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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by RobertDavid on November 3, 2005, at 10:41:17
I've been on Lyrica for over a month now. I have managed to get off 2mgs of Klonopin at the same time. Though I've had moments where I thought I was getting better I'm not. I have not been able to tolerate a dose higher than 200mgs. I just feel drugged, tired, no energy and out of it.
My social anxiety has returned as well as generalized anxiety. I've tried moving doses around which has not helped. I have not been able to take more than 50mgs in the morning as I feel it rushing on then just feel completely out of it. Yesterday I went to work and forgot to put my belt on. Last night I came home, put my sox in the trash can (instead of the hamper).
I can't do this any more. My life has been a mess for a month, I want it back. I'm going to my doctor today thank god. I think I'm going to go back on klonopin for now even though I was depressed on it, but will see if I can get by taking 1mg instead of 2mgs. Perhaps he'll have other suggestions.
I'm ready to try the only thing I haven't tried, an MAOI, but I've been hoping I could hold out for the approval of the EMSAM patch, try it before Nardil. It's my understanding it could be out by February.
Anyway, thats my experience on Lyrica for those that were interested. Perhaps it may work for those that can get the dose higher than I could tolerate. I think giving the med a full month is long enough for me. When I've tried new meds I'm always conserned I quit before really giving it a chance. I wonder what its like to feel normal!
Posted by Glydin on November 3, 2005, at 14:19:46
In reply to Lyrica Update, posted by RobertDavid on November 3, 2005, at 10:41:17
Thanks for your update. I have been sad to read Lyrica has not met it's expectations for a number of folks that has posted on it. I certainly wish for more options for anxiety treatment that WORK without extreme excess baggage.... maybe someday.
Posted by Greif on November 4, 2005, at 21:59:57
In reply to Re: Lyrica Update » RobertDavid, posted by Glydin on November 3, 2005, at 14:19:46
Thanks for the update. I tried Lyrica for 3 weeks and quit. Back on K. Maybe you withdrew from K too quickly...however, your experience sounds similar to mine. I would forget everthing and became very diistant on increased doses (according to my wife). I cut K in half during the process but am now at 1.5mg and feel much better. Too bad Robert. You gave it a great try. I learned on LAmuicatal too quit sooner rather than later.
Posted by RobertDavid on November 4, 2005, at 23:19:20
In reply to Re: Lyrica Update, posted by Greif on November 4, 2005, at 21:59:57
My doctor agreed with me to get off the Lyrica. It just wasn't working for me. I was having trouble talking, headaches, tense, eyes would move rapidly when closed, not to mention little help with anxiety and no help with social anxiety. I just felt stoned (and not in a fun way).
I just couldn't tolerate a dose above 150mgs. My doctor wants me back up to 1.5 Klonopin once a day (at bedtime). I don't think I'll need to go all the way back to 2mgs, at least I'm going to try it at the lower dose. Unfortuately lower doses just don't cut it.
Once I get there I'm going to try adding Remeron to offset the slight depressed feeling I get when taking Klonopin. None of the other anti depressants have worked, but he says Remeron is unrelated to all the ones I've tried and it just might work for both anxiety and depression.
If the Remeron isn't a fit for me I'm going to wait for EMSAM to come out (assuming it does - should be out in a few months). I was prepared to just dive into taking Nardil, but he says it would be best to try the EMSAM patch first and switch to Nardil later if I don't get a good response to EMSAM.
He said that it would be harder to take Nardil for a while and then switch to EMSAM when it comes out. So, if Remeoron doesn't help, it's to the patch and if that doesn't help, it's off to Nardil.
At least I know what to expect with the Klonopin. I can get to about 80% where I want to be with it (thank god for that). And at least theres hope when there's a gameplan.
My guts telling me I'll ultimately be taking both Nardil and Klonopin, the two gold standards for social anxiety. I probably should have done it years ago. But who knows, it's trial and error with these meds (which stinks). I just wonder what it's like to take a med and really know/feel it's kicking in and doing the job. Something to hope for I guess.....
Posted by Greif on November 5, 2005, at 22:57:10
In reply to Re: Lyrica Update, posted by RobertDavid on November 4, 2005, at 23:19:20
Good luck Robert. Your posts have been helpful. Not too much info out there yet in Lyrica. I never tolerated SSRIs before. I take 5mg day (morning) of Lexapro and it helps evens out the Klonopin depression. Funny how often Nardil mentioned here. I have never seen a MD who likes it or will prescribe it. Zanax was no problem but Nardil was eliminated from menu due to docs experience with patients with my clinical background. (anxiety, depression).
