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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by ClearSkies on December 11, 2006, at 0:05:21
I am on
Cymbalta 60mg
Lamictal 400mg
these are for bipolar IICampral 333mg, the tiniest dosage
for keeping alcoholism in remission
Enjuvia 1.25mg for estrogen (HRT therapy)
Prometrium 100mg for same
these are for a wicked perimenopauseRozerem 8mg, just started it a week ago
I cannot, cannot sleep when I go to bedI don't take benzos because of the addiction risk. I completely agree with my pdoc on this opinion.
My hair has started to shed very quickly. With fine hair, I can't afford it to thin as well.My depression and anxiety are attacking again.
Mucho family/holiday stress. Family wedding, lots of partying I don't partake in.
I am a mess and feeling worse by the minute. What the heck is going on??????
ClearSkies
Posted by lymom3 on December 11, 2006, at 0:28:50
In reply to What is happening to me?, posted by ClearSkies on December 11, 2006, at 0:05:21
I'll put my money on Lamictal for the hair loss. When you don't or can't sleep, it's a vicious cycle. Sometimes you can't sleep because you're depressed and it messes with your sleep patterns and sometimes you may not be depressed or anxious until you string together a few nights where you can't sleep and then the anxiety and depression kicks in.
Posted by ClearSkies on December 11, 2006, at 0:52:11
In reply to Re: What is happening to me?, posted by lymom3 on December 11, 2006, at 0:28:50
I think that Lamictal is doing me no good whatever right now.
Posted by blueberry on December 11, 2006, at 4:13:13
In reply to What is happening to me?, posted by ClearSkies on December 11, 2006, at 0:05:21
I'm sorry for what you are going through. I can sure relate.
It is just an opinion, but I think both of the primary meds are iffy. Lamictal is only approved for delaying the next episode, but not preventing one. Cymbalta has worked well for a few people, but generally not. Its clinical trials for depression aren't very impressive compared to other antidepressants. The best med in its category is effexor.
I think hormones have a lot to do with moods and neurotransmitter chemistry, but I do not know anything about them.
Have you tried depakote? Lithium? Zyprexa? What other antidepressants?
If and when you try to wean off cymbalta, you'll see what it feels like to be addicted to something. All the rage is about benzo withdrawals, but withdrawals from many other meds are pretty darn severe.
Just another thought...a common philosophy with top psychiatrists is that if you are bipolar, it is important to get rid of anything that accelerates or causes cycling...which includes antidepressants. The belief is to be on a couple mood stabilizers, as monotherapy with mood stabilizers doesn't usually work.
Where to go from here is tough. Please let us know what's going on.
Posted by madeline on December 11, 2006, at 6:38:51
In reply to What is happening to me?, posted by ClearSkies on December 11, 2006, at 0:05:21
I think it is very important that you start sleeping again. Insomnia just makes everything worse - depression, anxiety etc...
It might be something as simple as adjusting your estrogen dose (as I'm sure you know, menopause can really wreck your sleep patterns).
Also, there are several alternatives to benzos that may help you sleep. For instance, trazadone worked for me, but I don't know about its use in bipolar disorder. I would definately talk to your doc.
Also, when I am stressed, I shed my hair like a bobcat in july. It grows back. Does your hair loss seem to be all over your head or just in one or two places?
Posted by polarbear206 on December 11, 2006, at 7:18:36
In reply to What is happening to me?, posted by ClearSkies on December 11, 2006, at 0:05:21
> I am on
> Cymbalta 60mgYou> Lamictal 400mg
> these are for bipolar II
>
> Campral 333mg, the tiniest dosage
> for keeping alcoholism in remission
>
> Enjuvia 1.25mg for estrogen (HRT therapy)
> Prometrium 100mg for same
> these are for a wicked perimenopause
>
> Rozerem 8mg, just started it a week ago
> I cannot, cannot sleep when I go to bed
>
> I don't take benzos because of the addiction risk. I completely agree with my pdoc on this opinion.
> My hair has started to shed very quickly. With fine hair, I can't afford it to thin as well.
>
> My depression and anxiety are attacking again.
>
> Mucho family/holiday stress. Family wedding, lots of partying I don't partake in.
> I am a mess and feeling worse by the minute. What the heck is going on??????
