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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Jeffrey on February 4, 2004, at 14:08:56
Dear psycho-babblers,
I have posted a few times over the last 8 months about my anxiety problems. I will repeat and update those postings.
I have a history of reacting to very, very low risk sexual experiences with an obsessive fear that I caught HIV. I could not relax, felt on edge and had panic attacks and a racing nervous mind. I responded well to zoloft and effexor (2 episodes), and clozazpam and xanax as needed while I waited for my test results to come back after 3-6 months. When they came back negative, I stayed on the meds for 6 months and then was in full and complete remission from anxiety and the depression that resulted from the anxiety.
Upon finding out my wife was pregnant with our first child, we remembered she had an x-ray early in her pregnancy in her pelvic area, before she knew she was pregnant. I became consumed with fear that the baby would get cancer, either as a child or later as an adult. After doing lots of research and talking to Doctors, I determined her risk to be very small. Depending on the source, somewhere between 30%-80% more likely than a mother who did not have an x-ray or possibly no risk at all or not statistically significant. In any event, the studies are not conclusive and their methodology is questionable. However, there is some certainty that there is a low risk of the baby getting cancer from the x-ray recevied during pregnancy. This risk is considered lower than spontaneous cancer.
Anyway, I began effexor again. I had a partial response. I worked my way up to 300 mg xr with no further benefit than I recived on 150mg. So I reduced my dose to 150 mg. I added Celexa gradually working up to 60mg a day while, continuing the 150 mg effexor. During this time I noticed marked improvement in my physical symtoms. On this med mix, I am not devestated by the posssibility of my unborn kid getting cancer, or the much more realistic scenario that I will never "get over this" and be able to enjoy my first child. I have these thoughts many times every day. I have not enjoyed this preganancy and feel the rest of my life will be spent worrying.
On my current medical mix, 150 mg effexor XR, 60 mg Celexa and clonazepam about .5 mg a day as needed, I can function normally but still cannot enjoy things very much and remain anxious. I tried augmenting the Effexor with Remeron before I started the Celexa and that was a disaster. I felt like a zombie and very uneasy.
Please advise on what I might try next. I would really appreciate any suggestions that anyone has. Please provide me some hope if you have an idea. I dont wan to suffer anymore. Best wishes and good health to everyone. Thanks.
Posted by Eddie Sylvano on February 4, 2004, at 15:45:53
In reply to Please help me I am still suffering - My story, posted by Jeffrey on February 4, 2004, at 14:08:56
> I have a history of reacting to very, very low risk sexual experiences with an obsessive fear that I caught HIV.
>I became consumed with fear that the baby would get cancer, either as a child or later as an adult.
--------------Someone else recently posted with OCD symptoms. Not to say you have OCD, but it might be worth looking into, particularly if you have a history of such fears. Chronic, intrusive thoughts are a hallmark of the disorder, along with the rituals one performs to reduce the specific thought anxiety. Given that you responded well to Celexa, and large-dose SSRIs are a first line treatment for such problems, perhaps you could discuss the possibility of either increasing your Celxa, or augmenting with another SSRI (Paxil).
Posted by Jeffrey on February 4, 2004, at 19:41:07
In reply to Re: Please help me I am still suffering - My story » Jeffrey, posted by Eddie Sylvano on February 4, 2004, at 15:45:53
> > I have a history of reacting to very, very low risk sexual experiences with an obsessive fear that I caught HIV.
> >I became consumed with fear that the baby would get cancer, either as a child or later as an adult.
> --------------
>
> Someone else recently posted with OCD symptoms. Not to say you have OCD, but it might be worth looking into, particularly if you have a history of such fears. Chronic, intrusive thoughts are a hallmark of the disorder, along with the rituals one performs to reduce the specific thought anxiety. Given that you responded well to Celexa, and large-dose SSRIs are a first line treatment for such problems, perhaps you could discuss the possibility of either increasing your Celxa, or augmenting with another SSRI (Paxil).Thanks for your reply. I do have some features of OCD. I ruminate on thoughts. However, I have no compulsions.
