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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Towervu on November 2, 2005, at 12:34:31
Thank you for reading this. If you feel you have some insight on medications for me, please respond. I was diagnosed with GAD 20 years ago (I'm 41), and took Impramine for many years. Switched to Effexor which really helped for about 5 years. As time has passed, the anxiety seems to have been replaced by depression. It seems to be quite chronic, yet worse in winter. I still work at a stressful job and would like to continue but all the med's I'm on seem to not be working, and could be making things worse. I've been out of the loop on new medications, so any suggestions would help. Here is what I am on: lexapro 30 mgs; remeron 45 mg, geodon 40 mgs; lamictal 300 mgs; klonopin 1 mg; adderall xr 30 mgs. I know it's a lot, but I'm sure I don't need them all, they just accumulated over the years. I am working with my doctor to try and trim or replace some. My main request is for suggestions on replacements. Thank you.
Posted by Emily Elizabeth on November 2, 2005, at 20:42:12
In reply to Suggestions wanted on treatment resistant patient, posted by Towervu on November 2, 2005, at 12:34:31
I might have some ideas, but could you give just a bit more info? Specifically, I was wondering how much of each med you take, what times you take them, and why you started each. Also, do you have any symptoms of psychosis or mania?By the way, welcome to babble!
Best,
EE
Posted by med_empowered on November 2, 2005, at 20:46:11
In reply to Suggestions wanted on treatment resistant patient, posted by Towervu on November 2, 2005, at 12:34:31
hi! OK, first off...I'd try to ditch the Geodon. You don't have psychotic issues, you're not bipolar, and antipsychotics can exacerbate anxiety in some people (besides, the cardiovascular side effects, blood sugar issues, and potential tardive dyskinesia FAR outweigh any potential benefits). Then, you might want to adjust the benzo...if depression is becoming more prominent (without any signs of bipolar), then you might want to swtich from Klonopin to something else...valium, librium, ativan, and xanax xr are good choices; serax would be another option. You should probably avoid Tranxene if you have depression issues. Personally, I find that although Adderall can help a lot of issues, I usually need two doses--maybe you could try generic adderal (ir-version), breaking it up into 2, 3 doses? That'll give a smoother experience. The Lamictal helps a lot of people w/ treatment-resistant unipolar depression, but can also exacerbate anxiety in some people and induce hypomanic symptoms. So..you may want to evaluate your need for it, and adjust the dose or eliminate it as you see fit. Adding BuSpar might help; in addition to potential anti-anxiety effects (it does NOTHING for some people, but is quite helpful for others), it can also serve to boost antidepressants, while reducing SSRI problems (sexual dysfuntion, anxiety, etc.). I think its usually started at 15mgs/day--5mgsX3--but some docs start at 20. Usually, doses stop at about 45mgs, but you can go up to 60mgs if you feel that'll help. The antidepressants could be adjusted, but that's a trickier area--lexapro and remeron are both good for both anxiety and depression, so you may want to leave them alone unless you're having side effects or they're not really doing much anymore. Propranolol might be useful for stressful situations--it won't get rid of the actual anxiety, but it will reduce the physical symptoms of anxiety, which can help (this would be good for meetings, public speaking, that kind of thing). Some people do well with mood-stabilizers--depakote, trileptal,etc.--for anxiety, but I think they're more trouble (blood work, cognitive dulling, etc.) than they're worth in that area. Good luck!
Posted by theo on November 2, 2005, at 22:01:13
In reply to Re: Suggestions wanted on treatment resistant pati, posted by med_empowered on November 2, 2005, at 20:46:11
Did you quit all meds? I posted in another area but don't believe I caught your response.
Posted by katekite1 on November 2, 2005, at 23:02:38
In reply to Suggestions wanted on treatment resistant patient, posted by Towervu on November 2, 2005, at 12:34:31
Hi,
Given your original problem you seem like you are on just a heck of a lot of medication! It must be hard to take them correctly every day. For example the adderall is probably just to wake you up after all the other stuff puts you to sleep.
I need more info to try to suggest alternative meds.
So you were on imipramine for quite a few years. Did it help?
Then after 5 years on Effexor, how did you get from there to being on 6 meds? What were the drugs you started during or right after Effexor and why?
Kate
Posted by towervu on November 3, 2005, at 12:19:00
In reply to Re: Suggestions wanted on treatment resistant patient, posted by Emily Elizabeth on November 2, 2005, at 20:42:12
Thank you for your suggestions. I did state the amount I take in the original post. I take all at night except for the lexapro and adderral which I take in the morning. I think I switched from Impramine because Effexor was just newer? I can't recall. The reason I am on so many is because depression would break thru and my doctor would add a new drug, and now it's a big mess! I know I need to get off some, and your advice on getting rid of Geodon is good advice. I wish I could just get on 1 or 2 drugs so badly. I'm on uppers during the day, and downers at night. I'm sure my health is suffering. If I didn't have my stressful job I feel I could experiment more on going off med's. I feel caught in a bad drug situation. Any more help is appreciated. Thank you!
