![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by JerryPharmStudent on June 18, 2007, at 7:22:15
Many of you know my med history and history with server treatment-resistant depression. It' just seem TOO weird to NOT being able to respond well enough on all these different meds, cocktails over the past 15 years. SOMETHING has to be causing my TRD. SOMETHING has to be causing my intolerance and resistance to meds. I NEED my life back. If I don't get it back soon I will die- I know this.
So I BEG you - my friends on this board to lend me your opinions and advice. There HAS to be something that will bring me out of this darkness and let me return to life.
Currently on BuSpar 30mg 2x daily
Adderall 20mg 3x daily
Klonopin 1mg 4x daily
Hydrocodone 5g 4x daily
Ambien CR 12.5 mg hs
Lexapro 20mgMy current symptoms:
- Server lack of motivation (which hydrocodone help tremendously but is not a long term solotuion)
- Severe anticipatory anxity/panic attacks/social discomfort
- Extreme dysphoria
- Periods of insomnia
- Overwheling thoughts of all my stressors
-Fatigue
- weight gain
-NO sexual pleasure at ALL
- Feeling numb emotionally
-hopelessness
- Lack of stamina
- VERY low self-esteem
the list goes on and onI live in a small town with only ONE pdoc. He's an "effexor/antipsychotic " believer - meaning he prescribes Effexor for everyone and Antipsychotics like Geodon for everything from bipolar disorder to anxity, to insomnia to depression.
Of course my case is different. He sees my 15 years of med trials and can't come up with anything creative.
The bottom ALWAYS feels like it's going to or is falling out underneath me. There HAS to be something that will work - either a certain cocktail or a med used off label (although I'm on many offlabel treatments now).
Choices:
Abilify?
Effexor + Lithium?
SSRI + Tricyclic?
Addition of Lamictal?If I am OFF stimulants - I sit on my couch staring at the wall. If someone were to (God forbid) die in my family I wouldn't "care." I NEED to /want to feel a sense of STABILIZATION - but those kind of meds only seem to add to my growing weight gain problems and cognitive impairment.
I've recently started having problems with my short and long-term memory which really worries me. I almost feel as if all these meds over the years have simply burned out all my neurons in my brain.
I have NO sexual desire and have not had an erection in 4 months.
Sunny days make me MORE anxious and depressed compared to days that are rainy and/or overcast.
I have a terrible intolerance to heat.
Go off everything? I've tried that. Doesn't work.
So PLEASE PLEASE - post your ideas - thoughts - suggestions - advice - ANYTHING. I NEED to return to life before I end it.
I see my Pdoc today at 2:45PM central time USA
If you are wondering what I have tried - I have tried EVERYTHING - every SSRI, benzo, MAOI, ECT, VNS, Testosterone and cortisol replacement therapies, vitamins, Fish oil, magnesium supplements - you name it.
There HAS TO BE AN ANSWER. I am a 35 year old male and was diagnosed at 20. I have been in therapy for 15 years as well. I've seen endocrinologists who found out my testosterone levels were low along with my cortisol levels - but it was never followed up.
What if there is a 'dysfunction" in my HPA axis? Hormones? Thyroid seems to be within limits. What if this has nothing to do with serotonin? What about problems with blood glucose levels?
Depression, OCD, anxiety run VERy strong in my family - however no one has been treatment resistant like me.
WHAT'S WRONG!?
Please - anyone - maybe you see something that I've missed - something that could be helped or investigated- but be reminded I have NO health insurance and no access to public aid medical assistance as of yet - so complex testing is out of the question.
I cannot continue unliving my life like this. PLEASE - anyone - help
Thanks
Jerry
Posted by gardenergirl on June 18, 2007, at 8:44:42
In reply to See my Pdoc today - PLEA for advice! PLEASE HELP, posted by JerryPharmStudent on June 18, 2007, at 7:22:15
Hi Jerry,
I don't have the knowledge of med combos to answer your question in detail. I just wanted to tell you about my lithium experience. I've been on Nardil for a few years now, and it's been the only AD to effect my atypical depression. I've had to augment it in order to really get all of the depression. It wasn't until I added Lithium to the mix, in a low dose, that I started to feel depression-free. I've had relatively few side effects, and those have become manageable by drinking more water, and are pretty much no longer a problem.So lithium might be an easy thing to add, plus it's cheap. You do have to have bloodwork to monitor the blood levels, though in my case that hasn't been intrusive at all. It might be for those on higher doses, though.
