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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 146. This is the beginning of the thread.
Posted by Maxime on October 13, 2010, at 22:32:42
A close friend of mine told me that I don't look like the person I was a year ago. I am very overweight and at the same time I look bloated(puffy face and hands. I have an eating disorder (ED NOS)and I restrict my food a lot.
I can't blame the meds for everything ... but I can blame them for a lot.
I'm going to slowly come off the Parnate. I will keep the Nortriptaline for a while so I don't crash and burn. Then I will slowly decrease the Nortrip. I will stay on the Trileptal to keep my mood "stable" -ha! What a joke! I will also stay on the Adderall XR.
Of course I am going to ask my pdoc if it's okay to do this. Maybe he will give me tips on how to decrease the Parnate.
I really hope that I am not creating a disaster. Do you think I am? I just don't want to be on all these meds. I want my old body back. I want to have all my cognitive functions working properly (of course one could argue that coming off the med will create cognitive problems)
Does anyone have any thoughts on my plan of action? Maybe there is something I have not thought of yet.
Thanks y'all! :)
Posted by Christ_empowered on October 13, 2010, at 23:14:36
In reply to Thinking of coming off meds, posted by Maxime on October 13, 2010, at 22:32:42
I think it sounds like you've got a plan in place. Keeping your meds to a minimum is always a good idea, as long as you're getting what you need out of your pharmaceuticals.
Just based on my own experiences taking trileptal and adderall, I like the idea of combining them. Trileptal is more anti-manic (just in my experience) and mood-leveling; the adderall should help perk you up a little bit. I guess its kind of like a build-your-own antidepressant.
Anyway, good luck to you; I hope the weight comes off and the new meds work well for you.
Posted by Phillipa on October 13, 2010, at 23:53:45
In reply to Re: Thinking of coming off meds, posted by Christ_empowered on October 13, 2010, at 23:14:36
Maxie I understand where you are coming from but weren't you in the crisis center not long ago suicidal? Not sure you will get a lot of support on your plan. Talk it over with you doc and sleep on it. See how the weekend goes also as seems you kind of crash and burn on weekends. Ultimately it's your decision and yours alone. Love Phillipa
Posted by SLS on October 14, 2010, at 1:35:41
In reply to Thinking of coming off meds, posted by Maxime on October 13, 2010, at 22:32:42
What has you convinced that it is the Parnate that is responsible for the weight-gain? I would have thought that the nortriptyline would be responsible for it.
I think you will crash and burn if you remove both antidepressants. I hope that I am wrong. You were in a very bad place before you began taking Parnate. If you try to lower the nortriptyline first, you can recapture the antidepressant response immediately by quickly returning to your therapeutic dose if you relapse. If you come off the Parnate first, it will take longer to recapture the therapeutic effect as it takes a while to reestablish MAO inhibition.
One thing to keep in mind is that if you discontinue these drugs too rapidly, you might experience a withdrawal rebound depression that is not the same thing as relapse. Withdrawal depression would begin early and contemporaneously with other withdrawal symptoms, and be self-limiting within a week or so. A true relapse is more likely to occur after a longer period of time. This is not an absolute rule, though. I often relapse upon dosage reductions within days of effecting them. Cliche, but everyone is different.
- Scott
Posted by bleauberry on October 14, 2010, at 4:58:25
In reply to Thinking of coming off meds, posted by Maxime on October 13, 2010, at 22:32:42
I think the whole thing sounds reasonable to me. I think it needs to be done slowly and carefully. Very tiny changes while dropping dosage. Personally I would probably whittle down the doses of the other meds too in tiny amounts at the same time.
Maybe it's just me, but I see no logical or justifiable reason to stay on meds that have done little or nothing to improve quality of life. It boggles my mind, but probably countless people do it.
Feeling worsened symptoms while decreasing the dosages will probably happen, and each time it will pass in a few days to a week or two. It's adjustment stuff happening. Many people erroneously think "oh, that means the med was doing something good after all, and I get worse without it"....wrong. It's called withdrawals and readjustments. The true baseline will not be evident for a month to three months after a final dose. Everything up until that time is related to readjustment.
Plan of action for going forward?
Japaneses Knotweed
Siberian ginseng
High potency refrigerated probioticThose would be basic staples to whatever else you do.
