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Dr. Bob is Robert Hsiung, MD,
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Posted by linkadge on August 8, 2010, at 20:39:20
In reply to Should I try Requip?, posted by Dima on August 8, 2010, at 16:23:49
>On Thursday, I stopped taking the Abilify >because of the akathisia, and my doctor >prescribed 600 mg Lithium per day and 100 mg >Seroquel to sleep. This was added to 15 mg >Remeron and 40 mg Celexa.
>Tomorrow, I plan to call my family doctor about >my RLS and hopefully he will prescribe either >Requip or Mirapex. Doesn't it seem like it's a >low dopamine issue? Family history of >Parkinson's, low motivation, social anxiety, >RLS, muscle twitches...
I have to totally agree with Ed! First of all, many of the meds you are taking can induce tremor, muscle rigidity, and RLS.
All of lithium, seroquel, citalopram, and remeron have been associated with RLS. Citalopram, like other SSRI's is associated with RLS, probably due to the indirect suppressive effect that boosting serotonin has on dopamine neurotransmission. Lithium will augment this. As mentioned, the seroquel is a dopamine antagonist (effectively doing the exact opposite that a dopamine agonist like mirapex would do).
Muslce twiches aren't associtated with low dopamine, but they are associated with citalopram and / or lithium.
First of all...figure out what in the heck your diagnosis is. It looks like your doctor is adding mood stabilizers onto your antidepressant. Is the diagnosis of bipolar disorder in question?
If this is true, reduce the citalopram and this may indirectly improve your RLS. Parkinsons disease is not due to low dopamine, it is due to distruction of the dopamine receptors in the brain.
You're taking 4 meds right now, all of which have been associated with RLS symptoms. You really don't want to be on a fifth medication to combat side effects of the first 4.
I'm 27 but was on many meds when I was your age too. I'm still suffering the effects of some of the wierd multi med concoctions the doctors dreamed up. I got onto the roller coaster of knee jerk reactions to drug side effects. Please, care for your brain. I wish I could have gone back to tell myself just to settle down and stick to 1 or 2 meds that really help.
Linakdge
Posted by linkadge on August 8, 2010, at 20:40:56
In reply to Re: Should I try Requip?, posted by Dima on August 8, 2010, at 16:32:31
>Oh, yeah, and Adderall makes me feel better and >more energetic. Only for a couple hours though, >then I feel more restless with racing thoughts >for a few hours until I fall asleep.
Adderall makes everyone feel better and more energetic for a couple of hours though, then leading to more restlessness and racing thoughts for a few hours till they fall asleep.
Liinkadge
Posted by Phillipa on August 8, 2010, at 21:27:41
In reply to Re: Should I try Requip?, posted by linkadge on August 8, 2010, at 20:40:56
I know one person not currently on babble that takes requip for TRD and for him it worked at 2.5 and 5mg. Phillipa. ps he takes very low doses of other meds with it. Good luck.
Posted by BrainDamage on August 9, 2010, at 5:00:20
In reply to The brain is not like a pot of soup, posted by ed_uk2010 on August 8, 2010, at 17:16:16
An excellent Post by Ed!
The Brain is an Extremely complex series of systems that interact with each other.
No one truly understands how it works (yet)Anyone who tells you otherwise is deluding themselves & you.
Muscle twiches & cramps could be linked to an electrolyte imbalance.
I'm probably completely wrong, but make sure you have enough Pottasium & Magnesium in your diet> I don't think it's quite so simple. There's an increasing tendency to talk about the brain as if it were a pot of soup.....if only we could add a bit more dopamine and serotonin, a bit less NE and maybe a smidgen of acetylcholine, it would all be OK. This really isn't how it works. It is the popular psycho-babble (or should I say neuro-babble) of the 21st century! The incredible complexity of the brain (and how psychiatric drugs affect its function) is beyond the complete comprehension of even the most knowledgable neuroscientists - I don't understand it, you don't understand it and in all probability your doctor doesn't understand it.