At any rate, I think very highly of lithium.
I hope you and your doc put together the right plan for you and that you find some true relief very soon.
Take care and let us know how it goes.
gg
Posted by Viking on June 18, 2007, at 9:03:53
In reply to See my Pdoc today - PLEA for advice! PLEASE HELP, posted by JerryPharmStudent on June 18, 2007, at 7:22:15
Hi Jerry
Very sorry to hear you are feeling so bad.
If I remember correctly, you once mentioned that tricyclics had helped you. Why not try that again? Some of them (but not all!!) can be combined with SSRIs and probably also Effexor. Here is some articles on the subject:
http://www.psychotropical.com/dual_action_ads.shtml
http://www.psychotropical.com/Antidepressants_Choices_TCAs_vs_the_rest.shtml
brgds
Viking
Posted by polarbear206 on June 18, 2007, at 9:25:37
In reply to See my Pdoc today - PLEA for advice! PLEASE HELP, posted by JerryPharmStudent on June 18, 2007, at 7:22:15
> Many of you know my med history and history with server treatment-resistant depression. It' just seem TOO weird to NOT being able to respond well enough on all these different meds, cocktails over the past 15 years. SOMETHING has to be causing my TRD. SOMETHING has to be causing my intolerance and resistance to meds. I NEED my life back. If I don't get it back soon I will die- I know this.
>
> So I BEG you - my friends on this board to lend me your opinions and advice. There HAS to be something that will bring me out of this darkness and let me return to life.
>
> Currently on BuSpar 30mg 2x daily
> Adderall 20mg 3x daily
> Klonopin 1mg 4x daily
> Hydrocodone 5g 4x daily
> Ambien CR 12.5 mg hs
> Lexapro 20mg
>
> My current symptoms:
> - Server lack of motivation (which hydrocodone help tremendously but is not a long term solotuion)
> - Severe anticipatory anxity/panic attacks/social discomfort
> - Extreme dysphoria
> - Periods of insomnia
> - Overwheling thoughts of all my stressors
> -Fatigue
> - weight gain
> -NO sexual pleasure at ALL
> - Feeling numb emotionally
> -hopelessness
> - Lack of stamina
> - VERY low self-esteem
> the list goes on and on
>
> I live in a small town with only ONE pdoc. He's an "effexor/antipsychotic " believer - meaning he prescribes Effexor for everyone and Antipsychotics like Geodon for everything from bipolar disorder to anxity, to insomnia to depression.
>
> Of course my case is different. He sees my 15 years of med trials and can't come up with anything creative.
>
> The bottom ALWAYS feels like it's going to or is falling out underneath me. There HAS to be something that will work - either a certain cocktail or a med used off label (although I'm on many offlabel treatments now).
>
> Choices:
>
> Abilify?
> Effexor + Lithium?
> SSRI + Tricyclic?
> Addition of Lamictal?
>
> If I am OFF stimulants - I sit on my couch staring at the wall. If someone were to (God forbid) die in my family I wouldn't "care." I NEED to /want to feel a sense of STABILIZATION - but those kind of meds only seem to add to my growing weight gain problems and cognitive impairment.
>
> I've recently started having problems with my short and long-term memory which really worries me. I almost feel as if all these meds over the years have simply burned out all my neurons in my brain.
>
> I have NO sexual desire and have not had an erection in 4 months.
>
> Sunny days make me MORE anxious and depressed compared to days that are rainy and/or overcast.
>
> I have a terrible intolerance to heat.
>
> Go off everything? I've tried that. Doesn't work.
>
> So PLEASE PLEASE - post your ideas - thoughts - suggestions - advice - ANYTHING. I NEED to return to life before I end it.
>
> I see my Pdoc today at 2:45PM central time USA
>
> If you are wondering what I have tried - I have tried EVERYTHING - every SSRI, benzo, MAOI, ECT, VNS, Testosterone and cortisol replacement therapies, vitamins, Fish oil, magnesium supplements - you name it.
>
> There HAS TO BE AN ANSWER. I am a 35 year old male and was diagnosed at 20. I have been in therapy for 15 years as well. I've seen endocrinologists who found out my testosterone levels were low along with my cortisol levels - but it was never followed up.
>
> What if there is a 'dysfunction" in my HPA axis? Hormones? Thyroid seems to be within limits. What if this has nothing to do with serotonin? What about problems with blood glucose levels?
