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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 texastrixie on April 24, 2010, at 12:48:08
Hi all - this is my first post so please pardon me if it's redundant to others already here. I'm feeling extremely frustrated and can use all the support I can get. My long story short - for about 4 years, I was doing great on a daily dose of Wellbutrin XL 150 mg + 900 mgs of Gabapentin 3 x a day. Then all heck broke loose last September and I started having what felt like panic attacks in the middle of the night (including fun night sweats, heart pounding out of control, no chance getting back to sleep). I had my gyno check to see if I could be in early menopause - nope. My psychiatrist took me off Wellbutrin. Helped calm me down a bit but I felt depressed and still couldn't sleep. Fast forward to now - I'm on 1600 mg of Gabapentin 4 x a day + .5 mg of clonazapem at night. I'm sleeping, more or less, but I still feel depressed (sad, hopeless, no energy). My psychiatrist suspects that a change in manufacturer of the generic Gabapentin could be the culprit - does that sound legit? And does the dosage of Gabapentin seem extremely high? I have just come through an extremely stressful time but am on the other side of it - life is manageable again. At this point, I want to ditch Gabapentin (I can't afford the brand name Neurontin) and try something completely different. I'd appreciate any thoughts you guys have. Thank you.
Posted by texastrixie on April 24, 2010, at 13:02:09
In reply to Frustrated with meds (now Gabapentin), posted by texastrixie on April 24, 2010, at 12:48:08
> Hi all - this is my first post so please pardon me if it's redundant to others already here. I'm feeling extremely frustrated and can use all the support I can get. My long story short - for about 4 years, I was doing great on a daily dose of Wellbutrin XL 150 mg + 900 mgs of Gabapentin 3 x a day. Then all heck broke loose last September and I started having what felt like panic attacks in the middle of the night (including fun night sweats, heart pounding out of control, no chance getting back to sleep). I had my gyno check to see if I could be in early menopause - nope. My psychiatrist took me off Wellbutrin. Helped calm me down a bit but I felt depressed and still couldn't sleep. Fast forward to now - I'm on 1600 mg of Gabapentin 4 x a day + .5 mg of clonazapem at night + 50 mcg of synthroid. I'm sleeping, more or less, my thyroid function is just fine (it was borderline before - not a big problem) but I still feel depressed (sad, hopeless, no energy). My psychiatrist suspects that a change in manufacturer of the generic Gabapentin could be the culprit - does that sound legit? And does the dosage of Gabapentin seem extremely high? I have just come through an extremely stressful time but am on the other side of it - life is manageable again. At this point, I want to ditch Gabapentin (I can't afford the brand name Neurontin) and try something completely different. I'd appreciate any thoughts you guys have. Thank you.
Posted by Phillipa on April 24, 2010, at 13:31:00
In reply to Re: Frustrated with meds (now Gabapentin), posted by texastrixie on April 24, 2010, at 13:02:09
If a stressful time give yourself some time to settle down. Are you saying the regular neurotin worked? If so can you get assistance for brand name? Phillipa and welcome to babble
Posted by bleauberry on April 24, 2010, at 14:44:10
In reply to Frustrated with meds (now Gabapentin), posted by texastrixie on April 24, 2010, at 12:48:08
The generic issue could very well be a major player in all this. One of my docs has seen so much trouble with generics that he won't even prescribe them anymore. Gabapentin was one of the ones on his listed that he insisted has to be brand in order to work properly. If you can't afford it, find a way to.
Something else I think happens a lot with many psych meds is a change in the adrenal circuits. For example it is my hypothesis that longterm ssri's will cause the adrenal glands to burn out trying so hard to step up adrenalin action to the artificially raised serotonin action. Gabapentin and/or wellbutrin could also play a role in throwing the whole adrenal machinery out of whack. I've had those symptoms and what you described is exactly like them. Basically you are getting an adrenalin rush during sleep time? Which would suggest they are either 12 hours out of sync, or so burned out that the only time they can pump enough adrenalin is when you are resting in bed, and they overdo it because the whole brake system/balance system is screwed up.
With the adrenal working so weakly, depression is an obvious predictable result. Add on top of that more inhibitory substances and it's even worse. While it makes sense that too much adrenalin would cause anxiety and wafefulness, too little does the same thing. The sleep aids and anxiety aids are making that worse. Believe it or not, if this thinking is correct, what would help you the most would be a med strong on norepinephrine, such as milnacipran. Wellbutrin is not.
Just thinking out loud.
Posted by ed_uk2010 on April 24, 2010, at 16:30:52
In reply to Frustrated with meds (now Gabapentin), posted by texastrixie on April 24, 2010, at 12:48:08
Hi there,
>My psychiatrist suspects that a change in manufacturer of the generic gabapentin could be the culprit - does that sound legit?
