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Dr. Bob is Robert Hsiung, MD,
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Posted by Maxime on October 27, 2010, at 18:20:21
In reply to Re: Thinking of coming off meds, posted by Maxime on October 27, 2010, at 17:23:39
Oh, and I didn't get permission from me pdoc to do that. I see him on Friday and will tell him why I discontinued it. If he feel strongly about me taking it, then I guess I have to go back on it, but I hope not.
Posted by Phillipa on October 27, 2010, at 20:31:43
In reply to Re: Thinking of coming off meds, posted by Maxime on October 27, 2010, at 18:20:21
Good luck and no withdrawal stopped cold turkey? Phillipa
Posted by Conundrum on October 28, 2010, at 12:06:47
In reply to Re: Thinking of coming off meds » bleauberry, posted by Maxime on October 14, 2010, at 21:27:57
I agree with everyone else that nortriptyline is probably causing the weight gain.
Many people do not realize it, but nortriptyline is not only an antihistamine, but also at 5 HT2C antagonist, with an inhibition constant of approximately 7.0. Antagonizing the 5HT2C receptor can cause massive weight gain. For instance Zyprexa and Remeron block this receptor and are also antihistamines and both can cause huge weight gain.
Parnate due to its preference of MAO-B inhibition should increase stimulating hormones. Taking this along with adderall, I would imagine would cause a net weight loss, in the absence of nortriptyline that is.
Also nortriptyline can cause retention of water in the body which could be causing the puffyness, which is different from weight from fat.
I remember how you were a few months ago and you seem much better now. I wouldn't let someones comments about how you look derail the progress you have made.
Posted by Conundrum on October 28, 2010, at 12:09:48
In reply to Re: Thinking of coming off meds » Phillipa, posted by Maxime on October 14, 2010, at 22:17:29
Adrenergic drugs like nortriptyline can cause acne and other kinds of skin problems, but so could being overweight and sweating. I'd try to see how you do without it for awhile.
>
> 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 floatingbridge on October 28, 2010, at 12:45:09
In reply to Re: Thinking of coming off meds, posted by Conundrum on October 28, 2010, at 12:09:48
Conundrum, your post was so informative and kind, too. Makes sense about the puffiness. I knew meds could cause abnormal weight gain (ratio of caloric intake to fat stored imbalanced) from experience but not the science behind it.
I've been puzzling over the acne piece. Maxime, could it be somehow related to your tendency to have elevated prolactin levels? (I know I'm butchering the science!) Some other here have that problem, too, men and women. So is there an endocrine piece to this?
Maxime, good luck and be well.
fb
Posted by Maxime on October 28, 2010, at 14:32:56
In reply to Re: Thinking of coming off meds » Maxime, posted by Phillipa on October 27, 2010, at 20:31:43
> Good luck and no withdrawal stopped cold turkey? Phillipa
No, I didn't stop cold turkey. I was on 75 mg and I dropped the dosage by 25 mg every 5 days or so. I didn't think I was going through withdrawal, but now that I think about it maybe that is why I feel like sh*t - flu like aches in every part of my body. I can't remember which came first ... the weaning or the aches and pains. So yeah, physically I feel like sh*t but I don't know if it is from coming off of the Nortrip.
Posted by Maxime on October 28, 2010, at 14:35:41
In reply to Re: Thinking of coming off meds » Maxime, posted by Conundrum on October 28, 2010, at 12:06:47
Thank you. It was just my friend's comment about my weight that upset me. It was my weight gain period. Nothing fits. I tried on my winter coat the other day and it's too tight. I don't know what to do. I can't afford to go out and buy a new wardrobe. Sigh. I hope you are right and that the weight starts to come off. :)
Posted by Maxime on October 28, 2010, at 14:37:58
In reply to Re: Thinking of coming off meds, posted by Conundrum on October 28, 2010, at 12:09:48
> Adrenergic drugs like nortriptyline can cause acne and other kinds of skin problems, but so could being overweight and sweating. I'd try to see how you do without it for awhile.