>
> I'm not saying that Requip won't help, but I do think you should tread carefully when it comes to starting new meds, especially at the young age of 19.
>
> >And I've read that Lithium and Seroquel both lower dopamine. Do I really need more of that?
>
> I doubt it. Treatment with antipsychotics such as Seroquel needs a clear justification. In the absence of any psychotic symptoms, use for insomnia should be very carefully considered. The side effects (such as pronounced weight gain) may be worse than the insomnia.
Posted by Maxime on August 9, 2010, at 9:06:32
In reply to The brain is not like a pot of soup, posted by ed_uk2010 on August 8, 2010, at 17:16:16
Posted by violette on August 9, 2010, at 9:06:34
In reply to Re: The brain is not like a pot of soup, posted by BrainDamage on August 9, 2010, at 5:00:20
Ed,
This is one of the best posts I've ever seen on this site...actually the whole thread.
Nice 'essay' Ed! (I'd encourage you to put this as your signature...)
Dima, I hope you consider Ed's advice when making your decision as it really is wise.
re: electrolytes-you could try Gatorade in investigating the problem....
Posted by violette on August 9, 2010, at 9:27:14
In reply to Re: Should I try Requip?, posted by linkadge on August 8, 2010, at 20:39:20
This would be a great signature too ;)
"You really don't want to be on a fifth medication to combat side effects of the first 4."
Posted by ed_uk2010 on August 9, 2010, at 15:36:27
In reply to Re: The brain is not like a pot of soup » BrainDamage, posted by violette on August 9, 2010, at 9:06:34
>Nice 'essay' Ed! (I'd encourage you to put this as your signature...)
Thanks! Which bit do you think I should use?
Posted by bleauberry on August 9, 2010, at 16:33:49
In reply to Should I try Requip?, posted by Dima on August 8, 2010, at 16:23:49
Of the symptoms you listed, the ones that jumped out at me as being disturbing...hinting at something more than a psychiatric condition, were the leg numbness and twitching. I wonder if you have Lyme disease or something similar? About the only thing missing is the sore joints and muscles, though those do not happen with everyone.
Don't know if restless legs was a problem before celexa, but for sure celexa is making it a lot worse. Remeron also. That's a frequent complaint with remeron.
The meds are working badly for you, so I would need someone to give me one good reason to stay on them. I can't think of any.
A dopamine agonist might help. I hear their side effects are a bit rough but I don't know. The only one I ever tried was Trivastal which was quite tame in terms of side effects.
IMO the whole treatment plan is off course by relying so heavily on an SSRI as the core. Given the set of symptoms, it makes no sense to not try a blind trial of Doxycylcine just to see what happens.
I wish I had some suggestions for you in terms of psych meds. Amisulpride, or amisulpride with SNRI, or amisulpride with dopamine agonist, those are things I would be tempted to mention. For a wide array of bizarre neurological problems such as you described, my Lyme doctor finds Gabapentin to be broad spectrum with many of them. One of his common prescriptions. I just picked up my script of it but have not tried it. If you were limited to purely antidepressants, I would probably vote for cymbalta, even though it is not among my favorites list. It more appropriately targets your symptom spectrum than most of the others. Microdoses though...we're talking open a capsule, dump out the beads, and start with just a couple, increasing each day as tolerated. 10 beads is 1mg. My LLMD starts patients on lexapro at 1 drop, which is 1/10th of a mg, with final doses being between 1mg and 5mg. A completely different approach than psychiatrists who do not understand a bizarre nervous system is different than just depression. Comparing lexapro to cymbalta, a starting dose would be one to two beads of cymbalta. Almost all docs have samples of these they can give you for free. It could be a straight across switch from celexa or a cross taper. I would drop the remeron, or at most keep maybe 1mg-3mg just for sleep. Tiny chunks will zonk you out.
