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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 Roslynn on December 23, 2009, at 16:00:10
Hi everybody,
There are some very smart people here and I just wanted to post about my meds and see if anyone had any input.
I was on Prozac 40mg, nortriptyline 50mg, ativan 1-2mg, and lithobid 600mg. (I am unable to tolerate higher lithium dose.) Diagnosed with depression.
I saw a new doc and he seems nice. He thinks I may be showing some signs of bipolar, maybe bipolar II. I have a first-degree relative with bipolar I.
The new doc wants me to cut both antidepressant doses in half and add lamictal. Also, he has prescribed Geodon for the time period before the lamictal kicks in, especially since I am cutting my antidepressants in half. I think he is worried about anxiety from the med changes.
Does this sound like a typical protocol if someone is starting to show bipolar II? (I may have been this way for quite a while but I didn't recognize it since I have never been manic.)
Also has anyone else heard of using Geodon as a short-term med to relieve anxiety while a person's other meds are being adjusted?
Thank you for any input!!
Roslynn
Posted by bleauberry on December 23, 2009, at 17:08:58
In reply to question about my meds, posted by Roslynn on December 23, 2009, at 16:00:10
You ask some good questions.
I think it is important to realize that all psychiatrists will treat a particular patient differently. Ten psychiatrists diagnosing and suggesting treatment for the same patient will probably come up with 5 different diagnosis and widely varying choices of meds. All the meds are experimental, all combinations are experimental, all assumptions of diagnosis are subjective not fact, and all doctors have their own preferred approaches. Some are influenced by their past successes or failures, some have the influence of pharmaceutical reps (free kickbacks under the table for prescribing their brand), some have the influence of their favorite mentors, some are just naturally born talent and excellent at pioneering choices, and such. Some are in it for a well paid profession, some are in it for the passion of helping people, and most fall somewhere inbetween. All theses things will influence the diagnosis and the treatments.
In other words, as in most medical situations, it is very much a creative approach and not science.
The only thing I can comment on regarding your meds is that I think it is unwise to change any more than one thing at a time...either dosage or med...and that each change needs at least 2 weeks before doing anything else. If too much changes too fast and things get weird, there is no way to know what is doing what, and thus no way to know what to do about it. All treatments are basically guesses. Changing more than one thing at a time increase the amount of guessing that will be needed, further confounding the situation.
I assume you are having some symptoms that you feel warrant attention, or else you wouldn't be considering med changes or you wouldn't be here seeking advice. I don't know what the history is or what the symptoms are. But you do sound at least "stable". My gut instinct and past experience tells me that making these rather dramatic changes in a short time frame has a high risk of destabilizing.
My two cents.
Posted by Roslynn on December 23, 2009, at 19:48:58
In reply to Re: question about my meds, posted by bleauberry on December 23, 2009, at 17:08:58
Dear bleauberry,
Thank you so much for your detailed response; I really appreciate it. Some things to think about I guess...
Roslyn
> You ask some good questions.
>
> I think it is important to realize that all psychiatrists will treat a particular patient differently. Ten psychiatrists diagnosing and suggesting treatment for the same patient will probably come up with 5 different diagnosis and widely varying choices of meds. All the meds are experimental, all combinations are experimental, all assumptions of diagnosis are subjective not fact, and all doctors have their own preferred approaches. Some are influenced by their past successes or failures, some have the influence of pharmaceutical reps (free kickbacks under the table for prescribing their brand), some have the influence of their favorite mentors, some are just naturally born talent and excellent at pioneering choices, and such. Some are in it for a well paid profession, some are in it for the passion of helping people, and most fall somewhere inbetween. All theses things will influence the diagnosis and the treatments.
>
> In other words, as in most medical situations, it is very much a creative approach and not science.
>
> The only thing I can comment on regarding your meds is that I think it is unwise to change any more than one thing at a time...either dosage or med...and that each change needs at least 2 weeks before doing anything else. If too much changes too fast and things get weird, there is no way to know what is doing what, and thus no way to know what to do about it. All treatments are basically guesses. Changing more than one thing at a time increase the amount of guessing that will be needed, further confounding the situation.
>
> I assume you are having some symptoms that you feel warrant attention, or else you wouldn't be considering med changes or you wouldn't be here seeking advice. I don't know what the history is or what the symptoms are. But you do sound at least "stable". My gut instinct and past experience tells me that making these rather dramatic changes in a short time frame has a high risk of destabilizing.
>
> My two cents.
Posted by Roslynn on December 23, 2009, at 19:53:40
In reply to Re: question about my meds, posted by bleauberry on December 23, 2009, at 17:08:58
Dear bleauberry,
I forgot to say in my response that I was in a very bad state when I saw this doc and that was on Monday... I'm feeling much better now, but for the last few months I've experienced some drastic swings in mood and it can vary from day to day.
Posted by Phillipa on December 23, 2009, at 20:12:12
In reply to Re: question about my meds, posted by Roslynn on December 23, 2009, at 19:53:40
When you say mood swings exactly what do you mean and if feeling better now maybe it was a temporary relapse so to speak? Phillipa
Posted by Roslynn on December 23, 2009, at 20:26:15
In reply to Re: question about my meds » Roslynn, posted by Phillipa on December 23, 2009, at 20:12:12
Hi Phillipa,
My moods are up and down and it does vary from day to day, even from hour to hour, although I've never been manic...but the up and down feeling is horrible & very uncomfortable...