Doxycycline has to be tried. No ifs, and, or buts, about it. Again logic comes into play....if a boatload of psych meds have not done the trick, then something else is going on. Doxy and the above plants just happen to cover a wide range of them.
Posted by SLS on October 14, 2010, at 5:31:56
In reply to Re: Thinking of coming off meds, posted by bleauberry on October 14, 2010, at 4:58:25
> I think the whole thing sounds reasonable to me.
Why?
Do you have some insight into Maxime's condition and history to be able to come to this conclusion?
> I think it needs to be done slowly and carefully. Very tiny changes while dropping dosage. Personally I would probably whittle down the doses of the other meds too in tiny amounts at the same time.
Why?
What should Maxime do should she relapse while performing a slow taper of her medications?
> Maybe it's just me, but I see no logical or justifiable reason to stay on meds that have done little or nothing to improve quality of life.I would agree with this, but I think you should ask questions of Maxime regarding her treatment history before you suggest what is the right thing for her to do.
> It boggles my mind, but probably countless people do it.
How are you feeling today? Not too bad? Perhaps you don't share the same desperation as others.
> Feeling worsened symptoms while decreasing the dosages will probably happen, and each time it will pass in a few days to a week or two.
According to whom?
> It's adjustment stuff happening. Many people erroneously think "oh, that means the med was doing something good after all, and I get worse without it"....wrong. It's called withdrawals and readjustments. The true baseline will not be evident for a month to three months after a final dose. Everything up until that time is related to readjustment.
Perhaps you should clarify how you would distinguish between withdrawal rebound depression and relapse before suggesting to someone that they commit to continuing to taper medications gradually despite feeling worse.
> Doxycycline has to be tried. No ifs, and, or buts, about it.
Why doxycycline? What might its mechanism of action be?
> Again logic comes into play....if a boatload of psych meds have not done the trick, then something else is going on.
It does not follow from logic given your supposition that any one drug be indicated over another. Why not try rectal suppositories of bisacodyl? Afterall, antidepressants don't work.
Posted by Jay_Clockwork_Angels on October 14, 2010, at 11:23:35
In reply to Thinking of coming off meds, posted by Maxime on October 13, 2010, at 22:32:42
> A close friend of mine told me that I don't look like the person I was a year ago. I am very overweight and at the same time I look bloated(puffy face and hands. I have an eating disorder (ED NOS)and I restrict my food a lot.
>
> I can't blame the meds for everything ... but I can blame them for a lot.
>
> I'm going to slowly come off the Parnate. I will keep the Nortriptaline for a while so I don't crash and burn. Then I will slowly decrease the Nortrip. I will stay on the Trileptal to keep my mood "stable" -ha! What a joke! I will also stay on the Adderall XR.
>
> Of course I am going to ask my pdoc if it's okay to do this. Maybe he will give me tips on how to decrease the Parnate.
>
> I really hope that I am not creating a disaster. Do you think I am? I just don't want to be on all these meds. I want my old body back. I want to have all my cognitive functions working properly (of course one could argue that coming off the med will create cognitive problems)
>
> Does anyone have any thoughts on my plan of action? Maybe there is something I have not thought of yet.
>
> Thanks y'all! :)Hi Maxime:
I am sorta answering your post from up a few above as well. I personally think, and I believe Scott may agree, that the Nortriptyline might be the weight and the cognitive-clouding culprit out of all your meds. So, I think you should give yourself a few days to really think this over. Even if you have been helped a fraction, it still may be worth it to stay on the med. Plus, in my experience of being on Notriptyline for over 6 years, some of the weight comes off after awhile.
Please just be very careful with any sudden changes in med doses. I am sure you know that they can cause some real hardships if you change doses sometimes even just a little. I understand the side-effects may be making you feel lousy, but as somebody on here once said, going without certain meds *also* has side-effects.Keep us posted...
Best,
Jay
Posted by creepy on October 14, 2010, at 12:50:28
In reply to Thinking of coming off meds, posted by Maxime on October 13, 2010, at 22:32:42
Theres been studies showing metformin helps with AAP-induced weight gain. Nothing that really says SSRIs or other drugs work with it unfortuantely.
I found that a small amount of topamax kept a lot of the food cravings down. You may find it helps quell the anxiety that underpins your ED.