For sure the meds you are on are doing nothing good for how you feel and are doing absolutely nothing to address numbness and twitching. I would think a visit to a Neurologist and an Infectious Agent specialist would be more beneficial than a Psychiatrist.
And I feel strongly a common antibiotic such as doxycycline should be tried as a test for a few weeks. The trial itself is the diagnostic test. Don't try to do some test to validate taking an antibiotic. It's the other way around. Take an antibiotic to rule in or rule out a suspicion. Your symptoms raise red flags of suspicion IMO.
This is tough stuff. I can feel your pain bigtime and I'm just trying to save you some suffering and get this thing improved as fast as possible. No matter what you do, the celexa and remeron gotta go. They have already proven to be worthless for you and in fact may be making you worse than without them.
>
> - Anhedonia
> - Very low motivation
> - Slightly numb part of upper left leg
> - Muscle twitches, such as leg muscles or eyelids
> - Restless Leg Syndrome
> - Physically weak
> - No focus
> - Lots of scrambled thoughts constantly running through head
> - No emotional connection to anyone or anything
> - No emotions, period (sadness, happiness)
> - Poor memory
> - Dreams are pretty vivid and I remember some of them when I wake up, but forget throughout the day
> - Developed horrible akathisia with Abilify as low as 2.5 mg/day
> - Social anxiety/avoidance
> - Feels like I have mild akathisia (Restless, Agitated)
> - Irritable
> - No patience (hate driving because of how much I hate red lights)
> - Energy varies by day and throughout the day
> - Some suicidal ideation
> - Basically, I can barely function and feel like crap.
>
> My father and his mother both have Parkinson's.
>
> On Thursday, I stopped taking the Abilify because of the akathisia, and my doctor prescribed 600 mg Lithium per day and 100 mg Seroquel to sleep. This was added to 15 mg Remeron and 40 mg Celexa.
>
> Tomorrow, I plan to call my family doctor about my RLS and hopefully he will prescribe either Requip or Mirapex. Doesn't it seem like it's a low dopamine issue? Family history of Parkinson's, low motivation, social anxiety, RLS, muscle twitches...
>
> I'm just not comfortable in any moment. Every second just feels "bad". After experiencing akathisia from the Abilify, I realized that how I normally feel is just a milder form of this. I always have some part of my mind thinking about how to feel better. I also always want to be doing something. The second I get any energy, I try to be as productive as possible..doing yoga, cleaning, exercising, etc, but sometimes I'm only a few minutes into it and the motivation/energy disappears.
>
> And I've read that Lithium and Seroquel both lower dopamine. Do I really need more of that, and the possibility of more akathisia?
>
> Bleauberry suggested Amisulpride, but I can not afford ordering it. I will try to get disability payments, then maybe I can try it.
>
> What should I do??
Posted by violette on August 10, 2010, at 19:26:44
In reply to Re: The brain is not like a pot of soup » violette, posted by ed_uk2010 on August 9, 2010, at 15:36:27
Hmmm. well you could use the whole message; or-simply state "the brain is not like a pot of soup". I really like that. :)
Posted by Dima on August 10, 2010, at 19:51:40
In reply to Re: Should I try Requip?, posted by bleauberry on August 9, 2010, at 16:33:49
Thank you, bleauberry.
I've actually cut out all meds except Lithium, because I just started it and maybe it'll do something.
Also, I've gone on a zero carb diet. The last time I felt good amidst my depression for seemingly no reason, I was a few days into a zero carb diet. I started feeling worse when I started eating junk again. You actually recommended cutting out sugar many months ago in another post.
It seems to me like my dopamine is too low and my serotonin is too high. I'm basically a carb addict, so it would make sense, along with my emotional numbness.
By the way, I've had most of these symptoms, including numbness and twitching, since I was fourteen or fifteen. I also have an ongoing pilonidal cyst infection which reoccurred twice after past surgeries which I've had since about the same time. I remember RLS type symptoms since I was even younger, so it's not a side effect of any drugs.