It's possible, but realistically it probably isn't the cause. In fact, in situations like this, it isn't normally possible to establish a definite cause.
>And does the dosage of Gabapentin seem extremely high?
1600mg four times a day is high, yes. If it isn't working at this dose, it is extremely unlikely to help whatever brand you take. I think you need to try a different treatment instead. I do not think that you would benefit from a switch to Neurontin.
Have you tried an SSRI antidepressant yet? SSRIs such as Lexapro can be helpful for depression + panic. For patients who suffer from panic, the starting dose should be reduced eg. 5mg Lexapro initially. Too high a starting dose can aggravate anxiety. The dose can be increased after a couple of weeks. Benefit can be expected after about 8 weeks. Unfortunately, SSRIs can take quite a while to relieve anxiety and panic, but the effects are normally sustained quite well in the long run.
Hope this helps.
Posted by SLS on April 24, 2010, at 16:59:23
In reply to Re: Frustrated with meds (now Gabapentin) » texastrixie, posted by ed_uk2010 on April 24, 2010, at 16:30:52
> Hope this helps.
Your posts always do.
- Scott
Posted by ed_uk2010 on April 24, 2010, at 19:48:32
In reply to Re: Frustrated with meds (now Gabapentin) » ed_uk2010, posted by SLS on April 24, 2010, at 16:59:23
> > Hope this helps.
>
> Your posts always do.
>
>
> - ScottThanks!
I think it's fair to say that any potential (and probably very small) variation in the bioavailability of different gabapentin generics is not going to make the difference between success and failure when on such a high dose. 1600mg QID (6400mg per day) is already above the usual maximum dose. Given that the absorption of gabapentin from the GI tract is saturable, increasing the dose any further probably wouldn't make much difference.
Just my opinion...
Posted by Zyprexa on April 26, 2010, at 5:41:55
In reply to Frustrated with meds (now Gabapentin), posted by texastrixie on April 24, 2010, at 12:48:08
I know what you mean by wellbtrin being an antidepressant. I tried cutting out that one before and it never worked. Wellbutrin can raise blood pressure, which could be part of your problem. You can take some thing like metoprolol sucsinate, its generic. If you can't sleep, I take perphenazine, which is also a generic. I also found that the generic wellbutrin SR is less on side effects.
Posted by bulldog2 on April 26, 2010, at 12:33:07
In reply to Frustrated with meds (now Gabapentin), posted by texastrixie on April 24, 2010, at 12:48:08
> Hi all - this is my first post so please pardon me if it's redundant to others already here. I'm feeling extremely frustrated and can use all the support I can get. My long story short - for about 4 years, I was doing great on a daily dose of Wellbutrin XL 150 mg + 900 mgs of Gabapentin 3 x a day. Then all heck broke loose last September and I started having what felt like panic attacks in the middle of the night (including fun night sweats, heart pounding out of control, no chance getting back to sleep). I had my gyno check to see if I could be in early menopause - nope. My psychiatrist took me off Wellbutrin. Helped calm me down a bit but I felt depressed and still couldn't sleep. Fast forward to now - I'm on 1600 mg of Gabapentin 4 x a day + .5 mg of clonazapem at night. I'm sleeping, more or less, but I still feel depressed (sad, hopeless, no energy). My psychiatrist suspects that a change in manufacturer of the generic Gabapentin could be the culprit - does that sound legit? And does the dosage of Gabapentin seem extremely high? I have just come through an extremely stressful time but am on the other side of it - life is manageable again. At this point, I want to ditch Gabapentin (I can't afford the brand name Neurontin) and try something completely different. I'd appreciate any thoughts you guys have. Thank you.
I've had to go up to the 2400-3600 mg range on neurontin to keep it working. When it works its a good drig on both anxiety and depression.
Posted by RainyOcean on April 30, 2010, at 0:49:22
In reply to Re: Frustrated with meds (now Gabapentin) » texastrixie, posted by bulldog2 on April 26, 2010, at 12:33:07
I've been on anxiety medications since I was 4 and depression medications for about 10 years. What I've always found is that for some reason over time they stop being as effective as they were initially and I need to switch. Currently I'm taking Paxil for both, but I can't even begin to name all the medications I've been on that worked for a while and then stopped (including both Neurontin and Gabapentin). It's just my opinion, but it might be worth trying something else. Just don't get discouraged if the first one or two things you try don't work. It takes time to find the right meds, and sometimes it's just trial and error to see what works. If you don't think the Gabapentin is helping and you want to go off of it tell your doctor and ask him what he suggests.
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