>Oh, I didn't know that about Nortrip. I hope it is the cause of my acne. Although I am sure that the weight gain is also contributing. I am so ugly.
Posted by Maxime on October 28, 2010, at 14:41:16
In reply to Re: Thinking of coming off meds » Conundrum, posted by floatingbridge on October 28, 2010, at 12:45:09
> Conundrum, your post was so informative and kind, too. Makes sense about the puffiness. I knew meds could cause abnormal weight gain (ratio of caloric intake to fat stored imbalanced) from experience but not the science behind it.
>
> I've been puzzling over the acne piece. Maxime, could it be somehow related to your tendency to have elevated prolactin levels? (I know I'm butchering the science!) Some other here have that problem, too, men and women. So is there an endocrine piece to this?
>
> Maxime, good luck and be well.
>
> fb
Well, maybe it was the Nortrip that was causing it. Maybe it's just messed up hormones (like my prolactin. At any rate it is UGLY, ver UGLY. Sigh. Weight gain and acne.At least my hair isn't falling out.
Posted by maxime on October 29, 2010, at 16:29:25
In reply to Re: Thinking of coming off meds, posted by Maxime on October 28, 2010, at 14:41:16
I saw my pdoc today. He said it was okay to stop the Nortrip. The only thing I have noticed without it I am in a lot more physical pain. I think I will put up with the pain.
He doesn't want me to reduce ANY of meds. He is worried that I will fall into a worse depression. One where I would not be able to function and have a job.
He is looking into TMS for me. He doesn't think much of it, but he says that we must try everything.
So my appt. didn't really go as planned but it went as expected. I didn't think he would want me to come off my meds. At least he is okay with no more Nortrip.
I hope he gets some information soon on TMS, he is calling the psychiatrist in charge of it this week.
Posted by floatingbridge on October 29, 2010, at 18:08:49
In reply to Re: Thinking of coming off meds NO WAY!, posted by maxime on October 29, 2010, at 16:29:25
Maxime,
Personally, I'm relieved. I was told that most patients need maintence meds after rTMS. And your increased aches and pains could abate as part of the with discontinuation. That makes sense.
He may not think much of rTMS, however, if you're a part of the percentile it helps, yes! Others regard it highly. Hope you get in. I'd be at Stanford in a heartbeat had I the funds.
You doing alright?
Posted by maxime on October 29, 2010, at 19:20:54
In reply to Re: Thinking of coming off meds NO WAY! » maxime, posted by floatingbridge on October 29, 2010, at 18:08:49
> Maxime,
>
> Personally, I'm relieved. I was told that most patients need maintence meds after rTMS. And your increased aches and pains could abate as part of the with discontinuation. That makes sense.
>
> He may not think much of rTMS, however, if you're a part of the percentile it helps, yes! Others regard it highly. Hope you get in. I'd be at Stanford in a heartbeat had I the funds.
>
> You doing alright?Thanks Fb. I'm doing ok except for the exhaustion and aches and pains. Today I took some tylenol and some the pain went away. That makes me wonder if it really is from depression or stopping my Nortip. Although I had the same aches and pains before I stopped the Nortrip. I can't help but wonder what the hell is wrong with me! I have been through depression most of my life and I never had physical manifestations.
How are you doing? When will you start the Cymbalta?
