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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Mike081078 on August 15, 2005, at 16:14:36
I've been coasting along pretty steady for the past 2 years. So much so that when my Therapist retired my M.D. thought I was doing good enough that I could survive without one.Which I've done for the last year or so.
I was also a fairly steady marijuana smoker (just about every day) for about the last 12 years of my life. Due to health problems with my lungs recently I decided to quit smoking and have been clean now for about 6 weeks.
My current medication combo is as follows:
125MG of Divalproex Sodium (Epival / Depakote) in the morning followed by 250MG at night
20MG of Celexa every night
25MG of Seroquel every night
1MG of Clonazepam every night
Anyways... after being unemployed for about a year, during which I had some bouts of chronic asthma and lung infections which required plenty of rest for weeks at a time, I started back on a labour intensive job (setting up and cleaning up a Stadium after Concerts, Hockey Games, etc.)
I lasted two shifts.... First day I worked from 8:00AM till 3:00PM. After which I went home and didn't really notice myself acting funny though the people that I live with claim that I couldn't sit still and that I wouldn't stop talking, jumping from one topic to another so quickly that it was giving them a headache.
I thought I was just hyper...
The next day I worked from 1:00PM till 3:00PM and then from 9:00PM till 1:00AM. This day is still kind of a blur to me.
The next day after I woke up (a day which I didn't have to work) I remember feeling exceptionally good all day... like I was tripping out on Extacy or something. I just felt very VERY happy all that day. It was the day after my Birthday so I called up every family member that called me the day before while I was at work and wound up talking to distant relatives for about an hour or so on end. That is definitely not normal behaviour for me lol....
The following day, however, I could barely drag myself out of bed in the morning... my body was tied up in knots just about all day, my stomach was upset and I had stomach cramps just about all day accompanied by diarehha and I really couldn't concentrate on anything. I'm an avid reader and usually go through a few books a week but that day it was a chore to even hold my attention for one page.
Since then I've been sleeping between 10-12 hours a night and am just starting to finally feel like myself again (3 days after the crash).
So I don't know... not really sure what to think. Could it be just that my body's chemistry is still acting up a bit after withdrawing from marijuana after smoking pretty heavy for 12 years?
Could it be simply from having to adapt to some sort of structure again in my life when I've been just a lazy bum for the last year (and that is the honest truth... I need to put some sort of structure around my days again regardless)
Or is something going screwy with my medication which needs to be attended to?
Anyways, I'm confused so any thoughts or opinions would really be appreciated. I see my MD on Thursday for a follow-up on my asthma and I'm thinking about bringing this up with him. I really wish I still had a Therapist though so I could just run this by her/him to get their advice.
Hell, I'm looking for just some advice period. Mostly everybody that I associate with on an every day basis doesn't understand anything about personality disorders.
The ones that believe now that they exist believe that if you pretend to make them go away they will just vanish "Just stop thinking about thinking about them and they'll go away" and the others simply don't believe in them... "You're making it up, stop being lazy"...
Not even sure how to go about finding a decent Therapist here in this city anymore. My last one I had off and on for most of my life.
So any thoughts, opinions, whatever will be greatly appreciated.
Posted by ed_uk on August 15, 2005, at 16:58:53
In reply to 2 years then Anxiety Attack... what would you do?, posted by Mike081078 on August 15, 2005, at 16:14:36
Hi Mike,
Have you been diagnosed with bipolar disorder? It sounds like you had some manic symptoms followed by a period of depression.
Btw, how long have you been on Celexa? Celexa can sometimes cause rapid swiching from mania to depression.
>2 years then Anxiety Attack... what would you do?
I'd strongly consider increasing your divalproex dose.
~ed
Posted by ed_uk on August 15, 2005, at 17:07:34
In reply to Re: 2 years then Anxiety Attack... what would you do? » Mike081078, posted by ed_uk on August 15, 2005, at 16:58:53
>I'd strongly consider increasing your divalproex dose.
..........and/or tapering off Celexa if possible.
