![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 21 to 45 of 72. Go back in thread:
Posted by inanimate peanut on July 17, 2010, at 18:50:56
In reply to Lou's response-, posted by Lou Pilder on July 17, 2010, at 18:29:20
I'm not taking 2mg every hour for 8 hours. I take 2mg every hour for maybe 2-3 hours. It's just to help get me to sleep. i don't actually use it at any other time of day.
Posted by Lou Pilder on July 17, 2010, at 19:33:43
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
> OK, I'm on Parnate which is the culprit in keeping me awake (plus a little help from the Mirapex)
>
> Last night (over 6 hours trying to fall asleep):
> approx. 30mg seroquel
> 8mg perphenazine
> 3mg lunesta
> 4-25mg benadryl
> 8mg ativan
> 50mg nortriptyline
> 12.5mg ambien CR
> I finally fell asleep and slept 3 hours
>
> Some notes...
>
> I won't normally be able to take the lunesta and ambien together because my insurance won't cover both at once and the pharmacy won't fill both at once.
>
> I don't think the seroquel is working at all. Drugs stop working when I go off them and then try to go back on them-- I did this with the seroquel I've tried the seroquel at high doses (300mg) and low doses (approx 30mg)
>
> Perphenazine makes me depressed, so I can't take more than 8mg. I don't want to take any at all
>
> I take the ativan 2mg at a time every hour
>
> I took the benadryl 4 hours apart
>
> THIS IS RIDICULOUS!
>
> Does anyone have ANY suggestions of what can be taken with Parnate and nortriptyline for sleep other than what I'm already taking? I would like to get off the seroquel and especially the perphenazine!
>
> inanimate peanut,
You wrote for suggestions.
In the list of drugs that you take above, I find it very hard to understand why a doctor precribed all of those to you, if that is the case.
You see, in my study of the chemical actions of these drugs, when taken together they could increase what they do. This means that if one drug causes central nervous system depression, then taking another drug with it could cause even more central nervous system depression. In the list of drugs at you give here, many of them taken together could be life -threatening due to CNS depression, heart problems, respiratory depression and the increase of the potential to cause movment disorders and tardive dyskinesia and other syndromes that could be life-ruining or cause death.
I am unsure as to what you posted as to if all of these drugs have been prescribed to you to take together or not. My suggestion is if all the drugs are prescribed to you to take together to forward this post to the doctor that did the prescribing and have a discussion to see why they were prescribed to take together.
Lou
Posted by jade k on July 17, 2010, at 19:34:07
In reply to Lou's response-kripke » Lou Pilder, posted by Lou Pilder on July 17, 2010, at 18:49:47
Posted by jade k on July 17, 2010, at 19:39:07
In reply to Re: You hangin in there peanut? (nm), posted by jade k on July 17, 2010, at 19:34:07
What's the plan for tonight? Have you gotten ANY sleep yet? I remember a few nights on Parnate where I just never went to sleep and carried on the next day and then sleep finally came the next night.
Posted by inanimate peanut on July 17, 2010, at 20:06:30
In reply to Re: You hangin in there peanut?, posted by jade k on July 17, 2010, at 19:39:07
I got sleep last night because I took lunesta and ambien (and nothing else). I checked the drug interaction checker and it was only a moderate risk so I decided it couldn't be worse that what I usually take. I can't get in the habit of that though because my insurance will only cover one or the other, not both. Tonight the plan is lunesta, perphenazine, seroquel, benadryl, ativan again and I bet I still won't sleep. This is just insane. Surely lunesta and ambien alone have to be safer than that cocktail, but the insurance says no. And yes, my doctor knows about/prescribes all of it except the benadryl, which is OTC. So yeah, I'm hangin in there and just shaking my head at how crazy this all is...
Posted by inanimate peanut on July 17, 2010, at 20:07:31
In reply to Re: You hangin in there peanut?, posted by jade k on July 17, 2010, at 19:39:07
Posted by jade k on July 17, 2010, at 20:11:44
In reply to Re: You hangin in there peanut?, posted by inanimate peanut on July 17, 2010, at 20:06:30
Ya know,
reading your posts reminds me of what a rollercoaster ride it was for me. I just had faith and kept my eye on the ball. Its not all good, but worth it if it works.