> ClearSkies
>How long have you been on the cymbalta? You may need to increase it or switch to another ad. In my situation, cymbalta did nothing for my depression. Effexor is an excellent ad. Have you tried it? The hair loss is from the lamictal. I recently decreased my dose of lamictal from 200mg to 100mg. I started to take klonopin again and I frankly don't care about the addiction claim. I had no problem weining off of it years ago. You are on many multiple meds and it can be hard to pinpoint the culprit. Less is best. When you take more than 3 meds, your bound to get unwanted side effects drug interactions. I wouldn't mess with taking hormones when your bipolar. This can exacerbate your mood cycling. You ad should be helping with this.
polarbear
Posted by ClearSkies on December 11, 2006, at 8:57:33
In reply to Re: What is happening to me? clearskies, posted by polarbear206 on December 11, 2006, at 7:18:36
I'm encouraged to hear that I can probably change something and feel better. And sleep. And grow my hair back (the thinning is all over, and not in one or two spots).
Effexor worked wonders for me except that my blood pressure became high the longer I took it. Trazadone completely knocks me for a loop for days, even at a very low dosage. Zyprexa made me into an eating machine. I've tried other ADs. Unfortunately my memory is still messed up with this lack of sleep so I can't recall them at the moment.
At least I know that I have some options for treatment. I really appreciate everyone's input! (This is just one thing I love about babble.)
Thanks,
CS
Posted by polarbear206 on December 11, 2006, at 10:17:20
In reply to Wow - great suggestions!, posted by ClearSkies on December 11, 2006, at 8:57:33
> I'm encouraged to hear that I can probably change something and feel better. And sleep. And grow my hair back (the thinning is all over, and not in one or two spots).
>
> Effexor worked wonders for me except that my blood pressure became high the longer I took it. Trazadone completely knocks me for a loop for days, even at a very low dosage. Zyprexa made me into an eating machine. I've tried other ADs. Unfortunately my memory is still messed up with this lack of sleep so I can't recall them at the moment.
>
> At least I know that I have some options for treatment. I really appreciate everyone's input! (This is just one thing I love about babble.)
>
> Thanks,
> CS
Since effexor worked wonders for you, was there another med you were taking that would of also contributed to your elevated blood pressure while you were on the effexor? I know it can cause this in some people. I take 300mg and have no problems.Polarbear
Posted by Tomatheus on December 11, 2006, at 10:23:22
In reply to What is happening to me?, posted by ClearSkies on December 11, 2006, at 0:05:21
> Rozerem 8mg, just started it a week ago
> I cannot, cannot sleep when I go to bed
>> My depression and anxiety are attacking again.
ClearSkies,
If you've noticed a significant worsening of your depressive and anxiety symptoms within the past week, then I would suspect that the Rozerem probably has something to do with it. MedPage Today (2005) quoted FDA official Robert Meyer, M.D., as saying, "We saw in clinical trials that Rozerem could increase depression in people who are depressed." Rozerem's hypnotic effects are believed to result from the drug's ability to stimulate two melatonin receptors, MT1 and MT2. I've noticed that I usually feel significantly more depressed (and sometimes more anxious) on days following nightly melatonin administration than on most days. Others on this board have reported having similar experiences with melatonin.
If you haven't already, you might want to consider switching sleep meds. Have you tried Lunesta, Ambien, or the OTC antihistamines (diphenhydramine HCl, doxylamine succinate)?
Tomatheus
==
REFERENCE
Woznicki, K. (2005, July 25). FDA approves Rozerem for insomnia. MedPage Today. Retrieved December 11, 2006, from http://www.medpagetoday.com/PrimaryCare/SleepDisorders/tb/1414
Posted by ClearSkies on December 11, 2006, at 10:54:05
In reply to Re: What is happening to me? » ClearSkies, posted by Tomatheus on December 11, 2006, at 10:23:22
>
> If you've noticed a significant worsening of your depressive and anxiety symptoms within the past week, then I would suspect that the Rozerem probably has something to do with it.Yes, yes yes!
> If you haven't already, you might want to consider switching sleep meds. Have you tried Lunesta, Ambien, or the OTC antihistamines (diphenhydramine HCl, doxylamine succinate)?Done those :-( I had an allergic reaction to Lunesta (hives), Ambien causes severe cognitive problems, and antihistamines make me sleepy but really wired, and I eventually wake up exhausted. I have also tried Sonata and Vistaril with no relief.
I have a call in to my pdoc to get in to see her this week. I feel as if I have taken an enormous leap backwards in the past week. Just ghastly.
Thanks!
CS
Posted by ClearSkies on December 11, 2006, at 10:56:29
In reply to Re: Wow - great suggestions!, posted by polarbear206 on December 11, 2006, at 10:17:20
> Since effexor worked wonders for you, was there another med you were taking that would of also contributed to your elevated blood pressure while you were on the effexor? I know it can cause this in some people. I take 300mg and have no problems.