Nice to hear from you and hope you are doing well.
Roslynn
> When you say mood swings exactly what do you mean and if feeling better now maybe it was a temporary relapse so to speak? Phillipa
Posted by Zyprexa on December 24, 2009, at 14:43:54
In reply to Re: question about my meds, posted by Roslynn on December 23, 2009, at 20:26:15
Geodon and lamictal are both meds that you would take for bi-polar. I belive they suggest not prescribing ADs for bipolar.
I've taken both of those and found them not to work, but I'm schitzoaffective, which is half bipolar and half schitophrenia. I do take zyprexa and perphenazine with realy good results. I also take an AD. I have not had any problems just stoping an AD and starting a new one right away, or none at all. But still taking zyprexa.
Posted by Zyprexa on December 24, 2009, at 14:47:55
In reply to question about my meds, posted by Roslynn on December 23, 2009, at 16:00:10
Also I have bad anxiety, and lamictal or geodon did not help it. Some thing like zyprexa might work better. But who knows you might find them usefull. I'm not trying to jinx your trial.
Posted by Lou Pilder on December 24, 2009, at 15:24:44
In reply to question about my meds, posted by Roslynn on December 23, 2009, at 16:00:10
> Hi everybody,
>
> There are some very smart people here and I just wanted to post about my meds and see if anyone had any input.
>
> I was on Prozac 40mg, nortriptyline 50mg, ativan 1-2mg, and lithobid 600mg. (I am unable to tolerate higher lithium dose.) Diagnosed with depression.
>
> I saw a new doc and he seems nice. He thinks I may be showing some signs of bipolar, maybe bipolar II. I have a first-degree relative with bipolar I.
>
> The new doc wants me to cut both antidepressant doses in half and add lamictal. Also, he has prescribed Geodon for the time period before the lamictal kicks in, especially since I am cutting my antidepressants in half. I think he is worried about anxiety from the med changes.
>
> Does this sound like a typical protocol if someone is starting to show bipolar II? (I may have been this way for quite a while but I didn't recognize it since I have never been manic.)
>
> Also has anyone else heard of using Geodon as a short-term med to relieve anxiety while a person's other meds are being adjusted?
>
> Thank you for any input!!
>
> RoslynnRoslynn,
You wrote,[...some very..people...see if anyone had any input...on ativan...new doc ..seems nice...].
I am unsure as to what you are wanting to mean here as to the new doc seems nice. He has you taking a benzodiazepine, ativan, that can cause addiction in that the withdrawal from it could be as severe as the withdrawal from a barbituate. And taken with other psychotropic drugs has other ramifications that I will explain in another post.
The lithium could lower body temperature when taken with ativan. Interations of other drugs with a BZD can cause death.
If you could post answerd here to the following, then I could respond accordingly.
A. How long have you been taking each of these chemicals into your system?
B. What kind of research for discovery, if any, did you do before you started taking the drugs that you mention here?
C. How do you feel (redacted by respondant)
D. other questions not stated
Lou
Posted by Maxime on December 24, 2009, at 18:56:46
In reply to question about my meds, posted by Roslynn on December 23, 2009, at 16:00:10
Prozac is known for causing hypomania in bipolar patients so it makes sense that he wants you to decrease it. What he is doing sounds right to me. I hope you don't have any mood swings as a result of the changes. Have you ever gone hypomanic? Do you know the signs? I would suggest that you keep a mood journal for your doctor. It will help him a lot and you as well. Hang in there.
Posted by bulldog2 on December 25, 2009, at 17:51:51
In reply to question about my meds, posted by Roslynn on December 23, 2009, at 16:00:10
> Hi everybody,
>
> There are some very smart people here and I just wanted to post about my meds and see if anyone had any input.
>
> I was on Prozac 40mg, nortriptyline 50mg, ativan 1-2mg, and lithobid 600mg. (I am unable to tolerate higher lithium dose.) Diagnosed with depression.
>
> I saw a new doc and he seems nice. He thinks I may be showing some signs of bipolar, maybe bipolar II. I have a first-degree relative with bipolar I.
>
> The new doc wants me to cut both antidepressant doses in half and add lamictal. Also, he has prescribed Geodon for the time period before the lamictal kicks in, especially since I am cutting my antidepressants in half. I think he is worried about anxiety from the med changes.
>
> Does this sound like a typical protocol if someone is starting to show bipolar II? (I may have been this way for quite a while but I didn't recognize it since I have never been manic.)
>
> Also has anyone else heard of using Geodon as a short-term med to relieve anxiety while a person's other meds are being adjusted?
>
> Thank you for any input!!
>
> RoslynnWell bleauberry has a good point about changing one thing at a time. Generally I would agree with that approach.
However Maxime also makes makes sense in that the cocktail sounds right. Perhaps this doctor has seen many patients before who have presented your combinations of symtpoms and have done well on his protocol.
Why not ask him the reasons for these changes and than perhaps you would feel better about making these changes. I think one should always be able to have this dialog with their p-doc.
This is the end of the thread.
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