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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by delna on November 20, 2009, at 2:44:52
Hi,
I really need help on this new one. I'm back with my problems again. Sorry. :(I originally wrote this for Scott (who does not seem to be around) on one of my threads so forgive me if you have read it already. But I am desperate for some insight.
I know I need a good pdoc but I don't have one right now and even if I do go to the UK or US its not going to take a week at least to organize (also depending on when I can get appointments). I'm finding it really hard to hang on and now I am feeling that there may be no point in bothering since I feel my chemistry is so random and messed up that nothing can help.Right now, my symptoms are changing daily even though I am on the same drugs. Most days I have been completely exhausted, but then suddenly one day I become much more awake but with bad anxiety. Again that passes and back to exhaustion. All this with no drug changes at all.
Now the terrifying thing seems that I am suddenly not tolerant to even 200mg of Provigil- it is giving me palpitations. I need stimulatnts to stay awake. Pre- Parnate, I was on 400mg + other stimulating things with no problems(that was around 5-6 weeks ago.) My anxiety never presents with palpitations so it's definitely not the anxiety.
The same thing happened to me post stopping Geodon- I suddenly couldn't tolerate even 25mg of Provigil (whereas I was used to 300-400mg daily.)
Regardless to say I was a zombie for 6 months but somehow not depressed at all. During this time I regularly re-challenged myself with 25mg Provigil and found that it gave me extreme palpitations- I needed Inderal(beta-blocker) 80mg in one go to control it. I discovered that I couldn't take any drug that touched NA- not even an SNRI like cymbalta. I went to the US to my pdoc because of this and he didn't know what to do either- he said to try abilify for wakefulness. His hands were tied, there was nothing he could do.
Just before starting Abilify, I randomly re-challenged myself with Provigil and found I was tolerant again. So I slowly upped the dose to 400mg and added the wellbutrin 300mg. I felt awake again but a few months later I suddenly became very depressed (induced by my period) and suicidal. It was very random. I had no anxiety even though I was on at these stimulating agents (the only difference between then and now is that I was on lexapro 10mg) I had to give that up before starting Parnate.Now I am daily(or every few days) fluctuating wildly. Yesterday I needed to knock myself out with Klonopin whereas a few days ago I was sleeping 20 hours with no dose changes.
I am scared to try the Prozac (which my pdoc here said okay to) because I feel every time I try something new my chemistry (which is already so weird and unstable) changes dramatically. So I really don't want to mess with drugs- especially since I am prescribing them to myself. But I am getting worse so I need to understand this. Is my constitution so freaky that there is no point in trying at all? Because trial and error doesn't work for me- it takes me months just to adjust to a drug being removed (plus the withdrawal itself)
My diagnosis is BP rapid cycling so i don't know if its just that and if I need another mood stabilizer. But even that doesn't make sense as I am not getting highs and lows, just fluctuating between exhaustion and anxiety.
Furthermore, if I'm again intolerant to the most vital drugs I take (stimulants) then I have really reached a dead end. Even if a sleep disorder is diagnosed, unless it is sleep apnea, stimulants are the treatment. So I don't know if there is any hope left.
Does anyone understand this strange phenomenon at all. My pdoc can't explain it (nor does he even try to)
I feel my problem is not just TRD but complicated by the fact that I am over sensitive to side effects like sedation and always seem to get the rarest side effects of drugs (TD on Geodon, Narrow angle glaucoma and near blindness on Topamax etc.) Plus every drug dramatically changes my chemistry and i have to wait months for things to resettle.Is there any hope? Could ECT maybe fix this and reset my chemistry?
Any thoughts really appreciated.
Thanks
DPS: Sorry for the long thread and for just being so problematic in general.
Posted by SLS on November 20, 2009, at 6:05:15
In reply to I don't understand what is going on! Help!!, posted by delna on November 20, 2009, at 2:44:52
> I'm finding it really hard to hang on and now I am feeling that there may be no point in bothering since I feel my chemistry is so random and messed up that nothing can help.
Try not to play neuroscientist. There is no reason to believe that your brain is ruined.
> Right now, my symptoms are changing daily even though I am on the same drugs. Most days I have been completely exhausted, but then suddenly one day I become much more awake but with bad anxiety. Again that passes and back to exhaustion. All this with no drug changes at all.
Bipolar?
Okay. I read further down and saw that you are.
> Now the terrifying thing seems that I am suddenly not tolerant to even 200mg of Provigil- it is giving me palpitations. I need stimulatnts to stay awake. Pre- Parnate, I was on 400mg + other stimulating things with no problems(that was around 5-6 weeks ago.) My anxiety never presents with palpitations so it's definitely not the anxiety.
With Parnate, heart palpitations sometimes occur just before a therapeutic response develops or it can signal the need for a dosage increase.
> The same thing happened to me post stopping Geodon- I suddenly couldn't tolerate even 25mg of Provigil (whereas I was used to 300-400mg daily.)
If your depression or anxiety gets worse upon discontinuing a drug, it might indicate that you are experiencing a symptom rebound. In this case, your autonomic nervous system can be provoked into malfunctioning, in which case stimulants might make things worse.
> Regardless to say I was a zombie for 6 months but somehow not depressed at all. During this time I regularly re-challenged myself with 25mg Provigil and found that it gave me extreme palpitations-
In this case, I have no explanations. Palpitations are often benign, and do not indicate heart problems. They are more the result of excessive excitation of the sympathetic nervous system. Again, this is the result of an autonomic imbalance.
I apologize for not remembering, but can you list the drugs you are currently taking?
