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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by blueberry on March 26, 2006, at 15:39:50
Doc wanted to try natural stuff. Didn't work out. In the process, longtime ssri use and zyprexa were phased out. I'm in rough shape, one day I'll be fairly ok, the next day will be overwhelming phsyical anxiety but not much depression, the next day pretty intense depression but not much anxiety.
Doc is meeting with 5 other top pdocs in the area and is going to present my case. We're waiting until then to decide what to do. In the meantime, I'm 6' tall and have gone from 142 pounds to 134 pounds in 4 weeks and doc says restart zyprexa for weight, use xanax because in the past it was good for me short term for both anxiety and depression, and consider remeron as well. She also mentioned lamictal.
I don't want to restart zyprexa. I'm past the worst of it. Was on it for 5 years already. The shakey hands and nightmares I got from it are clearing up. But the weight loss is scary...
Xanax is tempting. It has worked awesome before. But for how long? The thought of it letting me down eventually and then going through taper withdrawals really frightens me. It does boost my appetite...
Tinnitus is a factor too. Zyprexa lessens it. Xanax lessens it even more.
Low cortisol is also a problem. All of these meds lower cortisol even further.
Wow. Feel so swamped in indecision and inability to commit. Sometimes knowing too much is not a good thing.
Advice and comments deeply appreciated.
Posted by linkadge on March 26, 2006, at 16:11:18
In reply to Just can't decide what to do with meds ???, posted by blueberry on March 26, 2006, at 15:39:50
I would make decisions slowly and gradually. You won't fade away over night.
Have you ever taken remeron ? Perhaps you could take a low dose of remeron, which would help sleep and apetite, and then you could avoid going back on high doses of various med combinations.
What are you currently taking in terms of alternative meds ?
Linkadge
Posted by Racer on March 26, 2006, at 16:13:21
In reply to Just can't decide what to do with meds ???, posted by blueberry on March 26, 2006, at 15:39:50
Has your doctor considered starting Remeron now, as an alternative to the Zyprexa, to stimulate weight gain? Might work, and it was one of the options for going forward, right?
To me, restarting the Zyprexa, if you're not psychotic and were having problems with it, just doesn't sound like a great idea. Especially when it's being prescribed for weight gain, rather than for its more positive effects. Seems to me, and I am not a doctor and not intimately familiar with your specific issues, that trying something more specific to your issues -- like an anti-depressant known for weight gain, that could address your weight AND the depression and anxiety -- would make more sense.
Good luck with the consult, too.
Posted by med_empowered on March 26, 2006, at 16:13:37
In reply to Just can't decide what to do with meds ???, posted by blueberry on March 26, 2006, at 15:39:50
hi! sorry you're going through a rough patch. I wouldnt re-start zyprexa. Its rough stuff and the weight gain is usually a bad thing--its accompanied by cholesterol and blood sugar increases, and there's a risk of long-term metabolic problems. Xanax to me seems less problematic, but what about Klonopin? Or..valium, librium, tranxene...any longer-acting benzo? Xanax tapers are hell b/c xanax lasts for such a short time and dose escalation is hard to avoid b/c of the short half-life..maybe if you can try something that lasts longer, you'll have fewer problems. The good thing about longer-acting benzos is that you can use them for sleep AND anxiety...example: 1.5mgs/Klonopin spread out over the day, plus an extra .5-1mgs at dinner to help with sleep. Valium: 30mgs over the day, 10mgs at night. So on and so forth. Xanax XR might also be a good option, if that works for you.
Maybe a TCA would be good? I don't know how your cardio health is, but if that checks out they can cause weight gain and sedation, which could actually be pluses for you. One option--Limbitrol, the elavil/librium combo--stands out; it seems to work fast on anxious depression and helps with sleep...plus you usually need less of both the AD and the benzo, so your overall intake is reduced. I think you can take it all at night, but im not sure.
Posted by greywolf on March 26, 2006, at 16:21:57
In reply to Just can't decide what to do with meds ???, posted by blueberry on March 26, 2006, at 15:39:50
Have you tried an MAOI along with something for the anxiety? Nardil worked great for me for awhile, and weight gain would be an added benefit for you.