I've always considered my problems mostly genetic because my mother was socially anxious. My brothers also have somewhat low motivation and energy. And my dad has Parkinson's, so low Dopamine.
I've got a bottle of Cipro and a bottle of Metronidazole. I haven't really considered antibiotics because of all the people who say it'll mess up your good bacteria.
In terms of asking doctors, I've always had a problem with that. My social anxiety is pretty bad and my mind goes blank around doctors. It seems pretty scary to ask for a certain drug.
Tomorrow, I plan on seeing the doctor in the morning and telling him about my RLS, and hopefully he will give me Requip or Mirapex.
So my plan as of now is Lithium 600 mg/day, one of the two dopamine agonists, and a zero carb diet, which is already giving me a little more energy. Should I really try an antibiotic? Could it possibly have an effect on my mental problems?
Posted by Phillipa on August 10, 2010, at 21:32:23
In reply to Re: Should I try Requip?, posted by Dima on August 10, 2010, at 19:51:40
Dima you need some carbs the healthy ones. Fruits, vegtables and maybe some rice. Carbs do give you energy. Phillipa
Posted by Dima on August 11, 2010, at 13:29:33
In reply to Re: Should I try Requip?, posted by Dima on August 10, 2010, at 19:51:40
I took my first .5 mg dose of Requip a couple hours ago. I plan to build it up to 1 mg over the next few days. The only immediate effect is increased salivation. Anyone know why a dopamine agonist can cause somnolence?
I also started taking my Cipro and Metronidazole. Maybe the salivation is from those.
Posted by ed_uk2010 on August 11, 2010, at 16:00:39
In reply to Re: Should I try Requip?, posted by Dima on August 10, 2010, at 19:51:40
>It seems to me like my dopamine is too low and my serotonin is too high.
Dima, you can't possibly know whether (or not) you have 'low dopamine' or 'high serotonin' (if indeed such conditions actually exist). The causes of psychiatric illness are incredibly complex and involve a multitude of genetic, environmental, social, psychological and even educational factors. It's not generally a case of one or two neurotransmitters being too high or too low. It doesn't work like that.
This form of oversimplification and reductionism doesn't even make sense. What does 'low dopamine' mean?
In which region of the brain is dopamine 'low'?
How can we demonstrate that this is the case?
Is dopamine biosynthesis occuring at the usual rate?
Are we talking about intra-synaptic neurotransmitter levels.... or perhaps intra-neuronal levels?
Are we talking about neurotransmitter turnover?
Is dopamine re-uptake occuring at a higher than normal rate?
Is there an abnormality affecting dopamine release?
Are dopamine receptor densities reduced?
Which dopamine receptors are affected? D1, D2, D3, D4, D5?
When dopamine binds to a receptor, is the usual response occuring?
Are dopaminergic neurons damaged in some way?
Which dopamine 'pathways' are involved? The mesolimbic pathway? The mesocortical pathway? Others?
There are thought to be over 100 different neurotransmitters in the brain, including at least 50 neuropeptides. How would you know that your problems were related to dopamine, rather than one of the others?Do you see what I mean? You cannot possibly know that your mental health problems are due to 'low dopamine'.
>And my dad has Parkinson's, so low Dopamine.
The underlying cause of Parkinson's Disease is not clear. It appears that only a minority of cases are genetic in origin.
I'm not saying that Requip or Mirapex won't help. They might. In particular, they might reduce your restless leg symptoms. All I'm suggesting is that you need to be very careful about making sweeping generalisations about the cause of your illness. The reality of the situation is that the true cause(s) of psychiatric symptoms are never really known. We can only guess. I really think it's important not to get too hung up on any particular theory. The problem with theories is that they can lead you down the wrong path........and discourage the trial of other treatments which might be of benefit, despite not acting directly on the neurotransmitter(s) which you believe to be at fault.Talk of 'low dopamine' is very common on psycho-babble. We hear of babblers wanting to experiment with dopaminergic medications in attempt to relieve their depression, anhedonia, fatigue, lack of motivation and apathy. We have become dopamine obsessed. Whilst we are busy worrying about dopamine, our attention is drawn away from other possible causes or contributing factors to our illness.