>
> Depression, OCD, anxiety run VERy strong in my family - however no one has been treatment resistant like me.
>
> WHAT'S WRONG!?
>
> Please - anyone - maybe you see something that I've missed - something that could be helped or investigated- but be reminded I have NO health insurance and no access to public aid medical assistance as of yet - so complex testing is out of the question.
>
> I cannot continue unliving my life like this. PLEASE - anyone - help
>
> Thanks
>
>
> Jerry
>
>
>
>Jerry,
I think the best thing IMO is to keep the number of medications you are taking to a minimum. The combination of all of these drugs is dramatically impairing and having an adverse reaction on you. I would ditch the stimulant and opt for a more activating AD like Effexor or an MAOI. Wellbutrin added on to Effexor has worked very well for me. Gardengirl has some very good suggestions about mood stabilizers. I can't say enough good things about Lamictal for mood stabilization. Start low and slow and try to see if you can keep it to 3 drugs at a time.Polarbear 206
Lamictal 100mg
Effexor 75mg
Wellbutrin 150mgP.S. I cut my Effexor back from 300mg to 75mg and cut Lamictal in half to 100mg since I added Wellbutrin. This has resulted in more energy, return of normal sex life, normal sleep cycle. I just feel a balance that I haven't experienced in a very long time. Hope this helps.
Posted by linkadge on June 18, 2007, at 10:19:35
In reply to See my Pdoc today - PLEA for advice! PLEASE HELP, posted by JerryPharmStudent on June 18, 2007, at 7:22:15
I've heard of some cases of effexor + lithum being usefull. Nortryptaline + lithium has a good track record of helping certain TRD.
Linkadge
Posted by Justherself54 on June 18, 2007, at 10:30:29
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HELP, posted by polarbear206 on June 18, 2007, at 9:25:37
I'm just over 2 weeks with Parnate and only at 10 mg..and I'm feeling better already..no social anxiety (I even went to a dance Saturday night)..go figure!
I was on Lexapro for over 2 years..it initally worked to lift my depression but was soon replaced with extreme apathy and lack of motivation. I can't believe how uninterested in life I was..and gained more weight too.
I have a long history of meds too..only one I haven't been on is Remeron..can't take the sedatation of tricyclics...everything else poops out on me..
Even this small does of Parnate is allowing me to even consider getting back to work and having some sort of life outside the walls of my house..
I know what it's like to be so frustrated with trying med after med to the point where you want to throw them and your pdoc againt the wall..but hang in there..
What experience did you have with MAOI's? Perhaps another trial with them or discuss another tricyclic..
Please let us know how your appointment went today.
Posted by Phillipa on June 18, 2007, at 10:40:12
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HELP, posted by Justherself54 on June 18, 2007, at 10:30:29
Jerry I know you live in a small town any possibility of going to a teaching University somewhere close? Love Phillipa
Posted by dispatcher on June 18, 2007, at 12:31:04
In reply to See my Pdoc today - PLEA for advice! PLEASE HELP, posted by JerryPharmStudent on June 18, 2007, at 7:22:15
the adderrall, klonopin and vicodin are all working at cross purposes. I would deep 6 all three. Definitely, no doubt in my mind - they can create a roller coaster effect as well as withdrawal symptoms like you describe.
Sounds like you need a mood stabilizer, though there is no medication that will work for low self-esteem or psychological issues.
An anti-psychotic sounds like it could be a good thing at the right dose - lessens anxiety (which can contribute to depression) as well as a therapuetic does of an SSRI.
Posted by flame on June 18, 2007, at 12:45:41
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HELP, posted by polarbear206 on June 18, 2007, at 9:25:37
Polarbear,
Not to pull away from this thread or anything, but do you mind me asking you how long you have been on your current med regimen? I ask because I believe my husband has been having problems (for the past three years) because of his current regimen. He has been on Effexor XR 375mgs (for anxiety and depression), Ambien CR 12.5mg , Mirapex 1 mg (for RLS) and Provigil to control sleepiness the next day. I'm thinking that the sleepiness is caused by the Mirapex taken the "night before" ..?
Anyway, I'm wondering if the main reason he is experiencing such bad RLS symptoms is because of the high dose Effexor? The Mirapex, has .. I believe, caused compulsiveness that resulted in heavy drinking and spending money. He has also decided (somewhere during this three year period) that he "cannot" work any more.