Posted by RobertDavid on November 6, 2005, at 14:39:18
In reply to Re: Lyrica Update, posted by Greif on November 5, 2005, at 22:57:10
It's interesting to me to hear how the various doctors feel about certain meds such as Nardil. My doctor has always said if he only had one try/one shot at a med with me it would be Nardil.
But he's someone that it heavy in the research side of treating anxiety disorters. He lectures to doctors worldwide about how to treat depresson/anxiety. I'm so lucky that he still will even see. But as far as Nardil is concerned, it's been me that has resisted trying it, hoping something else would work.
I've always felt I would be a good candidate for Nardil it as nothing else has worked (other than klonopin). I'm certain that the answer for me is Klonopin & an anti depressant. The problem has been finding an anti depressant that works and doesn't have side affects I can't tolerate. Unfortunately I'm one of those that seems to feel all the side affects from these meds. I've tried almost all anti depressants you can think of. Some I've lasted over a month and some one day was all I could handle.
But before I dive into Nardil, he's advising me to wait and try the EMSAM patch. He has indicated it probably will not be as "powerful" as Nardil, but that I may respond well to it and have far fewer side affects (not to mention no food restrictions). I just have this gut feel that an MAOI will work best. I've been tracking EMASAM for years and am inpatient now that it's just around the corner
What I do know after getting off klonopin (and now back on it) is that it works. Works better than anything I've tried. I feel so much better. I'm taking 1 mg at night (instead of 2 like before my Lyrica trial). So far so good at the lower dose (and lower dose equals less depressive side affects).
Primarily my issue is generalized anxiety and social anxiety. Seems to me that the depression I do feel is related to being anxious, my lack of zest for life. Perhpas it's more than that.
Anyway, there's always hope, new meds. For me, that means doing my best on Klonopin and waiting and hoping that EMSAM will work for me. I'm still considering trying Remeron in the mean time.........
Posted by anodyne on November 6, 2005, at 18:13:38
In reply to Re: Lyrica Update, posted by RobertDavid on November 6, 2005, at 14:39:18
Your problems seem to exactly mirror mine. For what it's worth I have given the Nardil/ Parnate thing a shot and they made me feel really strange.
Have you ever considered Keppra. It works wonders for me with no side effects. I lean on it when the Klonopin starts getting me down (I can cut my Klonopin in 1/4 with Keppra). It seems to poop out after a couple of months at which time I cycle back to mono Klonopin for a couple of weeks, then back to Keppra.
Not the perfect answer but it's a thought. I just started a trial of Lyrica to see if it could be a solution to the Keppra poop out. It sounds like another make you stupid medication. That won't work for me. I am starting low at 75mg, we shall see.
Hope this helps. I know how you feel. -Dan
Posted by Bill LL on November 7, 2005, at 10:23:31
In reply to Lyrica Update, posted by RobertDavid on November 3, 2005, at 10:41:17
I believe that when taking drugs for depression, most people take more than just one drug at the same time. Maybe you could go back on 2 mg of Klonopin, and take an antidepressant along with it. A Harvard study that I recently read recommended this strategy for people depressed on Klonopin.
> I've been on Lyrica for over a month now. I have managed to get off 2mgs of Klonopin at the same time. Though I've had moments where I thought I was getting better I'm not. I have not been able to tolerate a dose higher than 200mgs. I just feel drugged, tired, no energy and out of it.
>
> My social anxiety has returned as well as generalized anxiety. I've tried moving doses around which has not helped. I have not been able to take more than 50mgs in the morning as I feel it rushing on then just feel completely out of it. Yesterday I went to work and forgot to put my belt on. Last night I came home, put my sox in the trash can (instead of the hamper).
>
> I can't do this any more. My life has been a mess for a month, I want it back. I'm going to my doctor today thank god. I think I'm going to go back on klonopin for now even though I was depressed on it, but will see if I can get by taking 1mg instead of 2mgs. Perhaps he'll have other suggestions.
>
> I'm ready to try the only thing I haven't tried, an MAOI, but I've been hoping I could hold out for the approval of the EMSAM patch, try it before Nardil. It's my understanding it could be out by February.
>
> Anyway, thats my experience on Lyrica for those that were interested. Perhaps it may work for those that can get the dose higher than I could tolerate. I think giving the med a full month is long enough for me. When I've tried new meds I'm always conserned I quit before really giving it a chance. I wonder what its like to feel normal!
>
>
Posted by zero on November 7, 2005, at 22:34:16
In reply to Re: Lyrica Update, posted by RobertDavid on November 6, 2005, at 14:39:18
Very courageous try. Beyond disapointing that the Lyrica didn't pan out.
