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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Izzy50 on August 27, 2006, at 20:50:40
I am still experiencing extreme daytime fatigue.
Since increasing the Ambien by 5g. I have been sleeping at night.
At about 9pm I take 1 1/2 Ambien, Effexor, and propalonol.
In the morning I take 10 mg hydrocortone,Armour 4.5 grains, hormones(testosterone, estrodial,) and the Lamictal. (I am on day 23 at 50mg)
Getting out of bed and staying awake is difficult. I wake at 6:45AM for work.
My depression is easing, but the fatigue is not.
Posted by jealibeanz on August 27, 2006, at 21:51:19
In reply to Daytime Fatigue, posted by Izzy50 on August 27, 2006, at 20:50:40
I'm experiencing major depression-related fatigue right now. I've never clearly understood why it occurs or how it subsides. But I need my energy and motivation back so I can physically get through the day without laying in bed for 18 hours! :(
Posted by Emily Elizabeth on August 27, 2006, at 22:34:36
In reply to Daytime Fatigue, posted by Izzy50 on August 27, 2006, at 20:50:40
Is there a reason that you take Effexor at night? It is pretty stimulating, which might explain why you need the extra ambien. It might help you perk up during the day if you take it in the AM. Also, some people find Lamictal sedating and prefer to take it at night. Would some switching around be possible for you?
Best,
EE
Posted by jealibeanz on August 27, 2006, at 22:55:12
In reply to Re: Daytime Fatigue, posted by Emily Elizabeth on August 27, 2006, at 22:34:36
When I took Effexor, I'd take it as soon as I woke up. It was very energuzing and stimulating, yet I slept through the night.
Posted by Tom Twilight on August 28, 2006, at 4:25:52
In reply to Re: Daytime Fatigue, posted by jealibeanz on August 27, 2006, at 22:55:12
Good daytime fatigue is annoying!
I take Nardil and makes me tired 24-7
Because I live in the UK there's no chance of augmenting with anything.
I take Caffeine in the Morning, and use Provigil sometimes.
I had a frustrating time with Effexor, it gave me insomnia, but did nothing for depression and made me more fatigued than ever.
I'm going to have to travel to the US sooner or later, for treatment, but thats another story....
What really helped me was adding Remeron to Effexor, I slept at night, but had more energy and better mood during the day.
Only problem with Remeron is weight gaine.
Posted by gardenergirl on August 28, 2006, at 7:18:10
In reply to Re: Daytime Fatigue-Nardil, posted by Tom Twilight on August 28, 2006, at 4:25:52
I used to get that with Nardil, too. Napping was something I was quite skilled at, unfortunately. What helps me with that is Provigil and light therapy every day. I actually haven't taken an afternoon nap (often 2+ hours!) more than once or twice in the last several months.
gg
Posted by Phillipa on August 28, 2006, at 10:19:30
In reply to Re: Daytime Fatigue-Nardil, posted by gardenergirl on August 28, 2006, at 7:18:10
I'm always tired and the heat isn't helping. But taking a med in the am hasn't been suggested yet. Love Phillipa
Posted by jealibeanz on August 28, 2006, at 11:34:35
In reply to Re: Daytime Fatigue-Nardil, posted by gardenergirl on August 28, 2006, at 7:18:10
How do you all get Provigil prescribed? I mentioned I've taken it before to my PA and he acting like it was crack. I'd love to have it right now since I'm barely functioning due to my lack of sleep. :(
Posted by Tom Twilight on August 28, 2006, at 16:05:45
In reply to Re: Daytime Fatigue-Nardil, posted by gardenergirl on August 28, 2006, at 7:18:10
Sorry once again I hijacked a thread!
Unfortunatly, Provigil doesn't do much for my fatigue.
I've been thinking of using Adrafinil or Desipramine.
Unfortunatly I'm not sure about the safey of Adrafinil with Nardil, and Desipramine sounds a bit scary!Jealibeanz, I'm sorry to hear you doctor is being a pain, there are plenty of places to order Provigil on the net.