Posted by Phillipa on October 29, 2010, at 20:14:45
In reply to Re: Thinking of coming off meds NO WAY! » floatingbridge, posted by maxime on October 29, 2010, at 19:20:54
Thyroid, hormones? Fibromyalgia? Phillipa
Posted by floatingbridge on October 29, 2010, at 22:04:56
In reply to Re: Thinking of coming off meds NO WAY! » maxime, posted by Phillipa on October 29, 2010, at 20:14:45
Phillipa and Maxine,
I was thinking perimenopause (fsh test), or ms (if ms flares or has pain symptoms). Thyroid, too. Recently a rheumy told me that my hashimoto's was adequately treated because on paper it looks good (last tsh test was .94), yet every single symptom I have falls under hashimoto's. Such a common disease, yet I suspect there is no real treatment unless the thyroid was removed. The same rhuemy told me not to fall into the
t3 trap out of desperation. I've had a crash course in doctors this past year, and I pretty much filed his advice under 'whatever'. I think my new gp will write a compound script of t4 and slow release t3. Slow release t3 is key for me. I spun out on it once.Doesn't sound like fibro to me. But fatigue can cause pain. Years of depression and sleep deprivation lead to fatigue, not to mention the major life stressors you've dealt with the past 18 months.
Posted by Phillipa on October 29, 2010, at 22:41:48
In reply to Re: Thinking of coming off meds NO WAY! » Phillipa, posted by floatingbridge on October 29, 2010, at 22:04:56
FB we must talk. Did you read any of Mary Shoman's articles? on thyroid and gets into adrenal fatigue and fibro also. If you told me the name of that med I forgot as only know the compounded version armour thyroid the pig. I'd say no to MS as a spinal tap and MRI of brain would rule that in or out. I feel you are also getting overwhelmed as I do too. Too much info too fast. Ick!!!! Love Phillipa
Posted by floatingbridge on October 30, 2010, at 0:04:06
In reply to Re: Thinking of coming off meds NO WAY! » floatingbridge, posted by Phillipa on October 29, 2010, at 22:41:48
Hi Phillipa,
I don't think I have MS. Not at all. The last doc, a rheumy said that I was right, that I didn't fit any category. Pain level to low for fibromyalgia, but definitely fibro-ish, no sore throat but even more strongly CFS, and not enough sleep disturbance for CPS, though he ordered a sleep study. He thinks it's depression fallout and should stop looking for a dx. Pooh-poohed the hashi's.
What name of what med? Do you mean the compounded synthetic t3 & t3 slow release? Does it have a name?
And how often do you have your thyroid antibodies checked?
Posted by SLS on October 30, 2010, at 5:01:27
In reply to Re: Thinking of coming off meds NO WAY! » Phillipa, posted by floatingbridge on October 29, 2010, at 22:04:56
> Doesn't sound like fibro to me. But fatigue can cause pain.
Major depressive disorder itself can produce pain. I have some minor, but persistent, aches and pains that disappear completely when I begin to respond to treatment. In addition, I experience an increase in muscle strength and cardiovascular capacity during these times.
- Scott
Posted by SLS on October 30, 2010, at 5:23:01
In reply to Re: Thinking of coming off meds NO WAY! » Phillipa, posted by floatingbridge on October 30, 2010, at 0:04:06
Here are a few abstracts to be found on PubMed:
http://www.ncbi.nlm.nih.gov/pubmed/20149391http://www.ncbi.nlm.nih.gov/pubmed/19482603
http://www.ncbi.nlm.nih.gov/pubmed/19573475
http://www.ncbi.nlm.nih.gov/pubmed/19573472
http://www.ncbi.nlm.nih.gov/pubmed/19317954
Posted by maxime on October 30, 2010, at 6:48:55
In reply to Re: Thinking of coming off meds NO WAY! » Phillipa, posted by floatingbridge on October 30, 2010, at 0:04:06
> Hi Phillipa,
>
> I don't think I have MS. Not at all. The last doc, a rheumy said that I was right, that I didn't fit any category. Pain level to low for fibromyalgia, but definitely fibro-ish, no sore throat but even more strongly CFS, and not enough sleep disturbance for CPS, though he ordered a sleep study. He thinks it's depression fallout and should stop looking for a dx. Pooh-poohed the hashi's.
>
> What name of what med? Do you mean the compounded synthetic t3 & t3 slow release? Does it have a name?
>
> And how often do you have your thyroid antibodies checked?Would you all mind making your own thread about this. It confuses me to have it lumped in mine.
