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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by cbwarejr on October 28, 2003, at 6:04:25
Wife has been taking meds for 20+years and MAOI Parnate seems to work best for her. Side effect is terrible insomnia though. So her dr prescribed Tamezepam. SHe has been taking nightly for 5 years.
But she also uses to "check out" and talks of wanting to end things, life not worth living etc and having a two month supply of sleeping meds worries me.
Problem is that the Parnate seems to work well for her depression. all others dont .
This summer she stopped taking parnate and the sleeping meds, but the depression kicked back in within three weeks so we have stared new meds.
First Paxil, when wellbutrin, now lexapro. All during this time though she has been taking tamezepam on and off.
I took her tamezepam away, but before bed she used to go in the closet for a bit and then fall asleep in 15 minutes so I knew she had some sleeping meds somewhere. I went on a search and found a bottle of Ambien that was prescribed by her doc on Sept 1. She did not tell me about the meds. Also, she changed Dr.s and did not tell the first doc she changed and that is how she got the sleeping meds.
Her new doc, wanted her off the tamezepam/ambien totally becuase she feels long term usage is bad and causes its own problems.
As far as depresson, it runs in family, her dad 78 is on Remeron, Celexa, and zyprexa.
She also has Avoidant Borderline Personality Disorder and bits of this and that. You know what it is like with someone who is depressed.
What are your thoughts??
Posted by Ame Sans Vie on October 28, 2003, at 6:51:15
In reply to Temazepam Dependent?, posted by cbwarejr on October 28, 2003, at 6:04:25
Hi there,
First of all, don't worry about her committing suicide with the sleeping medications alone. Overdose is nearly impossible with Ambien, Sonata, Imovane, and benzodiazepines. Just watch and make sure she doesn't have *anything* to drink while under their influence.
There really isn't a big problem with taking sleep meds long-term, provided that tolerance doesn't develop. This especially applies to Ambien and Sonata, which often continue working indefinitely without development of tolerance. And on many of these antidepressants (especially Parnate, which has amphetamine-like action) I can totally understand her need for a hypnotic before bed. I would say to just watch her carefully and be there for her.
Also, I'm not sure what the situation is surrounding her discontinuation of Parnate, but I would see about getting her back on that medication, pronto. Just to make sure, has she tried Nardil? It could be just as effective as Parnate (both being MAO-inhibiting antidepressants) and may not keep her up at night. Eldepryl, at doses higher than those used to treat Parkinson's disease (i.e. 15-25mg) could also be very helpful.
Good luck!
Posted by cbwarejr on October 28, 2003, at 11:11:20
In reply to Re: Temazepam Dependent? » cbwarejr, posted by Ame Sans Vie on October 28, 2003, at 6:51:15
She got off the parnate because she was really feeling the effects of "artificial sleep" from the continued use of tamezepam.
SHe is a teacher, and used the summer to get off things for a few weeks to see what it was like.
However, it was only 3 weeks before things got crappy for her again.
SHe has not been totally up front with her MD Psych about how she feels. Fortunately, she does let me go along and put in my viewpoint, which is totally different than hers of course.
Being in the bad state she is, there is at the moment nothing but doom and gloom, life is really bad, nothing will change etc.
She had been seeing the same Doc for years, but as we only got recently married she has been to see him alone. So he only got her side of things based on how she was feeling at the time of the visit. Now, as important, is how I see her doing because my input is helpful to the Doc.
Another problem is with her other "state of mind" in which she said if I ever talked to her family or doctors about her, and I did not tell her, she would "end things". This is a big emotional blackmail trip on me. She really leads two lives, the one she is able to put up at work and in front of friends, and to a degree with the kids. The other is the person who is severly depressed. On one talk with her MD, he said, "man I had no clue as to some of the things that go on because she never told me".
Well of course not. She feels so bad about herself that revealing anything that reflects badly on her makes her even feel worse. SHe does have some type of Personality Disorder, there is no question.
She is brilliant, a good mom, a sharp gal, a stunner to look at, funny, everything I married her for. But she sees nothing of that right now, and the depression of course has deadened her loving, kind, compassionate side.
I at times, normally I think, feel rejected, as though I don't exist and my feelings are irrevelant. It is hard to realize just really where she is at mentally. SHe won't go to couples therapy, because talking to her about the negatives of how I feel when she is depressed adds to that depression. Does this make any sense.
Over the last 6 months, she has also gone from very sexual to a state where now even touching her bothers her. Seperate problem though I guess. It is all so intertwined and complicated.
My gut is that she will go back on nardil or parnate, and that the Doc with our input will also prescribe something else to help, but I have no clue.
Thanks
Posted by Ame Sans Vie on October 28, 2003, at 17:36:15
In reply to Re: Temazepam Dependent?, posted by cbwarejr on October 28, 2003, at 11:11:20
That really is a tough situation... maybe your wife could avoid the MAOIs altogether, until some better drugs are released (i.e. Cymbalta, substance P antagonists, selective mu1 opioid agonists)? Central nervous system stimulants can be absolutely wonderful for depression, especially when it's at its worst. I have a bit of ADD and take DextroStat (dextroamphetamine) at 10mg three times daily, but my doctor prescribes me double that each month because he understands that I find a single 30mg dose to be very helpful during my most severe depressive phases. Dexedrine/DextroStat (d-amphetamine), Adderall (d-amphetamine and racemic amphetamine), Desoxyn (d-methamphetamine), and Ritalin/Concerta/Metadate (methylphenidate) can all be incredibly helpful. Cylert (magnesium pemoline), another stimulant, may also be helpful but it's not a first-line med as it has great potential for causing serious liver problems. Provigil, while much milder in it's stimulant effect, is also an incredible medication, and doctors are less afraid to prescribe it due to its Schedule IV controlled substance status (as opposed to Schedule II like the amphetamines/methylphenidate). And although most opioids are Schedule II, some doctors are willing to prescribe them for treatment refractory patients -- methadone, Subutex/Suboxone (buprenorphine), and Ultram (tramadol) are most commonly used for this purpose, though OxyContin (oxycodone), Dilaudid (hydromorphone), morphine, codeine, and others have been used. It may seem rather drastic, but desperate times -- desperate measures. For what it's worth, I found Ultram to be absolutely wonderful for my mood. It's a non-scheduled opioid that has an effect I describe as a cross between Vicodin and Effexor, and not being a controlled substance makes doctors much more willing to prescribe it.