Dopamine has undoubtedly become the neurotransmitter du jour!
Posted by 10derHeart on August 11, 2010, at 19:59:29
In reply to The dangers of reductionism » Dima, posted by ed_uk2010 on August 11, 2010, at 16:00:39
What a great post, ed. I learn so much from you. Very glad you are here a lot now. I think maybe when I was very active on Babble (2005-2008)you were more of a wistful memory (but *my* memory could be off, too)or posted infrequently. Now it's obvious why you were so sorely missed!
Just had to say this.
Posted by Phillipa on August 11, 2010, at 20:47:02
In reply to Re: The dangers of reductionism » ed_uk2010, posted by 10derHeart on August 11, 2010, at 19:59:29
Oh I definitely second that and glad to not hear the word dopamine. As there are many others. PJxx
Posted by morgan miller on August 12, 2010, at 1:45:42
In reply to Re: Should I try Requip?, posted by Dima on August 10, 2010, at 19:51:40
Dima, are you exercising vigorously and stretching on a regular basis? This could really help your RLS.
I agree with Ed, I don't think you should mess with any dopamine agonists right now. You are young and your brain is still developing. Just give lithium some time, start getting in some intense exercise 5 days a week, do some yoga, and take some supplements that could help with sleep and RLS.
Are you taking fish oil? It could simply help with overall brain function.
Morgan
Posted by SLS on August 12, 2010, at 4:25:33
In reply to Re: The dangers of reductionism » ed_uk2010, posted by 10derHeart on August 11, 2010, at 19:59:29
> What a great post, ed.
Agreed.
- Scott
Posted by ed_uk2010 on August 12, 2010, at 9:40:10
In reply to Re: The dangers of reductionism » ed_uk2010, posted by 10derHeart on August 11, 2010, at 19:59:29
Thank you. It's very sweet of you to say so, I really appreciate it.
I think I posted most in 2005, but I don't remember exactly. I've been visiting babble since the early days, but I didn't post for quite a long time. I just read the boards.
About Dima... I hope he can see that I'm not criticising him in any way. I am a bit worried that he might feel attacked by my posts. This is certainly not my intention. The reason that I posted was because I think he needs to be more cautious with psychiatric medication. Rapidly switching from one potent drug to another can leave the brain in a state of disarray, so to speak :)
Dopamine agonists such as Requip and Mirapex are known to be effective in a proportion of cases of RLS but their role in psychiatry is not yet clear. During initial treatment, nausea, vomiting and dizziness can be a problem. After a few weeks or months, impulsive/addictive behaviours can develop. This can land people in a lot of trouble, especially when it involves sex or gambling. Sleep attacks can also occur as a side effect, and can lead to car accidents. Paranoia and psychotic symptoms are sometimes induced.
Again, I'm not saying that dopamine agonists won't help. I just think that treatment with this type of medication needs to be very closely monitored by an experienced psychiatrist.
So Dima - please be careful. Consult your doctor regularly and don't make any changes to your medication without your doctor's approval.
Posted by Dima on August 12, 2010, at 10:15:27
In reply to Re: The dangers of reductionism » 10derHeart, posted by ed_uk2010 on August 12, 2010, at 9:40:10
Thank you ed, and every one else.
What are the dangers of dopamine agonists such as Requip other than the side effects you mentioned? The impulsive behavior side effect seems like a step in the right direction for me, seeing as I'm the exact opposite.
I don't feel like I can follow my doctor's advice exactly because I can't get my thoughts across to her. I say I'd like to try Parnate, she says no it's dangerous and puts me on Seroquel, and my mind goes blank. I'm way too afraid of any such conflict.