~ed
Posted by med_empowered on August 15, 2005, at 17:26:46
In reply to Re: 2 years then Anxiety Attack... what would you do? » ed_uk, posted by ed_uk on August 15, 2005, at 17:07:34
hey! If you have a bipolar disorder, or some indications of it (sometimes you can have "soft bipolar," which usually means unipolar disorder with some sub-clinical bipolar features), then this could be indicative of a very brief period of hypomanic-type symptoms followed by a rapid "switch" into a period of "atypical" (sleeping too much, lack of focus, weight gain/loss) depression symptoms. Whether its a problem or not is really dependent upon you and the history of your mood-disorder. In some people, little "blips" on the radar screen like this can come and go and, although they're unpleasant, they can be handled without medication or a change in existing medication. On the other hand...for some people, little "blips" can be indicative of future full-fledged mood-episodes, so it may be something to be concerned about. It could also be medication-related (like ed said, celexa and the other antidepressants, especially the SSRIs and Tricyclics, can cause "switching"; SSRIs are now thought by some to cause an increase in "cycling" from high-to-low, even if the med doesn't induce a full-fledged manic, mixed, or depressive episode). I guess you could ask your doc about upping the depakote and/or seroquel but...that move could have some undesirable side-effects. If it were me, I'd probably ask about a reduction of the celexa (or a full-fledged withdrawal, if you think you can handle it) and possibly a bump in the Klonopin dose (I used to take Klonopin for the early signs of mania/mixed-episodes and/or rapid mood-switching; it helped me keep things under control without increasing my mood-stabilizer dose, which was nice). If you use the Klonopin to help control these kind of mood-shifts, you might be able to minimize the depakote and seroquel dose *and* adjust the klonopin dose up or down, depending on your needs...its really flexible. But, it really depends on you and your lifestyle; if this kind of thing is causing or could cause major disruptions in your personal life or work, then you may want to consider upping the mood-stabilizer...upping the Seroquel, or having some extra to take as-needed, could work as well. Good luck!
Posted by Mike081078 on August 15, 2005, at 18:30:14
In reply to Re: 2 years then Anxiety Attack... what would you do? » Mike081078, posted by ed_uk on August 15, 2005, at 16:58:53
The Doctors were never really able to give me a clear diagnosis. I've heard some Doctors say that I was Bi-Polar in the sense that unless I wanted to add about a dozen different disorders onto my condition, all of which I show certain signs of, then Bi-Polar is as close as I'm going to get.
Celexa I've been on for at least 3 years. Same thing with the Divalproex, Celexa, and Seroquel, and all at the same doses.
Clonazepam I've been on for close to 5 years.
> Hi Mike,
>
> Have you been diagnosed with bipolar disorder? It sounds like you had some manic symptoms followed by a period of depression.
>
> Btw, how long have you been on Celexa? Celexa can sometimes cause rapid swiching from mania to depression.
>
> >2 years then Anxiety Attack... what would you do?
>
> I'd strongly consider increasing your divalproex dose.
>
> ~ed
>
>
Posted by ed_uk on August 15, 2005, at 18:57:44
In reply to Re: 2 years then Anxiety Attack... what would you do?, posted by Mike081078 on August 15, 2005, at 18:30:14
Hi :-)
Would you consider increasing your divalproex dose?
>a dozen different disorders
Tell us more....
~ed
Posted by Mike081078 on August 15, 2005, at 18:57:58
In reply to Re: 2 years then Anxiety Attack... what would you, posted by med_empowered on August 15, 2005, at 17:26:46
Ok, for me, the Celexa really got rid of the Depression that I was suffering from. When I was first beginning to be treated the Depression was the worst symptom that I had and I honestly don't think I could deal with that if it came back.
Also, the Celexa helped with the Depression within Days. I went from basically bawling every day (which is not a good thing for a guy to have to go through) to becoming almost too energetic during the days.
The Klonopin is for sleeping... that puts me out like a baby even though it takes an hour for it to kick in... if I started using that during the day, it would either A) make me extremely drowzy or B) stop helping me with my insomnia when it came time to sleep.
For years, I was lucky sometimes if I got 10 hours of sleep a week. There were MANY night where I didn't get to sleep at all. I was basically becoming a Zombie... I looked and felt horrible and my emotional state was almost catatonic lol
So that leaves me with Divalproex or Seroquel.
At one point, one Doctor had me up to 100MG of that a day. I could barely keep myself awake with that. I was sleeping like 16 hours a day and when I was awake I was still basically asleep. This was a Doctor that I was sent to for some sort of analysis (can't remember what) while my normal Therapist was away on Vacation. When she got back and saw me like that, let's just say that she was very PO'd...
To be honest, I'm not even sure why I'm on Seroquel because I've never been delusional, heard voices, or experienced hallucinations. I forget exactly why I started taking it in the first place BUT I've been fairly steady for about 3 years and didn't want to fix something that wasn't broken.
I, however, have never been past 375MG of Divalproex in a day (125 in the morning, 250 at night).
