![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 31. Go back in thread:
Posted by tonyz on June 18, 2009, at 15:50:38
In reply to Re: Question about med combinations, posted by Frustratedmama on June 18, 2009, at 15:26:53
Thanks. I have tried ambien, lunesta, sonata, rozera. The first three might keep me asleep for an hour. temazepam (restoril) works, but since it is like valium and I've been on either clonazepam or valium since November 2007 now I'm not sure how to adjust the dosage or if it would work at this point. That was one of the options I talked about with my pdoc. We settled on the other two. There is also the fact that the binding sites for gaba kind of get desensitized after a while which is why you need an increasingly larger dosage to get the same effect. (I know I am not explaining this properly, but you get the general idea).
I am a little bit scared right now as to what to do.
I was hoping to hear from someone who had taken Nortriptyline and Trazodone concurrently
Posted by linkadge on June 18, 2009, at 18:00:45
In reply to Re: Question about med combinations, posted by tonyz on June 18, 2009, at 15:50:38
I believe there is less poop out with the TCA's. I think there is some evidence too that they are more likely to result in remission.
I think the multiple targets of the TCA's possible makes them less likely to pul any one neurotransmitter too far out of whack.
Linkadge
Posted by linkadge on June 18, 2009, at 18:02:19
In reply to Question about med combinations, posted by tonyz on June 18, 2009, at 12:23:16
I would lower the nortriptyline, ditch the seroquel and add some gabapentin and amitryptyline to augment.
Linkadge
Posted by Frustratedmama on June 18, 2009, at 20:01:45
In reply to Re: Question about med combinations, posted by tonyz on June 18, 2009, at 15:50:38
I took trazadone but found I could take it during the day too - kind of strange huh? Also, at higher doses I went through withdrawls in AM- thus more irritable..... :( SO I switched to restoril- I hope you find something that works! Nortriptyline caused too much dry mouth for me.... However, I took an SSRI (prozac) with trazadone and valium (15 years ago) without difficulty and felt ok!
Posted by bleauberry on June 18, 2009, at 20:04:38
In reply to Question about med combinations, posted by tonyz on June 18, 2009, at 12:23:16
> I am currently taking Nortriptyline 150mg, 14mg valium, and 150 mg seroquel. My depression seems like it gets worse each day.
Hello? Do you see what you just said? It does not speak well of the meds you are taking, and could easily be, likely be, that one of them is making you WORSE.
>Sleep seems to alternate between maybe 4-5 hours to 2 hours the next night. This has been going on for a while now.
Serotonin is important for sleep. The current combo is pretty much anti-serotonin. Nortirptyline is mostly norepinephrine. Seroquel is increasing norepinephrine and dopamine in the brain, and leaving serotonin either untouched or lowering it. Valium is causing the body to make even less serotonin since it already perceives the GABA department as taking the lead role in calming things. That's my way of viewing it. Could be wrong.
>
> Discussed a number of options with my pdoc today. I think lithium will be a good long term maintenance choice for me but for now we kind of settled on these 2 options. I am wondering if anyone out there has taken this combination or something similar and has any thoughts on the subject. I am getting pretty desperate at this point.
>
> Option 1: 200mg Seroqeul, 20mg Valium, 150mg Nortriptyline
>
> Option 2: 200mg Seroquel, 15mg valium, 150mg Nortriptyline, 50mg trazodone.
>I am sorry to say, I do not like any of the above options. You know, in clinical trials when patients deteriorate on the meds, one of two things happens. They either drop out, or the people in charge remove them. They don't continue. Why is that a lot of us deteriorate on certain meds and we continue with them? Why do we not see that it is highly possible it is the meds themselves causing the deterioration, and not just a normal course of the disease worsening. Well, ok, even if it is naturally worsening, that also speaks badly for those meds, because they are obviously impotent at stopping it, much less reversing it. I do not feel your worsening depression is a natural course. It is the meds. They are the wrong ones for you.
