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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Minnie-Haha on November 2, 2005, at 11:59:59
Haven’t checked-in in a while so I thought I’d give an update. First, my history: I am a 46-year-old, perimenopausal woman, overweight but active. Good marriage and two kids that I stress out about a little. (One lives at home and is “twice-exceptional” and the other is a grown man deploying for Iraq. Ugh!) My diagnoses are mild Bipolar Type 2 Disorder and OCD. I also have frequent neck and shoulder pain, and I take Zocor for high cholesterol.
In December 2004, after 15 months of anxiety, nausea, insomnia, and ultimately depression, I started Cymbalta at 30 mg daily. (I had been on a drug holiday when this year-plus illness started, but by the end I was trying – unsuccessfully – to manage it with benzos and a mood stabilizer.)
By mid-January 2005 I had been on 60mg Cymbalta for almost 4 weeks, was sleeping well and feeling great – but not manic – and was pain free. However, by mid-February, my appetite was a little too high (esp. for carbs), my motivation was a little too low, I was having some heart palpitations, and my blood pressure was up, so I dropped to 40 mg Cymbalta. My mood was OK, but I started noticing some aches and pains.
At the beginning of March, I started Bupropion 75mg to try to help with the appetite (had gained about 5 pounds) and amotivation. It didn’t help much, though I did feel more “activated” (got some songs stuck in my head, anxiety was back a little bit, wasn’t sleeping as well).
By mid-April I’d gained 10 pounds and had increased my night-time dose of Trileptal to help me sleep a little better. Mid-May I switched to Wellbutrin XL 200mg, which seemed a little “cleaner” than the Bupropion, but I was still sleeping restlessly 4-5 nights per week. Mid-June I switched to Wellbutrin SR 200mg, but that made me a little too jittery, so about the beginning of July I dropped to 150mg Wellbutrin SR.
I stayed on this combo – morn: 150mg Wellbutrin SR, 150mg Trileptal; eve: 40mg Cymbalta, 300mg Trileptal – but have had increasingly bad headaches and sweating the past couple of months, so went in to see my PCP yesterday. My blood pressure was 150/100! She wants me to lay off salt, get some extra potassium, monitor my pressure daily, and come back in one week. She wants to put me on a high-blood-pressure med, but I’m already on four meds, and, for cost and hassle reasons, am loathe to get on a fifth.
Any suggestions? I’m thinking about 1) dropping the Wellbutrin. If that helps lower the blood pressure, great. If not, 2) adding a beta blocker (don’t some work to augment antidepressants?). And if that works, 3) seeing if I can get back on 60mg Cymbalta, because I really miss how good I slept and felt at that dose. (My son deploys within the next month and I have felt it in my sleep in mood, even though I continue to take talk therapy.)
Any ideas would be appreciated.
Thanks,
Minnie
Posted by KaraS on November 5, 2005, at 2:03:47
In reply to Cymbalta update… and question (long), posted by Minnie-Haha on November 2, 2005, at 11:59:59
> Haven’t checked-in in a while so I thought I’d give an update. First, my history: I am a 46-year-old, perimenopausal woman, overweight but active. Good marriage and two kids that I stress out about a little. (One lives at home and is “twice-exceptional” and the other is a grown man deploying for Iraq. Ugh!) My diagnoses are mild Bipolar Type 2 Disorder and OCD. I also have frequent neck and shoulder pain, and I take Zocor for high cholesterol.
>
> In December 2004, after 15 months of anxiety, nausea, insomnia, and ultimately depression, I started Cymbalta at 30 mg daily. (I had been on a drug holiday when this year-plus illness started, but by the end I was trying – unsuccessfully – to manage it with benzos and a mood stabilizer.)
>
> By mid-January 2005 I had been on 60mg Cymbalta for almost 4 weeks, was sleeping well and feeling great – but not manic – and was pain free. However, by mid-February, my appetite was a little too high (esp. for carbs), my motivation was a little too low, I was having some heart palpitations, and my blood pressure was up, so I dropped to 40 mg Cymbalta. My mood was OK, but I started noticing some aches and pains.
>
> At the beginning of March, I started Bupropion 75mg to try to help with the appetite (had gained about 5 pounds) and amotivation. It didn’t help much, though I did feel more “activated” (got some songs stuck in my head, anxiety was back a little bit, wasn’t sleeping as well).
>
> By mid-April I’d gained 10 pounds and had increased my night-time dose of Trileptal to help me sleep a little better. Mid-May I switched to Wellbutrin XL 200mg, which seemed a little “cleaner” than the Bupropion, but I was still sleeping restlessly 4-5 nights per week. Mid-June I switched to Wellbutrin SR 200mg, but that made me a little too jittery, so about the beginning of July I dropped to 150mg Wellbutrin SR.
>
> I stayed on this combo – morn: 150mg Wellbutrin SR, 150mg Trileptal; eve: 40mg Cymbalta, 300mg Trileptal – but have had increasingly bad headaches and sweating the past couple of months, so went in to see my PCP yesterday. My blood pressure was 150/100! She wants me to lay off salt, get some extra potassium, monitor my pressure daily, and come back in one week. She wants to put me on a high-blood-pressure med, but I’m already on four meds, and, for cost and hassle reasons, am loathe to get on a fifth.