Do you think increasing my dosage of Divalproex to 500MG a day (250 in the morning and 250 at night) would help to make a difference? Would there be a lot of negative side effects with that?
> hey! If you have a bipolar disorder, or some indications of it (sometimes you can have "soft bipolar," which usually means unipolar disorder with some sub-clinical bipolar features), then this could be indicative of a very brief period of hypomanic-type symptoms followed by a rapid "switch" into a period of "atypical" (sleeping too much, lack of focus, weight gain/loss) depression symptoms. Whether its a problem or not is really dependent upon you and the history of your mood-disorder. In some people, little "blips" on the radar screen like this can come and go and, although they're unpleasant, they can be handled without medication or a change in existing medication. On the other hand...for some people, little "blips" can be indicative of future full-fledged mood-episodes, so it may be something to be concerned about. It could also be medication-related (like ed said, celexa and the other antidepressants, especially the SSRIs and Tricyclics, can cause "switching"; SSRIs are now thought by some to cause an increase in "cycling" from high-to-low, even if the med doesn't induce a full-fledged manic, mixed, or depressive episode). I guess you could ask your doc about upping the depakote and/or seroquel but...that move could have some undesirable side-effects. If it were me, I'd probably ask about a reduction of the celexa (or a full-fledged withdrawal, if you think you can handle it) and possibly a bump in the Klonopin dose (I used to take Klonopin for the early signs of mania/mixed-episodes and/or rapid mood-switching; it helped me keep things under control without increasing my mood-stabilizer dose, which was nice). If you use the Klonopin to help control these kind of mood-shifts, you might be able to minimize the depakote and seroquel dose *and* adjust the klonopin dose up or down, depending on your needs...its really flexible. But, it really depends on you and your lifestyle; if this kind of thing is causing or could cause major disruptions in your personal life or work, then you may want to consider upping the mood-stabilizer...upping the Seroquel, or having some extra to take as-needed, could work as well. Good luck!
Posted by Mike081078 on August 15, 2005, at 19:36:46
In reply to Re: 2 years then Anxiety Attack... what would you do? » Mike081078, posted by ed_uk on August 15, 2005, at 18:57:44
Question...I'm taking 125MG of Divalproex right now during the mornings and 250MG at night.
I've had my blood work and everything done recently and I know that I'm alright as far as that goes. I can increase my dosage quite a bit more and still be in the safe zone.
Would it be a good or bad idea to increase that to 500MG tomorrow morning? Take 250MG in the morning and 250MG at night? That thought has already crossed my mind and I'm kind of getting curious.
Posted by ed_uk on August 16, 2005, at 5:11:37
In reply to Re: 2 years then Anxiety Attack... what would you » med_empowered, posted by Mike081078 on August 15, 2005, at 18:57:58
Hi Mike,
>.....almost too energetic during the days.....
Perhaps you're taking a bit too much Celexa. Too much can be destabilising. I think you said you were on 20mg, right? Have you tried 10mg?
>Do you think increasing my dosage of Divalproex to 500MG a day (250 in the morning and 250 at night) would help to make a difference?
I expect it would help to stabilise your mood.
Kind regards
~ed
Posted by ed_uk on August 16, 2005, at 5:13:28
In reply to Increasing my Divalproex Dose?? » ed_uk, posted by Mike081078 on August 15, 2005, at 19:36:46
Hi Mike,
>Take 250MG in the morning and 250MG at night?
Sounds like a good idea..... but speak to your doc first :-)
~ed
Posted by Mike081078 on August 16, 2005, at 7:31:01
In reply to Re: Increasing my Divalproex Dose?? » Mike081078, posted by ed_uk on August 16, 2005, at 5:13:28
Well, I've decided to boost my Divalproex dosage up to 250MG during the days. Started on that this morning.The only medication that I've been taking during the days up till now is the 125MG of Divalproex every morning. Everything else I take right before I go to sleep for the night.
I'm still sleeping fine as well. So figured that maybe by taking a little something extra during the days might help to fix that blip.
If not... then it's not a huge change and I can always drop it back.
Posted by ed_uk on August 16, 2005, at 7:57:06
In reply to Re: Increasing my Divalproex Dose??, posted by Mike081078 on August 16, 2005, at 7:31:01
Tell us how it goes :-)
~ed
Posted by Empathy on August 17, 2005, at 22:02:01
In reply to Re: Increasing my Divalproex Dose?? » Mike081078, posted by ed_uk on August 16, 2005, at 7:57:06
This is just my opinion:
You mentioned that you had recently stopped smoking pot after smoking regularly for several years. I would take that in to consideration, as your body is adjusting to life without that drug.