Can't name any though all I'll get barred!
Does anyone have any other advice?
Would raising my Blood Pressure help fatigue?
Posted by jealibeanz on August 28, 2006, at 16:36:12
In reply to Re: Daytime Fatigue-Nardil-jealibeanz, posted by Tom Twilight on August 28, 2006, at 16:05:45
I didn't ask my doctor about it. I mentioned it to my PA when we were talking about ADHD meds. He said "we don't use that one here anymore". I didn't really ask why. I'm not sure if he meant for ADHD or at all. Probably for ADHD, but maybe not ever. It's not a medication that a family practice has to utilize, since it's only FDA approved for narcolepsy, only very rare patients meet that criterion.
I could ask my doc. I actually might mention to him that I was prescribed it once before when I went through my "non-stop sleeping phase", which I now recognize as depression, and am currently going through again.
Yup, I've got some ordered and should be arriving this week or next week. It's how I've obtained it in the past. However, it's expensive (my insurance would cover it, and with a verrry low copay). Plus, I'd like to be treated fully by my doctor, not try to hide things and fill in gaps by myself. That's not in my best interest, long-term.
Posted by Izzy50 on August 28, 2006, at 17:22:48
In reply to Re: Daytime Fatigue-Nardil-jealibeanz, posted by jealibeanz on August 28, 2006, at 16:36:12
Thanks everyone- I will switch my Effexor to AM and Lamictal to PM.
I see my shrink again tomorrow so I'll get some provigil to tide me over. I just don't want to burn my adrenals out.
I hate being tired. I usually love yoga, running, weights. I haven't done a thing in months.
Last night I forgot to take my Ambien. Got into bed and after about an hour my heart stared pounding and I was wide awake. My pulse is always around 17-18 beats per 15 seconds when it feels like my throat is going to close-I get headaches too.
Propalonol makes me tried and I have been gaining weight on it too. Maybe I should try another beta blocker. Nothing seems to help.
It is a MISERABLE way to live.
Posted by llrrrpp on August 28, 2006, at 20:14:36
In reply to Re: Daytime Fatigue, posted by Izzy50 on August 28, 2006, at 17:22:48
Hi Izzy,
is it possible to try seroquel rather than ambien at night? The seroquel really helps keep me calm, and has an anxiolytic effect.I'm on cymbalta, which is an SNRI, like effexor. Funny how in the long run it is probably GOOD for my anxiety, but shortly after taking it, I will get noticeble sympathetic nervous system effects. I have been wearing deoderant to bed (tmi, right?!) and my heart rate goes through a little pounding and I also feel a tad sick to my stomach and have some strange visual distortions/disorientation.
I take cymbalta at night, because I'd rather deal with this in bed than at work. I also enjoy breakfast as the healthiest and happiest meal I eat all day!
I take seroquel, because it is very sedating and has few side effects. Ambien tends to hit me really hard, but has little power to *keep* me asleep, and then when I wake up, I cannot sleep much longer. On the rare occasions I have woken up within 3 hours of dosing, I have had very very strange hallucinations.
I asked pdoc for something to help me with daytime drowsiness. I told him that I was drinking 4-5 humongous cups of coffee/cola, and that the caffeine was making me incredibly jittery, but that I could still fall asleep at the drop of a hat. I can even fall asleep right here on your couch, I said! I was taking 2 naps before noon and 2 naps after noon. ugh. He suggested provigil. MAN. made all the difference.
This past month, I have been feeling SOOOO much better. I actually have energy to fight back the parts of my "environment" that cause me stress. Having power and energy to improve my situation is really good for my depression.
I couldn't take provigil 4 days last week. I was back to my napping schedule. No amount of caffeine could rouse me, although I had no problem getting OUT of bed, I would crash 45 mins later, like clockwork.