~Jade
Posted by jade k on July 17, 2010, at 20:14:29
In reply to thanks for caring :-) (nm) » jade k, posted by inanimate peanut on July 17, 2010, at 20:07:31
Posted by Lou Pilder on July 17, 2010, at 20:15:32
In reply to Lou's reply » inanimate peanut, posted by Lou Pilder on July 17, 2010, at 19:33:43
> > OK, I'm on Parnate which is the culprit in keeping me awake (plus a little help from the Mirapex)
> >
> > Last night (over 6 hours trying to fall asleep):
> > approx. 30mg seroquel
> > 8mg perphenazine
> > 3mg lunesta
> > 4-25mg benadryl
> > 8mg ativan
> > 50mg nortriptyline
> > 12.5mg ambien CR
> > I finally fell asleep and slept 3 hours
> >
> > Some notes...
> >
> > I won't normally be able to take the lunesta and ambien together because my insurance won't cover both at once and the pharmacy won't fill both at once.
> >
> > I don't think the seroquel is working at all. Drugs stop working when I go off them and then try to go back on them-- I did this with the seroquel I've tried the seroquel at high doses (300mg) and low doses (approx 30mg)
> >
> > Perphenazine makes me depressed, so I can't take more than 8mg. I don't want to take any at all
> >
> > I take the ativan 2mg at a time every hour
> >
> > I took the benadryl 4 hours apart
> >
> > THIS IS RIDICULOUS!
> >
> > Does anyone have ANY suggestions of what can be taken with Parnate and nortriptyline for sleep other than what I'm already taking? I would like to get off the seroquel and especially the perphenazine!
> >
> > inanimate peanut,
> You wrote for suggestions.
> In the list of drugs that you take above, I find it very hard to understand why a doctor precribed all of those to you, if that is the case.
> You see, in my study of the chemical actions of these drugs, when taken together they could increase what they do. This means that if one drug causes central nervous system depression, then taking another drug with it could cause even more central nervous system depression. In the list of drugs at you give here, many of them taken together could be life -threatening due to CNS depression, heart problems, respiratory depression and the increase of the potential to cause movment disorders and tardive dyskinesia and other syndromes that could be life-ruining or cause death.
> I am unsure as to what you posted as to if all of these drugs have been prescribed to you to take together or not. My suggestion is if all the drugs are prescribed to you to take together to forward this post to the doctor that did the prescribing and have a discussion to see why they were prescribed to take together.
> Lou
>
inanimate peanut,
I have given more inspection to the drugs that you are taking.
One combination that alarms me here is that you are taking Parnate with nortriptyline. My study of the combination of these two drugs is that they are dangerous when taken together. And when combined with the other drugs in the list, I find it very hard to understand why a doctor prescribed these to take together, if one did.
You asked for suggestions. I suggest that you call a poison control center in your phone area and ask them about the taking of these drugs in combination as to if they could cause death or life-ruining conditions and hear what they have to say. If they say that the drugs taken together will not cause seriouss consequences or death, I would like for you to post thier tel number for me to call them.
Lou
>
>
>
Posted by Phillipa on July 17, 2010, at 20:21:17
In reply to Re: You hangin in there peanut?, posted by inanimate peanut on July 17, 2010, at 20:06:30
Pseudo benzo both I wonder if that fits into the equation? Agree sounds safer than above meds. But I'm not a doc or pharmacist. Will goggle lunesta and ambien. Phillipa
Posted by Lou Pilder on July 17, 2010, at 20:51:01
In reply to Lou's reply » Lou Pilder, posted by Lou Pilder on July 17, 2010, at 20:15:32
> > > OK, I'm on Parnate which is the culprit in keeping me awake (plus a little help from the Mirapex)
> > >
> > > Last night (over 6 hours trying to fall asleep):
> > > approx. 30mg seroquel
> > > 8mg perphenazine
> > > 3mg lunesta
> > > 4-25mg benadryl
> > > 8mg ativan
> > > 50mg nortriptyline
> > > 12.5mg ambien CR
> > > I finally fell asleep and slept 3 hours
> > >
> > > Some notes...