I am not very suspect of Nortriptyline. But I am very suspect of Seroquel and Valium. I mean, you take ten people off the street and put them on Valium for a few weeks or months, 8 of them are going to get depressed.
The APs can and do work magic when combined with SSRIs or SNRIs. But with the strong antihistamine effect of Nortriptyline in combination with the super strong antihistamine effect of Seroquel, I am not surprised you are getting more depressed.
This is all armchair quaterbacking. That said, what would I do in your shoes? Well, the thought of getting off Seroquel is not fun, and Valium, not fun, but that's what I would be planning.
If I absolutely had to have a benzo for the switch, it would be Xanax. At least it has some antidepressant potential.
To keep an AP in the mix, it would have to be a real good one. And it would have to have more of a serotonin partner to work with. To me, that would mean replacing Seroquel straight across for Zyprexa. Maybe risperdal very low dose. For the serotonin, I would add in low-moderate doses of either Zoloft, Lexapro, Prozac, or Celexa. Brand only. No generics. Too much at stake at this point to worry about the extra cost.
Forget the trazodone. That won't do you any good at all. Will probably make you feel worse. I hear you when you say sleep is an issue. It is. Take 10mg-25mg Amitriptyline instead. Its metabolite turns into Nortriptyline, so in a way you are getting a little more serotonin help, and a bit higher dose of Nortriptyline, and sleep, from just adding a little bit of Amitriptyline.
Nortriptyline, SSRI, Zyprexa, maybe Xanax, maybe Amitriptyline. I think you'll sleep a lot better and feel a lot better when you get some serotonin in the mix, get some of the antihistamine out of the mix, and get some of the GABA out of the mix.
You mentioned Lithium. Well, there have been a few cases here over the years where Lithium was THE thing that calmed everything down even when high doses of Klonopin would not. So that is possible. I personally feel lithium is not very useful when combined with serotonin meds, because it is sort of acting on the same pathways, but that it can be much more worthwhile as an enhancer for norepinephrine meds, since it gives a serotonin angle that is otherwise missing.
It is all more complicated than the way I am saying it of course. My basic message is, you are getting worse on your meds, it aint the depression getting worse by itself, and you gotta change the meds. I am trying to offer some rational ideas of what meds to change to, for maximum potential and for minimal trauma when ditching the ones you are on.
No one has ever done it, but I bet if we went back in time to collect all the posts on Seroquel and Zyprexa to get some kind of judgement as to which is better for depression, I think Zyprexa wins easy. That is my experience and observation. And you gotta get some serotonin in the mix. Nortriptyline works a ton better with an SSRI partner.
Posted by tonyz on June 18, 2009, at 21:57:54
In reply to Re: Question about med combinations, posted by bleauberry on June 18, 2009, at 20:04:38
Thanks Blueberry for the lengthy response now you have me wondering. When I went into a day hospital last year I was taking around 125-150mg of Nortriptyline, 300mg seroquel, 150mg of trazodone, and 20mg of valium and lunesta all at bedtime.
The first change the doc made was to lower the NTP to 100mg, stop the lunesta and trazodone and increase the seroquel to 400mg. The next change was to decrease the seroquel to 300mg. The valium stayed constant at 20mg throughout the process. Next change was adding abilify 1.25mg 2x a day and increasing the NTP to 125mg. At some point around that time and this is over a 2-3 week period I was getting some improvement. The seroquel was reduced to 200mg valium to 12.5mg, same amount of Notriptyline (125mg) the abilify was taken every other day, and I asked about taking L-tryptophan and the doc didn't know it was back on the market. So I started taking 1500 mg every night. Within a week I decreased the valium to 10mg. According to my notes I was doing ok with this reduction. The abilify was the first to go completely and then gradual reductions of the seroquel and valium. The Nortriptyline was the last to go and I was med free from May 2007 through most of November which is when I relapsed.
