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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 Amelia_in_StPaul on April 24, 2009, at 18:20:11
Hi everyone, at the suggestion of garnet, I thought I would post this here; I had this post at neurotransmitters, but am not getting much luck with responses (except for the wonderful garnet). I had already gotten a (thank you, bleauberry et al) few suggestions about trying MAOIs and maybe adding abilify, but I thought if you had more of my history that that would help. Here is the post...I'll try to trim it a bit...
I need to come up with a regimen that works for me and am hoping that I could get your input. I am 7 days off fluoxetine, so that I can get a sleep study next Sunday. Once that's done, I have to figure out what to do next. I have to say that after 9 months, fluoxetine seemed to be building up in my system--I am a 2D6 intermediate metabolizer. I was only on 20 mgs (the most I could ever tolerate in my 15+ years of depression), but often I would feel sort of stimulated and fatigued at the same time, and then finally, totally apathetic and unmotivated. The great thing about being off the fluoxetine has been the restoration of my physical health (um, aside from some vitamin deficiencies).
Anyway, a bit of history:
My diagnoses are PTSD, Major Depression recurrent, GAD, OCD, social anxiety, and borderline features (the emotionally labile part), and non-restorative (lack of stage 4) sleep. All of them seem to fit.
I have been on and off (mostly on) fluoxetine/Prozac since the age of 21 (I am in my late 30s). Fluoxetine seemed to cease to work for me in 2007, and I went off of it, hoping to experience a normal physical state (non-fatigued) for the first time since my youth. I have tried various other drugs, which I list below, but could not tolerate their effects.
About 9 mos. after I went off fluoxetine, I experienced anxious depression (I had always had just regular old depression before--major, atypical, and dysthymic). I was experiencing major panic attacks, social anxiety, reactivation of PTSD, etc.
I ended up on the couch, unable to move, shaking, not eating, not showering, just waking up and moving to the corner of the couch, where I sat all day, freaking out. I thought I was becoming schizophrenic. I was obsessed with that thought. I went inpatient, ended up being verbally abused by the staff, manipulated and retaliated against when I complained to the hospital ombudsman, and left the hospital worse than when I came in. Spent four weeks in a state of extremely severe anxiety. Went into a partial hospital program at another hospital, went inpatient for awhile to sort out my sleeping, started the road to healing.
During that time, I tried to get back on fluoxetine, twice: first time, too sleepy, second time, too agitated. Third time, in the partial program, the pdoc started me off at 5 mg every other day, and it took me 4 months to work my way up to 20 mg fluoxetine. It worked great for six months, and then seemed to poop out. (Is it something about mid-winter? That's when everything went downhill for me off fluoxetine.)
Some days, I experience suicidal ideation still. Others, I seem fine.
Med History-Failed Trials
Effexor (eye dilation, intense nausea, double vision, flu-like symptoms lasting 24 hours)
Serzone (migraine headache)
Paxil (double vision, unable to see/focus)
Zoloft (first trial in 1993, slept for most of the next 72 hours, flu-like symptoms; second trial in 2008, chest paint for four days, sleepy but not helping me sleep)
Elavil (zombie-feeling, bumping into things, unable to concentrate)
Lexapro (eye dilation, woozy, spacey, tried for two days but couldn't take it)
Wellbutrin (as an adjunct to fluoxetine it used to work to wake me up, but then I started to have panic attacks on it; tried it on its own in 2008, on 35mg daily ended up incredibly hostile, angry, climbing walls)
Seroquel (tried in 2003, knocked me out for 13 hours but didn't seem to help with deep sleep, got up and slept most of hte next day. Headache and flu-like symptoms; tried in 2008 in the hospital, ended up with panic attacks, agitation, hyperventilation, and unable to judge accurately the distances between me and objects and the size of some objects)
Okay, so in sum, the things that have only ever worked out:
Prozac/fluoxetine (was on 20mg until 5 days ago)
Ativan (was for a year and half on .5 in morning, 1.5 in evening; I started tapering off and am on .25 in the morning, same evening dose)
Trazodone (but I develop tolerances to it, and then take more, but anything over 25mg just makes me non-functioning the next day, without necessarily keeping me asleep the night before).Family History
Mother - depression
Sister - schizophrenia
Sister - nothing
Father - depression (tried meds in the late 70s, couldn't tolerate them)/fatal heart attack (fit as a fiddle--genetic cholesterol condition)
Grandparents - maternal side, both undx'ed depression
Grandparents - paternal side, one with undx'ed personality disorder
Great-grandparent - maternal, suicideThough in females, the timeframe for developing schizophrenia is most commonly 20-35, it is still possible to develop it later in life, especially with hormonal changes. In the last year and a half, I have had what my doctor calls a stress-induced brief hallucination (last summer, after a huge amount of caffeine and lack of sleep), and quasi-hallucinations--for instance, I have hpynogogic and hypnopompic hallucinations (occurs in normal populations, but new to me). All of this was probably brought on by my intense obsessions over fear of becoming schizophrenic, as I would think of all the things I could think or see or hear that would be unreal. I unfortunately have an intimate knowledge of my sister's delusions and hallucinations, and I have absorbed them and obsessed over them.
