome. I'm 20 years old, yet I sort of feel like a little old lady sorting out my vast array of pills for the next day before going to bed. Oh well.
>
> I'm just a bit concerned the Elavil, Lexapro, and Flexeril (which is essentially a tricyclic, with muscle-relaxant properties) may have a little (or a lot) too much effect on serotonin. I haven't been on any of these long enough to really tell if there are any adverse effects (except the painfully obvious dry mouth with the Flexeril), but should I be concerned about having all this serotonergic action going on in my head?
>
> Also, is it common to be on this many meds for FMS/CFS? It sure seems like there's a lot of overlap in the symptoms the meds are supposed to treat... TIA
Posted by Ame Sans Vie on April 15, 2003, at 17:54:50
In reply to Re: Elavil, Lexapro, and Flexeril--serotonin overload?, posted by Dragonslayer on April 15, 2003, at 16:34:31
Thanks for the reply... and yes, my psychiatrist is fully aware of the meds my rheumatologist has me on and vice versa. Guaifenesin is on the list of things to try for the FMS/CFS but my doctor is saving it "just in case" as right now the pain is under control with Ultram and Soma, and I seem to be sleeping better since starting the Elavil. I'm not concerned about the Tranxene at this point as far as the dangers of continuing to take it, as I'm a veteran benzo-user. I am still hoping the Lexapro will do its thing in the upcoming weeks. So what you say is true, only time will tell.
Posted by Ame Sans Vie on April 15, 2003, at 17:58:05
In reply to Re: Elavil, Lexapro, and Flexeril--serotonin overload?, posted by Snoozy on April 15, 2003, at 16:45:51
Posted by Snoozy on April 15, 2003, at 18:41:15
In reply to Sorry, new to CFS... what's a tilt table test? (nm) » Snoozy, posted by Ame Sans Vie on April 15, 2003, at 17:58:05
A tilt table test tests for neurally mediated hypotension. If you've ever found yourself standing in line, and after a few minutes felt like you would pass out, that's a symptom of nmh. Or if you get faint in a hot room. What happens when you have nmh, to simplify, is if you are in an upright position and not moving, your blood pools in your legs and doesn't circulate the way it should and your blood pressure drops.
I actually got this article from a local CFIDS group some years ago. I'll quote a bit of it:
"Results of a new Johns Hopkins study show that chronic fatigue syndome is strongly linked to a common and potentially treatable abnormality of blood pressure regulation...In the Hopkins study, 22 of 23 patients with CFS tested positive for neurally mediated hypotension. After treatment, nine patients reported full recovery from fatigue and seven others noted some improvement."What happens during a tilt table test is: you are strapped to a table which is tilted until you are almost fully upright and stay there for a while. Your blood pressure and heart rate are monitored. If you have the condition, your bp will drop. If not, it's totally painless. (It's not painful if you have it, just uncomfortable).
There are several treatments for nmh, some of them non-drug.
Looking through the article, I also note that it says many chronic fatigue patients take tricyclic antidepressants, which can exacerbate the glitch in the nervous system that causes drop in blood pressure.
I don't want to go on too long here, but if this sounds familiar, I'd be happy to provide some more information.
I see you mentioned guaifenesin - I was talking to someone recently who had a very positive experience with it. I'll have to ask about it.
Posted by Snoozy on April 15, 2003, at 19:15:08
In reply to Re: Sorry, new to CFS... what's a tilt table test?, posted by Snoozy on April 15, 2003, at 18:41:15
> A tilt table test tests for neurally mediated hypotension. If you've ever found yourself standing in line, and after a few minutes felt like you would pass out, that's a symptom of nmh. Or if you get faint in a hot room. What happens when you have nmh, to simplify, is if you are in an upright position and not moving, your blood pools in your legs and doesn't circulate the way it should and your blood pressure drops.
>
> I actually got this article from a local CFIDS group some years ago. I'll quote a bit of it:
> "Results of a new Johns Hopkins study show that chronic fatigue syndome is strongly linked to a common and potentially treatable abnormality of blood pressure regulation...In the Hopkins study, 22 of 23 patients with CFS tested positive for neurally mediated hypotension. After treatment, nine patients reported full recovery from fatigue and seven others noted some improvement."
>
> What happens during a tilt table test is: you are strapped to a table which is tilted until you are almost fully upright and stay there for a while. Your blood pressure and heart rate are monitored. If you have the condition, your bp will drop. If not, it's totally painless. (It's not painful if you have it, just uncomfortable).