That's my LOOONG story. Can't tolerate much caffeine. Sudafed & even albuterol (asthma inhaler) make me feel super jittery and super crappy! (guessing that I'd not be a good candidate for amphetamine-type stimulants.
Provigil keeps me awake, but not too stimulated.
-ll
Posted by jealibeanz on August 28, 2006, at 20:22:27
In reply to Re: Daytime Fatigue » Izzy50, posted by llrrrpp on August 28, 2006, at 20:14:36
I can say the same thing about my fatigue, except that one nights before class, I'm too anxious to sleep. Otherwise, I take 4-5 naps a day! That's what I used to do too, but without the insomnia at night. I'd sleep 8-9 hours at night. Get up, eat breakfast, go back to bed. Go to a class, go to bed. Go to class, go to bed, Go to class, go to bed. Go to sports practice, nighttime nap. Wake eat a little, Go to sleep for the night. Always terribly tired and unhappy, disconnected because I was living in the real world, I was asleep and agitated because of it.
Posted by Izzy50 on August 28, 2006, at 21:23:49
In reply to Re: Daytime Fatigue » Izzy50, posted by llrrrpp on August 28, 2006, at 20:14:36
> Hi Izzy,
> is it possible to try seroquel rather than ambien at night? The seroquel really helps keep me calm, and has an anxiolytic effect.
>
> I'm on cymbalta, which is an SNRI, like effexor. Funny how in the long run it is probably GOOD for my anxiety, but shortly after taking it, I will get noticeble sympathetic nervous system effects. I have been wearing deoderant to bed (tmi, right?!) and my heart rate goes through a little pounding and I also feel a tad sick to my stomach and have some strange visual distortions/disorientation.
>
> I take cymbalta at night, because I'd rather deal with this in bed than at work. I also enjoy breakfast as the healthiest and happiest meal I eat all day!
>
> I take seroquel, because it is very sedating and has few side effects. Ambien tends to hit me really hard, but has little power to *keep* me asleep, and then when I wake up, I cannot sleep much longer. On the rare occasions I have woken up within 3 hours of dosing, I have had very very strange hallucinations.
>
> I asked pdoc for something to help me with daytime drowsiness. I told him that I was drinking 4-5 humongous cups of coffee/cola, and that the caffeine was making me incredibly jittery, but that I could still fall asleep at the drop of a hat. I can even fall asleep right here on your couch, I said! I was taking 2 naps before noon and 2 naps after noon. ugh. He suggested provigil. MAN. made all the difference.
>
> This past month, I have been feeling SOOOO much better. I actually have energy to fight back the parts of my "environment" that cause me stress. Having power and energy to improve my situation is really good for my depression.
>
> I couldn't take provigil 4 days last week. I was back to my napping schedule. No amount of caffeine could rouse me, although I had no problem getting OUT of bed, I would crash 45 mins later, like clockwork.
>
> That's my LOOONG story. Can't tolerate much caffeine. Sudafed & even albuterol (asthma inhaler) make me feel super jittery and super crappy! (guessing that I'd not be a good candidate for amphetamine-type stimulants.
>
> Provigil keeps me awake, but not too stimulated.
>
> -llThat's a thought-trying the seroquil at night.
Ambien does not always keep me asleep either. Ambien has given me "crack" dreams-so does Effexor when I play with my doses.
I will try the Provigil and pray it doesn't give me heart a new reason to pound out of my chest.
It would be so good to be able to do the things I used to love doing. Dance, yoga, weight traing, running,
Right now, I am lucky to get my body out of bed and it hurts me all over. I think it is from lying down too much-inactivity. Th eold eat/sleep syndrome.