Back on Klonopin makes good sense - even though it has the downside of some depression (and I get it too), 70% better is *not insignificant*.
Maybe the EMSAM patch will help. And if necessary, there's always Nardil. Nardil helped my SA and depression the best of all the meds. I've tried (unfortunately, I became hypomanic after 3 months or so and had to stop it - "unmasked my bipolarity" as my doc' put it).
Thanks for your informative postings.
Wishing you the best.
zero
Posted by RobertDavid on November 8, 2005, at 0:51:36
In reply to Re: Lyrica Update » RobertDavid, posted by zero on November 7, 2005, at 22:34:16
I appreciate everyone's impute here on Psycho-Babble. Lot's of smart and thoughtful people. Seems like a great place to learn, share and vent at times.
Anyway, though I'm relatively new here, I've been researching and trying medicines for years in my quest to "get normal". I think one of everyones main challenges here is to find a doctor that thinks outside the box. Once you have found that it's just trial and error.
Unfortunately for me, I'm one of those treatment resistent individuals (other than klonopin). I have realized that Klonopin is not a bad drug. Like my doctor says "take it, it's good for you" and as I learned with my recent trial to replace it with Lyrica, I need it, it works and works pretty damn good. I'm back up to 1.25 klonopin and feel so much better.
For me the challenge now is to find the right blend with it. Those that have been able to do mono therapy with one medicine are fortunate. So next up for me is to try to ad Remeron with the Klonopin to lift my mood and perhaps gain additional anxiety relief. I haven't seen much posted here about Remeron.
I did do some research on it and it appears that some of it's pluses are that it helps (or can help) with sleep, something I struggle with. That in addition it works well for some with anxiety (a real plus for me). That it's a relatively clean med which isn't supposed to be hard on the old libido (something I've had trouble letting go of with other meds). I guess you can gain some weigh with it, but I'll deal with that and so what if I put on a few pounds if it works.
So again with a new med trial there's hope. My doc says that there's a good chance I'll respond well to it. More hope! He says Remeron is unrelated to all the SSRI's and tryciclics (not to mention others) I've failed on. So many side affects, so little positive responses.
So I'm going to give Remeron a go and hope it works. Start low and work my way up. Hang with it long enough to feel I've given it a real try. If it doens't work I'll wait for EMSAM (again more hope). And as I've stated before, if that fails, I'll try the one two punch of Klonopin and Nardil (and hope I can tolerate it's side affects - throw in the towel and just avoid certain foods).
Sorry to make a short story long, just venting I guess. Again, I really appreciate everyones take on this medicine stuff. I hope that some of my comments are useful to others. People who don't deal with anxiety/depression have no clue what the rest go through just to feel normal.
I've been dealing with this stuff since I was a kid. I'm 49 now. Somehow I feel life is just around the corner. There's always hope.....
Posted by CamW on November 10, 2005, at 7:07:21
In reply to Re: Lyrica Update, posted by RobertDavid on November 8, 2005, at 0:51:36
RobertDavid - Treatment-resistant depression really is a pain (pane) where I wouldn't put a window. Unfortunately, we really do not have a good grip on what the cause(s) of depression (& thus, depressive symptoms) really are. It is not due to a lack of serotonin in the brain, nor is it just due to the uncoupling of the body's HPA axis. I strongly believe that reactive depression (ie. depression resulting from the experiencing of a traumatic life experience) is a totally different disorder, with an entirely different set of physiological and genetic mechanisms, than that of most, if not all, cases of treatment-resistant depression.
Even though the overt symptomatology (eg.the lack of energy, the emotional lability and ultimate, physiological expression, etc.) of these (at least) two separate disorders appear identical, their the biochemical causes are probably (more or less) mutually exclusive of one another, in several instances..
Adding serotonin (by treating with SSRIs) over an extended period of time (eg 9 - 12 months) to a reactive depression does seem to "reboot" the body's HPA axis, resulting in the "normalization" of many the brain's other physiological systems. A return to the normalization of functioning to predepression levels is seen in the binding of cortisol to glucocorticoid and mineralocorticoid receptors in the brain.
Also, any abnormal thyroid function usually returns to normal, as do several other hormonally controlled systems (eg. estrogen/testosterone functioning; and cellular surface concentrations of alpha- & beta-adrenoceptors, and other physiological systems that have not been fully recognized as "causing" depression - or at least contributing to the overt symptoms of what we call "depression").
We still do not know the causes of depression, both the reactive form, and the chronic, treatment resistant varieties. I think that it would be a safe bet to hypothesize that the "cause" of most of the treatment-resistant forms of depression is due to some genetic malfunction that has been passed down from one or both parents, &/or from a mutation has arisen spontaneously, in utero, during development.