I have always responded best to SSRIs. I am on 60mg of Celxa which is considered a high dose and I am also on 150 mg of Effexor XR which also acts a lot like an SSRI at this dose. Do you think I should go higher on the Celexa or augment with something else? I dont think I would take what is effectively a third SSRI at the same time.Thanks again for your thoughts. I would appreciate any input from anyone on meds. I feel I am at a dead end.
Posted by HappyGirl on February 4, 2004, at 20:24:17
In reply to Re: Please help me I am still suffering - My story, posted by Jeffrey on February 4, 2004, at 19:41:07
Hi:
One thing I know is that there is no point to add another, a third SSRI, because you have been on two different SSRIs, (believing the higher-dosage Effexor XR has similar efficacy to SSRI).
More than two same form of med. just killing each other, in other word, 'wasting money' on another SSRI.
In my suggestion, try to augument your current ADs with complete different med., ... even it might work good with 'Lithium' that is surely for Bipolar, ... but also uses for 'augumentation' for AD such as yours. However, I didn't read your previous post along with all replies you got, ... then I can not be sure to say. Try to talk to your pdoc. in this regard.
H.G.
Posted by Jeffrey on February 4, 2004, at 20:51:31
In reply to Re: Please help me I am still suffering - My story, posted by HappyGirl on February 4, 2004, at 20:24:17
> Hi:
> One thing I know is that there is no point to add another, a third SSRI, because you have been on two different SSRIs, (believing the higher-dosage Effexor XR has similar efficacy to SSRI).
> More than two same form of med. just killing each other, in other word, 'wasting money' on another SSRI.
> In my suggestion, try to augument your current ADs with complete different med., ... even it might work good with 'Lithium' that is surely for Bipolar, ... but also uses for 'augumentation' for AD such as yours. However, I didn't read your previous post along with all replies you got, ... then I can not be sure to say. Try to talk to your pdoc. in this regard.
> H.G.
Thanks for your reply HG. I hadnt considered lithium to augment. I will ask my pdoc about it. Any other ideas for augmentation? Anyone? I have trouble not thinking about my unborn child getting cancer from the x-ray and more recently I have come to the rational realization that the risk is very small, but I am worried that I wont be able to stop worrying and enjoy my child. I get very nervous still. Otherwise, I am a fully functioning lawyer, who suffers siletly.
Until this episode it had been 2 years of complete remission without any meds except the occational clonazapam. Now I just want to feel good again. Thanks so much for taking time to respond. Any thoughts are appreciated.
Posted by Guy on February 4, 2004, at 21:31:10
In reply to Please help me I am still suffering - My story, posted by Jeffrey on February 4, 2004, at 14:08:56
Zyprexa is the only med that zaps my anxiety and obsessive thoughts. Try 10 mg a day...but keep in mind that it will take you a few day to get over the sedation.
Posted by HappyGirl on February 4, 2004, at 23:03:05
In reply to Re: Please help me I am still suffering - My story, posted by Guy on February 4, 2004, at 21:31:10
Hi Jeffery:
It sounds like you have not only depression also 'Anxiety' as reading your 'excess' worry about unborn child in regard to 'cancer' theory. Your worry is very understandable, but still too much worry is not good to both of you, you and your wife. She needs some rest and peace since things(x-ray) did happen already.
As someone suggested, atypical med., not only Zyprexa also other AP, Seroquel might be a good idea, because your anxiety is NOT too significant. Zyprexa that I've been on due to Bp, but this med. is said to be 'A King of APs,' quite strong AP. On the otherhand, Seroquel is milder AP, for that reason some of M.I. folks taking as for 'sleep well'/insomnia remedy.
BTW, 5mg Zyprexa is plenty for me, ... then 10 mg. Zyprexa sounds to me 'awful a lot,' if you have 'regular form of Anxiety.' But, ... again everyone reacts differently on different medications. Then, you need to talk to your pdoc. at your impending appt.
H.G.