Posted by Izzy50 on August 28, 2006, at 21:29:40
In reply to Re: Daytime Fatigue, posted by jealibeanz on August 28, 2006, at 20:22:27
> I can say the same thing about my fatigue, except that one nights before class, I'm too anxious to sleep. Otherwise, I take 4-5 naps a day! That's what I used to do too, but without the insomnia at night. I'd sleep 8-9 hours at night. Get up, eat breakfast, go back to bed. Go to a class, go to bed. Go to class, go to bed, Go to class, go to bed. Go to sports practice, nighttime nap. Wake eat a little, Go to sleep for the night. Always terribly tired and unhappy, disconnected because I was living in the real world, I was asleep and agitated because of it.
My God< I can relate so much. That's just what I did on Sunday. Got up. made coffee/fed dogs back to bed. Got up, cleaned kitchen, went back to bed. Got up at two, went food shopping,cooked a pot of sauce, took a nap,Layed on the couch eating fruit and yogurt while watching tv.
Still thinking that everybody's an *sshole...
Not good to be in my head these days.
Posted by Izzy50 on August 30, 2006, at 5:03:22
In reply to Daytime Fatigue, posted by Izzy50 on August 27, 2006, at 20:50:40
I saw my shrink today. He thinks that we are on the right track with the lamictal. As far as the heart palps and anxiety, he wants to wait another month and see if the Lamictal will take of that. I am only on week four at 50mg.
For the daytime fatigue, he gave me a free 7 day supply of Provigil. He gave me the trial supply in case it causes further agitation/stimulation of heart palps. He said I could go down to 1/4 of a pill if I wanted to.
My mood seems to getting better. It is hard to say because I am not experiencing a linear process. This morning I am up at 5:30 with good energy. We'll see how I feel at 9AM.
My thinking is fuzzy-not sharp. Sometimes my head feels as though it is underwater. It amazes me how well I function at work despite my mental handicapps.
I hope I can start to do some exercising soon without taking four days to recover.
Thank you all for supporting me through this difficult time.
Posted by jealibeanz on August 30, 2006, at 5:36:01
In reply to Re: Daytime Fatigue, posted by Izzy50 on August 30, 2006, at 5:03:22
What's your diagnosis Izzy?
Posted by Izzy50 on August 30, 2006, at 17:16:12
In reply to Re: Daytime Fatigue, posted by jealibeanz on August 30, 2006, at 5:36:01
> What's your diagnosis Izzy?
Depression/Bipolar II
Posted by Izzy50 on August 31, 2006, at 19:13:38
In reply to Re: Daytime Fatigue, posted by jealibeanz on August 30, 2006, at 5:36:01
Saw my shrink last night.
He gave me Provigil to combat the daytime fatigue until we get the Lamictal up to a therapeutic dose.
Of course if it produces more anxiety I am to stop taking it.
I am feeling better today with the Provigil. A little hyper-I think. Anything above dead is hyper to me lately.
I asked him if the Effexor could be causing my heart palps. He said yes, but after all this time,(2 years) unlikely.
When I become stable, we can try trying lowering the dose slowly, but he has reservations..
I actually cleaned my car today and bought new mats-that is miraculous.
It is amazing to me how much depression/mental illness can affect one's (my) physical well being. I can see now that I was INCAPABLE of doing many everyday tasks. Somewhere in my psyche I believed that I was just lazy or a bad person.
I call it "the beating after the beating"
I still have a ways to go-but I hope I am on my way up. (in a good way):)
Posted by Izzy50 on September 2, 2006, at 10:59:56
In reply to Re: Daytime Fatigue/Provigil, posted by Izzy50 on August 31, 2006, at 19:13:38
100 mg Provigil gave me fierce headache and palps on day two.
I cut it down to 50 mg this morning-we'll see. I don't think it's going to work for me.
Posted by alohashirt on September 9, 2006, at 0:29:42
In reply to Re: Daytime Fatigue/Provigil » Izzy50, posted by Izzy50 on September 2, 2006, at 10:59:56
The headaches disappear> 100 mg Provigil gave me fierce headache and palps on day two.
> I cut it down to 50 mg this morning-we'll see. I don't think it's going to work for me.
This is the end of the thread.
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