>
> There are several treatments for nmh, some of them non-drug.
>
> Looking through the article, I also note that it says many chronic fatigue patients take tricyclic antidepressants, which can exacerbate the glitch in the nervous system that causes drop in blood pressure.
>
> I don't want to go on too long here, but if this sounds familiar, I'd be happy to provide some more information.
>
> I see you mentioned guaifenesin - I was talking to someone recently who had a very positive experience with it. I'll have to ask about it.Here are a few sites that provide good basic information on nmh, one of them from a fibromyalgia perspective:
http://home.vicnet.net.au/~mecfs/general/nmh1.html
http://www.nfra.net/LowBlood.htm
Posted by Ame Sans Vie on April 15, 2003, at 20:06:49
In reply to Re: Sorry, new to CFS... what's a tilt table test?, posted by Snoozy on April 15, 2003, at 19:15:08
Thanks for clarifying, and for the links. They were very informative-- in fact, I believe my mother has this problem, though I don't think she's ever been officially tested and/or diagnosed for it. She also has FMS/CFS and panic disorder. In fact pretty much my whole family is comprised of nut-jobs and psychopaths, but I digress. :-)
As for myself, I don't experience hypotension triggered by the things described in those sites, but I have always had trouble with orthostatic hypotension (<insert sarcastic tone here> which made my Nardil trial extra fun). Do you happen to know if that could be related?
Posted by Snoozy on April 15, 2003, at 21:05:26
In reply to Re: Sorry, new to CFS... what's a tilt table test? » Snoozy, posted by Ame Sans Vie on April 15, 2003, at 20:06:49
Nmh does have a hereditary tendency I believe. I think it's something that just isn't tested for. I never had any idea there was something wrong with me - I thought I was just so out of shape that rapid eye movement was an aerobic activity! You can do what my doctor called a poor man's tilt table test. Just stand and stay completely still for 20 or 30 minutes. (I know that sounds like a joke, but if you have nmh you'll probably start unconsciously fidgeting - the fidgeting gets the blood moving).
Orthostatic hypotension - ahh, it's like having your own amusement ride! It sounds like you have had problems with it before, unrelated to medication? I have a tendency toward it, and when I was on tricyclics, I would stand up and my field of vision would go completely dark. I don't know what causes it, but it could be somewhat related to nmh. If the orthostatic is caused by a miscommunication with the blood/nervous system maybe. I'll see if I can find anything on this.
I talked to my friend about her experience with guaifenesin. About a year ago, she was taking some for a cold. After a few days, she noticed her chronic pain due to inflammation was much better. When her pain gets bad again, she takes guaifenesin. It sounds like an interesting drug - I guess there are lots of wild claims on the internet for it. Her doctor said it does appear to be effective for various things other than colds. Just an anecdotal report.
May I ask if you've tried many things for the chronic fatigue? I know it sucks to be so young and feel so awful.
> Thanks for clarifying, and for the links. They were very informative-- in fact, I believe my mother has this problem, though I don't think she's ever been officially tested and/or diagnosed for it. She also has FMS/CFS and panic disorder. In fact pretty much my whole family is comprised of nut-jobs and psychopaths, but I digress. :-)
>
> As for myself, I don't experience hypotension triggered by the things described in those sites, but I have always had trouble with orthostatic hypotension (<insert sarcastic tone here> which made my Nardil trial extra fun). Do you happen to know if that could be related?
Posted by Ame Sans Vie on April 16, 2003, at 10:04:56
In reply to Re: Sorry, new to CFS... what's a tilt table test?, posted by Snoozy on April 15, 2003, at 21:05:26
> Orthostatic hypotension - ahh, it's like having your own amusement ride! It sounds like you have had problems with it before, unrelated to medication?
Yep, as long as I can remember.
> I have a tendency toward it, and when I was on tricyclics, I would stand up and my field of vision would go completely dark.
Same here, but my field of vision goes black even without medication exacerbating the problem. I referred to Nardil in my last post which, among other things, is known for the orthostatic hypotension it tends to cause. I don't really have much experience with tricyclics, but now I'm on Elavil and Flexeril... yikes.
> I don't know what causes it, but it could be somewhat related to nmh. If the orthostatic is caused by a miscommunication with the blood/nervous system maybe. I'll see if I can find anything on this.
I'd always been told it was caused by just having low blood pressure in general... I'd be interested to hear if that's really the case though.