Posted by Jeffrey on February 5, 2004, at 9:27:16
In reply to Re: Please help me I am still suffering - My story, posted by HappyGirl on February 4, 2004, at 23:03:05
Thanks for all your replys. I really appreciate them. My doctor last time mentioned risperdal as a possibility for augmentation. Does this make sense? I felt zombie like on Remeron. I understand that the antipsychotics can also produce this feeling. It ws scary and very unpleasant. Any thoughts? Thanks again.
Posted by nicky847 on February 5, 2004, at 10:06:12
In reply to Please help me I am still suffering - My story, posted by Jeffrey on February 4, 2004, at 14:08:56
Jeffrey-
Have you tried CBT? Cognitive Behavioral Therapy..it could be very helpful for you..
Posted by Jeffrey on February 5, 2004, at 13:22:12
In reply to Re: Please help me I am still suffering - My story, posted by nicky847 on February 5, 2004, at 10:06:12
> Jeffrey-
> Have you tried CBT? Cognitive Behavioral Therapy..it could be very helpful for you..
>
>Thanks for the suggestion. I have begun CBT. I have seen a psychologist 4 times. It has been a little bit helpful. I am glad I am doing it but the results have been mixed. I am continuing with it. My therapist is pretty good. Any particular CBT strategy you have in mind for my problems? I just want to enjoy my child and not worry about it getting cancer from the x-ray. The worry is taking all the pleasure from my life. Thanks again.
Posted by HappyGirl on February 5, 2004, at 13:26:07
In reply to Re: Please help me I am still suffering - My story, posted by Jeffrey on February 5, 2004, at 9:27:16
Hi Jeffery:
Risperdal is a strong AP med., in a way it might be more potent than Zyprexa.
Frankly, I rarely heard/read Risperdal is good for 'augumentation,' rather this med. alone ... 'mono-therapy' for 'Shizophrenia' and/or similar form to classify more severe form of M.I.
In my guess, being a lawyer(that I read somewhere in one of your posts, here), your life is practically much more stressful than any other office workers. Then, your pdoc. seems to get aggressive treatment to fix your problem. Also, even Remeron dosage, I wonder you went 'very slowly' to get therapeutic level. Otherwise, you might have experienced 'terrible side-effects.' Most of psycho.- meds. needed to move 'slowly,' like starting from tiniest dosage to effective dosage your system needs.
In my other suggestion, ... since you have depression along with Anxiety, ask 'Seroquel' as I mentioned in my previous post, ... for 'test.
If this med., Seroquel that is most mild form of AP, either does NOT help or bad reaction from Seroquel, ... then you may have to rule out 'AP is NOT for you,' because all of AP med., Zyprexa, Risperdal, and few newer ones are all same family. In other word, one of AP family does NOT do anything for you, then you need to look for other family, like Serzone. However, there is a lot of 'issues' in regard to Serzone because of 'Liver Issue' among few of Serzone takers, then ONLY your pdoc. knows whether Serzone is good for you. Firstoff, you need 'a strong Liver,' if you have NO confidence on your liver, then Serzone is OUT of list to eliminate from the list.
That's all I know so far.
H.G.
Posted by Jeffrey on February 5, 2004, at 13:27:37
In reply to Re: Please help me I am still suffering - My story, posted by HappyGirl on February 4, 2004, at 23:03:05
Anyone have any thoughts on augmenting with neurontin or other other antiseizure meds? Thank you. I would like to be well informed before I take the next step. I never thought I might be on 3-4 meds at once! Thanks.
Posted by Jeffrey on February 5, 2004, at 13:42:25
In reply to Re: Please help me I am still suffering - My story, posted by HappyGirl on February 5, 2004, at 13:26:07
> Hi Jeffery:
> Risperdal is a strong AP med., in a way it might be more potent than Zyprexa.
> Frankly, I rarely heard/read Risperdal is good for 'augumentation,' rather this med. alone ... 'mono-therapy' for 'Shizophrenia' and/or similar form to classify more severe form of M.I.
> In my guess, being a lawyer(that I read somewhere in one of your posts, here), your life is practically much more stressful than any other office workers. Then, your pdoc. seems to get aggressive treatment to fix your problem. Also, even Remeron dosage, I wonder you went 'very slowly' to get therapeutic level. Otherwise, you might have experienced 'terrible side-effects.' Most of psycho.- meds. needed to move 'slowly,' like starting from tiniest dosage to effective dosage your system needs.