There is a withdrawal time with any drug and the longer the use, the more time needed to remove it all from your system.About 6 months ago, I asked to be weaned off several of my medications and withdrawal from each was "interesting" and "unique" and lasted for about 3 months. Thankfully, I KNEW what to expect and why I was having some very weird personality shifts.
Hang in there and best wishes on staying pot free - your lungs will thank you.
Posted by Mike081078 on August 17, 2005, at 22:36:45
In reply to Re: Increasing my Divalproex Dose??, posted by Empathy on August 17, 2005, at 22:02:01
Yeah, I can definitely attribute some of the increased anxiety to withdraw from pot. After the first week I found that I had a lot of extra energy... now it's been six weeks and I've got waaaaaay too much energy which I think is causing the anxiety.Smoking pot every day was like putting yourself into a nice comfy cocoon where you are just mellow and tired all the time and nothing seems to bother you because you just don't have the energy to really care. Didn't really notice how much damage that was doing to me emotionally untill I decided to quit since my friends are all either 'growers' or musicians... and all of which smoked about 10 times more then I did.
So what I did to combat the anxiety was increase my Divalproex dosage to 250MG at night and 250MG in the morning. That I did two days ago so I think it's still too soon to really judge if this is making any difference. However, I have noticed that my head has been working better... not so many racing thoughts. Though I still have a very high energy level... just feel incredibly hyper all the time.
So I went and got myself a gym membership.... had my first serious workout in about 8 years today and that felt absolutely amazing for my body and my mind. I think I would have to recommend that now for anybody that is suffering from just a slight case of depression (where it hasn't completely overcome your life).
Now I've got an app't with my MD tomorrow afternoon for a follow-up on my lungs. Going to have to fill him on in the fact that I've decided to increase my medication dosage. I wonder if he'll suggest that I go for any other additional counselling? I don't feel that I really need any... but if it's offered... and he seems to have some pretty good connections... it couldn't hurt.
Posted by ed_uk on August 18, 2005, at 9:58:39
In reply to Re: Increasing my Divalproex Dose??, posted by Mike081078 on August 17, 2005, at 22:36:45
>250MG at night and 250MG in the morning
It's still a low dose - there's plenty of room for future increases if you need it. I'm not saying that you will, it's just worth bearing in mind.
~ed
Posted by Mike081078 on August 18, 2005, at 10:25:52
In reply to Re: Increasing my Divalproex Dose?? » Mike081078, posted by ed_uk on August 18, 2005, at 9:58:39
Oh, I know that. My Therapist told me when I first started on the medication that she had some patients that were as high as 1000MG per day.
I've also heard from both my Therapist and my MD whenever I went in to have blood work done that I had a huge range of room to increase my dosage if need be.
> >250MG at night and 250MG in the morning
>
> It's still a low dose - there's plenty of room for future increases if you need it. I'm not saying that you will, it's just worth bearing in mind.
>
> ~ed
Posted by ed_uk on August 18, 2005, at 11:54:08
In reply to Re: Increasing my Divalproex Dose??, posted by Mike081078 on August 18, 2005, at 10:25:52
>some patients that were as high as 1000MG per day.........
Well some people take 2500mg - but not many. It's hardly likely that you'll need that much LOL!~ed
Posted by Empathy on August 18, 2005, at 14:55:10
In reply to Re: Increasing my Divalproex Dose??, posted by Mike081078 on August 17, 2005, at 22:36:45
Very cool about joining the gym. My 20 year old son is very ADHD (Attention Deficet Hyper-activity Disorder) and he joined a gym about 2 months ago - he works out everyday - hard, has gained 30lbs of muscle and he is training to compete. He says the endorphins are amazing off of it and he is sleeping REALLY good for the first time in his life. So you are right. Working out must helps with anxiety and high energy.
Posted by Mike081078 on August 18, 2005, at 16:23:11
In reply to Re: Increasing my Divalproex Dose?? 4 Mike081078, posted by Empathy on August 18, 2005, at 14:55:10
I'm still way too amped today. Everything still feels like it's moving much too fast.I've been driving around running errands for most of the afternoon. I noticed a few times that I was going at least 20KM over the speed limit. Also, pretty much everybody that I had to deal with asked me to repeat myself a few times. Was wondering what was going on... was I speaking too quietly or something?
Then I got a phone call from one of my best friends... a guy that has known me since before Pre-School. He's been on the road for the past few months (musician) and something that he just saw had reminded him of me so he called.
Anyways, I'm talking to him for like 5 minutes when he says...