I was interested in your current regimen because I thought that maybe I would aks my husband's psychiatrist why he could not consider changing my husband's regimen to something similar to yours?
Thanks,
Flame"I think the best thing IMO is to keep the number of medications you are taking to a minimum. The combination of all of these drugs is dramatically impairing and having an adverse reaction on you. I would ditch the stimulant and opt for a more activating AD like Effexor or an MAOI. Wellbutrin added on to Effexor has worked very well for me. Gardengirl has some very good suggestions about mood stabilizers. I can't say enough good things about Lamictal for mood stabilization. Start low and slow and try to see if you can keep it to 3 drugs at a time.
Polarbear 206
Lamictal 100mg
Effexor 75mg
Wellbutrin 150mgP.S. I cut my Effexor back from 300mg to 75mg and cut Lamictal in half to 100mg since I added Wellbutrin. This has resulted in more energy, return of normal sex life, normal sleep cycle. I just feel a balance that I haven't experienced in a very long time. Hope this helps. "
Posted by Jedi on June 18, 2007, at 12:49:38
In reply to See my Pdoc today - PLEA for advice! PLEASE HELP, posted by JerryPharmStudent on June 18, 2007, at 7:22:15
Hi Jerry,
I think you have been on as many combinations as myself. One thing you may not have tried because it is officially contraindicated is a combination of the tricyclic nortriptyline and the MAOI phenelzine. Keep the clonazepam for the anxiety, maybe add a little lithium because it is a proven augmentor and dump the rest of the stuff. Just an idea.
Good luck,
JediPS I see my MD this Friday and think I'm going to drop everything but the clonazepam. I can live with dysthymia, I did for 25 years. If the major depression returns, I'm going to get his assurance that I can go back on phenelzine augmented with lithium.
References:
A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=7560546&ordinalpos=38&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumTreatment response of depressed outpatients unresponsive to both a tricyclic and a monoamine oxidase inhibitor antidepressant.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=8071301&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumCombined MAO-inhibitor and tri- (tetra) cyclic antidepressant treatment in therapy resistant depression.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=3406429&ordinalpos=16&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Posted by tgo on June 18, 2007, at 16:53:12
In reply to See my Pdoc today - PLEA for advice! PLEASE HELP, posted by JerryPharmStudent on June 18, 2007, at 7:22:15
Jerry,
I have some similar symptoms as you. I recently added a mood stabilizer and it made a huge difference. I think you need to go that route to get your mood and energy levels stable and then an antidepressant will work much better.
tgo
Posted by Phillipa on June 18, 2007, at 20:02:50
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HE » JerryPharmStudent, posted by tgo on June 18, 2007, at 16:53:12
Jerry are you back yet and what happened with your meds? Love Phillipa
Posted by saturn on June 18, 2007, at 20:41:04
In reply to See my Pdoc today - PLEA for advice! PLEASE HELP, posted by JerryPharmStudent on June 18, 2007, at 7:22:15
> Sunny days make me MORE anxious and depressed compared to days that are rainy and/or overcast.I can *totally* relate to this.
Posted by polarbear206 on June 18, 2007, at 22:24:56
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HELP » polarbear206, posted by flame on June 18, 2007, at 12:45:41
> Polarbear,
>
> Not to pull away from this thread or anything, but do you mind me asking you how long you have been on your current med regimen? I ask because I believe my husband has been having problems (for the past three years) because of his current regimen. He has been on Effexor XR 375mgs (for anxiety and depression), Ambien CR 12.5mg , Mirapex 1 mg (for RLS) and Provigil to control sleepiness the next day. I'm thinking that the sleepiness is caused by the Mirapex taken the "night before" ..?
>
> Anyway, I'm wondering if the main reason he is experiencing such bad RLS symptoms is because of the high dose Effexor? The Mirapex, has .. I believe, caused compulsiveness that resulted in heavy drinking and spending money. He has also decided (somewhere during this three year period) that he "cannot" work any more.
>
> I was interested in your current regimen because I thought that maybe I would aks my husband's psychiatrist why he could not consider changing my husband's regimen to something similar to yours?