This was not my first experience with a day hospital. Years earlier I was treated with amitriptyline but because of severe constipation the doc switched it to Nortriptyline (he didn't know about Miralax) I don't know off hand what I was taking for sleep but it was either Clonazepam, Valium or temazepam.
You seem to know quite a bit about these meds. My instinct suggested that trazodone might not be a good thing to mix in at this point.
My understanding was that Nortriptyline worked by preventing serotonin and noradrenaline from being reabsorbed back into the nerve cells in the brain.
So doesn't Notriptyline work on serotonin? Or are you saying there just isn't enough serotonin being produced with the current mix of meds.So it's 10:30 now and I have to figure out what to do?
All these guys have different opinions, while my pdoc was on vacation I called to the doc on call and he didn't recommend mixing the NTP with trazodone. So that is at least two docs that agree on something.
For tonight I think my best option is to bump up the Seroquel and continue with the Nortriptyline and try and leave the valium where it is.
I'm just looking at what you suggesting and I think I understand your theory about there not being enough serotonin to go around. I don't want to be taking a whole bunch of meds. That gets too complicated - I'm sure these drugs are never tested in combination in most clinical trials.
I'm wondering how I got better last year with what I was taking?
Posted by Phillipa on June 19, 2009, at 0:01:37
In reply to Re: Question about med combinations, posted by tonyz on June 18, 2009, at 15:22:08
No it doesn't. SSRI's always stimulated me also no remissions so always aborted wierd this low dose of luvox and l0 of valium .25 of xanax is it now and trying the bioidentical compounded hormones. Good luck seriously with new pdoc!!!! Love Phillipa
Posted by morganpmiller on June 19, 2009, at 2:01:49
In reply to Re: Question about med combinations » tonyz, posted by Phillipa on June 19, 2009, at 0:01:37
I agree with trying to dump the seroquel and valium in the long run.
Zyprexa at night, maybe 10 mgs, would most likely be a better option for you right now. Eventually I would try to get off all antispychotics if possible.
I know I having been pushing Lithium a whole lot around here. I just feel it could not hurt to add a low dose and see what happens.
If you do try an SSRI, I would definitely go with prozac, zoloft, or paxil(although I'm not sure how well paxil will work for depression) over the more selective SSRIs, celexa and lexapro. I wouldn't worry about "poop out". Even if you have another bout of depression on a medication that has worked for you, the depression will most likely be nothing compared to what you are experiencing now. At that "poop out" moment, you may just need to stick it out or raise the dose. I just don't believe in this whole "poop out" phenomenon, at least not to the degree that others do.
Definitely fire your psychiatrist. This guy doesn't seem to have a clue as to what you need.
Do your research and find the best psychiatrist you can. And, take notes on some of the advice given above, tell your new p doc, and see what they think. Sounds like a lot of people around here know what they are talking about and have good things to say. Good Luck!
Posted by morganpmiller on June 19, 2009, at 2:15:10
In reply to Re: Question about med combinations, posted by tonyz on June 18, 2009, at 21:57:54
I also think your on way too much crap that may harm you more than help you in the long run. If you find yourself worse than before you started taking all these meds, the meds may be part of your problem. I'm sure things were complicated with you that is why the doctor was trying everything you are on now. I had a major major mixed episode a year and a half ago. I could not sleep more than 3 hours a night. I was constantly pacing and talking really fast about thing I regretted. My mind and body where in fast motion. I had so much anxiety and aggitation I simply couldn't bear it. In the hospital they gave me Depakote and Zyprexa. That was it. It actually worked pretty well for a while. Why am I telling you this? Well, I guess because I think you are way over medicated.