Posted by Racer on November 3, 2005, at 18:38:32
In reply to Suggestions wanted on treatment resistant patient, posted by Towervu on November 2, 2005, at 12:34:31
>>lexapro 30 mgs; remeron 45 mg, geodon 40 mgs; lamictal 300 mgs; klonopin 1 mg; adderall xr 30 mgs.
That is certainly a lotta pills there. I'm hardly a meds genius, so most of what I'm going to say is based on ignorance and my own experience, rather than knowledge. With that warning, here goes:
I've never tried Geodon, and only know that the people I've known who've taken it have all ended up more depressed and gaining weight. Again, that's based on second hand ignorance, if you will.
Remeron sent me so far over the edge, with frightening rage -- very, very unlike me -- so I hardly managed a week on it. I was feeling so nuts, I only remember wanting to die if I was going to feel that way for any length of time. {shudder} If you've been taking it for a while, you'll know your own reactions to it, but if you're leaning more towards depression now, such a sedating drug might not be the best choice, wouldn't you think? I don't really know, though.
And now the reason I'm really taking your time here: both Lexapro and Lamictal knocked me out and increased my depression a very great deal. The Lamictal was more of a tease -- gave me a couple of days of feeling as though it was going to work when I got near and then into the therapeutic range, but then just yanked the floor out from under me -- I went from kinda icky (that's a technical term) to hiding under a quilt on the sofa in a couple of days. And I mean only my nose sticking out from that quilt, and tears coming out instead when I would try to talk to anyone -- cats, spouse, dust bunnies... I certainly couldn't manage to contact anyone else. The Lexapro wasn't even that activating for me -- I couldn't have cried if I'd wanted to. I certainly couldn't talk. I was near catatonic -- I felt as though I was trapped way deep inside my body, without being able to communicate with the surface. If either drug has actually worked for you, that's great -- but if this is just a case of your doctor adding something because your depression is breaking through, I'd look very seriously at these two.
If I were spinning the meds wheel, I think I'd can the Geodon -- which I'm assuming you're taking for anxiety, rather than psychosis? -- and switch the Lexapro for another SSRI that might work better for you. Seems as though Adderall might not be the first choice for someone suffering anxiety, but Provigil can be helpful for some people. Personally, it augments my ADs and can even brighten my mood on its own. And then I'd see about weaning off the Remeron and Lamictal unless there are compelling reasons to stay on them.
By the way, any reason you didn't go back on the imipramine? Often, the TCAs will work again if you restart them. Or, at least that's what my pdoc told me way back when.
Posted by Emily Elizabeth on November 3, 2005, at 20:57:04
In reply to Suggestions wanted on treatment resistant patient, posted by Towervu on November 2, 2005, at 12:34:31
(Sorry that I missed the amts, the 1st time--I guess I was too tired.)
I can feel for your situation b/c I am in a very similar one, except with totally different meds! (Lex, Desipramine, Neurontin, Dexedrine, Ambien, Lithium). My pdoc and I have expressed the same concerns that you have--maybe something I’m taking is actually making it worse. One thing that has caused me to wait to drop some meds is that I am at a time in my life where having a few weeks of a bad withdrawal would be a disaster. So, I guess I'd add that you might think about if you can afford withdrawal at this time.
That said, what abt the Klonopin? Are you taking it for sleep or anxiety? Some people talk abt that making them more depressed. If your anxiety is better at this point, maybe you want to go to using it as needed rather than every day. Or taking something to help sleep only when you are having a night where sleep is a problem.
I don’t know how similar Adderall is to Dexedrine, but my pdoc has been pretty flexible abt me using it. She said it is pretty easy to take a little more or less as needed, so perhaps that might be one place where you have some room to change things?
Also, I guess I’d encourage you to think abt which med causes you the most side effects. Dropping a high side effect med might be a good place to start.
Hope this is helpful. I really wanted to respond to your post b/c of our similar situation. Good luck!
Best,
EE
Posted by towervu on November 4, 2005, at 13:30:47
In reply to Suggestions wanted on treatment resistant patient, posted by Towervu on November 2, 2005, at 12:34:31
Thank you for your help. We all are in this together. Best wishes to all. Thank you Emily. If you want to stay in touch my e-mail is Towervu@comcast.net. Anyone else feel free to say hello for giving and getting support. I've been battling for years and have some good insight myself. Thanks again. Never give up and do what you can to help end Stigma.
Posted by katekite on November 7, 2005, at 21:15:01
In reply to Re: Suggestions wanted on treatment resistant patient, posted by towervu on November 4, 2005, at 13:30:47
I agree with the person that had the idea to retry imipramine. Seems like for so many years that was a one-drug solution. Maybe it wouldn't be a final solution but a goal to get to just be on one thing for a while, a way to see if the depression is caused by all these other things you are on now.
Kate
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