>
> PolarbearMy bp went up when the effexor dose was higher than 150mg (at which it didn't actually work for me). I also took Wellbutrin with the effexor, although I think it created more problems than it solved... agitation for me.
CS
Posted by Phillipa on December 11, 2006, at 11:25:46
In reply to Re: Wow - great suggestions! » polarbear206, posted by ClearSkies on December 11, 2006, at 10:56:29
Clear Skies I'm sure you've had your thyroid checked but hair thinning is a sign of thyroid being out of wack. And during the stage of life you're in expect hormones to change thyroid being one. Right now my hair is doing the same thing and I know it's from the thyroid. Love Phillipa
Posted by Tomatheus on December 11, 2006, at 11:48:04
In reply to Re: What is happening to me? » Tomatheus, posted by ClearSkies on December 11, 2006, at 10:54:05
> > If you haven't already, you might want to consider switching sleep meds. Have you tried Lunesta, Ambien, or the OTC antihistamines (diphenhydramine HCl, doxylamine succinate)?
>
> Done those :-( I had an allergic reaction to Lunesta (hives), Ambien causes severe cognitive problems, and antihistamines make me sleepy but really wired, and I eventually wake up exhausted. I have also tried Sonata and Vistaril with no relief.I'm sorry to hear this :(
Maybe you could try reducing your dose of Rozerem? Valerian also might be worth looking into, if that's something that you also haven't already tried.
> I have a call in to my pdoc to get in to see her this week. I feel as if I have taken an enormous leap backwards in the past week. Just ghastly.
Ugh... I do feel for you, and I wish that there were more that I could say or do to help. It does sound like the Rozerem is probably contributing to the worsening in your depressive/anxiety symptoms, along with the added situational stress.
When you call your pdoc, could you ask her to suggest some possible alternatives to 8 mg of Rozerem (even if that might just mean reducing your dose) that might allow you to sleep well at night without causing you to feel too depressed and anxious during the day? That's probably the best thing that I can suggest at this point.
Tomatheus
Posted by emme on December 11, 2006, at 13:46:07
In reply to What is happening to me?, posted by ClearSkies on December 11, 2006, at 0:05:21
Hi. For your sleep problems, have you considered a low dose of seroquel? I could not tolerate trazodone, lunesta, rozerem, or ambien. Melatonin did not work well and made me more depressed. About 6 mg of seroquel has worked better for me than anything else, and feels the most natural as far as getting drowsy and drifting off. Hope you feel better.
emme
Posted by dreamboat_annie on December 11, 2006, at 18:08:26
In reply to What is happening to me?, posted by ClearSkies on December 11, 2006, at 0:05:21
I'm so sorry, clearskies :-( One thing that may be aggravating things is the prometrium. Some women find it can cause or worsen depression, especially if it is taken everyday. If you are taking it everyday, perhaps you can cycle it instead (last 14-28 days of your cycle). A friend of mine cycles hers, rather than taking it continuously, and that has helped. You can also talk to your doctor about another form of bio-identical progesterone (suppository form)which, I think, is taken less often and does not cause depression. My own doctor told me that cycling is perfectly fine and safe, and that it is an individual thing (some women prefer continuous and others cycled).
The other thing is the Xanax. I understand your reluctance and fear to useit, but perhaps if you just use it during those exceptionally high anxiety times, it would quell the anxiety enough that it doesn't get out of control and exacerbate your depression. I have found that if I leave my anxiety unchecked, I can end up in a really, really bad way (meaning - quite depressed). I understand, though, your trepidation. I, too, am an alcoholic (many years sober), but I have had Xanax on hand since the early days of my sobriety (as prescribed by my doctor who knows of my alcoholism) and I have never abused it. It is very, very rare that I will even use more than .25mg a day and then I only use it until I get the anxiety under control. I am terrified of becoming addicted to another substance. I am a more anxious person than a depressed person, but if I am spinning out of control internally with anxiety, I become depressed. Just a few days anxiety-free and my mood improves.
Anyway, just my thoughts. Take care, and I hope things start to improve for you really soon.
> I am on
> Cymbalta 60mg
> Lamictal 400mg
> these are for bipolar II
>
> Campral 333mg, the tiniest dosage
> for keeping alcoholism in remission
>
> Enjuvia 1.25mg for estrogen (HRT therapy)
> Prometrium 100mg for same
> these are for a wicked perimenopause
>
> Rozerem 8mg, just started it a week ago
> I cannot, cannot sleep when I go to bed
>
> I don't take benzos because of the addiction risk. I completely agree with my pdoc on this opinion.
> My hair has started to shed very quickly. With fine hair, I can't afford it to thin as well.
>
> My depression and anxiety are attacking again.