> > >
> > > I won't normally be able to take the lunesta and ambien together because my insurance won't cover both at once and the pharmacy won't fill both at once.
> > >
> > > I don't think the seroquel is working at all. Drugs stop working when I go off them and then try to go back on them-- I did this with the seroquel I've tried the seroquel at high doses (300mg) and low doses (approx 30mg)
> > >
> > > Perphenazine makes me depressed, so I can't take more than 8mg. I don't want to take any at all
> > >
> > > I take the ativan 2mg at a time every hour
> > >
> > > I took the benadryl 4 hours apart
> > >
> > > THIS IS RIDICULOUS!
> > >
> > > Does anyone have ANY suggestions of what can be taken with Parnate and nortriptyline for sleep other than what I'm already taking? I would like to get off the seroquel and especially the perphenazine!
> > >
> > > inanimate peanut,
> > You wrote for suggestions.
> > In the list of drugs that you take above, I find it very hard to understand why a doctor precribed all of those to you, if that is the case.
> > You see, in my study of the chemical actions of these drugs, when taken together they could increase what they do. This means that if one drug causes central nervous system depression, then taking another drug with it could cause even more central nervous system depression. In the list of drugs at you give here, many of them taken together could be life -threatening due to CNS depression, heart problems, respiratory depression and the increase of the potential to cause movment disorders and tardive dyskinesia and other syndromes that could be life-ruining or cause death.
> > I am unsure as to what you posted as to if all of these drugs have been prescribed to you to take together or not. My suggestion is if all the drugs are prescribed to you to take together to forward this post to the doctor that did the prescribing and have a discussion to see why they were prescribed to take together.
> > Lou
> >
> inanimate peanut,
> I have given more inspection to the drugs that you are taking.
> One combination that alarms me here is that you are taking Parnate with nortriptyline. My study of the combination of these two drugs is that they are dangerous when taken together. And when combined with the other drugs in the list, I find it very hard to understand why a doctor prescribed these to take together, if one did.
> You asked for suggestions. I suggest that you call a poison control center in your phone area and ask them about the taking of these drugs in combination as to if they could cause death or life-ruining conditions and hear what they have to say. If they say that the drugs taken together will not cause seriouss consequences or death, I would like for you to post thier tel number for me to call them.
> Lou
>
inanimate peanut,
I am now greatly concerned about the combination that you say that you will take. In particular but not limited to the combination of Seroquel and perphenazine.
The two together could cause a psychotic episode, seizures , memory loss and more. There is also the potential for movment disorders to arise including tardive dyskinesia.
You asked for suggestions.
I posted a way to see a video here by Dr Kripke.
There is a lot of infomation about sleeping pills in that video.
My overiding concern now is that by taking the 5 drugs that you listed here tonight, that those 5 togeher could cause central nervous system depression and I find it now very difficult to understand why they have been prescribed to you to take all together, if that be the case.
You asked for suugestons. All I can do is post the facts here for you to make an informed decision on your own.
Lou
> >
> >
> >
>
>
Posted by Phillipa on July 17, 2010, at 21:19:39
In reply to Re: You hangin in there peanut?, posted by inanimate peanut on July 17, 2010, at 20:06:30
Hey peanut I also use drug checker and the luvox I take and valium and xanax also are a risk. But been doing it for years. No insurance for benzos. Can you afford to buy them? I'd combine them again tonight. Or what about a double dose of either ambien or lunesta? Safer then the combo. Right now at a risk for serotonin syndrome and my pdoc prescribed the adding of lexapro to luvox and the xanax and valium. So legally got a script for all. Phillipa
Posted by Lou Pilder on July 17, 2010, at 21:27:54
In reply to Re: You hangin in there peanut? » inanimate peanut, posted by Phillipa on July 17, 2010, at 21:19:39
> Hey peanut I also use drug checker and the luvox I take and valium and xanax also are a risk. But been doing it for years. No insurance for benzos. Can you afford to buy them? I'd combine them again tonight. Or what about a double dose of either ambien or lunesta? Safer then the combo. Right now at a risk for serotonin syndrome and my pdoc prescribed the adding of lexapro to luvox and the xanax and valium. So legally got a script for all. Phillipa
Phillipa,
You wrote,[...what about a double dose of...]