>
> Thanks,
> Flame
>
> "I think the best thing IMO is to keep the number of medications you are taking to a minimum. The combination of all of these drugs is dramatically impairing and having an adverse reaction on you. I would ditch the stimulant and opt for a more activating AD like Effexor or an MAOI. Wellbutrin added on to Effexor has worked very well for me. Gardengirl has some very good suggestions about mood stabilizers. I can't say enough good things about Lamictal for mood stabilization. Start low and slow and try to see if you can keep it to 3 drugs at a time.
>
> Polarbear 206
>
> Lamictal 100mg
> Effexor 75mg
> Wellbutrin 150mg
>
> P.S. I cut my Effexor back from 300mg to 75mg and cut Lamictal in half to 100mg since I added Wellbutrin. This has resulted in more energy, return of normal sex life, normal sleep cycle. I just feel a balance that I haven't experienced in a very long time. Hope this helps. "
>
>
HiWould you mind giving me a more detailed history about your husband? Was he on the effexor first before the others? What were his symptoms of depression prior to the start of antidepressants? What other drugs has he tried or been on in the past. The high dose of effexor can exacerbate his symptoms, esp if he has an underlying bipolar disorder. The mirapex and provigal don't help matters either if this is the case. Has he tried to cut back the effexor to see if his symptoms improve? He is not getting the proper response on the effexor if he needs something to help him sleep and something to keep him awake during the day. Why has his doctor let this continue for so long without switching to another AD? I hope he is seeing a psychiatrist and not a family doctor. The drinking and spending raise some red flags. Has it been discussed that this could be drug induced mood cycling? Sorry for all the questions.
Polarbear
Posted by flame on June 19, 2007, at 8:26:53
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HELP » flame, posted by polarbear206 on June 18, 2007, at 22:24:56
"Would you mind giving me a more detailed history about your husband?"
My husband began having "problems" after we had been married for a couple of years. We are 28 yrs. married this year .. so obviously it's been going on for quite a while.
In talking with counselors/psychologists that he and "we" had seen in the past, they say part of my husband's problem is his emotional immaturity. My husband finally found a counselor that he "respected", but the minute this guy appeared to begin getting to the "crux" of my husband's issues, he would bail on the counseling sessions. Now he is adamant about the fact that he doesn't need counseling .. psychologists are all in it for the money .. and he knows what he has to do, he just has to do it. (Very frustrating because even though he "knows" what he has to do, he can't do it!)
What my husband reported (all along) as his symptoms were and ARE extreme depression and anxiety. In the past he told me that he actually had panic attacks while driving on the road and had to pull over until he got through it. This happened several times, from what I can remember. He hasn't mentioned to me that he has had anything like that again, so I'm assuming that (at least) in the past three years, he hasn't?
Those are what my husband reports as his symptoms/problems. I add to this his uncontrollable anger. He can be set off very easily. I will also add to this (for most recently) is his drinking and wreckless spending.
"Was he on the effexor first before the others?"
My husband had been on Paxil and Buspar for years, through his family doc. He finally got a name of supposedly a good psychiatrist from that previous "respected" psychologist and has been going to this current doc (psychiatrist) since March of 2004. I received a print out from our pharmacy .. from back then, and it appears that this new doc started him on Effexor 150mg and Lorazepam 0.5mg. He was on that for two months and then I see in May 2004, the doc kept him on current Effexor (150mg), stopped the Loraxepam and began Mirapex (1mg) and Ambien 10mg. I believe that it was over the next couple of months that the Effexor was gradually increased to the current 375mgs. Ambien is now Ambien CR 12.5mgs and Mirapex is still at 1 mg. I mentioned that he as on the Provigil (this is newer, probably in the past year or so) and in looking at my journaling/notes, I see that not only is that supposed to help husband's daytime sleepiness, but it (somehow) augments the Effexor..?
"What other drugs has he tried or been on in the past?"
He has tried a lot of different antidepressants throughout the years. I believe that wellbutrin was one .. and I believe I remember him saying that it made him not feel anything. Besides that and what I mentioned above, I can't remember all that he has tried.
I don't think his doc has diagnosed him as bipolar. I have looked up his diagnosis code (in the past) and usually it just has something to do with depression and anxiety ...?
What are some things that I would look for in bipolar disorder? I know I can look this up, but am trying to get your perspective here.
"The mirapex and provigal don't help matters either if this is the case."
What would/will these two do IF this IS the case?
No, he hasn't tried to cut back on anything. It is only just recently that I "realized" that his current problems are more than likely induced by his current prescription regimen. I am at the end of my rope and am almost feeling like I am grasping. I sent my husband pdoc a letter and I am very afraid that he will not put much stock in it.