Also these meds mostly tend to make you fat and slow, I agree get off of what you can.
Im trying to go as low as I can on psych drugs. Hoping I can use therapy to cover the rest.
Posted by ed_uk2010 on October 14, 2010, at 13:45:05
In reply to Thinking of coming off meds, posted by Maxime on October 13, 2010, at 22:32:42
Maxie,
Why did you decide to start by tapering Parnate rather than nortriptyline?
I know you are very concerned about your weight gain so I think it makes sense to keep the Parnate for now and taper nortriptyline. Although nortriptyline may be providing some benefit, I suspect that these are strongly counteracted by its potential to increase your weight.
Posted by Maxime on October 14, 2010, at 21:13:28
In reply to Re: Thinking of coming off meds, posted by Phillipa on October 13, 2010, at 23:53:45
> Maxie I understand where you are coming from but weren't you in the crisis center not long ago suicidal? Not sure you will get a lot of support on your plan. Talk it over with you doc and sleep on it. See how the weekend goes also as seems you kind of crash and burn on weekends. Ultimately it's your decision and yours alone. Love Phillipa
Yes, Phillipa. I was suicidal just before I got my job. But you know what? I still think about suicide because I am not happy. I really enjoy my new job but I am not getting happiness from it. Maybe I am expecting too much. But when I was unemployed for 18 months I used to think that once I got a job, I would be happy.
You are right though about the weekends. I think it is because I always have to be up and energetic for my job and it DRAINS me so much.
I won't do anything until I get the go ahead (or not) from my psychiatrist.
Thanks Phillipa.
Posted by morgan miller on October 14, 2010, at 21:13:55
In reply to Re: Thinking of coming off meds, posted by ed_uk2010 on October 14, 2010, at 13:45:05
I agree that you should probably taper Nortriptyline and not Parnate.
I feel like you really should be in intensive therapy and making life style changes instead of changing too many of your medications. You're looking for the medication cure instead of dealing with yourself and working hard at growing internally. I don't think medications are even close to the main reason for your appearance change. I think malnutrition and chronic depression have much more to do with it. The mistake you may be making, and I too have made it before, is thinking you will be better off without some medications. The reality may be that you are feeling better because of a few of these medications and that is in part creating the illusion that you will be fine without them.
I like the supplement suggestions BB gave you, but I feel he is a bit too "far to the left" and extreme with his approach. You are not him and you are not going to react the same way he does. It sounds like he believes that because these things worked with him, and maybe several others, that there is a good chance it will work for you. If he does not know everything about your history, I do not think he should be giving such potentially dangerous advice. Besides, you may not have the money to afford the supplements he suggested. If you do resveratrol(the main beneficial compound in japanese knotweed), you want a very high quality product and these are usually fairly expensive.
Scott, I think BB believes that many of us may have some chronic infection like Lyme and this could be one of the causes of our mental illness. Thus, doxycycline could be the start of a plan to treat a chronic infection like Lyme.
Morgan
Posted by Maxime on October 14, 2010, at 21:16:25
In reply to Re: Thinking of coming off meds, posted by Christ_empowered on October 13, 2010, at 23:14:36
Thank you. It's as if I made a sudden realisation that I am on way too many pills! My hormones are all over the place. I a very high prolactin level which worries my endo. but I know that it is from the Nortrip.
Posted by morgan miller on October 14, 2010, at 21:20:01
In reply to Re: Thinking of coming off meds » Phillipa, posted by Maxime on October 14, 2010, at 21:13:28
>But when I was unemployed for 18 months I used to think that once I got a job, I would be happy.
Your job was never going to make you happy. You need to start loving yourself in order to be happy. The only way you can achieve this is to start dealing with reality and get some therapy. Sorry for being hard on you. Until you start working hard in therapy, no matter what med you are on or what job you have, you will never achieve true happiness. Hopefully therapy will get you to eventually love yourself enough to be able to fill your life with positive fulfilling relationships. Life is love and relationships, without them, you will never be happy.
Morgan
Posted by Maxime on October 14, 2010, at 21:22:52
In reply to Re: Thinking of coming off meds » Maxime, posted by SLS on October 14, 2010, at 1:35:41
It is not that I believe the Parnate is causing the weight gain. It's just that my hormones are not right. I have a very high level of prolactin level (which is from the Nortrip). I have acne all over my face and I am 41 and not 13. I just don't want take so many pills anymore. I know that sounds stupid but the amount of meds I am on is crazy imo.