Posted by Maxime on October 30, 2010, at 8:18:42
In reply to Re: Thinking of coming off meds NO WAY! » floatingbridge, posted by Phillipa on October 29, 2010, at 22:41:48
> FB we must talk. Did you read any of Mary Shoman's articles? on thyroid and gets into adrenal fatigue and fibro also. If you told me the name of that med I forgot as only know the compounded version armour thyroid the pig. I'd say no to MS as a spinal tap and MRI of brain would rule that in or out. I feel you are also getting overwhelmed as I do too. Too much info too fast. Ick!!!! Love Phillipa
Would you mind talking in your own thread. Don't highjack my thread please.
Posted by floatingbridge on October 30, 2010, at 14:46:55
In reply to Re: Thinking of coming off meds NO WAY! » floatingbridge, posted by SLS on October 30, 2010, at 5:23:01
Scott,
The second article down was the most helpful--treating all symptoms creates greater chances for breaking the cycle.
I think I'm having a bad morning, but I felt maybe the list from you was sent to me with anger or frustration.... Maybe because I haven't figured this out for
myself by now? And if this is pure projection on my part, I'm sorry.
Posted by floatingbridge on October 30, 2010, at 15:39:00
In reply to Re: Thinking of coming off meds NO WAY! » floatingbridge, posted by maxime on October 30, 2010, at 6:48:55
> >>> Hi Phillipa,
> >
> > I don't think I have MS. Not at all. The last doc, a rheumy said that I was right, that I didn't fit any category. Pain level to low for fibromyalgia, but definitely fibro-ish, no sore throat but even more strongly CFS, and not enough sleep disturbance for CPS, though he ordered a sleep study. He thinks it's depression fallout and should stop looking for a dx. Pooh-poohed the hashi's.
> >
> > What name of what med? Do you mean the compounded synthetic t3 & t3 slow release? Does it have a name?
> >
> > And how often do you have your thyroid antibodies checked?
>
> Would you all mind making your own thread about this. It confuses me to have it lumped in mine.
Posted by SLS on October 30, 2010, at 16:37:08
In reply to Re: Thinking of coming off meds NO WAY! » SLS, posted by floatingbridge on October 30, 2010, at 14:46:55
> I think I'm having a bad morning, but I felt maybe the list from you was sent to me with anger or frustration.... Maybe because I haven't figured this out for myself by now? And if this is pure projection on my part, I'm sorry.
You are such a silly thing.
:-)
I'm sorry for not writing anything along with the links. I really didn't have the energy at the time. I just wanted you to see the associations between depression and pain before the thread died. Anxiety, insomnia, and fatigue are often contributory to the presentation of this type of pain in depression.
- Scott
Depression, Musculoskeletal Pain May Respond to Antidepressant Therapy, Pain Self-ManagementJune 16, 2009 Optimized antidepressant therapy followed by a pain self-management program is associated with substantial improvement in depression as well as moderate reductions in pain severity and disability, according to the results of a randomized controlled trial reported in the May 27 issue of the Journal of the American Medical Association.
"Two types of treatment (one pharmacological and the other behavioral) could prove synergistic in the treatment of comorbid musculoskeletal pain and depression," write Kurt Kroenke, MD, from Regenstrief Institute Inc, in Indianapolis, Indiana, and colleagues. "Antidepressants are a well-established therapy for depression, and there is also evidence for at least moderate efficacy in pain, which may vary by type of painful disorder and antidepressant class. Pain self-management programs have proven efficacious for both low back pain and osteoarthritis."
The goal of this study was to assess the effects of a combined pharmacologic and behavioral intervention on depression and pain in primary care patients with musculoskeletal pain and comorbid depression. The Stepped Care for Affective Disorders and Musculoskeletal Pain study was conducted at 6 community-based clinics and 5 Veterans Affairs general medicine clinics in Indianapolis, Indiana, with enrollment of 250 patients from January 2005 to June 2007 and follow-up completed in June 2008.