Any time I have been on a benzo, not only did I not sleep well, but I seemed to have a harder time stabilizing while I was on it. Once I was able to get off the benzo, it became clear that it was more of a short term fix that was interfering with me finding a long term solution. This may or may not apply to you..JMHO I could just be talking out of my *ss right now
Posted by morganpmiller on June 19, 2009, at 2:21:01
In reply to Question about med combinations, posted by tonyz on June 18, 2009, at 12:23:16
I guess your only on 3 so I take back my last post. I still think two good medications that work to stabilize you where you are sleeping well and feeling good during the day, would be ideal. Plus, no more benzo or just use on an as needed basis. I guess whatever you end up doin, if you feel good on it and sleep well with few or no noticeable side effects, that is more important than anything.
Posted by tonyz on June 19, 2009, at 10:47:42
In reply to Re: Question about med combinations, posted by morganpmiller on June 19, 2009, at 2:21:01
Really appreciate all the responses I have gotten from everyone. When this started in November I started taking clonazepam and nortriptyline then added seroquel to the mix.
In January I had gotten up to 200mg of Seroquel, 175mg of Nortriptyline and was taking 1mg Clonazepam. I had gone from 150 of Seroquel to 200mg in 1 day.
Then I switched the clonazepam to valium (20mg) to start tapering. I was tapering the valium about 2.5mg every 4-5 days while also tapering the seroquel roughly 25mg every 4 days. I reduced the Nortriptyline to 150mg.
Got off the Seroquel had the valium at 7.5mg and the Nortriptyline at 150mg. I was feeling better but quickly relapsed.
The doc said I got of the Seroquel too quickly. Ok so I tried taking it again for 5 nights 50-50-25-25-25. Just couldn't do it -- I had too much anxiety over taking the Seroquel (or any anti-psychotic for that matter). The doc knows I don't like the seroquel so he prescribed wellbutrin (100mg) as an augment for the Notriptyline. Stayed on that for about 2-3 weeks. I felt a little something from the Wellbutrin but it wasn't doing the trick sleep was erratic but I was getting some sleep each night. Valium also went up during this time between 10-15mg. Would vary.
Apparently around mid March I started feeling better because the Nortriptyline was down to 100mg and and the valium was at 7,5mg getting tapered by about 2.5mg every 4 days. I was getting good sleep according to my records. I continued tapering the NTP and valium and got it down 25mg NTP and 2.5 mg valium. This was early April.
Then I started having sleep issues again so the Valium went up to 8mg and the trazodone was added
(100mg a night). The combination of the trazodone and valium was very sedating intitially but then I would awaken during the night.I had taken Sam-e with some success in the past so started down that route. Pdoc knows I don't like meds so he suggested it but didn't give me any guidelines. Did 400mg for 3 days, then 600mg for 3 days. I think I had some reactions and sleep was starting to deteriorate. I was also taking the valium at this time which had been increased to 10mg.
Then I saw another doctor but in the same office, I told her I really didn't like taking meds but I needed something for sleep she had suggested raising the sam-e to 800mg and taking 7.5mg remeron for sleep Valium was 10mg at this time.
The remeron seemed to help with sleep, initially but then stopped working so began back with the seroquel and Notriptyline and the valium ramped back between 17.5 and 20mg. The remeron and Sam-e were stopped.If I read some of the postings on the benzo withdrawal boards which someone was kind enough to point out from this group, that sounds like me:
the depersonalization, very bad memory problems, poor concentration, having trouble remembering the sequence of events during the day, etc.I tell this to my pdoc and he says you need to think about hospitalization. The problem I have with this is 1)the loss of control in the sense that you feel more compelled to follow their recommendations exactly - it is a day program you just go during the day and there are different group sessions. Generally start off by rating depression and anxiety every day, and then to other groups. You usually meet with your doctor every other day for maybe 10-15 minutes and he makes adjustments to your medication. I don't think I want to do this again. I have to admit it did work for me last year.
The neuroleptics scare the c*** out of me, but being in this state is not good either.
Right now the Nortriptyline is at 150mg, the seroquel 200mg and the valium 19mg - so I caved in last night. I estimate I got about 5-6 hours sleep and there was dreaming, but I feel like crap this morning, I guess I was a bit agitated by some of the postings because it made me think that perhaps these meds are screwing me up.