I am unsure as to what you are wanting to mean here. If you could post answers to the following, then I could have thee opportunity to respond accordingly.
A. Are you referring to inanimate peanut taking a double dose of either ambian or lunesta?
B. If so, have you researched if doubling the dose of either could cause serious complications or death?
C. If you (redacted by respondent)
Lou
Posted by morgan miller on July 18, 2010, at 1:35:00
In reply to HELP! NO SLEEP DRIVING ME CRAZY!, posted by inanimate peanut on July 16, 2010, at 19:59:34
What about replacing ativan with klonopin?
Man that is an arsh load of sleep aids you have in your arsenal. It would put me into a coma.
Posted by morgan miller on July 18, 2010, at 1:36:20
In reply to Re: HELP! NO SLEEP DRIVING ME CRAZY!, posted by Guy on July 16, 2010, at 21:47:21
I agree you should try zyprexa in place of seroquel.
Posted by ed_uk2010 on July 18, 2010, at 11:54:21
In reply to Re: You hangin in there peanut?, posted by inanimate peanut on July 17, 2010, at 20:06:30
Hi Peanut,
Is there any possibility that you could reduce your dose of Parnate to help with the insomnia? You said that you thought Parnate was a major contributor to the insomnia.
The insomnia is obviously very severe and so I really think you should consider this, under the supervision of your doctor. Now that you're taking nortriptyline, a lower dose of Parnate might be sufficient for your depression. What do you think? Taking so many drugs for sleep is not a solution. There are risks involved and it's not even working.
Posters have suggested Zyprexa instead of Seroquel. I do think this might help but it could lead to binge eating, which I believe you said was a problem for you.
Also, how are you taking Parnate at the moment? What dose - and how are the doses spread out across the day? Your regimen needs to be reconsidered.
Posted by inanimate peanut on July 18, 2010, at 12:40:46
In reply to Lou's reply » Lou Pilder, posted by Lou Pilder on July 17, 2010, at 20:15:32
Nortriptyline and Parnate can be dangerous in combination, but there's also plenty of academic literature as well as people on this board who have demonstrated the safety and efficacy of this combination if used correctly.
Posted by inanimate peanut on July 18, 2010, at 12:44:55
In reply to Re: You hangin in there peanut? » inanimate peanut, posted by Phillipa on July 17, 2010, at 21:19:39
Even a double dose of ambien with all the other drugs wasn't working, plus insurance won't pay for double doses. I slept well last night with lunesta with rest of the drugs, which is more than I can say for Ambien. So, at least now I can sleep, even if it is on 6 drugs
Posted by inanimate peanut on July 18, 2010, at 12:55:09
In reply to Re: You hangin in there peanut? » inanimate peanut, posted by ed_uk2010 on July 18, 2010, at 11:54:21
I'm taking 100mg of Parnate as a single dose first thing in the morning. This seems to work best for my mood throughout the day and gets it as far away from sleep time as possible. I've tried going down to 90mg and my depression gets much worse. The nortriptyline might be making me worse (see later post). In my mind, I will deal with the sleep crap to keep my Parnate. It's literally the only reason I'm alive. The lunesta seems to work better than the ambien (with the ambien even with the whole arsenal I couldn't sleep and with lunesta last night I went right off to sleep), so I'm going to start out tonight with just the lunesta and the perphenazine and see if those two are enough alone, as I think they are the most active of the combo. I can't go off the perphenazine since it would then not work if I needed it in the future (that nasty little habit my brain has on letting drugs only work once and cease to work if d/c and restrarted). That sucks since I think the perphenazine worsens my depression. Anyway, I've tried everything I can think of. Let me know if you have ideas I may have missed.
Posted by Lou Pilder on July 18, 2010, at 13:18:10
In reply to Re: Lou's reply, posted by inanimate peanut on July 18, 2010, at 12:40:46
> Nortriptyline and Parnate can be dangerous in combination, but there's also plenty of academic literature as well as people on this board who have demonstrated the safety and efficacy of this combination if used correctly.
inanimate peanut,
You wrote,[...Nortrptyline and Parnate can be dangerous in combination...plenty of academic liturature..people on this board..safety and efficacy..used correctly...]