"Why has his doctor let this continue for so long without switching to another AD?"
VERY good question! In my opinion, my husband cannot see the forest from the trees right now. I believe that he is going to his three month med check appointments and saying things are okay. I am ALSO thinking that husband probably plays things down 'cause his doc has brought up to him too many times that he should not be drinking.
"The drinking and spending raise some red flags. Has it been discussed that this could be drug induced mood cycling?"
If you read up on Mirapex, you will see that there are many cases of compulsive behaviour linked to taking this drug. My husbands ..I believe, is drinking (has he become an alcoholic?) and spending money wrecklessly.
I have no idea if his doc explored "drug induced mood cycling". If his doc was "exploring" this, wouldn't there have been some med changes going on? Could you explain this to me a bit more?
I appreciate all of your questions AND your response. I need to be educated! Anything you can give me as far as ideas ..or fill me in on is SO appreciated!
My husband's attitude .. for way too long, is that he just has to get through life .. SOMEHOW. He appears to have given up on ever being helped.
I posted this reply on this thread again, because I was afraid it would be missed by polarbear if I did not. Anyone .. please advise if there is another way I should be doing this. I really do not intend to hi-jack this thread ...
Thanks,
Flame
Posted by polarbear206 on June 19, 2007, at 8:51:30
In reply to Long Response to Polarbear » polarbear206, posted by flame on June 19, 2007, at 8:26:53
> "Would you mind giving me a more detailed history about your husband?"
>
> My husband began having "problems" after we had been married for a couple of years. We are 28 yrs. married this year .. so obviously it's been going on for quite a while.
>
> In talking with counselors/psychologists that he and "we" had seen in the past, they say part of my husband's problem is his emotional immaturity. My husband finally found a counselor that he "respected", but the minute this guy appeared to begin getting to the "crux" of my husband's issues, he would bail on the counseling sessions. Now he is adamant about the fact that he doesn't need counseling .. psychologists are all in it for the money .. and he knows what he has to do, he just has to do it. (Very frustrating because even though he "knows" what he has to do, he can't do it!)
>
> What my husband reported (all along) as his symptoms were and ARE extreme depression and anxiety. In the past he told me that he actually had panic attacks while driving on the road and had to pull over until he got through it. This happened several times, from what I can remember. He hasn't mentioned to me that he has had anything like that again, so I'm assuming that (at least) in the past three years, he hasn't?
>
> Those are what my husband reports as his symptoms/problems. I add to this his uncontrollable anger. He can be set off very easily. I will also add to this (for most recently) is his drinking and wreckless spending.
>
> "Was he on the effexor first before the others?"
>
> My husband had been on Paxil and Buspar for years, through his family doc. He finally got a name of supposedly a good psychiatrist from that previous "respected" psychologist and has been going to this current doc (psychiatrist) since March of 2004. I received a print out from our pharmacy .. from back then, and it appears that this new doc started him on Effexor 150mg and Lorazepam 0.5mg. He was on that for two months and then I see in May 2004, the doc kept him on current Effexor (150mg), stopped the Loraxepam and began Mirapex (1mg) and Ambien 10mg. I believe that it was over the next couple of months that the Effexor was gradually increased to the current 375mgs. Ambien is now Ambien CR 12.5mgs and Mirapex is still at 1 mg. I mentioned that he as on the Provigil (this is newer, probably in the past year or so) and in looking at my journaling/notes, I see that not only is that supposed to help husband's daytime sleepiness, but it (somehow) augments the Effexor..?
>
> "What other drugs has he tried or been on in the past?"
>
> He has tried a lot of different antidepressants throughout the years. I believe that wellbutrin was one .. and I believe I remember him saying that it made him not feel anything. Besides that and what I mentioned above, I can't remember all that he has tried.
>
> I don't think his doc has diagnosed him as bipolar. I have looked up his diagnosis code (in the past) and usually it just has something to do with depression and anxiety ...?
>
> What are some things that I would look for in bipolar disorder? I know I can look this up, but am trying to get your perspective here.
>
> "The mirapex and provigal don't help matters either if this is the case."
>
> What would/will these two do IF this IS the case?
>
> No, he hasn't tried to cut back on anything. It is only just recently that I "realized" that his current problems are more than likely induced by his current prescription regimen. I am at the end of my rope and am almost feeling like I am grasping. I sent my husband pdoc a letter and I am very afraid that he will not put much stock in it.