Doctors typically look at past experience and that is their starting point. I keep very good records of what I take, but now since I have the history of improving when on Seroquel at 400mg, 125 of Nortriptyline and 20 mg of valium and abilify that is probably going to be the starting point.
Seroquel has the potential for a lot of serious health issues - other than being very shaky last year I was fortunate in not incurring any of the other side effects with the exception of my cholesterol being raised slightly but I can't blame that on the seroquel for sure.
If you've read this far I am very grateful. What do you think about adding L-tryptophan and/or benadryl, scaling back on the valium. I also have some temazepam but it is just a few months past its expiration. That is also an option. The seroquel - I would just scale back by 25mg a night. On a Friday, the probability of finding a doctor and getting an appointment for today is going to be nearly impossible.
The pattern last night was no different sleep wise. I alternate between a few hours 1 day and better the next day so I don't think the additional valium and seroquel did very much.
Guys and Gals if I ever get out of this hole I'll will try to contribute as much as I can to this group. I really appreciate all of the responses.
Posted by Frustratedmama on June 19, 2009, at 12:13:59
In reply to Re: Question about med combinations, posted by tonyz on June 19, 2009, at 10:47:42
I can take loads of valium without fatigue yet the restoril in modest doses works to help with sleep for me..... benadryl makes me more wired.... I hope you find some releif....
Just a side note..... I added verapamil to my mix and although I don't think it is helping much right now I will say that If I take a verapamil with my lunesta it WORKS for sleep- IE the lunesta seems to work so much better- I stay asleep longer and actually felt tired.... However, I need to be awake in the AM and I had extreme difficulty doing that with the combination of verapamil and lunesta so now I take my verapamil at least 3 hours before the lunesta..... Lunesta doesn't work wonders for me but it helps on its own- I know some people who take 6 mg- how high did you go? GOOD LUCK!
Posted by linkadge on June 19, 2009, at 17:26:44
In reply to Re: Question about med combinations, posted by tonyz on June 19, 2009, at 10:47:42
Nortriptyline is an SNRI but it acts more potently on norepinephrine than serotonin. For some people it is too stimulating.
Thats why I suggest lowering the dose and adding something serotonergic.
Linkadge
Posted by bleauberry on June 19, 2009, at 18:43:42
In reply to Re: Question about med combinations, posted by tonyz on June 18, 2009, at 21:57:54
When I said in my earlier response to try to get some serotonin enhancement into the mix, what I meant specifically was adding an SSRI such as Zoloft of Prozac. Nortriptyline goes well with either.
Nortriptyline is thought of as an SNRI, with its strongest action on norepinephrine. But, one has to conclude that its effects on serotonin are minimal if any, evidenced by the fact that people take Nortriptyline with MAOIs and do not get serotonin toxicity syndrome. If its reuptake of serotonin was at all meaningful, it would be a deadly combination with MAOIs.
That's why I think serotonin is the missing link in the cocktail.
Seroquel and Valium need to be replaced. Zypexa alone would be a ton better. If not quite enough, Xanax instead of Valium.
Nortriptyline+Zoloft(or Prozac)+Zyprexa+optional Xanax. Brand not generic on the Zoloft, Prozac, Zyprexa, and Xanax (Greenstone generic is good).
Posted by desolationrower on June 19, 2009, at 18:49:00
In reply to Re: Question about med combinations, posted by tonyz on June 19, 2009, at 10:47:42
The big problem here is insomnia?
I think for bad insomnia, you should try to cover most of the neurotrasnitters implicated in arousal. So an antihistamine like low dose mirtazipine or high dose of cyproheptadine. a gaba drug like a benzo. a andrenergic drug like clonidine. etc.
i also wonder if using a stimulant to both wake you up during the day, and cause rebound fatigue at night could be beneficial. i'd be interested in hearing from anyone who has tried taht.