I am unsure as to what you are wanting to mean here. If you could post answers to the following, then I could have the opportunity to respond accordingly.
A. What kind of danger is there in as you know when combining Parnate and Nortriptyline?
B. in the academic lituratur tha you mention here, could you post some links to those here?
C. I can not remember anyone here advocating to take the two drugs together. Could you post a link to one of the posts for such?
C. What is the correct use of taking the two drugs together to constitute {using correctly}?
D.If the drugs are central nervous system depressants, and could cause heart problems, (redactedby respondent)
E. other answers not related to the questions above.
Lou
Posted by inanimate peanut on July 18, 2010, at 13:28:41
In reply to Lou's reply-pschohmeidahmho » inanimate peanut, posted by Lou Pilder on July 18, 2010, at 13:18:10
Below are the abstracts of using TCA/MAOIs together. As for naming people on this board, you'll have to search the archives as I'm not going to start calling people out (although I can think of 2 in particular who are/have been on the combo). Here's your abstracts:
Prog Neuropsychopharmacol Biol Psychiatry. 1988;12(4):523-32.
Combined MAO-inhibitor and tri- (tetra) cyclic antidepressant treatment in therapy resistant depression.
Schmauss M, Kapfhammer HP, Meyr P, Hoff P.
Department of Psychiatry, University of Munich, West Germany.
1. One aspect of using MAO-inhibitors - combining them with tricyclic antidepressants in the treatment of therapy resistant depression - has always been controversely discussed in regard to its unusual toxicity and efficacy. 2. To obtain detailled information about safety and efficacy of such a combined treatment, the charts of 94 inpatients treated with a tranylcypromine - tri- (tetra) cyclic antidepressant combination were reviewed. 3. Within a mean treatment period of 21.9 days, 68% of the patients demonstrated a very good or good improvement to combined treatment, the most effective combination being tranylcypromine + amitriptyline. 4. The incidence of side effects among the patients on the combined regimen was slightly, but not significantly lower as compared to the patients on single tri- (tetra) cyclic antidepressant treatment. 5. Our retrospective study supports the general safety and efficacy of combined MAOI-TCA treatment and suggests that combined treatment, if properly administered, leads to neither serious complications nor an inordinate number of side effects.
J Clin Psychiatry. 1985 Jun;46(6):206-9.
Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.
Feighner JP, Herbstein J, Damlouji N.
Patients with "treatment resistant" depression who do not respond to standard methods or relapse over time have a moral and legitimate right to innovative therapy. Combined treatment with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and stimulants has been resisted by practitioners because of hypertensive and hyperthermic crises noted in certain cases. This paper reports a case series demonstrating the safety and efficacy of adding a stimulant to an MAOI or to a combination of TCA and MAOI in the treatment of intractable depression.
Encephale. 1996 Nov-Dec;22(6):450-60.
[The tolerability and efficacy of combined antidepressant therapy: literature review]
[Article in French]
Taleb M, Gorwood P, Bouleau JH, Rouillon F.
Service de Psychiatrie, Hôpital René-Dubos, Pontoise.
There are many pharmacological strategies in order to manage depressed patients with treatment resistance. Combined antidepressants therapy is currently prescribed, mostly for depressions which resist to a single antidepressant, or to another therapeutic, such as electric-convulsive-therapy. Combined treatments are usually considered to have a more rapid action than monotherapy, although mainly is based on personal experience. It is generally admitted that the better efficacy of combined antidepressants therapy with different biochemical characteristics is explained by the synergic action of both norepinephrine and serotonin systems. The combination treatment of MAOI and tricyclic agents has been widely studied, sometimes on hundreds of patients. Numerous studies showed a good efficacy, and the toxicity of such an association was exaggerated, thus they are nevertheless rarely prescribed. As reversible MAOI-A are now available, combination treatment with tricyclic antidepressants is theoretically safer. The combination treatment of SSRI and tricyclic antidepressants is more frequently reported in the recent literature. Studies analysing such an association are however insufficient, and cannot lead to any clear conclusion. The combined treatment of mianserin and tricyclic antidepressants have also been quoted, with an efficacy that has been confirmed on randomized placebo-controlled studies. Resistant depressions are the main indication for combined antidepressants therapy. Anxious disorders have recently been considered as interesting new indications, such as panic disorder or obsessive compulsive disorder, with or without a comorbid mood disorder. In conclusion, controlled studies devoted to the analysis of combined antidepressants therapy are relatively few, and do not allow to draw any conclusion about their efficacy. Nevertheless, as this type of prescription is frequent, scientific evaluation of their specific efficacy is needed.