>
> Any suggestions? I’m thinking about 1) dropping the Wellbutrin. If that helps lower the blood pressure, great. If not, 2) adding a beta blocker (don’t some work to augment antidepressants?). And if that works, 3) seeing if I can get back on 60mg Cymbalta, because I really miss how good I slept and felt at that dose. (My son deploys within the next month and I have felt it in my sleep in mood, even though I continue to take talk therapy.)
>
> Any ideas would be appreciated.
>
> Thanks,
> Minnie
>
Hi Minnie,Good to see your name back here. I'm sorry to hear about your son's deployment. That has to be very anxiety provoking.
I can't speak to all of your questions but I can tell you a little bit about beta blockers. I took atenolol for a couple of months recently. My pdoc thought it might help with my anxiety and indirectly with depression. Unfortunately, it didn't help much with anxiety and it didn't touch the depression - though it was nice not having a racing heart.
Pindolol is a beta blocker that was used in the past to augment antidepressants. It doesn't seem to be used much for that purpose anymore so I don't think it was very effective. Also, you may be aware that beta blockers can potentially increase depression. The cardiospecific ones, like the antenolol I took, have less of a chance of producing that effect. A beta blocker could certainly help you to tolerate the 60 mg. of Cymbalta but you'd still have the issue of less motivation on that dosage.
Hope that helps some. Take care.
Kara
Posted by Minnie-Haha on November 5, 2005, at 8:55:51
In reply to Re: Cymbalta update… and question (long) » Minnie-Haha, posted by KaraS on November 5, 2005, at 2:03:47
> Good to see your name back here. I'm sorry to hear about your son's deployment. That has to be very anxiety provoking.
>
> I can't speak to all of your questions but I can tell you a little bit about beta blockers. I took atenolol for a couple of months recently. My pdoc thought it might help with my anxiety and indirectly with depression. Unfortunately, it didn't help much with anxiety and it didn't touch the depression - though it was nice not having a racing heart.
>
> Pindolol is a beta blocker that was used in the past to augment antidepressants. It doesn't seem to be used much for that purpose anymore so I don't think it was very effective. Also, you may be aware that beta blockers can potentially increase depression. The cardiospecific ones, like the antenolol I took, have less of a chance of producing that effect. A beta blocker could certainly help you to tolerate the 60 mg. of Cymbalta but you'd still have the issue of less motivation on that dosage.
>
> Hope that helps some. Take care.
>
> KaraThanks for the feedback. I see my PCP next week and it will be good to have some specifics to discuss.
Posted by katekite on November 5, 2005, at 18:11:45
In reply to Cymbalta update… and question (long), posted by Minnie-Haha on November 2, 2005, at 11:59:59
Hi,
I have had experiences with two beta blockers.
I started with atenolol (for blood pressure) which did work for racing heart or for that feeling that the heart is pounding, and jittery or sweaty hands, and helped me breathe more regularly. It did not help at all with feelings of anxiety.
Atenolol chemically does not cross the blood brain barrier so it can't help with brain things.
Switched to propranolol (which is able to go into the brain), that has been just excellent for the brain anxiety component. It can help me get to sleep if every little noise makes me alert and wake up. Times when I would be going around half holding my breath feeling jittery, or feeling irritable with a short fuse, take a pill of propranolol and 15 minutes later without feeling a drugged feeling start with giant sighs and feel so much more relaxed.
There are times when its not enough, times for example when I am specifically anxious about something, those are times for me that benzodiazepines like Ativan or Valium are more helpful. But for general whole body anxious/jitter/amped/agitated feeling then beta blockers have been really helpful for me.
Don't start with too much. 10 mg of propranolol maybe, different people need really different amounts. If nothing happens in a hour then you can take more.
If you take too much beta blocker you will notice a heavy feeling or get light headed, as your blood pressure drops a bit low. Also it can be associated with "the beta blocker blues" a dull feeling like depression for some people (though not for me).
Kate
Posted by Minnie-Haha on November 6, 2005, at 12:07:08
In reply to Re: Cymbalta update… and question (long) » Minnie-Haha, posted by katekite on November 5, 2005, at 18:11:45
> ... I started with atenolol (for blood pressure) which did work for racing heart or for that feeling that the heart is pounding, and jittery or sweaty hands, and helped me breathe more regularly. It did not help at all with feelings of anxiety.
>
> Atenolol chemically does not cross the blood brain barrier so it can't help with brain things.
>
> Switched to propranolol (which is able to go into the brain), that has been just excellent for the brain anxiety component. It can help me get to sleep if every little noise makes me alert and wake up. Times when I would be going around half holding my breath feeling jittery, or feeling irritable with a short fuse, take a pill of propranolol and 15 minutes later without feeling a drugged feeling start with giant sighs and feel so much more relaxed...
>
> KateThanks for sharing.
This is the end of the thread.
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