-d/r
Posted by tonyz on June 19, 2009, at 18:58:39
In reply to Re: Question about med combinations, posted by linkadge on June 19, 2009, at 17:26:44
Thanks everyone.
You raise some interesting points. I read that Zoloft and Nortriptyline work well together and maybe the Nortriptyline is too stimulating. I think I got about 5 hours last night but that was upping the valium and seroquel.
Understand the comments about Zyprexa, I just would prefer to avoid all of the neuroleptics.
I don't know how to explain it, I am not myself just feel very fuzzy.There were some comments made w/ regard to the benzos and some folks being on them for a very long time. I believe you can develop a dependence on these drug which requires increasing amounts to get the same effect. I also believe they cause memory and cognition problems, but maybe for some people that doesn't happen.
I checked the Ashton guideline on the benzos which is a way of tapering with Valium. She includes a detailed schedule for each drug. I could add some temazepam in the mix with the valium. I only have 30mg so I would have to open one of the capsules and kind of split with 1/2 valium and 1/2 of the temazepam. I think I will just try a little less valium and the Tryptophan and hope for the best.
Thanks for all the support. You are all very kind and helpful.
Posted by tonyz on June 19, 2009, at 22:55:43
In reply to Re: Question about med combinations, posted by desolationrower on June 19, 2009, at 18:49:00
Thanks d/r, you are really up on the different meds. What you are suggesting makes sense, I just get a bit nervous combining too many different drugs.
Insomnia and lack of concentration/depression are the problems. The lack of sleep adds to the anxiety and depression, memory is severely effected. I have trouble remembering what I did for the day.
I try to get exercise every day and I think that is helping. When I had tapered off of everything except the valium (I was down to 2.5mg) I was sleeping 3-4 hours a night but I was much more focused and alert during the day.
So it is hard to evaluate if ramping up on all the meds has caused the state of confusion now or the insomnia just caught up with me. My biggest concern is the neuroleptics - I understand they can be very effective when paired with an anti-depressant but they just scare the hell out of me. That is just me - they are fine for some people.
When I started back on the meds 7.5 of remeron with the 2.5mg of valium seemed to be working but then things started going downhill. I had seen another doctor in the same office though and she had indicated that remeron in small doses can be effective with insomnia. That is an option but I don't want to add too much stuff now. I've got the three: Nortiptyline (150mg) Seroquel (which I am reducing by 25 mg every night or two) I have only been taking since mid May and ramped up t0 200mg and was back to 0mg by June 4. On June 5 I started back with a low dose of 25mg and have been incresing last night was 200, tonight its 175 on the seroquel and 17 on the valium. I will reconsider the remeron because it seemed to have a good effect initially, but I had stopped the NTP at the time and that may have caused the depression to relapse.
I'm flying blind here and my pdoc doesn't seem to want to make too many changes at once so it leaves it to me to tweak things a bit which I am not real comfortable with but I feel I don't have a choice.
The fact that I was a hell of a lot better even getting little sleep with very few meds tells me something. Last year when I was on 20 mg of valium when I went into the hospital I reduced by 2.5mg every week and the last week 2,5mg every other day. When I was at 12,5mg I added 1500 mg of l-tryptophan. Checking drug interactions that is kind of a no-no for the current dosage of valium but when I reduce further I will be adding that again.
I've had the best response w/ Amitriptyline in the past although the side effects are awful and Blueberry had a very goint point about the serotonin potentially being absent. Maybe all I need is a little serotonin in the mix and scaling back on the NTP and adding some Amitriptyline may be just the ticket.
As I mentioned when I was treated as an outpatient in a hospital I was on amitriptyline and was having severe constipation. How can I put this politely - normally my body is very efficient at processing food. He suggested ducosate sodium which did nothing for me. The current doc told me about miralax and that is just a super laxative for me. Others may have different experiences. I suppose it is also possible that the side effect profile may diminish over time. Notriptyline is easier in terms of constipation, occular pressure, blood pressure changes, for me tremors may be about the same (don't remember).