I do appreciate your input Scott. Yes, I would agree that coming off the Nortrip. first would be wise.
Something has messed my metabolism, but what med I don't know. Or maybe it's a combo.
I am not going to do anything until I get some advice from my psychiatrist. I am sure he will let me slowly come off my meds. He can help me what order I should do it.
Posted by Maxime on October 14, 2010, at 21:27:57
In reply to Re: Thinking of coming off meds, posted by bleauberry on October 14, 2010, at 4:58:25
Thanks B. If the meds were really helping me I would be able to put up with the side effects because it's trade off. Of course I want my mood to better and I would willing to endure certain side effects.
The good thing about the Parnate is that since it comes in 10 mg pills I can decrease it very slowly.
Something is making me very and ugly and it's not food!
Do you think my metabolism would improve once I am off the meds?
Posted by Maxime on October 14, 2010, at 21:34:09
In reply to Re: Thinking of coming off meds » Maxime, posted by Jay_Clockwork_Angels on October 14, 2010, at 11:23:35
Really? I didn't know that Nortrip cause cognitive problems! I thought I was just getting dumb. I teach computer courses to seniors and some my words will get mixed up or I lose my tain of thought which isn't like me at all. It's really embarrassing because it feel like minutes are going by until I find the the right word or term, I know it's only a couple of seconds, it feels much longer than that!
Posted by Maxime on October 14, 2010, at 21:36:34
In reply to Re: Thinking of coming off meds, posted by creepy on October 14, 2010, at 12:50:28
Yes, I have heard that about Metformin. I should research is closely.
I have used Topomax before and both times I went psychotic and I ended up in the hospital. No more Topomax for me.
Posted by Maxime on October 14, 2010, at 21:42:07
In reply to Re: Thinking of coming off meds, posted by ed_uk2010 on October 14, 2010, at 13:45:05
> Maxie,
>
> Why did you decide to start by tapering Parnate rather than nortriptyline?
>
> I know you are very concerned about your weight gain so I think it makes sense to keep the Parnate for now and taper nortriptyline. Although nortriptyline may be providing some benefit, I suspect that these are strongly counteracted by its potential to increase your weight.
>
>I can't remember my logic behind why I choose Parnate. I can't remember much these days!
Ed, do meds mess your metabolism? When I saw my endo. last time she was really concerned about my weight. I told her that I don't eat much and she responded I that I am eating enough to be fat (that really hurt) I know that restricting can my metabolism to slow down ... but what about meds? I guess it could also be the Nozinan that I use to help me sleep.
I appreciate your help. xxx
Posted by Phillipa on October 14, 2010, at 21:51:47
In reply to Re: Thinking of coming off meds » ed_uk2010, posted by Maxime on October 14, 2010, at 21:42:07
Maxie sure nortriptaline can cause weight gain. But also thyroid causes this and not trying to be mean or hurtful but at over 40 some younger women do start menopause and weight goes up. Get hormone levels checked. All are interconnected. You know my job made me happy cause until working I grew up with a Mother who blamed me for her illness and death. And when I had my kids I realized that carrying me up stairs couldn't have made her ill. So my self esteem went up and continued to climb with nursing and getting good grades. Actually I feel I was depressed when young. Not now though as I've achieved and traveled accomplished all and more than I ever dreamed I could. These are my thoughts only. Phillipa
Posted by Maxime on October 14, 2010, at 22:17:29
In reply to Re: Thinking of coming off meds, posted by Phillipa on October 14, 2010, at 21:51:47
Phillipa, I have my thyroid levels checked every six months. Two months ago they were fine ( a little on the hyper side but that is where I feel best and the endo is fine with keeping me there).
I thought I was entering menopause and my GP did some blood work and she said that I have not started menopause. Also, I not talking about 10-15 pounds. It is about 65 pounds which on my short stature is very FAT, UGLY and NOTICEABLE. And what is up with the acne? UGH. I now have a medicated cream to use.
Posted by huxley on October 14, 2010, at 22:33:33
In reply to Re: Thinking of coming off meds » ed_uk2010, posted by Maxime on October 14, 2010, at 21:42:07
All I know is that the lower I go on my medications the better I feel.
