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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by emilio on February 8, 2008, at 5:21:03
i tried paxil for ocd,can tale ultram wiht that to feel better
Posted by Robert35 on February 8, 2008, at 5:54:04
In reply to ultram, posted by emilio on February 8, 2008, at 5:21:03
> i tried paxil for ocd,can tale ultram wiht that to feel better
Hi Emilio,
I guess you are worried about a serotonin syndrome ?
Everyone may react differently with meds.
Apart from being a pain patient I am quite healthy (weight , don't smoke, not much alcohol, (some) excercise etc ..)
I take Ultram (2 (and occasionaly: 3) x 50 mg capsules per day) plus prozac (15 mg a day).
Two years ago I took Ultram together with 60 mg Cymbalta, later that year Ultram with up to 225 mg Effexor a day.
(I also have heard of/read about others combining an ssri and ultram.)
What does you doctor think about it?
The painspecialists I consulted don't seem to be worried at all about a serotonin syndrome or increased risk of seizures.
Amongst other things it helps considerably
against depressive moods.
My advise would be (not being a doctor): find a doctor who is not unsympathetic to prescribe it (though that might be difficult ...).
Good luckRobert
Posted by emilio on February 8, 2008, at 6:08:54
In reply to Re: ultram, posted by Robert35 on February 8, 2008, at 5:54:04
tank robert, my doctor does not like this medication.
he is afraid about acdiction,
maybe i cab ask somebody else
Posted by Robert35 on February 8, 2008, at 7:54:06
In reply to Re: ultram, posted by emilio on February 8, 2008, at 6:08:54
Hi Emilio,
You 're welcome :-)!
Yep ... I think I would have a hard time quitting.
But as an opioid it is a very weak one .. . I read it has the painkilling properties of between a 10th and a 100th of that of codein (don't know if it is true).
But using it for six year now I have the feeling that it works mainly on norepinephrine and serotonin.
Regarding difficulty discontinuing some people have compared it with effexor (the chemical structure of ultram seems to resemble that of effexor; a chemist would probably say that that doesn't really mean it has to work the same); regarding quitting I think the comparison is a good one.
The willingness of a doctor to prescribe it is (in his way of thinking) also limited by the indication of use (so e.g. if you were having severe lower backpain he might prescribe it to you).
Best regards,Robert
Posted by Phillipa on February 8, 2008, at 12:36:35
In reply to Re: ultram, posted by Robert35 on February 8, 2008, at 7:54:06
Docs are so reluctant to prescribe any pain meds. It's kind of sad as I know they can be addictive but so are so many other meds. Phillipa
Posted by Robert35 on February 10, 2008, at 6:45:17
In reply to Re: ultram » Robert35, posted by Phillipa on February 8, 2008, at 12:36:35
> Docs are so reluctant to prescribe any pain meds. It's kind of sad as I know they can be addictive but so are so many other meds. Phillipa
Hi Philippa,
Yep, that's true .
I mentioned buprenorphine on occasion but my paindoc didn't like the idea because of drowsiness issues.
For the same reason he doesn't like to prescribe lyrica.
Reading this board trivastal seems like a good bet for me now.
Last time I saw him he prescribed wellbutrin, which I couldn't handle; trivastal (which seems to do the same as wellbutrin) looks like a better alternative given the fact that there is no risk of seizures (with the other meds that I use) and doesn't place such a load on the liver.
Best regards,Robert
Posted by yxibow on February 20, 2008, at 6:28:54
In reply to Re: ultram » Robert35, posted by Phillipa on February 8, 2008, at 12:36:35
> Docs are so reluctant to prescribe any pain meds. It's kind of sad as I know they can be addictive but so are so many other meds. Phillipa
Its not just because they have liability issues -- all psychiatrists are MDs, but it isn't their specialty.
I can sort of see the argument of my doctor like this -- Would you want your psychiatrist to perform brain surgery with a burr needle ? I mean they've been through medical school and residency but its not their -specialty-.
They haven't gone through a complete residency in that field.
Do you want an antibiotic prescribed without any testing or background on your allergic reactions? They can't but send you to the ER with their phone when penicillin V causes your throat to clamp up.I know its difficult -- I suffer through pain as a possible result from medications and through my disorder itself. I wish I could get bupenorphine or a drop of codeine now and then.
But that requires 1) a psychiatrist trained in addiction medication or 2) a not so board certified psychiatrist out there -- there are plenty, who will be willing to serve one's request, and suffer the consequence of the informed consent and uniformed result.