The pre-, perinatal- and post-natal environments of those who grow-up and experience chronic, treatment-resistant depression later in life, surely also contribute to the extent and severity of the disorder
As with ANY chronic disorder without an effective treatment or cure, the most important thing that one can do (while waiting for science to tease apart the different disorders that we currently call "depression") is to learn to live one's life to the best of their abilities, as is allowed, within the boundaries of the disorder. Just because one has a (currently) untreatable disorder, does not mean the one should give up and let the disorder control them. The afflicted must learn to live their life in such a way as to maximize the quality of that life. An incurable disorder may be a life sentence, but one can, with much hard work, still be able to lead a productive life, and be able to contribute to society.
Just some thoughts I have had since I have come to the realization that I am going to have to live with bouts of depression for the rest of my life. I cannot let the depression control how I live my life. I have a daughter who needs me to teach her the skills that she will need to succeed in this world. Just because my depression sometimes makes me feel like staying in bed, under the covers, for weeks at a time, does not mean that I have to stay in bed. I must force myself to get up, shower, and shave, so that I can be with my daughter and teach her the importance of learning new concepts, so that she too will be better able experience the the sheer ecstacy and pleasure of figuring out how to understand a concept in a much deeper, meaningful way.
Sorry, I know that this is kinda off-topic, but it was something that I just had to put on paper. The Lyrica may not work as well as you wanted it to; but there will be another drug to try, then another, until we have teased apart depression and found an entirely new treatment modality that will work for your particular form of depression.
Just thinking out loud. - Cam
Posted by MiaSavage on November 11, 2005, at 15:08:38
In reply to Re: Lyrica Update, posted by RobertDavid on November 4, 2005, at 23:19:20
Just as a bit of hope I want to say that when Remeron first came out, I got on it as NOTHING had worked for me. Be prepared it has a peculiar effect where you are very sedated and groggy at the 15mg dose--which resolve and you have added energy at the 30mg dose. My doc is the medical director where I go and quite bright, so I was (thankfully) warned of this!!! It is now 8 years later and I am STILL taking Remeron as part of my artillery! At times I have come off the rest of my meds, changed them all--but the Remeron stays because it is THE ONE the gave me back MYSELF. Hope that gives you a little something to hold onto.
Best--
Mia
Posted by RobertDavid on November 11, 2005, at 15:17:10
In reply to Re: Lyrica Update, posted by MiaSavage on November 11, 2005, at 15:08:38
Thanks for the post Mia:
May I ask what your starting dose was and how much you went up to? I've leveled out on Klonopin again (so glad to be back on it and off the Lyrica), but know I need something to blend in to help my mood, energy and mental altertness. My anxiety is better, but I feel "flat".
I plan on starting the Remeron next week. I'm considering waiting to see if EMSAM gets approval when the FDA meets on it on Nov 27th. I have not heard from many people that take Remeron. Any additional insight would be great. The SSRI's, Effexor, Wellburon, Tryciclics, etc. did nothing for me but give me side affects. Thanks for your impute!
Posted by MiaSavage on November 11, 2005, at 16:31:11
In reply to Re: Lyrica Update, posted by RobertDavid on November 11, 2005, at 15:17:10
I take 45mg of Remeron. That was a long time in coming though. Initially the dose target was 30mg and I was wonderful with that for the longest time. I BEGAN at 15mg as this is a med that takes a few weeks to kick in (although the unfortunate sedation side effect happens immediately upon initiating 15mg). I went from 15mg to 22.5mg (adding half a pill) after a week. I'd been on the med for 2 weeks when I advanced to 30mg. I began to notice a difference about 2 weeks after initiating the full 30mg dose.
Remeron is a "tetracyclic" antidepressant. It is completely different from other antidepressants. It causes the brain to have more available norepinephrine and serotonin, and blocks certain seretonin reuptake receptors. I have gone as high as 65mg, which caused me to feel extremely irritable and agitated. I have taken up to 400mg Wellbutrin w/the Remeron when I had an increase in depression. This provided no relief. I now take 300mg Topomax, and 20mg Lexapro. I can stop the other meds when I'm feeling better--but not the Remeron. I will immediately relapse into serious suicidal depression without it. No other med provides me the stability that Remeron does.Best--
Mia
Posted by gardenergirl on November 11, 2005, at 17:00:35
In reply to Re: Lyrica Update » RobertDavid, posted by CamW on November 10, 2005, at 7:07:21
This is the end of the thread.
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