Inclusion criteria were low back, hip, or knee pain for at least 3 months and depression severity at least moderate based on a Patient Health Questionnaire 9 score of 10 or higher. Patients were randomly assigned to receive usual care (n = 127) or an intervention (n = 123) consisting of 12 weeks of optimized antidepressant therapy (step 1) followed by 6 sessions of a pain self-management program for 12 weeks (step 2) and a continuation phase of therapy for 6 months (step 3).
Study assessments included depression, measured with the 20-item Hopkins Symptom Checklist, pain severity and interference measured with the Brief Pain Inventory, and global improvement in pain at 12 months.
At 12 months, the intervention group had a much lower number of patients with major depression (50 [40.7%]) vs the standard care group (87 [68.5%]; relative risk [RR], 0.6; 95% confidence interval [CI], 0.4 - 0.8). Reduction in depression severity from baseline of 50% or greater occurred in 46 (37.4%) of the 123 intervention patients and in 21 (16.5%) of 127 usual-care patients (RR, 2.3; 95% CI, 1.5 - 3.2).
The intervention group also fared better in a greater likelihood of clinically significant (= 30%) pain reduction (51 intervention patients [41.5%] vs 22 usual-care patients [17.3%]; RR, 2.4; 95% CI, 1.6 - 3.2) and in global improvement in pain (58 [47.2%] vs 16 [12.6%], respectively; RR, 3.7; 95% CI, 2.3 - 6.1). The primary outcome of combined improvement in both depression and pain occurred in 32 intervention patients (26.0%) vs 10 usual-care patients (7.9%; RR, 3.3; 95% CI, 1.8 - 5.4).
"Optimized antidepressant therapy followed by a pain self-management program resulted in substantial improvement in depression as well as moderate reductions in pain severity and disability," the study authors write. "Additional interventions may be needed to produce larger improvements in pain and higher depression response and remission rates."
Limitations of this study include possible ascertainment bias, inability to determine the effect of the pain management program alone, inability to compare the efficacy of different antidepressants, limited generalizability to other patient groups, and some discordance between patient self-report and electronic medical record data.
"Because pain and depression are among the leading causes of decreased work productivity, an intervention that is effective for both conditions may further strengthen a business model," the study authors write. "Also, an intervention that allows a care manager to cover several conditions rather than a single disorder may enhance its implementation and cost-effectiveness. Given the prevalence, morbidity, disability, and costs of the pain-depression dyad, the SCAMP [Stepped Care for Affective Disorders and Musculoskeletal Pain] trial results have important implications."
The National Institute of Mental Health supported this study. Two of the study authors have disclosed various financial relationships with Eli Lilly, Pfizer, Wyeth, Astra-Zeneca, Forest Laboratories. Abbott, and/or Cephalon.
JAMA. 2009;301:2099-2110.
Posted by maxime on October 30, 2010, at 18:15:39
In reply to sorry maxime » maxime, posted by floatingbridge on October 30, 2010, at 15:39:00
Posted by floatingbridge on October 30, 2010, at 18:53:44
In reply to Re: Thinking of coming off meds NO WAY! » floatingbridge, posted by SLS on October 30, 2010, at 16:37:08
> You are such a silly thing.
>
> :-)Yes, this has been established :) . I have also been very twitchly lately :( So my apologies to you.
>
> I'm sorry for not writing anything along with the links. I really didn't have the energy at the time. I just wanted you to see the associations between depression and pain before the thread died. Anxiety, insomnia, and fatigue are often contributory to the presentation of this type of pain in depression.
>
>
> - ScottThanks for the links, esp the following. It (below) seems to be the course I'm taking--antidepressants, and mbct which had benefited me before. Thanks for taking the time to clarify. I was, indeed, having an awful morning.
Best to you,
fb
>
>
>
>
> Depression, Musculoskeletal Pain May Respond to Antidepressant Therapy, Pain Self-Management
>
> June 16, 2009 Optimized antidepressant therapy followed by a pain self-management program is associated with substantial improvement in depression as well as moderate reductions in pain severity and disability, according to the results of a randomized controlled trial reported in the May 27 issue of the Journal of the American Medical Association.