Anyway, you guys are really great to keep responding to my postings. You have given me a lot of support which I haven't been able to get elsewhere and I continue to be very thankful. I hope we all find something that has a minimum side effect profile and works for all of us.
> The big problem here is insomnia?
>
> I think for bad insomnia, you should try to cover most of the neurotrasnitters implicated in arousal. So an antihistamine like low dose mirtazipine or high dose of cyproheptadine. a gaba drug like a benzo. a andrenergic drug like clonidine. etc.
>
> i also wonder if using a stimulant to both wake you up during the day, and cause rebound fatigue at night could be beneficial. i'd be interested in hearing from anyone who has tried taht.
>
> -d/r
Posted by morganpmiller on June 20, 2009, at 1:39:44
In reply to Re: Question about med combinations, posted by tonyz on June 19, 2009, at 18:58:39
> Thanks everyone.
>
> You raise some interesting points. I read that Zoloft and Nortriptyline work well together and maybe the Nortriptyline is too stimulating. I think I got about 5 hours last night but that was upping the valium and seroquel.
>
> Understand the comments about Zyprexa, I just would prefer to avoid all of the neuroleptics.
> I don't know how to explain it, I am not myself just feel very fuzzy.
>
> There were some comments made w/ regard to the benzos and some folks being on them for a very long time. I believe you can develop a dependence on these drug which requires increasing amounts to get the same effect. I also believe they cause memory and cognition problems, but maybe for some people that doesn't happen.
>
> I checked the Ashton guideline on the benzos which is a way of tapering with Valium. She includes a detailed schedule for each drug. I could add some temazepam in the mix with the valium. I only have 30mg so I would have to open one of the capsules and kind of split with 1/2 valium and 1/2 of the temazepam. I think I will just try a little less valium and the Tryptophan and hope for the best.
>
> Thanks for all the support. You are all very kind and helpful.
>
>
I think the reasoning behind switching to Zyprexa is that you are already on Seroquel to begin with. Unless you plan on dumping the Seroquel soon, you may want to consider trying something like Zyprexa that might make you feel better. I just don't think it would hurt to replace seroquel with zyprexa. If you are going to get off seroquel and not include any antipsychotic in your treatment, then forget about the Zyprexa suggestion.Am I making any sense?
Hope you feel better soon! I'm experiencing my own little piece of hell right now so I can definitely relate.
Posted by morganpmiller on June 20, 2009, at 1:45:18
In reply to Re: Question about med combinations, posted by tonyz on June 19, 2009, at 10:47:42
You do know that seroquel and zyprexa are in the same drug class, atypical antipsychotics. Neuroleptics and antipsychotics are one and the same; two different terms used to describe the same thing.
Not trying to worry you or agitate you further. Just want to make sure you know that Seroquel is a neuroleptic/antipsychotic.
Posted by tonyz on June 20, 2009, at 7:28:58
In reply to Re: Question about med combinations, posted by morganpmiller on June 20, 2009, at 1:39:44
Yes Morgan. What you and others have suggested makes perfect sense w/ regard to Zyprexa vs Seroquel. However, I am planning on ditching the Seroquel. My plan is to taper both the Seroquel and Valium at the same time. If it doesn't work out I will stay on the Valium longer.
But so far so good - got a decent 6 hours sleep last night which comparatively speaking is very good. The problem I have now is once I wake up I don't get back to sleep.
Memory and concentration is still a problem, but hopefully that will improve.
So what problems are you having now -- sorry to hear of your situation.
Posted by tonyz on June 20, 2009, at 7:31:43
In reply to Re: Question about med combinations, posted by morganpmiller on June 20, 2009, at 1:45:18
Yep, I know, and I plan on never taking one of those again. It's a thing with me and I don't want to upset others that may need these drugs by going into the details.
Posted by morganpmiller on June 20, 2009, at 22:05:14
In reply to Re: Question about med combinations, posted by tonyz on June 20, 2009, at 7:31:43
> Yep, I know, and I plan on never taking one of those again. It's a thing with me and I don't want to upset others that may need these drugs by going into the details.