> In my other suggestion, ... since you have depression along with Anxiety, ask 'Seroquel' as I mentioned in my previous post, ... for 'test.
> If this med., Seroquel that is most mild form of AP, either does NOT help or bad reaction from Seroquel, ... then you may have to rule out 'AP is NOT for you,' because all of AP med., Zyprexa, Risperdal, and few newer ones are all same family. In other word, one of AP family does NOT do anything for you, then you need to look for other family, like Serzone. However, there is a lot of 'issues' in regard to Serzone because of 'Liver Issue' among few of Serzone takers, then ONLY your pdoc. knows whether Serzone is good for you. Firstoff, you need 'a strong Liver,' if you have NO confidence on your liver, then Serzone is OUT of list to eliminate from the list.
> That's all I know so far.
> H.G.
Thanks again for taking the time to write. We cant get Serzone in Canada anymore. I will mention to my pdoc that I read that other AP's are less potent than Risperdol and see what he says. So augmenting with an AP makes more sense than neurontin or similar drug type? Thanks again.
Posted by HappyGirl on February 5, 2004, at 13:46:55
In reply to Re: Please help me I am still suffering - My story, posted by Jeffrey on February 5, 2004, at 13:27:37
Hi Jeffery:
Anti-seizure meds., such as Depakote, Tripetal and Lamical is for Bipolar, ... not to use for 'depression' and 'anxiety' purpose. However, one of them, Lamical has a good effect to depression, but this is ONLY if you have Bipolar. Then, any of anti-seizure meds. are out of the list.
In regard to 'Neurontin,' ... in my knowledge this med. is mostly used for 'add-on' or 'pain management,' not this med. alone therapy. Alos, Neurontin is also for Bipolar, not for 'depression,' or 'anxiety.'
I just wonder your pdoc. is faily a reputable pdoc.? The reason is because your symptoms, Depression along with Anxiety is faily serious form, ... from your several posts. Then, your problem needs EXPERT pdoc. to rule things out more accurately and precisely that is a very first step to get appropriate med. combo. However, any serious form of M.I. usually takes quite awhile for any pdoc. to research and find a right med. combo. Then, it may take more time. It's VERY hard, ... very frustrating for anyone to endure this ordeal, ... but I believe that most of folks here echoes the same senerios/story in regard to finding a right med. combo.
H.G.
Posted by nicky847 on February 5, 2004, at 14:47:59
In reply to Re: Please help me I am still suffering - My story, posted by Jeffrey on February 5, 2004, at 13:22:12
Jeffrey-
If I were you I would stick with the CBT and give it time...sometimes it takes as many as 10-12 sessions before you see a noticeable improvement..the most important thing in CBT is to be honest with your therapist about the irrational/obssessive thoughts you have..then they will be more able to help you...it really sounds to me like good CBT would be great for you b/c you need to examine the obssessive fears that you have and see that they have no basis in rational thought..
> > Jeffrey-
> > Have you tried CBT? Cognitive Behavioral Therapy..it could be very helpful for you..
> >
> >
>
> Thanks for the suggestion. I have begun CBT. I have seen a psychologist 4 times. It has been a little bit helpful. I am glad I am doing it but the results have been mixed. I am continuing with it. My therapist is pretty good. Any particular CBT strategy you have in mind for my problems? I just want to enjoy my child and not worry about it getting cancer from the x-ray. The worry is taking all the pleasure from my life. Thanks again.
>
Posted by Jeffrey on February 5, 2004, at 16:34:16
In reply to Re: Please help me I am still suffering - My story, posted by nicky847 on February 5, 2004, at 14:47:59
> Jeffrey-
> If I were you I would stick with the CBT and give it time...sometimes it takes as many as 10-12 sessions before you see a noticeable improvement..the most important thing in CBT is to be honest with your therapist about the irrational/obssessive thoughts you have..then they will be more able to help you...