Posted by Phillipa on March 26, 2006, at 20:37:39
In reply to Re: Just can't decide what to do with meds ???, posted by greywolf on March 26, 2006, at 16:21:57
I say from personal experience go with the xanax. I didn't have trouble getting off of it. the worst that can happen is they will switch you to valium to wean you off. but you won't be on it for years like I was. Good lucks. Fingers and toes crossed. Love Phillipa Babblemail always open
Posted by SLS on March 27, 2006, at 11:55:46
In reply to Just can't decide what to do with meds ???, posted by blueberry on March 26, 2006, at 15:39:50
I like the Remeron idea.
- Scott
Posted by TylerJ on March 27, 2006, at 14:25:50
In reply to Just can't decide what to do with meds ???, posted by blueberry on March 26, 2006, at 15:39:50
> Doc wanted to try natural stuff. Didn't work out. In the process, longtime ssri use and zyprexa were phased out. I'm in rough shape, one day I'll be fairly ok, the next day will be overwhelming phsyical anxiety but not much depression, the next day pretty intense depression but not much anxiety.
>
> Doc is meeting with 5 other top pdocs in the area and is going to present my case. We're waiting until then to decide what to do. In the meantime, I'm 6' tall and have gone from 142 pounds to 134 pounds in 4 weeks and doc says restart zyprexa for weight, use xanax because in the past it was good for me short term for both anxiety and depression, and consider remeron as well. She also mentioned lamictal.
>
> I don't want to restart zyprexa. I'm past the worst of it. Was on it for 5 years already. The shakey hands and nightmares I got from it are clearing up. But the weight loss is scary...
>
> Xanax is tempting. It has worked awesome before. But for how long? The thought of it letting me down eventually and then going through taper withdrawals really frightens me. It does boost my appetite...
>
> Tinnitus is a factor too. Zyprexa lessens it. Xanax lessens it even more.
>
> Low cortisol is also a problem. All of these meds lower cortisol even further.
>
> Wow. Feel so swamped in indecision and inability to commit. Sometimes knowing too much is not a good thing.
>
> Advice and comments deeply appreciated.I would use the xanax Blueberry...it'll help w/anxiety as you know, and also has antidepressent properties as well. You can slowly taper off later, but now..I think you need it. Also, Remeron in my opinion and from personal experience is an excellnt AD. Also works well for anxiety. I think it is much better than any ssri! And remeron works quickly usually 2 wks, will increase your appetite (which you desp. need) and will help you sleep-it's great for insomnia. Outside of the maoi's Remeron is my favorite AD, it helped me tremendously for 5-6 years. Best wishes Blue.
Tyler
Posted by blueberry on March 27, 2006, at 18:00:31
In reply to Just can't decide what to do with meds ???, posted by blueberry on March 26, 2006, at 15:39:50
Thanks all for your responses. It looks like the majority favors remeron for me. The problem with that is that I took it for about a year, maybe 5 years ago, and it increased the loudness of my tinnitus pretty bad. Even though it is usually a good sleep med, it really wasn't for me.
The xanax thing is looking better all the time. I just wish I could someone know in advance how long its excellent antidepressant properties would keep working...weeks...months...years? I have never tried it more than a week, but each time was just so nice and normal it was unbelievable.
I did take 1.25mg zyprexa tonight. I'll have to see how I feel about it tomorrow before going any further with it. I mainly took it because it was one of my doctor's main instructions for me, and I wanted to at least show a hint of cooperation. Also, zyprexa lessens my tinnitus quite a bit. She also said xanax is fine, which also lessens my tinnitus...soo..we'll see. Remeron and tinnitus though, not good for me.
Posted by TenMan on March 27, 2006, at 18:28:34
In reply to Re: Just can't decide...remeron and tinnitus, posted by blueberry on March 27, 2006, at 18:00:31
What about St. Johns Wort in combo with 5HTP?