Gotchya, I feel the same way about neuroleptics/antipsychotics. It's not the stigma that comes with the name, it's the potential health risks/side effects. I would not be opposed to using zyprexa in the short term for mania, I just would want to do everything I could to get off of it and never use it again. I don't think I am one that needs these types of drugs all the time. I am sure you may be the same and feel the same.
Sorry, I was not sure if you were going to stay on Seroquel. Maybe I didn't read your posts carefully enough. My bad. Yeah if you can get stable on safer meds, I am totally for that for anyone.
I understand you not wanting to upset anyone that takes drugs like Zyprexa and Seroquel. I wouldn't want to either. If it works for them, and they have a condition that requires it, then I totally understand why these drugs are being used, especially in the case of the most severe bipolar and psychotic disorders.
Good luck Tony, I'm assuming that is your name.
Posted by Brainbeard on June 21, 2009, at 7:03:12
In reply to Re: Question about med combinations, posted by morganpmiller on June 20, 2009, at 1:45:18
Oof, just worked my way through these posts. Wish I'd had some Adderall. But I've reached the end of the thread alive (and awake).
I think Bleauberry is right in saying that SRI or serotonergic action is missing. And I personally feel that lowering the nortriptyline might be important. Nortriptyline can be very effective for sleep in doses as low as 25mg. On higher doses, its noradrenergic stimulation might start to disturb sleep.
One SSRI that I'm missing here and which deserves mentioning, is Luvox (fluvoxamine), since Luvox is the most sedating SSRI and thus the one most likely to help with sleep. When I combined it with 25mg nortriptyline and 10mg of clomipramine (Luvox raises clomipramine blood levels enormously), I slept like a log.
I wouldn't take the combination of meds you were on when you felt better as a starting point, since you may have felt better for completely different reasons than the meds you were on. Unless you are sure it were the meds.
Posted by tonyz on June 21, 2009, at 14:13:21
In reply to Re: Question about med combinations, posted by Brainbeard on June 21, 2009, at 7:03:12
Yep I think Blueberry probably knows more than the pdoc I've been seeing. Got an appointment with someone else at the end of this month, so hopefully I can hold until then.
I really appreciate the enormous amount of support I've been getting from this group. Yesterday was a better day; it's possible lowering the Seroquel might have made a difference. Haven't been on it very long, but I think I will taper a little more slowly just to be safe. Had started retaking in May at 50mg for about a week and then stopped, but 2 days later started taking again at 50mg and within a week was up to 200, then started tapering back and within a week had stopped for 1 day and then started taking again, the last jump up was from 150 to 200, then I started tapering 25mg / night, but I think I will probably have to give it about 4 days between reducing by 25mg until I'm down to 0. I think I slept ok last night, but I am not sure.
For me it is just recurrent depression. No one thinks I am bipolar, but the consensus seems to be a mood stabilizer is needed.
I'm just very foggy and slowed in my thinking could be the combination of drugs or the depression, probably both.
Posted by morganpmiller on June 22, 2009, at 1:22:38
In reply to Re: Question about med combinations, posted by tonyz on June 21, 2009, at 14:13:21
If you never had any kind of mixed episode/manic episode and you definitely are not bipolar, I can't help but think that there must be an AD out there that works for you. I am guess that if your p doc put you on Seroquel, he is wondering if you are bipolar. Agitation alone can be a manifestation of bipolar.It is not an easy diagnosis in many cases. Sometimes I think it is over diagnosed nowadays. Evidently, some are diagnosed with bipolar that have never experienced mania of any kind. So who knows...they really don't know yet. Things will change over the next 10 to 20 years.
I had a major mixed episode a year and a half ago. I was stabilized on Zoloft alone for 8 long years. Life was good back then though, that definitely has something to do with it.
This is the end of the thread.
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