"Man, are you high or something? You sound like you're speeding. You're talking too fast and it's hard to follow you"
I guess that's why everybody has been asking me to repeat myself???
So... since I just upped my dosage of Divalproex like 3 days ago.... how long does it take before the increase should start to effect me?
Posted by ed_uk on August 18, 2005, at 18:07:35
In reply to Still Speeding... How Long Till It Kicks In???, posted by Mike081078 on August 18, 2005, at 16:23:11
Hi,
It should kick in fairly soon, but 500mg might not be enough. You could try taking 250mg three times a day for a while.
~Ed
Posted by Mike081078 on August 18, 2005, at 20:19:45
In reply to Re: Still Speeding... How Long Till It Kicks In??? » Mike081078, posted by ed_uk on August 18, 2005, at 18:07:35
Wow, that's more than double what I was taking just a few days ago.
For that, I think I'm going to wait and see what my MD says so that nothing bad happens.
For a few hours this afternoon for some reason I got some incredible speed going. Now I've settled back down though. Focused my energy in cooking a HUGE meal for myself :-)
BBQ Ribs and Shrimp, and Ceasar Salad.
Now I'm just stuffed and tired and not looking forward to my allergy testing tomorrow morning. If I remember correctly, from when I was a little kid, they stick you with all kinds of crazy needles and... I don't like needles :-(
> Hi,
>
> It should kick in fairly soon, but 500mg might not be enough. You could try taking 250mg three times a day for a while.
>
> ~Ed
Posted by ed_uk on August 19, 2005, at 9:50:04
In reply to Re: Still Speeding... How Long Till It Kicks In???, posted by Mike081078 on August 18, 2005, at 20:19:45
>For that, I think I'm going to wait and see what my MD says so that nothing bad happens.
Yes, I think you should talk to your MD. Even so, you were on a mini-dose before so I wouldn't worry.
~Ed
Posted by Mike081078 on August 23, 2005, at 16:15:02
In reply to 2 years then Anxiety Attack... what would you do?, posted by Mike081078 on August 15, 2005, at 16:14:36
MD's Advice...Stay on 500MG for another two weeks and continue to work out hard every 2nd day or so. The work outs will strengthen my lungs and my body plus get rid of any extra "__" (forget that word) that my body might be producing since my body's chemistry is naturally a bit off and because I've completely withdrawn from almost daily marijuana smoking.
I always told him that I smoked marijuana whenever the "smoking" topic would come up... but I don't think he had expected that I'd been doing so for nearly 12 years and just about every day. It's hard to believe that right now is the longest that I've gone without smoking a joint since before my Mom died.
He was also kind of surprised that I was able to just stop completely. *shrugs* I wound up in the hospital in a bed on the same floor that my Mom was on before she was moved to the hospital that she died at because of something that I was doing to myself. I think that would make just about anybody analyze their lives REAL Good.
So apparently if you're "Bi-Polar" or whatever the Docs want to call what I'm dealing with, if you've been smoking marijuana hardcore for more then a decade, sudden withdraw can cause you to go manic lol...
I've also got another follow-up app't for this in 2 weeks.
Posted by ed_uk on August 23, 2005, at 17:08:37
In reply to Re: 2 years then Anxiety Attack... what would you do?, posted by Mike081078 on August 23, 2005, at 16:15:02
Hi Mike,
I wonder whether you'll be able to reduce your divalproex dose in a few months time - when marijuana is a distant memory ;-)
~ed
Posted by Mike081078 on August 23, 2005, at 20:38:32
In reply to Re: 2 years then Anxiety Attack... what would you do? » Mike081078, posted by ed_uk on August 23, 2005, at 17:08:37
*shrugs* My guess would be that the only reason I was so mellow before and my 'mania' wasn't kicking into a higher gear and forcing me to increase my Divalproex dosage before now was because I was pretty much constantly stoned.Every time I would get stressed out or worried about something... basically, whenever my body started to act up and my mania would normally be kicking in I'd simply roll another joint.
My guess is that I was on a very low dosage to start with and the marijuana was why I was able to maintain myself on such a low dose.
My MD was talking about something called a "level" today...
I'm 5'8 and about 190lbs... not really fat but stocky... and with 375MG of Divalproex per day, that put me way below that "level". Hell, with 500MG per day I'm still quite a bit below that "level".
I knew that from the beginning which is why I didn't hesitate before increasing my dosage... and my MD found that out as soon as he looked at my last blood work which was done just like 3 weeks ago.
This is the end of the thread.
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