> I talked to my friend about her experience with guaifenesin. About a year ago, she was taking some for a cold. After a few days, she noticed her chronic pain due to inflammation was much better. When her pain gets bad again, she takes guaifenesin. It sounds like an interesting drug - I guess there are lots of wild claims on the internet for it. Her doctor said it does appear to be effective for various things other than colds. Just an anecdotal report.
I called my rheumatologist and she's calling in a prescription for extended-release guaifenesin for me to start taking. She said according to her information it has no known interactions and only three or four common potential side effects, so at least I shouldn't have those things to worry about. I couldn't help but notice that guaifenesin is closely related to hydromorphone (Dilaudid)... could this have anything to do with its efficacy in FMS/CFS?
> May I ask if you've tried many things for the chronic fatigue? I know it sucks to be so young and feel so awful.
Well I've just been diagnosed very recently (about two weeks ago), but I've had the symptoms for quite some time. And through all that I've been trying various psych meds, and subsequentially was able to cross them off the list of things to try (i.e. Neurontin). And in the past I've tried several muscle relaxants (Robaxin, Skelaxin) and know that they don't do a thing for me.
Posted by Snoozy on April 17, 2003, at 18:32:28
In reply to Re: Sorry, new to CFS... what's a tilt table test? » Snoozy, posted by Ame Sans Vie on April 16, 2003, at 10:04:56
From what I've read, orthostatic hypotension can be caused by a number of things (I wish I had paid more attention in biology!), but a lot of the treatments for it are the same ones used to treat nmh: eat more salt, elevate the head of your bed, support stockings, Florinef, Midodrine.
I hope you find the guaifenesin helps you. My friend that took it is extremly hypersensitive to drugs and she didn't have any side effects.
A couple of years ago, I saw a doctor who was the top chronic fatigue person in the area. (She must be good - she's moved on to California.) She suggested for me to take Flaxseed oil and Evening Primrose, 1 tablet (of each) twice a day. I did take them for 2 or 3 weeks, at that point I wasn't really noticing any benefit, and so I started trying other drugs. I don't think I gave the supplements long enough to work. You might want to ask around and see if anyone has tried it.
I know it's really hard to go through this process of trying all kinds of drugs, and trying to figure out if any of them are making you better or worse. Sometimes I'll find a drug might help me with one thing, but make another thing worse. Just hang in there! It helps to know that you're not the only one dealing with this.
I'd love to hear if the guaifenesin helps you at all. I truly hope you will find something that will make your life better.
> > Orthostatic hypotension - ahh, it's like having your own amusement ride! It sounds like you have had problems with it before, unrelated to medication?
>
> Yep, as long as I can remember.
>
> > I have a tendency toward it, and when I was on tricyclics, I would stand up and my field of vision would go completely dark.
>
> Same here, but my field of vision goes black even without medication exacerbating the problem. I referred to Nardil in my last post which, among other things, is known for the orthostatic hypotension it tends to cause. I don't really have much experience with tricyclics, but now I'm on Elavil and Flexeril... yikes.
>
> > I don't know what causes it, but it could be somewhat related to nmh. If the orthostatic is caused by a miscommunication with the blood/nervous system maybe. I'll see if I can find anything on this.
>
> I'd always been told it was caused by just having low blood pressure in general... I'd be interested to hear if that's really the case though.
>
> > I talked to my friend about her experience with guaifenesin. About a year ago, she was taking some for a cold. After a few days, she noticed her chronic pain due to inflammation was much better. When her pain gets bad again, she takes guaifenesin. It sounds like an interesting drug - I guess there are lots of wild claims on the internet for it. Her doctor said it does appear to be effective for various things other than colds. Just an anecdotal report.
>
> I called my rheumatologist and she's calling in a prescription for extended-release guaifenesin for me to start taking. She said according to her information it has no known interactions and only three or four common potential side effects, so at least I shouldn't have those things to worry about. I couldn't help but notice that guaifenesin is closely related to hydromorphone (Dilaudid)... could this have anything to do with its efficacy in FMS/CFS?
>
> > May I ask if you've tried many things for the chronic fatigue? I know it sucks to be so young and feel so awful.
>
> Well I've just been diagnosed very recently (about two weeks ago), but I've had the symptoms for quite some time. And through all that I've been trying various psych meds, and subsequentially was able to cross them off the list of things to try (i.e. Neurontin). And in the past I've tried several muscle relaxants (Robaxin, Skelaxin) and know that they don't do a thing for me.
>
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.