>
> Mucho family/holiday stress. Family wedding, lots of partying I don't partake in.
> I am a mess and feeling worse by the minute. What the heck is going on??????
> ClearSkies
>
Posted by ClearSkies on December 13, 2006, at 17:00:58
In reply to Wow - great suggestions!, posted by ClearSkies on December 11, 2006, at 8:57:33
A couple of things have transpired...
Rozerem definitely does not work for me. After 10 days I have still not been able to fall asleep. I do not stay asleep. I am plenty tired - mostly due to lack of sleep - but it's my crazy-monkey-mind's jumping around that prevents me from falling asleep. Also, my hair is falling out (I think I shared that already).I happened to see my GYN today for an appointment, and I mentioned these 2 symptoms, wondering if hormones/thyroid might be the problem. She asked about all the other meds I am on, and said, "sounds like you really need an anti-anxiety drug so your mind will rest enough to let you sleep." Sheer brilliance.
So I toodled off to the pdoc to tell her that I wasn't sleeping on Rozerem and my hair is shedding. Hmm, she said, Rozerem can do that sometimes. Better stop taking it. OK, so what next? She suggested Pamelor, about which I know nothing. She said, it causes sedation, and the side effects are constipation and weight gain. Gaaack!!
I started to cry. I can't GET any more constipated than I am - a daily dose of Metamucil is working, but I daren't skip a day. The weight I've gained to date while on antidepressants has afflicted enough damage to my poor self esteem already. I can't willingly take another medication that "should" make me sleepy, and will most likely cause those other 2 side effects.So, here is the BIG mistake I made - I told her about my GYN's suggestion. That an antianxiety med would probably let my mind calm down enough so my natural tiredness would put me to sleep. Oh, no, she said, xanax (or any other benzo) could trigger an increased dependence on alcohol. I did see the hair on the back of her neck stand up as soon as I mentioned this other doctor. I said, can you see that I am frustrated? I went to one doctor with my complaint, who gave me a recommendation and sent me off to my pdoc for treatment.
Yes, she says, but MY specialty is in psychiatry, and your other doctor's specialty is gynocology. I didn't want to start defending my GYN's qualifications, like how she was going to pursue psychiatry as her specialty before finally deciding on being a GYN.Pdoc was completely huffy by this time. Why don't you speak with my doctor, I said, and get this resolved. I really don't want one doctor telling me to do one thing and another doctor telling me to do another. I signed a release form and gave her my GYN's card so they can "chat".
I left the pdoc's office without paying or making another appointment. I was going to leave the scrip for Pamelor behind altogether, but figured that I don't want her to fire me before I can do it first.The lack of appreciation for the unintended impact the myriad of drugs have on our bodies is downright insulting. Giving me a prescription for Pamelor and telling me to take Metamucil and exercise more to deal with the side effects is frankly, an insult to me. Oh, and she suggested that instead of Metamucil that I take a fiber supplement. To this, I just stared at her. It *is* a fiber supplement, I said. Has a laxative effect at higher dosages, and acts as a fiber supplement at lower doses. Besides, I said, my intention is not to take MORE pills and supplements, but less.
Quite a rant I have here.
I'm thinking this stuff through. I am going to ask my therapist if she can recommend a pdoc (this one has never called her for a consult although I have offered for her to do so many times). I can also talk with my GP and ask for him to either take over my treatment or recommend another pdoc.Right now, though, I just want to calm down, and later, to sleep tonight. Just writing all this venom and frustration down has helped a lot.
Posted by Phillipa on December 13, 2006, at 20:18:04
In reply to I think I want to fire my pdoc., posted by ClearSkies on December 13, 2006, at 17:00:58
Clear Skies welcome to the club I so relate to you. I will think of you tonight as I do the same. Oh I have the benzos but now supposedly I'm tolerant and the seroquel that was prescribed. I am not psychotic and do not want diabetes since it runs in my family along with all the other autoimmune diseases. That's horrible where are these"teams" that we are told will treat us? Lucky for you you've had your GP for a while so he/she knows you and your history. I'm truly sorry. Love Phillipa
Posted by ClearSkies on December 15, 2006, at 0:58:04
In reply to Re: I think I want to fire my pdoc. » ClearSkies, posted by Phillipa on December 13, 2006, at 20:18:04
I am going to pursue a second opinion. Re evaluate my dx, my meds, factor in my age and the effects of hormonal changes on my moods.... I just think that my current pdoc is too firm in her beliefs; whenever I have suggested a medication that may be suitable for treating my complaints, she not only poo-poo's them but is plainly annoyed that I am even the least bit educated regarding the medications I am on.