>
> "Two types of treatment (one pharmacological and the other behavioral) could prove synergistic in the treatment of comorbid musculoskeletal pain and depression," write Kurt Kroenke, MD, from Regenstrief Institute Inc, in Indianapolis, Indiana, and colleagues. "Antidepressants are a well-established therapy for depression, and there is also evidence for at least moderate efficacy in pain, which may vary by type of painful disorder and antidepressant class. Pain self-management programs have proven efficacious for both low back pain and osteoarthritis."
>
> The goal of this study was to assess the effects of a combined pharmacologic and behavioral intervention on depression and pain in primary care patients with musculoskeletal pain and comorbid depression. The Stepped Care for Affective Disorders and Musculoskeletal Pain study was conducted at 6 community-based clinics and 5 Veterans Affairs general medicine clinics in Indianapolis, Indiana, with enrollment of 250 patients from January 2005 to June 2007 and follow-up completed in June 2008.
>
> Inclusion criteria were low back, hip, or knee pain for at least 3 months and depression severity at least moderate based on a Patient Health Questionnaire 9 score of 10 or higher. Patients were randomly assigned to receive usual care (n = 127) or an intervention (n = 123) consisting of 12 weeks of optimized antidepressant therapy (step 1) followed by 6 sessions of a pain self-management program for 12 weeks (step 2) and a continuation phase of therapy for 6 months (step 3).
>
> Study assessments included depression, measured with the 20-item Hopkins Symptom Checklist, pain severity and interference measured with the Brief Pain Inventory, and global improvement in pain at 12 months.
>
> At 12 months, the intervention group had a much lower number of patients with major depression (50 [40.7%]) vs the standard care group (87 [68.5%]; relative risk [RR], 0.6; 95% confidence interval [CI], 0.4 - 0.8). Reduction in depression severity from baseline of 50% or greater occurred in 46 (37.4%) of the 123 intervention patients and in 21 (16.5%) of 127 usual-care patients (RR, 2.3; 95% CI, 1.5 - 3.2).
>
> The intervention group also fared better in a greater likelihood of clinically significant (= 30%) pain reduction (51 intervention patients [41.5%] vs 22 usual-care patients [17.3%]; RR, 2.4; 95% CI, 1.6 - 3.2) and in global improvement in pain (58 [47.2%] vs 16 [12.6%], respectively; RR, 3.7; 95% CI, 2.3 - 6.1). The primary outcome of combined improvement in both depression and pain occurred in 32 intervention patients (26.0%) vs 10 usual-care patients (7.9%; RR, 3.3; 95% CI, 1.8 - 5.4).
>
> "Optimized antidepressant therapy followed by a pain self-management program resulted in substantial improvement in depression as well as moderate reductions in pain severity and disability," the study authors write. "Additional interventions may be needed to produce larger improvements in pain and higher depression response and remission rates."
>
> Limitations of this study include possible ascertainment bias, inability to determine the effect of the pain management program alone, inability to compare the efficacy of different antidepressants, limited generalizability to other patient groups, and some discordance between patient self-report and electronic medical record data.
>
> "Because pain and depression are among the leading causes of decreased work productivity, an intervention that is effective for both conditions may further strengthen a business model," the study authors write. "Also, an intervention that allows a care manager to cover several conditions rather than a single disorder may enhance its implementation and cost-effectiveness. Given the prevalence, morbidity, disability, and costs of the pain-depression dyad, the SCAMP [Stepped Care for Affective Disorders and Musculoskeletal Pain] trial results have important implications."
>
> The National Institute of Mental Health supported this study. Two of the study authors have disclosed various financial relationships with Eli Lilly, Pfizer, Wyeth, Astra-Zeneca, Forest Laboratories. Abbott, and/or Cephalon.
>
> JAMA. 2009;301:2099-2110.
>
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