So I am not psychotic but feel I could tilt that way.
In sum, I am looking for a medication regimen that may have some dopamine but does not carry with it a higher risk of psychosis (as does the TCAs). I am looking for wakefulness without inducing anxiety. I am looking for something to level out my days, whether that be an AD or a mood stabilizer, if that seems appropriate (and sometimes it does).
I am also looking to not be on a medication that carries a risk for metabolic syndrome or high cholesterol, since heart attacks due to high cholesterol is genetic in my family (father and uncle).
I'm not asking too much am I? ;-)
Willing to try proven alternative therapies.
Whew. If you have read through this post, you are a saint!
Desperately yours,
Amelia
Posted by Amelia_in_StPaul on April 24, 2009, at 18:53:51
In reply to Med Help Request (also at neutransmitters board), posted by Amelia_in_StPaul on April 24, 2009, at 18:20:11
Posted by Phillipa on April 24, 2009, at 23:10:16
In reply to Med Help Request (also at neutransmitters board), posted by Amelia_in_StPaul on April 24, 2009, at 18:20:11
Hi Amelia Garnet was right you will get a greater response on this board. So sleep study next week? If I were you I'd wait to see what it shows and then see what your doc suggests. Have to be off the ativan also. As that's a lot. Sorry you've had such a bad time of it. Love Phillipa
Posted by polarbear206 on April 24, 2009, at 23:27:02
In reply to Med Help Request (also at neutransmitters board), posted by Amelia_in_StPaul on April 24, 2009, at 18:20:11
> Hi everyone, at the suggestion of garnet, I thought I would post this here; I had this post at neurotransmitters, but am not getting much luck with responses (except for the wonderful garnet). I had already gotten a (thank you, bleauberry et al) few suggestions about trying MAOIs and maybe adding abilify, but I thought if you had more of my history that that would help. Here is the post...I'll try to trim it a bit...
>
> I need to come up with a regimen that works for me and am hoping that I could get your input. I am 7 days off fluoxetine, so that I can get a sleep study next Sunday. Once that's done, I have to figure out what to do next. I have to say that after 9 months, fluoxetine seemed to be building up in my system--I am a 2D6 intermediate metabolizer. I was only on 20 mgs (the most I could ever tolerate in my 15+ years of depression), but often I would feel sort of stimulated and fatigued at the same time, and then finally, totally apathetic and unmotivated. The great thing about being off the fluoxetine has been the restoration of my physical health (um, aside from some vitamin deficiencies).
>
> Anyway, a bit of history:
>
> My diagnoses are PTSD, Major Depression recurrent, GAD, OCD, social anxiety, and borderline features (the emotionally labile part), and non-restorative (lack of stage 4) sleep. All of them seem to fit.
>
> I have been on and off (mostly on) fluoxetine/Prozac since the age of 21 (I am in my late 30s). Fluoxetine seemed to cease to work for me in 2007, and I went off of it, hoping to experience a normal physical state (non-fatigued) for the first time since my youth. I have tried various other drugs, which I list below, but could not tolerate their effects.
>
> About 9 mos. after I went off fluoxetine, I experienced anxious depression (I had always had just regular old depression before--major, atypical, and dysthymic). I was experiencing major panic attacks, social anxiety, reactivation of PTSD, etc.