There are true board certified psychiatrists trained in pain and addiction, also psychiatrists trained in hypnosis (not waving a wand), which can be a pretty powerful suggestive tool for managing pain. Maybe I would seek a consult some time.
Ultimately its up to the individual of course how they trust the judgment of the relationship with their doctor and credentials and this doesn't mean or imply a character assassination on anyone's caregiver.
Posted by yxibow on February 21, 2008, at 3:29:48
In reply to Re: ultram, posted by Robert35 on February 10, 2008, at 6:45:17
To add to the above there have been serious incidents with SS combining with SSRIs. Now this doesn't mean that one as an individual may experience this but that is also a concern in u(mu)-mediated forays by some doctors into fighting depression and pain and depression I imagine too.
Like I previously said, I also have some pain issues too, neurological and possibly psychoneurologically based, so I can understand the frustration.
Posted by Robert35 on February 22, 2008, at 4:15:12
In reply to Re: ultram, posted by yxibow on February 21, 2008, at 3:29:48
Hi yxibow,
Thanks for your comment !
Regarding serotonin syndrome: I have read there is only one absolute restriction in combinations with MAOI's ... .
I discussed the possibility (prozac + tramadol) with the various doctors I have seen and a pharmacist but they think it is safe. One paindoctor said (what I don't understand bc as I understand SS can be lethal): if trouble arrises from this combo you can always go back to what you used before ... the damage is reversable .What do you mean by "that is also a concern in u(mu)-mediated forays by some doctors into fighting depression and pain"; what do mu receptors have to do with a serotonin syndrome ?
Do you have (sorry I didn't read all of your posts) a good (combo of) drug(s) now ?
Are you doing better ?
(I am still struggling ..)Best wishes,
Robert
> To add to the above there have been serious incidents with SS combining with SSRIs. Now this doesn't mean that one as an individual may experience this but that is also a concern in u(mu)-mediated forays by some doctors into fighting depression and pain and depression I imagine too.
>
> Like I previously said, I also have some pain issues too, neurological and possibly psychoneurologically based, so I can understand the frustration.
Posted by yxibow on February 24, 2008, at 0:05:37
In reply to Re: ultram, posted by Robert35 on February 22, 2008, at 4:15:12
> Hi yxibow,
>
> Thanks for your comment !
> Regarding serotonin syndrome: I have read there is only one absolute restriction in combinations with MAOI's ... .
> I discussed the possibility (prozac + tramadol) with the various doctors I have seen and a pharmacist but they think it is safe. One paindoctor said (what I don't understand bc as I understand SS can be lethal): if trouble arrises from this combo you can always go back to what you used before ... the damage is reversable .
Sub-clinical serotonin syndrome is not lethal, if noticed and reported by the patient or observed by a doctor. Lesser symptoms of SS will occur. I may have had that with some medication combination I forget. True serious SS is an immediate hospitalization and ICU issue.>
> What do you mean by "that is also a concern in u(mu)-mediated forays by some doctors into fighting depression and pain"; what do mu receptors have to do with a serotonin syndrome ?Nothing... mu receptors and others have to do with opiates. Pardon for the technical jargon mixup. I meant the same thing, experimenting with varieties of opiates for depressive and psychoneurological pain.
> Do you have (sorry I didn't read all of your posts) a good (combo of) drug(s) now ?
> Are you doing better ?
> (I am still struggling ..)I'm sorry to hear that... yes we all struggle at times with biological disorders. I am having a difficult time at the moment -- and it isn't all about medication. Therapy is an important part of it because there is no magic pill that will erase my symptoms and not destroy me. I have a unique set of multi-diagnosis and polypharmacy.
My main agents that seem to work the best are Seroquel (for other purposes than pure psychosis) and long term Valium (which has been a problem reducing because it brings back symptoms -- also a sticky wicket because I reserve a possibility of trying Clozaril which means no Valium and more muscle/iatrogenic neurological things possibly exposed). I also take a mid amount of Luvox (I dont want to go up on it because I dont want more problems at the moment) and Lamictal which may possibly be doing something for mood, again a small dose. The Neurontin is hard to say, I think its merely an additive to the Valium but when it is removed things happen also yet there is some tolerance. The Robaxin is not psychiatric, particularly, though it is for another long term muscular iatrogenic issue with dumping a benzo years ago.
>
> Best wishes,
>
> Robert
-- thanksJay
This is the end of the thread.
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