Fortschr Neurol Psychiatr. 1996 Oct;64(10):390-402.
[Combination therapies in antidepressive drug refractory depression--an overview]
[Article in German]
Schmauss M, Erfurth A.
Bezirkskrankenhaus Augsburg, Universität München.
Despite the availability of a wide range of effective antidepressant drugs, nearly 30% of depressed patients fail to respond to antidepressant treatment. Various pharmacological strategies have been developed to treat such refractory depression, of which augmentation therapies are one of the most important. This article reviews both benefits and risks of all known augmentation therapies. Among these treatment strategies the efficacy of lithium augmentation is very well documented by a large number of controlled studies - lithium augmentation can therefore be recommended in depression refractory to antidepressant treatment. The efficacy of triiodothyronine (T3) augmentation and the combination of different antidepressants - like a TCA-MAOI combination - is described in a large number of case reports and uncontrolled studies; the number of placebo controlled double blind studies, confirming the efficacy of these treatment strategies, is however relatively small. T3 augmentation and combined antidepressant treatment may therefore be considered in the treatment of refractory depression; in contrast to lithium augmentation these combination therapies are however only second-line strategies. Other augmentation therapies (TCA + stimulants, TCA + reserpine, TCA + yohimbine, TCA + fenfluramine, SSRI + buspirone) are very interesting clinical research strategies, but don't have too much importance in clinical practice at the moment.
J Affect Disord. 1995 Jun 8;34(3):187-92.
A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination.
Berlanga C, Ortega-Soto HA.
Division of Clinical Research, Mexican Institute of Psychiatry, México, DF.
Treatment-resistant depression is a clinical complication that not infrequently affects a certain number of patients. Within the treatment strategies proposed for this condition, the association of a MAO inhibitor (MAOI) with a tricyclic antidepressant has gained reputation both for its unusual efficacy, as for its potential toxicity. However, when cautions are taken, it may be safely administered. Most reports on this combination have been carried in nonresistant patients and, when resistant patients are included, only the acute phase of the treatment is reported. In this study, a group of well-defined resistant patients received an open trial with the association of isocarboxazide and amitryptiline (n = 25). Those who responded were followed during the next 3 years (n = 12) and every 6 months an attempt was made to discontinue the MAOI and continue only with amitryptiline. At the end of the study, 4 patients maintained response with single medication, 6 still required both drugs and 2 relapsed. No clinical differences were apparent between the outcome groups, except that those who maintained their response only with the 2 combined drugs had more previous depressive episodes than the others. The isocarboxazide/amitryptiline combination may be a good treatment option for at least some forms of resistant depression. The safety of this treatment modality is confirmed, even when given for long periods of time. The study also suggest that there are no clinical characteristics in resistant depression that may predict the treatment outcome but, perhaps in some patients, a combined treatment is required to obtain a broader biochemical effect that could convert them from nonresponders to responders.
Acta Psiquiatr Psicol Am Lat. 1994 Dec;40(4):314-20.
[Combined therapy with tricyclic and MAOI antidepressants in the treatment of resistant major depression]
[Article in Spanish]
Rosan TA, Mesones HL, Brengio F.
This paper shows the results of associating tricyclic and MAOI antidepressants in the treatment of resistant major depression. Forty five patients from private practice with diagnosis of major depression according to DSM III R criteria, with negative response to separate tricyclic or MAOI treatment, were given both types associated. They improved without dangerous side effects.
Posted by ed_uk2010 on July 18, 2010, at 13:53:40
In reply to Re: You hangin in there peanut? » ed_uk2010, posted by inanimate peanut on July 18, 2010, at 12:55:09
>I can't go off the perphenazine since it would then not work if I needed it in the future.......