Posted by ian34 on March 27, 2006, at 21:24:18
In reply to meds, posted by med_empowered on March 26, 2006, at 16:13:37
Hi,I was on remeron and it is extremely good for anxiety because it is "sedating". To me, it was almost like an AD and a benzo and it sure as heck made me gain a lot of weight which is good because I had just quit drinking and only weighed 123 lbs.
Posted by CK1 on March 27, 2006, at 23:13:03
In reply to Re: meds » med_empowered, posted by ian34 on March 27, 2006, at 21:24:18
I've been on Xanax (.25mg-.375mg/day) for over 2 months and have felt no need to increase the dose. It GREATLY helps physical anxiety symptoms. The ONLY side effect I've had is slight slurred speech/stuttering, which is anxiety provoking in itself so I might get off. I hardly ever stutter on it, but I'm always anxious of "what if I do?"
If I didn't have this speech problem with it, I'd be on it forever.
Posted by psychopharmacon on March 28, 2006, at 1:04:31
In reply to Re: meds, posted by CK1 on March 27, 2006, at 23:13:03
Didn't you take amisulpride before, but stopped because of elevated prolactin levels? What about starting with amisulpride again, but this time adding a prolactin-lowering drug like Dostinex or Parlodel?
Posted by blueberry on March 28, 2006, at 5:46:11
In reply to Re: meds, posted by psychopharmacon on March 28, 2006, at 1:04:31
Yeah, years ago amisulpride did work great for me. It was the elevated prolactin that really screwed it up.
The only problem I foresee with the combo of amisulpride/parlodel is that it would likely reduce my weight, partially through the amisulpride dopamine and partially through the parlodel side effect of nausea. I've lost so much weight it is scary.
Posted by blueberry on March 28, 2006, at 5:52:49
In reply to Re: Just can't decide...remeron and tinnitus, posted by TenMan on March 27, 2006, at 18:28:34
> What about St. Johns Wort in combo with 5HTP?
>
>Actually I have tried these both by themselves and in combination.
5htp did nothing except make me foggy. Took 150mg to 300mg for 2 months. Lousy sleep too.
I don't think my problems are serotonin related. All that extra serotonin though somehow did really quiet down the tinnitus.St Johns Wort worked really really good starting in about 3 weeks. It lasted 3 months and then just pooped out completely. It also increased the loudness of my tinnitus quite a bit, which I was able to bear considering how well I felt.
I think with SJW it was the dopamine reuptake and the gaba reuptake that did the trick for me. The serotonin reuptake and the norepinephrine reupate I don't think were very meaningful for me. When I tapered off it, I swear I had every withdrawal symptom in the book, bigtime, for benzo withdrawals.
Posted by TylerJ on March 28, 2006, at 7:23:17
In reply to Re: Just can't decide...remeron and tinnitus, posted by blueberry on March 27, 2006, at 18:00:31
> The xanax thing is looking better all the time. I just wish I could someone know in advance how long its excellent antidepressant properties would keep working...weeks...months...years? I have never tried it more than a week, but each time was just so nice and normal it was unbelievable.
>
Many people have had very positive results with Xanax for YEARS, I know you don't like to take it, but hey, if it makes you feel "Nice and Normal" and it's unbelievable...I think you should use it.
> Also, zyprexa lessens my tinnitus quite a bit. She also said xanax is fine, which also lessens my tinnitus...soo..we'll see. Remeron and tinnitus though, not good for me.How about trying Remeron with a little zyprexa, and in combo with Xanax? Maybe then the tinnitus wouldn't be so bad.
What other AD's are you considering besides the Remeron? What have you already tried?
Tyler
Posted by deniseuk on March 30, 2006, at 9:46:10
In reply to Just can't decide what to do with meds ???, posted by blueberry on March 26, 2006, at 15:39:50
Hi,
Well, from being overwhelmed by choice, you're now being overwhelmed by other peoples suggestions :-)
Anyway, why not try Zyprexa and Xanax as and when desperate and start the Remeron?
Denise
This is the end of the thread.
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