>
> "Why has his doctor let this continue for so long without switching to another AD?"
>
> VERY good question! In my opinion, my husband cannot see the forest from the trees right now. I believe that he is going to his three month med check appointments and saying things are okay. I am ALSO thinking that husband probably plays things down 'cause his doc has brought up to him too many times that he should not be drinking.
>
> "The drinking and spending raise some red flags. Has it been discussed that this could be drug induced mood cycling?"
>
> If you read up on Mirapex, you will see that there are many cases of compulsive behaviour linked to taking this drug. My husbands ..I believe, is drinking (has he become an alcoholic?) and spending money wrecklessly.
>
> I have no idea if his doc explored "drug induced mood cycling". If his doc was "exploring" this, wouldn't there have been some med changes going on? Could you explain this to me a bit more?
>
> I appreciate all of your questions AND your response. I need to be educated! Anything you can give me as far as ideas ..or fill me in on is SO appreciated!
>
> My husband's attitude .. for way too long, is that he just has to get through life .. SOMEHOW. He appears to have given up on ever being helped.
>
> I posted this reply on this thread again, because I was afraid it would be missed by polarbear if I did not. Anyone .. please advise if there is another way I should be doing this. I really do not intend to hi-jack this thread ...
>
>
> Thanks,
> Flame
Flame,I can babblemail you. Turn your babblemail on if it is off.
Polarbear
Posted by elanor roosevelt on June 19, 2007, at 21:31:13
In reply to See my Pdoc today - PLEA for advice! PLEASE HELP, posted by JerryPharmStudent on June 18, 2007, at 7:22:15
step one: get rid of the buspar
step two: switch the lexapro for another AD
Posted by KayeBaby on June 20, 2007, at 0:36:20
In reply to See my Pdoc today - PLEA for advice! PLEASE HELP, posted by JerryPharmStudent on June 18, 2007, at 7:22:15
Hey Jerry,
How did it go?
I hope you got the abilify.Let us know how it is going with you.
I dearly hope, better.Friend,
Kaye
Posted by JerryPharmStudent on June 22, 2007, at 3:05:49
In reply to JERRY-how did it go?? » JerryPharmStudent, posted by KayeBaby on June 20, 2007, at 0:36:20
> Hey Jerry,
> How did it go?
> I hope you got the abilify.
>
> Let us know how it is going with you.
> I dearly hope, better.
>
> Friend,
> KayeHI all-
Well, I went in and talked to my doc and just said "I'm sick of this - always feeling like the bottom is gonna fall out." Then asked him about Lamictal or Abilify - telling him I'd hear it can help with motivation,etc.
He had some vouchers for a fee 2 month supply of Abilify so we decided on that. 2.5mg.
He explained that Abilify is a partial antagonist/agonist but didn't go into great detail about how exactly it works.
Anyway, I've been on it since Monday and I've noticed some positive effects right away:
- Don't feel any restlessness
- Motivation is somewhat better
- Mood seem a bit more stable
- Don't feel the "need" to take as much hydrocodone
- Reduced irritability and anxiety
- Reduced over all depression
- No crying spellsNegatives:
- insomnia
- slight increase in appetite - but nothing like Seroquel or RemeronI hate to jinx anything - but I feel a bit more in control. Let's hope it sticks.
Can anyone tell me how Abilify works an an agonist/antagonist and why that is beneficial to depression and anxiety?
i SOOO appreciate everyone's support over the past months - I wish i could repay you all somehow.
Jerry :-)
Posted by JerryPharmStudent on June 22, 2007, at 3:07:22
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HELP » JerryPharmStudent, posted by saturn on June 18, 2007, at 20:41:04
>
> > Sunny days make me MORE anxious and depressed compared to days that are rainy and/or overcast.
>
> I can *totally* relate to this.Do you think there could be some link to depression? Light sensitivity? etc? My therapist is VERY interested in this.
Posted by JerryPharmStudent on June 22, 2007, at 3:09:59
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HE, posted by elanor roosevelt on June 19, 2007, at 21:31:13
> step one: get rid of the buspar
> step two: switch the lexapro for another ADWhy get rid of the BuSpar? My doc seem to think it has great AD properties - however I think it's more of a placebo. Just wondering how you thought about it.