Try not to challenge yourself or make changes in your daily routine of medication. The goal of treatment is to establish a new equilibrium of CNS processes. This can only occur if there is a stable biological environment within which the body can maintain homeostasis. With an ultra-rapid cycling presentation, this is critical. You are better off not playing with stimulants. Once the right treatment is implemented, you probably won't need them. Bipolar disorder, like major depressive disorder, can present differently between individuals. Depressed mood is not a necessary component of these disorders. The "zombie" effect and exhaustion is how some people experience depression. Anxiety and activation/agitation is how some people experience mania or hypomania. Your presentation of bipolar disorder is not uncommon.
- Scott
Posted by SLS on November 20, 2009, at 6:08:32
In reply to Re: I don't understand what is going on! Help!! » delna, posted by SLS on November 20, 2009, at 6:05:15
What I like to do is to make three lists of drugs that I have tried.
1. Drugs that have helped - no matter how long or how strong.
2. Drugs that have made things worse.
3. Drugs with no therapeutic effect, but that are tolerable.
For you, I would also like to see a list of drugs that you have had untoward reactions to, including a description of those reactions.
- Scott
Posted by delna on November 20, 2009, at 6:28:26
In reply to Re: I don't understand what is going on! Help!!, posted by SLS on November 20, 2009, at 6:08:32
Thank you Scott,
You are a life saver. I feel hopeful. Mabye i am ultra rapidly cycling. I never thought about this.I am now making a list and will post here and am also sending to my pdoc in UK
Thank you scott,
You really are the best.
Love DPS: currently i am on:
lamictal 200mg
provigil 200mg.
Plus klonopin to control anxiety.
I stopped parnate 3 weeks ago.
Posted by Phillipa on November 20, 2009, at 10:32:11
In reply to Re: I don't understand what is going on! Help!! » SLS, posted by delna on November 20, 2009, at 6:28:26
Delna just a thought if you just stopped parnate three weeks ago could you still be withdrawing from it? Love Phillipa
Posted by desolationrower on November 20, 2009, at 17:28:04
In reply to Re: I don't understand what is going on! Help!! » SLS, posted by delna on November 20, 2009, at 6:28:26
have you had a sleep test?
-d/r
Posted by Maxime on November 22, 2009, at 11:04:13
In reply to I don't understand what is going on! Help!!, posted by delna on November 20, 2009, at 2:44:52
Delna
What would happen if you were on no meds at all for two weeks? Then you could slowly stat introducing meds one at a time. It's really hard to know what is causing what especially the fact that you are/have been withdrawing from Parnate.
You need an expert mood clinic somewhere. If you have to go to the States, then go. If you think someone in the UK can help, then go. Don't give up!
Posted by Meltingpot on November 23, 2009, at 5:42:43
In reply to I don't understand what is going on! Help!!, posted by delna on November 20, 2009, at 2:44:52
Delna,
In my view you are experiencing all of these strange symptoms because of a combination of your bipolar and withdrawing off Parnate.
I know that doesn't help you much right now, you don't really want to be feeling like this regardless of the why's and wherefores.
Denise
Posted by delna on November 23, 2009, at 10:22:25
In reply to Re: I don't understand what is going on! Help!!, posted by desolationrower on November 20, 2009, at 17:28:04
> have you had a sleep test?
>
> -d/rThanks for asking.
I just saw a sleep specialist today and she didn't think it was likely that I had sleep disorder. ( I was told that before years ago when I was referred to a sleep lab by my pdoc)
I just have 2 suspicious sleep related problems which are excessive sleepiness and occasional sleep paralysis. But she said I should have the test to rule out any abnormalities in my sleep cycle- so sometime this week I am going in I hope.
TC
D
Posted by delna on November 23, 2009, at 10:27:22
In reply to Re: I don't understand what is going on! Help!!, posted by Meltingpot on November 23, 2009, at 5:42:43
> Delna,
>
> In my view you are experiencing all of these strange symptoms because of a combination of your bipolar and withdrawing off Parnate.
>
> I know that doesn't help you much right now, you don't really want to be feeling like this regardless of the why's and wherefores.
>
> DeniseHi Denise,
How are you doing?
I don't think its Parnate withdrawal because this has come up 2-3 weeks after withdrawal. Plus the 'swinging' has stopped and now I am just back to sleeping 18-20 hours a day. I have even reduced my klonopion dose and am only taking 100mg provigil to stay awake.
I think its depression that is getting worse.....
I need to be treated ASAP.
TC
Love
D
Posted by delna on November 23, 2009, at 10:47:56
In reply to Re: I don't understand what is going on! Help!! » delna, posted by Maxime on November 22, 2009, at 11:04:13
> Delna
>
> What would happen if you were on no meds at all for two weeks? Then you could slowly stat introducing meds one at a time. It's really hard to know what is causing what especially the fact that you are/have been withdrawing from Parnate.I am actually on nothing at the moment except the lamictal 200mg which I can't touch. Apart from that I am on bare minimum meds. Have cut Klonopin down because my sleepiness has reached epic proportions. My Provigil is only at 100mg.
I really don't think its the Parnate withdrawal itself itself but just the fact that I have been untreated for so long now.> You need an expert mood clinic somewhere. If you have to go to the States, then go. If you think someone in the UK can help, then go. Don't give up!
Will try. Right now I can't even finish preparing my history and drug history because I am sleeping most of the day and when I am awake I am too tired to think. That is really slowing down my going abroad...
Thnx
Love
D
This is the end of the thread.
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