![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by uncouth on December 20, 2008, at 17:57:40
Hi everyone. I'm having a bit of some trouble determining "how I feel" right now. I usually don't. But I'm taking the following:
80mg parnate
15 mg abilify
300mg lithium
100mg lamictal
25 mg seroquel for sleep
25 mg agomelatine for sleep / antidepressive action (don't ask or private message me how I got this).
800mg of sam-e
1800 mg of N-A-CIts a lot of drugs, I know, but I don't really count the seroquel and lithium due to their low dose.
In the past, I've taken Focalin 10-15mg (not while on parnate) and noticed what REAL stimulation felt like. It was a great increase in focus, a bit euphoric, and pretty darn antidepressive. But right now, I feel jumpy. Like I can't stand still for very long. I can't watch a movie, not because i'm not interested, but the plot just takes too long. I find myself driving aimlessly just to cut out the anxiety and to "do" something. And it's difficult for me to focus on work.
So on the one hand, I feel like with all the parnate and abilify, I *should* be feeling stimulated. But am I being overstimulated? Is that even possible? Is that why I can't pay attention to anything, or watch a TV show because it can't hold my attention? If so, then that seems pretty counterintuitive, as stimulation is supposed to help with focus...
I'm really messed up here right now and confused about what to tell my doctor the next time I see him. I should add that I have been feeling some general anxiety lately though cigarettes and xanax tend to help with that on occassion.
Posted by SLS on December 20, 2008, at 19:00:29
In reply to Over or understimulated - PLEASE HELP!, posted by uncouth on December 20, 2008, at 17:57:40
> Hi everyone. I'm having a bit of some trouble determining "how I feel" right now. I usually don't. But I'm taking the following:
>
> 80mg parnate
> 15 mg abilify
> 300mg lithium
> 100mg lamictal
EXCELLENT DRUG REGIME!!!Who's handiwork is it?
You might want to bring the Lamictal up to 200mg if you should find yourself stuck in depression.
I know it is hard to describe such subjective experiences, but can you be more specific regarding what you are feeling?I doubt you need a stimulant in this mix.
Sometimes, one feels more anxiety as they approach a good antidepressant response. You might feel more heart palpitations and experience an increase in heart rate. You might even experience an increase in dry mouth, dizziness, hand tremulousness, sweating, difficulty urinating, and blurred vision to name a few.
I believe that these things can be the result of changes in the relative tones of the sympathetic versus parasympathetic autonomic nervous systems. They are not necessarily drug side effects.
- Scott
Posted by yxibow on December 20, 2008, at 19:29:26
In reply to Over or understimulated - PLEASE HELP!, posted by uncouth on December 20, 2008, at 17:57:40
The only thing I would be careful with there is the Sam-E, it can be unpredictable, especially with the MAOI combination. On the other hand, if you've discussed this with your doctor
As for the agomelatine, I don't know if its being produced by any drug company in quantity, its still under drug trials even in Europe, but I'm not going ask like you said -- again, some caution that melatonin is a hormone and it does have serotonergic properties as well, caution there.
I think ultimately being open with your doctor about supplements is best. At least in my case.I take l-tryptophan and 5-HTP as adjuncts for sleep as well as doxylamine succinate, whether the supplements work, I can't say -- doxylamine is currently my mainstay for bad insomnia and I do have to take a considerable amount, even with Seroquel on board.
-- tidings
Jay
Posted by uncouth on December 20, 2008, at 19:29:36
In reply to Re: Over or understimulated - PLEASE HELP! » uncouth, posted by SLS on December 20, 2008, at 19:00:29
Thanks Scott. Iit's my pdoc, but I raised my parnate dose and added teh 100mg of lamictal on my own (used to be on lamictal monotherapy which was worthless at 200mg and caused cog side effects).
I guess the reason why I'm concerned is that i'm feeling a combination of psychomotor restlessness, a bit of anxiety (mostly mental, though some physical), so i'm wondering if my dopamine is too high. At the same time, I'm having concentration troubles, and it's hard to get through a chapter of a book, and watching TV, which I do enjoy, is almost impossible.
It could be more psychological (feeling guilt for doing things that are enjoyable), but when I smoke a bit of pot, I'm able to watch TV and it does hold my attention some more.
Honestly, I know this sounds silly, but I'll know i'm completely well when I can do my work, focus on it, and when i'm done, relax and chill out in front of the TV. That's not what I'm feeling right now -- it's more like a "gotta keep moving".
Perhaps my NE is too high relative to serotonin and dopamine? Who knows though. It's all guesswork.