Posted by ed_uk2010 on August 12, 2010, at 14:36:02
In reply to Re: The dangers of reductionism, posted by Dima on August 12, 2010, at 10:15:27
>What are the dangers of dopamine agonists such as Requip other than the side effects you mentioned? The impulsive behavior side effect seems like a step in the right direction for me, seeing as I'm the exact opposite.
The most common adverse effects are nausea/vomiting, abdominal pain, drowsiness, dizziness/fainting, hallucinations and fluid retention in the legs/ankles.
>I don't feel like I can follow my doctor's advice exactly because I can't get my thoughts across to her. I say I'd like to try Parnate, she says no it's dangerous and puts me on Seroquel, and my mind goes blank. I'm way too afraid of any such conflict.
Is there any chance you can see a different doctor? You need someone that you feel comfortable with. I appreciate that this may be difficult due to your social anxiety.
Posted by Dima on August 13, 2010, at 13:34:12
In reply to Re: The dangers of reductionism » Dima, posted by ed_uk2010 on August 12, 2010, at 14:36:02
> >What are the dangers of dopamine agonists such as Requip other than the side effects you mentioned? The impulsive behavior side effect seems like a step in the right direction for me, seeing as I'm the exact opposite.
>
> The most common adverse effects are nausea/vomiting, abdominal pain, drowsiness, dizziness/fainting, hallucinations and fluid retention in the legs/ankles.
>
> >I don't feel like I can follow my doctor's advice exactly because I can't get my thoughts across to her. I say I'd like to try Parnate, she says no it's dangerous and puts me on Seroquel, and my mind goes blank. I'm way too afraid of any such conflict.
>
> Is there any chance you can see a different doctor? You need someone that you feel comfortable with. I appreciate that this may be difficult due to your social anxiety.I've seen three different psychiatrists now and it seems like none of them will agree or listen to me, so I think it's mostly me and not them and I just feel like that. It's so hard to ask for something. Maybe I should bring some print outs of Parnate information to show I've researched it. I even say it worked on my brother when he's never had it to avoid actually trying to convince her.
Posted by ed_uk2010 on August 13, 2010, at 14:46:33
In reply to Re: The dangers of reductionism, posted by Dima on August 13, 2010, at 13:34:12
>It's so hard to ask for something. Maybe I should bring some print outs of Parnate information to show I've researched it.
I don't think there is much clinical trial evidence to support the use of tranylcypromine (Parnate) in anxiety disorders. Phenelzine (Nardil) has received much more study for anxiety, especially severe social phobia.
If you search the National Library of Medicine site 'PubMed', you will find some studies.
http://www.ncbi.nlm.nih.gov/pubmed
Try typing 'phenelzine social phobia' into the search box (but do not use quotation marks). If you want to search for anything else, don't forget to use drug names, not brand names.
>I even say it worked on my brother when he's never had it to avoid actually trying to convince her.
That's probably not a good idea. You might get asked difficult questions!
Posted by g_g_g_unit on August 16, 2010, at 2:30:58
In reply to MAOIs » Dima, posted by ed_uk2010 on August 13, 2010, at 14:46:33
> >It's so hard to ask for something. Maybe I should bring some print outs of Parnate information to show I've researched it.
>
> I don't think there is much clinical trial evidence to support the use of tranylcypromine (Parnate) in anxiety disorders. Phenelzine (Nardil) has received much more study for anxiety, especially severe social phobia.
>Granted, this is n=1, but I found Parnate to be more anxiolytic than Nardil, and I'm about as anxious as they came. Maybe the effect was dose-related, but at 60mg+, I found Nardil to be too activating for my liking. At 20mg, Parnate violently exacerbated my OCD, but once I hit 30mg, it was smooth sailing. I probably would have continued with Parnate if it wasn't for the insomnia.
Posted by violette on August 16, 2010, at 11:52:44
In reply to Re: MAOIs and anxiety » ed_uk2010, posted by g_g_g_unit on August 16, 2010, at 2:30:58
"this is n=1"
That cracked me up. I could always use a laugh-thanks. :)
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