Also, could I stop the lexapro if the Abilify I'm on now really works??
Posted by stargazer2 on June 22, 2007, at 8:37:55
In reply to Re: JERRY-how did it go??, posted by JerryPharmStudent on June 22, 2007, at 3:05:49
Jerry, I too just restarted Abilify since the Nardil alone wasn't cutting it and my fatigue and afternoon lethargy was very severe, hence the Abilify. except I started on 5 mg and my doc yesterday said togot to 10, yet small doses can be quite beneficial and i am actually more responsive to smaller doses so I hope we didn't increase too quickly.
The description in my drug book of abilify says it exerts partial agoinist activity at D2 and Serotonin 1A receptors and antagonist activity ot serotonin 2 A receptors. So that means, I think basically, that the dopamine transmittion is enhanced along with one serotonin receptor and one serotonin receptor is inhibited by the drug.
So go figure since they really always say they don't know how they work but Abilify enhances dopamine which is different than many other meds that don't affect dopamine but most of the antipsychotics do affect it.
Glad to hear some improvement has come your way, you were due for some.
Stargazer
Posted by Jedi on June 22, 2007, at 10:04:57
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HE » saturn, posted by JerryPharmStudent on June 22, 2007, at 3:07:22
Hi Jerry,
I always thought this affect was because with a beautiful sunny day, you think you should feel good. When it doesn't make your feel better, it is a downer. I've also had times when I was physically ill with the flu or something; I actually felt better because being down is what is expected when you are physically sick. Sounds weird, maybe just my warped brain.
Jedi
> > > Sunny days make me MORE anxious and depressed compared to days that are rainy and/or overcast.
> >
> > I can *totally* relate to this.
>
> Do you think there could be some link to depression? Light sensitivity? etc? My therapist is VERY interested in this.
>
>
Posted by Racer on June 22, 2007, at 12:01:34
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HE » saturn, posted by JerryPharmStudent on June 22, 2007, at 3:07:22
> >
> > > Sunny days make me MORE anxious and depressed compared to days that are rainy and/or overcast.
> >
> > I can *totally* relate to this.
>
> Do you think there could be some link to depression? Light sensitivity? etc? My therapist is VERY interested in this.
>
>I have had this experience, too. I know I read something about it once, but can't remember it now. What I do remember, is that it wasn't actually that uncommon with depression -- sunnier days led to deeper depression for some people. I don't have time to search right now -- taking a summer class, and it's brutally intense -- but you might try Medscape, see what pops up.
Posted by Racer on June 22, 2007, at 12:10:07
In reply to Re: See my Pdoc today - PLEA for advice! PLEASE HE » elanor roosevelt, posted by JerryPharmStudent on June 22, 2007, at 3:09:59
> > step one: get rid of the buspar
> > step two: switch the lexapro for another AD
>
> Why get rid of the BuSpar? My doc seem to think it has great AD properties - however I think it's more of a placebo. Just wondering how you thought about it.
>
>My experience was that Buspar was the best medication I've ever taken for anxiety -- except for the pesky problem of it increasing my depression. In fact, it increased my depression pretty significantly. It was really too bad, since it was far and away the best anxiolytic for me -- but the increased depression was too much.
I also had trouble with Lexapro. On 5mg, it just didn't help my depression and kinda left me feeling more blah. On raising it to 10mg, though -- have you heard of the "locked in syndrome" some comatose patients experience? That's what it reminded me of. I felt almost unable to speak, I just kinda went where someone took me, sat down, and got sucked back into my vortex of misery. The only place I can remember going was to our marriage counseling sessions, and even there I only went because my husband put me in the car and led me to the room. I'd sit on the sofa, and want to say something, but mostly couldn't manage to do it. It was not a pleasant experience.
Then again, I'm apparently quite weird about my reactions to medications...
I wonder if you might find that experimenting with dropping the Buspar was helpful to you? I wouldn't do it now -- I'm a big one for one variable at a time, you know? So, see how the Abilify works out, and then think about dropping the Buspar to see if that helps. You can always start it again is if it having more beneficial results than it did for me.
Just -- sorry, my history includes a doctor who would make five changes at once, and then blame me for spinning off into the stratosphere with anxiety and side effects that were additive between them, etc, so I am a bit of a proselytizer on this topic -- only one variable at a time, if you can...
I'm glad to hear the Abilify is helping though. I will keep my fingers crossed for you.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.