>
> I ended up on the couch, unable to move, shaking, not eating, not showering, just waking up and moving to the corner of the couch, where I sat all day, freaking out. I thought I was becoming schizophrenic. I was obsessed with that thought. I went inpatient, ended up being verbally abused by the staff, manipulated and retaliated against when I complained to the hospital ombudsman, and left the hospital worse than when I came in. Spent four weeks in a state of extremely severe anxiety. Went into a partial hospital program at another hospital, went inpatient for awhile to sort out my sleeping, started the road to healing.
>
> During that time, I tried to get back on fluoxetine, twice: first time, too sleepy, second time, too agitated. Third time, in the partial program, the pdoc started me off at 5 mg every other day, and it took me 4 months to work my way up to 20 mg fluoxetine. It worked great for six months, and then seemed to poop out. (Is it something about mid-winter? That's when everything went downhill for me off fluoxetine.)
>
> Some days, I experience suicidal ideation still. Others, I seem fine.
>
> Med History-Failed Trials
> Effexor (eye dilation, intense nausea, double vision, flu-like symptoms lasting 24 hours)
> Serzone (migraine headache)
> Paxil (double vision, unable to see/focus)
> Zoloft (first trial in 1993, slept for most of the next 72 hours, flu-like symptoms; second trial in 2008, chest paint for four days, sleepy but not helping me sleep)
> Elavil (zombie-feeling, bumping into things, unable to concentrate)
> Lexapro (eye dilation, woozy, spacey, tried for two days but couldn't take it)
> Wellbutrin (as an adjunct to fluoxetine it used to work to wake me up, but then I started to have panic attacks on it; tried it on its own in 2008, on 35mg daily ended up incredibly hostile, angry, climbing walls)
> Seroquel (tried in 2003, knocked me out for 13 hours but didn't seem to help with deep sleep, got up and slept most of hte next day. Headache and flu-like symptoms; tried in 2008 in the hospital, ended up with panic attacks, agitation, hyperventilation, and unable to judge accurately the distances between me and objects and the size of some objects)
>
>
> Okay, so in sum, the things that have only ever worked out:
> Prozac/fluoxetine (was on 20mg until 5 days ago)
> Ativan (was for a year and half on .5 in morning, 1.5 in evening; I started tapering off and am on .25 in the morning, same evening dose)
> Trazodone (but I develop tolerances to it, and then take more, but anything over 25mg just makes me non-functioning the next day, without necessarily keeping me asleep the night before).
>
> Family History
> Mother - depression
> Sister - schizophrenia
> Sister - nothing
> Father - depression (tried meds in the late 70s, couldn't tolerate them)/fatal heart attack (fit as a fiddle--genetic cholesterol condition)
> Grandparents - maternal side, both undx'ed depression
> Grandparents - paternal side, one with undx'ed personality disorder
> Great-grandparent - maternal, suicide
>
> Though in females, the timeframe for developing schizophrenia is most commonly 20-35, it is still possible to develop it later in life, especially with hormonal changes. In the last year and a half, I have had what my doctor calls a stress-induced brief hallucination (last summer, after a huge amount of caffeine and lack of sleep), and quasi-hallucinations--for instance, I have hpynogogic and hypnopompic hallucinations (occurs in normal populations, but new to me). All of this was probably brought on by my intense obsessions over fear of becoming schizophrenic, as I would think of all the things I could think or see or hear that would be unreal. I unfortunately have an intimate knowledge of my sister's delusions and hallucinations, and I have absorbed them and obsessed over them.
>
> So I am not psychotic but feel I could tilt that way.
>
> In sum, I am looking for a medication regimen that may have some dopamine but does not carry with it a higher risk of psychosis (as does the TCAs). I am looking for wakefulness without inducing anxiety. I am looking for something to level out my days, whether that be an AD or a mood stabilizer, if that seems appropriate (and sometimes it does).
>
> I am also looking to not be on a medication that carries a risk for metabolic syndrome or high cholesterol, since heart attacks due to high cholesterol is genetic in my family (father and uncle).
>
> I'm not asking too much am I? ;-)
>
> Willing to try proven alternative therapies.
>
> Whew. If you have read through this post, you are a saint!
>
> Desperately yours,
> Amelia
>
>With all of your symptoms and multiple drug failures, has it ever been mentioned that you may have an underlying bipolar disorder? There is a broad spectrum and you sure fit some of the criteria. Perhaps if you were on a mood stablizer, it would even you out, and you would be able to tolerate an AD. An AD used alone without a mood stablizer on board, can exacerbate your symptoms.