Interesting comment, though, on anxiety being a side effect of medication working, and a part of the pathway to wellness. How do you know that to be true?
Posted by SLS on December 20, 2008, at 20:30:54
In reply to Re: Over or understimulated - PLEASE HELP!, posted by uncouth on December 20, 2008, at 19:29:36
> Perhaps my NE is too high relative to serotonin and dopamine? Who knows though. It's all guesswork.
>
> Interesting comment, though, on anxiety being a side effect of medication working, and a part of the pathway to wellness. How do you know that to be true?It's all guesswork.
:-)
I have had discussions with a few doctors about my observations and that they could best be explained by a temporary increase in the dysautonomia that is a manifestation of depressive illness.
- Scott
Posted by Tomatheus on December 20, 2008, at 22:37:38
In reply to Over or understimulated - PLEASE HELP!, posted by uncouth on December 20, 2008, at 17:57:40
Uncouth,
Although I think it's generally true that increased stimulation leads to increased focus, I think it's possible that maybe you've become too distractible (possibly as a result of being overstimulated by your medications and supplements) and consequently less focused. One interesting thing about schizophrenia is that trouble with focus and concentration are common symptoms, even though the illness is often associated with excessive dopamine neurotransmission (a type of overstimulation, if you will). So, excessive stimulation doesn't necessarily lend itself to better focus.
I think that I should also point out that a lot of posters here have reported anxiety as a side effect of SAMe. I know that SAMe is a recent addition to your combination of medications and supplements because you asked about taking it with an MAOI recently, and I'm wondering if the anxiety that you're experiencing might be something that emerged recently when you added the SAMe to your combo.
Just a thought.
Tomatheus
Posted by uncouth on December 20, 2008, at 22:48:57
In reply to Re: Over or understimulated - PLEASE HELP! » uncouth, posted by Tomatheus on December 20, 2008, at 22:37:38
I actually started Sam-E after my first bout of extreme anxiety, and it seemed to help. I'm thinking now that what I'm feeling is actually a form of akathisia. It's not restless leg syndrome, which i've had before, but lots of the symptoms fit with akathisia. I did go up from 5mg to 10mg a few weeks ago on my abilify, and who knows how it works with an MAOI, so i'm thinking it might be a good idea to go back down and see if the akathisia remits. Although I'm getting good response otherwise.
Has anyone been successful treating akathisia with beta blockers or anything else? Xanax doesn't help all that much and mostly just puts me to sleep.
Posted by Phillipa on December 21, 2008, at 0:42:53
In reply to Re: Over or understimulated - PLEASE HELP!, posted by uncouth on December 20, 2008, at 22:48:57
I was also thinking akathesia don't know how anxiety could indicate lessening of depression as anxiety was my only symtom for over 30 some odd years not depression. There are two distinct diagnoses I believe one anxiety and one depression. but you were depressed before hence all the meds? Love Phillipa
Posted by desolationrower on December 21, 2008, at 14:57:34
In reply to Re: Over or understimulated - PLEASE HELP! » uncouth, posted by SLS on December 20, 2008, at 19:00:29
> > Hi everyone. I'm having a bit of some trouble determining "how I feel" right now. I usually don't. But I'm taking the following:
> >
> > 80mg parnate
> > 15 mg abilify
> > 300mg lithium
> > 100mg lamictal
>
>
> EXCELLENT DRUG REGIME!!!
>
> Who's handiwork is it?
>
>
> You might want to bring the Lamictal up to 200mg if you should find yourself stuck in depression.
>
>
> I know it is hard to describe such subjective experiences, but can you be more specific regarding what you are feeling?
>
> I doubt you need a stimulant in this mix.
>
> Sometimes, one feels more anxiety as they approach a good antidepressant response. You might feel more heart palpitations and experience an increase in heart rate. You might even experience an increase in dry mouth, dizziness, hand tremulousness, sweating, difficulty urinating, and blurred vision to name a few.
>
> I believe that these things can be the result of changes in the relative tones of the sympathetic versus parasympathetic autonomic nervous systems. They are not necessarily drug side effects.
>
>
> - Scott
>Hey scott, do you have babble-mail off?
also interested in your thoughts on symp. vs. parasym. systems, i was looking into them wrt social anxiety and meditation and some somatic treatments lately.
as far as the OP, remember thats its not just 'too high/low' it also is important where the neurotransmitter is high/low, and that phasic burst and tonic levels are very important. Also important the order of when you added drugs and when this side effect began to occur to figure out what is causing it. Also, what is your natural state like w/o drugs.
-d/r
This is the end of the 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.