I know you believe this to be the case....but I suspect that it's actually not.
Some points to consider....
1. You may have experienced the phenomenon of meds not working the second time around in the past. This does not mean that the same will apply to completely unrelated drugs eg. perphenazine.
2. A drug which does not work the second time around may not have worked the first time around either. For example, are you sure that perphenazine is actually helping you sleep? Since you are on so many meds, it is not possible to know.
3. What possible mechanism could there be behind ALL meds not working the second time around? It does not make pharmacological sense.
4. Your belief that no med will work the second time around is causing you to stay on meds which could be making you more depressed. Perphenazine is an example.
5. Some meds can actually work better after you've been off them for a while eg. benzodiazepines. This is because your tolerance is reduced after a med-free period.
6. The perceived efficacy of psych meds is controlled by psychological factors as well as the clinical effects of the med. If you strongly believe that a med won't work again, then it probably won't. This is like the reverse of the placebo effect.
Posted by inanimate peanut on July 18, 2010, at 14:15:55
In reply to Re: You hangin in there peanut?, posted by ed_uk2010 on July 18, 2010, at 13:53:40
I can't explain it, and maybe it is psychological, but every time I have tried to go back on a drug that I've quit, it won't work. TRUST ME, I wish this was not the case, but it always has been. Drugs that I've left and gone back to with no effect include effexor, lithium, wellbutrin, seroquel xr, and lexapro. There are many things we can't explain about the brain, and this is one of them about mine. You are completely right that it is keeping me on perphenazine and also lamictal (which I don't think is helping but am scared to go off just in case it is doing something and I stop and then can't go back on it). That's why I'm on so many meds, because you can add them but I won't allow them to be taken away because then they can't be added back. I would give anything to have either Wellbutrin or lithium work again, but neither does. Lunesta seems to be an exception to this rule, and I'm not sure why that would be. Also, PRNs like ativan work and I don't take them daily, so I don't know how to explain that either.
In other words, I think your logic is impeccable, but I'm the way I am now because of going off meds and having them not work when I went back on them. When I was on lithium, I had a great job, a townhome, a fiance, a normal life like I wasn't even bipolar at all and I've lost it all by going off lithium and not being able to go back on it or find anything that works like it. Every med I go off that won't work that we can't replace, I just get a little worse until I'm how I am now, which is nothing. So I've been burned enough that I'll stick with my theory.
Posted by Lou Pilder on July 18, 2010, at 14:37:25
In reply to Re: Lou's reply-pschohmeidahmho » Lou Pilder, posted by inanimate peanut on July 18, 2010, at 13:28:41
inanimate peanut,
I heave read such reports and there are different camps in relation to taking the two classes of drugs together.I lean to the camp that says that the two taken together could be very dangerous. In your situation, there are also other drugs being combined that are central nervous system depressants which brings in that the reports that you cited were taking the two classes of drugs together without consideration as to if a CNS-depressant was added. I also do not consider those type of reports to be significant because of the small population used. I give credence when the population is in the thousands.
Here is a link to an article and there is the list of classes of drugs that are dangerous when combined with the other class.
Lou
http://bipolar.about.com/od/maois/a/maois_profile.htm
Posted by ed_uk2010 on July 18, 2010, at 14:51:07
In reply to Re: You hangin in there peanut? » ed_uk2010, posted by inanimate peanut on July 18, 2010, at 14:15:55
>I would give anything to have either Wellbutrin or lithium work again, but neither does.
I don't think you should rule out the possibility that they might work again in future. If nortriptyline doesn't work out, you could consider another trial of lithium.
>Lunesta seems to be an exception to this rule, and I'm not sure why that would be. Also, PRNs like ativan work and I don't take them daily, so I don't know how to explain that either.
It makes sense. Even if some drugs don't work for you the second time around, this won't apply to all drugs. Benzos and night sedatives often work best if they're used for short courses or PRN. Continuous daily use can lead to tolerance and loss of efficacy. A med-free period can allow the drug to be effective again.
>So I've been burned enough that I'll stick with my theory.
I understand, but you need to be careful about staying on meds which might actually be making you worse, such as perphenazine. Could it be the perphenazine rather than nortriptyline which is causing you to cry more often?
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