Posted by Amelia_in_StPaul on April 26, 2009, at 13:26:06
In reply to Re: Med Help Request (also at neutransmitters board) » Amelia_in_StPaul, posted by Phillipa on April 24, 2009, at 23:10:16
Posted by Amelia_in_StPaul on April 26, 2009, at 13:28:50
In reply to Re: Med Help Request (also at neutransmitters board) (nm), posted by Amelia_in_StPaul on April 26, 2009, at 13:26:06
I have to rewrite my message. Something wonky happened as I tried to submit my post. Anyway, thanks for your message Phillipa. I think the doc said I could just not take Ativan the night and next day (for MSLT) of the sleep study. I wonder, though, if the megadoses of vitamins I'm taking (for deficiencies/malnourishment) will interfere. I will have to call Monday. Thanks again, Amelia
Posted by Phillipa on April 26, 2009, at 20:52:19
In reply to Oops was trying to respond to Phillipa, posted by Amelia_in_StPaul on April 26, 2009, at 13:28:50
Amelia you're welcome. Love Phillipa
Posted by Amelia_in_StPaul on April 27, 2009, at 13:12:52
In reply to Re: Med Help Request (also at neutransmitters board), posted by polarbear206 on April 24, 2009, at 23:27:02
Hello polarbear, great name! (polar=bipolarity?)
It has been suggested to me that I may have BPII but it is a very confusing landscape. It's all on a spectrum, I understand. It's difficult for me to think of a mood stabilizer since most of my moods are low, and I've only experienced low-normal or something approaching normality, with happiness and general stability. My energy level is almost always in the toilet. I rarely have energetic days. I never need little sleep; never am euphoric.
But there is that anxiety. And anger. And there are those days, mostly after I do not have a good night sleep, when I drive recklessly (sorry, all, it's a bad thing, I know).
When is it BPII and when the effects of PTSD? When is it BPII and when features of BPD, with strong feelings of emptiness? When is it BPII and when is it just loving my spouse but having a history in which he has left me hanging when I needed him the most?
I have this probably irrational, but maybe not, fear. When my sister was first dx'ed 20+ years ago, she was diagnosed as BPI. Put on Lithium all that. She appeared to do well, and then went in the tank--and was later dx'ed with schizophrenia.
I know it is irrational, but the association between medication for BP and her eventual schizophrenia looms huge in my mind.
I am not sure there is any pharmacological basis to it, but there it is. One of my fears.
Thanks for responding so thoughtfully, polarbear.
Posted by PC_Load_Letter on April 27, 2009, at 23:18:54
In reply to Med Help Request (also at neutransmitters board), posted by Amelia_in_StPaul on April 24, 2009, at 18:20:11
Hi Amelia,
Though I'm usually too exhausted to post regularly, I thought I should probably offer some advice to a fellow St. Paulite in need.
My 2 cents: Since Prozac has worked so well (albeit inconsistently) for you in the past, I would recommend restarting it and (after stabilizing on it at the maximum tolerated dose) augmenting it with desipramine or nortriptyline. I'm not aware of tricyclics being especially likely to induce psychosis in a unipolar depressive. (Any AD, of course, could switch a bipolar to mania.)
Good luck!
Posted by desolationrower on April 28, 2009, at 10:42:10
In reply to Re: Med Help Request (also at neutransmitters boar » Amelia_in_StPaul, posted by PC_Load_Letter on April 27, 2009, at 23:18:54
> Hi Amelia,
>
> Though I'm usually too exhausted to post regularly, I thought I should probably offer some advice to a fellow St. Paulite in need.
>
> My 2 cents: Since Prozac has worked so well (albeit inconsistently) for you in the past, I would recommend restarting it and (after stabilizing on it at the maximum tolerated dose) augmenting it with desipramine or nortriptyline. I'm not aware of tricyclics being especially likely to induce psychosis in a unipolar depressive. (Any AD, of course, could switch a bipolar to mania.)
>
> Good luck!hey thats true about the manic switch thing, maybe thats waht you had read about AMStP (or confusing nris with stimulants)?
-d/r
This is the end of the thread.
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