There are so many other options... has your wife tried dopamine agonists (i.e. Symmetrel [amantadine], Mirapex [pramipexole], Dostinex [cabergoline], Parlodel [bromocriptine], Requip [ropinirole])? Or Sinemet CR (carbidopa/levodopa)? These all increase dopaminergic activity and can have profound effects on mood, motivation, drive, confidence, energy, etc.
And what about Xanax (alprazolam)? It tends to have a terrific antidepressant effect, in most people, and has the added benefit of being tranquilizing and perhaps mood-stabilizing (not sedating though -- that side effect passes within a few weeks of taking it continuously). Now that Xanax XR, a 24-hour version of the drug, has been released it's a lot easier to take the drug. The immediate-release formulation that's been around for over 20 years lasts a good four or five hours at most.
There's also Xyrem (sodium oxybate [GHB -- formerly known as "the date rape drug"]). Though it can be a pain to get a prescription for, it really is a wonder drug. It would eliminate her need for sleeping pills, I guarantee you that. It's taken at night and knocks you out into a *natural*, extremely recuperative sleep; the next day you awaken with a dopamine rush which helps to eradicate negative thoughts and feelings. I'd look into it if I were you -- http://www.xyrem.com
A few last things that pop into my head at the moment are, first of all, a new drug called Emend (aprepitant)... I can't recall its method of action (NK-1 antagonist... agonist?), but it also has been shown useful against depression; secondly, a drug for amyotrophic lateral sclerosis (Lou Gehrig's disease) called Rilutek (riluzole) which is undergoing clinical trials to treat depression right now; lastly, the anticonvulsant Gabitril (tiagabine) has been reported by at least one person on this board to be useful for depression and perhaps anxiety.
Finally, supplementation, proper diet, and some sort of physical activity are a must. I doubt there's a person in this world who cannot be helped via this method. Diet is up to her, of course, but I recommend VERY highly a low-carbohydrate or low-glycemic-index diet. As for supplements, I have to suggest several things from personal experience as well as the experiences of many, many others (I used to counsel people on this and acted as sort of a naturopathic doctor at a health store -- I treated many people with mental difficulties). First and foremost, fish oil, fish oil, fish oil. Buy it only from a reputable source that keeps it refrigerated, and try to find capsules/gelcaps that contain at least 360mg EPA/240mg DHA per 1,000mg of oil. She should be very liberal taking these -- just go to the Alternative treatments board on this site -- so many people are swearing by fish oil, and I'm one of them. Next, DL-phenylalanine (DLPA) is a terrific supplement. It is a combination of the D- and L- forms of the amino acid phenylalanine. The L- form primary becomes a part of the brain's catecholamine system -- that is, it becomes alpha-phenethylamine, dopamine, norepinephrine, and epinephrine in the body. Wonderful for anergia and depression. The D- form is just as great -- it inhibits a certain enzyme which breaks down your body's "natural morphine", endorphins/enkephalins. Thus, levels of these natural mood-elevators/pain-relievers are raised and a great decrease in depression and feelings of physical and emotional comfort may ensue. It, like the L- isomer, also partly "degrades" into alpha-phenethylamine, a chemical made famous as "the chocolate amphetamine". It's found in chocolate (duh, lol) which probably accounts a great deal for the purported aphrodisiac and comforting effects of the food, and is also quite prominent in the brains of those who are in love/falling in love. Amphetamine itself, by the way, is just a hop, skip and a jump away from this substance -- it's beta-phenethylamine (which means, chemically, it differs only by the position of one group of atoms on the molecule; it's attached to the third carbon in the chain rather than the second). Beyond this, I always recommend a good B-complex vitamin (preferably in sublingual liquid form, as it is much more efficiently absorbed), a whole-food multinutrient and herbal supplement (for the millionth time on this board, I must endorse "Super Earth Formula", manufactured by Bluebonnet, which is absolutely wonderful -- http://www.bluebonnetnutrition.com/multivit_minerals/superearth.html), at least 1,200 I.U. vitamin E, and powdered vitamin C. NADH, kava kava, ashwagandha, eleuthero root (a.k.a. Siberian ginseng), and reishi fungus are also among the more helpful supplements. Finally, there are 5-HTP (5-hydroxytryptophan) and L-tryptophan (both precursors to serotonin), St. John's wort, and SAM-e, though these should be taken only after consulting with a doctor as they have potential to react with her other meds. As an aside, L-tryptophan (and possibly 5-HTP) could also eliminate her need for sleeping medication (as can many herbs... Valerian Poppy Supreme, by GAIA Herbs, is wonderful -- I don't respond to trazodone, Remeron, Elavil, Halcion, Dalmane, Restoril, ProSom, Doral, Sonata, Ambien, chloral hydrate, secobarbital, phenobarbital, amobarbital, or pentobarbital -- but this stuff works!!) Believe me, the natural route may just surprise you if you can get her to give it a chance. And I'm always here if you decide to go this route and have any questions -- just post them on the Alternative board.
Michael
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