Let's face it - Lamictal, which is supposedly regulating or flattening out my mood swings? is doing neither. I have equally expressive meltdowns while on this medication as I did before I took it. Anxiety was lessened, yes. But never to the point of beig able to rest enough to sleep.
More later.
Posted by yxibow on December 15, 2006, at 4:12:02
In reply to Re: I think I want to fire my pdoc. » ClearSkies, posted by Phillipa on December 13, 2006, at 20:18:04
> Clear Skies welcome to the club I so relate to you. I will think of you tonight as I do the same. Oh I have the benzos but now supposedly I'm tolerant and the seroquel that was prescribed. I am not psychotic and do not want diabetes since it runs in my family along with all the other autoimmune diseases.
I can sympathize but it is unlikely to cause diabetes at 25mg -- try 800, I fight it at the gym though I fortunately dont have any indications of type II. And I still encourage therapy for you Jan, and some slow migration to doing something out of the house, which would easily mitigate any weight gain -- volunteer work or something. I don't know. I'm just doing a segue here but I think its worthwhile to note.
That's horrible where are these"teams" that we are told will treat us? Lucky for you you've had your GP for a while so he/she knows you and your history. I'm truly sorry. Love Phillipa
Doctors generally don't like interference from others in different specialties -- some of this is arrogance perhaps, but there's also some truth to it all. The good ones, and admittedly this doesn't sound particularly great, do so because they have formed relations with others in their field and have instant knowledge in their mind of patients that they have treated with drug X.
When a drug falls out of their specialty, some will do it cautiously, and others will refer you back to your GP because a psychiatrist will know about prescribing Xanax, etc., but will not necessarily feel comfortable prescribing thyroid medication or an antibiotic because its just not their field and they feel the risk is too great.
Some medications, like clonidine, fall within both specialties, so either is more likely to prescribe.
Nonetheless, you have to build a rapport with a doctor and this takes time, and if you aren't happy with your psychiatrist, then say so and be direct about it and speak up. It is an unproductive use of time if both parties are at a loggerhead.-- tidings
Posted by Phillipa on December 15, 2006, at 20:56:30
In reply to Re: I think I want to fire my pdoc. » Phillipa, posted by yxibow on December 15, 2006, at 4:12:02
Jay I'm working on getting out more. Confirmed we will go to Florida to see my Daughter at Christmas and this is a big deal to me at this point. I just don't like seroquel and am waiting for a possible new pdoc. Love Phillipa ps Clear Skies did you sleep last night?
Posted by dreamboat_annie on December 15, 2006, at 21:16:45
In reply to Re: I think I want to fire my pdoc. » yxibow, posted by Phillipa on December 15, 2006, at 20:56:30
Hi Phillipa,I just wanted to let you know that, while I have never tried Seroquel, a friend of mine has been on it for close to a year and is doing very well. She has recurring depression, anxiety and more often than not can't sleep at night. She used to have a lot of fears about doing certain things (taking the bus, going places without her husband, except to work and even then he drove her and picked her up, being in the house alone . . .). Anyway, she is on the lowest dose of Seroquel, which she takes at night. She gets a great night's sleep, her anxiety has subsided and she is no longer fearful of doing things like riding the bus, being alone in the house, etc. I know it is scary to think about taking an antipsychotic, but, they aren't just for people with psychosis. My friend does not have any pyschotic features at all. I think at a certain point you just have to give the meds a chance to do what they are supposed to do, and try not to label yourself because of the med you are taking.
I hope you find some relief soon.
Take care.
Posted by dreamboat_annie on December 16, 2006, at 20:49:09
In reply to At the very least, posted by ClearSkies on December 15, 2006, at 0:58:04
is the form of estrogen you are on. It is made up of ten conjugated SYNTHETIC estrogens. The systhetic nature of the estrogen could be causing problems (and the fact that there are 10 types in it). Maybe you could ask your GYN to let you try some bio-identical estrogen, in a patch form (so it doesn't have that first pass through the liver, which can result in side effects). Vivelle Dot or Estrace are supposed to be good. A friend of mine has been using Viville Dot with good results and no side effects for a number of months.
Just some thoughts.
Posted by dreamboat_annie on December 16, 2006, at 21:05:27
In reply to The other thing that could be causing problems » ClearSkies, posted by dreamboat_annie on December 16, 2006, at 20:49:09
That the studies that have been done on estrogen for depression have been with 17-beta estrogen (hope I have that right), which is what you would get with Vivelle Dot, Estrace and, I think Climara. If I am remembering right, the author of "Screaming to be Heard" refers to 17-beta as well and does not recommend conjugated estrogens.
Ok, that's it for me.
This is the end of the thread.
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