>
> it really sounds to me like good CBT would be great for you b/c you need to examine the obssessive fears that you have and see that they have no basis in rational thought..
> > > Jeffrey-
> > > Have you tried CBT? Cognitive Behavioral Therapy..it could be very helpful for you..
> > >
> > >
> >
> > Thanks for the suggestion. I have begun CBT. I have seen a psychologist 4 times. It has been a little bit helpful. I am glad I am doing it but the results have been mixed. I am continuing with it. My therapist is pretty good. Any particular CBT strategy you have in mind for my problems? I just want to enjoy my child and not worry about it getting cancer from the x-ray. The worry is taking all the pleasure from my life. Thanks again.
> >
>
>Thank you for your reply. Currenly we are trying 3 things in CBT. During my workday when my mind goes to the child/x-ray issue, I say to myself I will dedicate an hour in the evening to just worrying about this. Then in the evening I expose myself to the possibilty that:
1)thing may not get better. ie I may always worry about this issue
2) the dice are rolled, whats done is done, the baby mayt or may not get cancer, just try to to think about what that means ie might as well live my life as best as I can-worrying does not help
3) exposure to ideas that I will spend my life worrying about bay/x-ray cancer.
Does this approach make any sense. I have always responded to drugs in the past. I turned to CBT out of some desperation. I ws in complete remission before this.
Thanks again. Any thoughts on meds or the above are appreciated.
Posted by antigua on February 6, 2004, at 12:42:35
In reply to Re: Please help me I am still suffering - My story, posted by Jeffrey on February 5, 2004, at 16:34:16
Having a child can bring up so many things, many that you wouldn't expect. Maybe this is something that requires a different approach because it's so different from what you've ever faced before. Maybe meds can be the quick fix, but you might have to go deeper inside now, below the issue itself. This may not apply to you at all, but having children totally changed my whole image of myself. Also, maybe you will be fine once the baby is born. I have a friend who went through something similar and once the baby was born he was able to let go of it.
Just my two cents,
antigua
Posted by Jeffrey on February 6, 2004, at 13:54:29
In reply to Re: Please help me I am still suffering - My story, posted by antigua on February 6, 2004, at 12:42:35
> Having a child can bring up so many things, many that you wouldn't expect. Maybe this is something that requires a different approach because it's so different from what you've ever faced before. Maybe meds can be the quick fix, but you might have to go deeper inside now, below the issue itself. This may not apply to you at all, but having children totally changed my whole image of myself. Also, maybe you will be fine once the baby is born. I have a friend who went through something similar and once the baby was born he was able to let go of it.
> Just my two cents,
> antiguaThank you for your response. I appreciate it. Did your friend have severe anxiety etc? I was so excited about having the baby until I found this out. How did he let go? Any further info would be helpful. Thanks again.
Posted by antigua on February 6, 2004, at 18:56:50
In reply to Re: Please help me I am still suffering - My story, posted by Jeffrey on February 6, 2004, at 13:54:29
I asked him. He doesn't know how he let go, it just happened. Once the baby was born and his wife was fine he was able to let go of the anxiety and the obsessing--he says that he got so busy (and tired) that he didn't even realize it was gone until it was gone. He says now that he was just so worried about his wife and baby being o.k. that he let his anxiety take over his life. He's a good father, and I imagine you will be too because in a sense you know what you don't know (does that make any sense?).
Be nice to yourself and take care of yourself and your wife.
antigua
Posted by Jeffrey on February 6, 2004, at 21:44:47
In reply to Re: Please help me I am still suffering - My story, posted by antigua on February 6, 2004, at 18:56:50
> I asked him. He doesn't know how he let go, it just happened. Once the baby was born and his wife was fine he was able to let go of the anxiety and the obsessing--he says that he got so busy (and tired) that he didn't even realize it was gone until it was gone. He says now that he was just so worried about his wife and baby being o.k. that he let his anxiety take over his life. He's a good father, and I imagine you will be too because in a sense you know what you don't know (does that make any sense?).
>
> Be nice to yourself and take care of yourself and your wife.
> antiguaThanks for asking your friend and your kind words.
This is the end of the thread.
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