That is after I go through a period of hell.
That period of hell is medication withdrawal not my 'original symptoms returning'.
If you are going to do it be careful. I know we are all different, for me it is so easy to spin out of control so I go very very slowly so I can reverse any change I made.
Best of luck with whatever you decide to do.
Posted by huxley on October 14, 2010, at 22:50:44
In reply to Re: Thinking of coming off meds » bleauberry, posted by SLS on October 14, 2010, at 5:31:56
> > I think the whole thing sounds reasonable to me.
>
> Why?
>
> Do you have some insight into Maxime's condition and history to be able to come to this conclusion?
>
> > I think it needs to be done slowly and carefully. Very tiny changes while dropping dosage. Personally I would probably whittle down the doses of the other meds too in tiny amounts at the same time.
>
> Why?
>
> What should Maxime do should she relapse while performing a slow taper of her medications?
>
> > Maybe it's just me, but I see no logical or justifiable reason to stay on meds that have done little or nothing to improve quality of life.
>
> I would agree with this, but I think you should ask questions of Maxime regarding her treatment history before you suggest what is the right thing for her to do.
>
> > It boggles my mind, but probably countless people do it.
>
> How are you feeling today? Not too bad? Perhaps you don't share the same desperation as others.
>
> > Feeling worsened symptoms while decreasing the dosages will probably happen, and each time it will pass in a few days to a week or two.
>
> According to whom?
>
> > It's adjustment stuff happening. Many people erroneously think "oh, that means the med was doing something good after all, and I get worse without it"....wrong. It's called withdrawals and readjustments. The true baseline will not be evident for a month to three months after a final dose. Everything up until that time is related to readjustment.
>
> Perhaps you should clarify how you would distinguish between withdrawal rebound depression and relapse before suggesting to someone that they commit to continuing to taper medications gradually despite feeling worse.
>
> > Doxycycline has to be tried. No ifs, and, or buts, about it.
>
> Why doxycycline? What might its mechanism of action be?
>
> > Again logic comes into play....if a boatload of psych meds have not done the trick, then something else is going on.
>
> It does not follow from logic given your supposition that any one drug be indicated over another. Why not try rectal suppositories of bisacodyl? Afterall, antidepressants don't work.
>
>I for one have been very grateful for Blueberries posts and experiences with coming of meds and she has been far more help than any dr or psyciatrist who knows my full history of meds and my condition.
Posted by Phillipa on October 14, 2010, at 23:38:10
In reply to Re: Thinking of coming off meds » Phillipa, posted by Maxime on October 14, 2010, at 22:17:29
Mine was also recently checked then hormone doseage changed and that changes the thyroid levels according to both endo and hormone doc. So I'm thinking I need to get mine rechecked. Maxie I'd freak out literally if I gained all that weight. I honestly don't know what to say about that. And I know food with some isn't the reason. I'm sorry. Phillipa
Posted by Phillipa on October 14, 2010, at 23:45:18
In reply to Re: Thinking of coming off meds, posted by huxley on October 14, 2010, at 22:50:44
Huxley the only thing I'll comment about doxy or any antibiotics is my infection control specialist feels the Biaxin XL I took for chronic lymes for two years three months on and three off is responsible for me losing all taste and smell 7 years ago. It's horrible to not taste and smell. I recently had another MRI of brain and sinuses and the doc was sad to confer I will never smell a rose or taste food again. So be careful with antibiotics. They are very powerful and the more you take them the more med resistant bugs are developing first it was MRSA now worse things. Just be careful. Explore all with different specialists. I strongly feel the mind, body organs, endrocrine systems tie in very closely and all if working correctly are playing harmoniously. Phillipa
Posted by SLS on October 15, 2010, at 5:10:38
In reply to Re: Thinking of coming off meds » creepy, posted by Maxime on October 14, 2010, at 21:36:34
> Yes, I have heard that about Metformin. I should research is closely.
>
> I have used Topomax before and both times I went psychotic and I ended up in the hospital. No more Topomax for me.That's interesting. Topamax exerted a mild antidepressant effect on me. I wonder how often manic reactions to Topamax occur.
I have witnessed Topamax effectively treat a dysphoric mixed-state bipolar.
- Scott
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