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Dr. Bob is Robert Hsiung, MD,
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Posted by floatingbridge on January 26, 2011, at 15:06:49
In reply to Thanks for ideas (nm), posted by greenwillow on January 26, 2011, at 15:04:45
Posted by greenwillow on January 26, 2011, at 17:11:16
In reply to Re: ptsd meds, posted by creepy on January 25, 2011, at 11:47:25
My symptoms are serious depression, and now it has come to manifest itself physically with severe heart palpitations which the cardiologist says is from adrenaline. Also I have developed nausea which is as of yet undiagnosed, and have also had some nightmares. You mention alpha/beta blockers. I do have a couple of beta blockers around the house, they are propanolol and bystolic. I take it that alpha blocker something different than beta blockers???? thanks GW
> I think this depends on what your primary symptoms are. Mine is the depression, since Ive worked through many of my triggers in therapy.
> If you have physical anxiety symptoms like fast heart rate, butterflies in stomach, etc. maybe an alpha/beta blocker would be useful. Prazosin is the only one Ive taken its supposed to be good for nightmares as well.
> If you have bad hyperarousal symptoms maybe a mood stabilizer would be used. Topamax is the only one Ive tried and I couldnt tolerate it.
> supposedly it slows the amygdala, which is involved in the stuck fight or flight response.
> If your primary symptoms are depression and anhedonia, maybe an SSRI, SNRI would be used. TCAs as a class can be fairly sedating and anxiolytic they may be helpful. The only TCA Ive tried was desipramine and it was good for fibro pain, not so much on depression or anxiety.
> Lexapro might be a good one if you have rage issues. It turned mine off like a switch at higher dosages. But for me the apathy was awful.
> I hope you give therapy a shot, I have found standard therapy useful, but there are several other types which can help such as CBT, EMDR and IFS.
Posted by creepy on January 26, 2011, at 21:04:54
In reply to Re: ptsd meds » creepy, posted by greenwillow on January 26, 2011, at 15:03:04
Inter family systems therapy. It seems to be about defining various 'parts' of your psyche that do work, like dissociate, get angry, defend against feeling helplessness, etc. Id have called them 'protective mechanisms' before trying this therapy.
The therapist has you focus on the part in question and ask it to tell its story.
Eventually the defensive parts may let up enough to let you get at 'exiles' which are parts that carry repressed feelings from traumatic experiences.
So far it seems like a different spin on what Ive already done for years, but the focused association is new. and its really hard to do for me =(
Posted by creepy on January 26, 2011, at 21:12:32
In reply to Re: ptsd meds » creepy, posted by greenwillow on January 26, 2011, at 17:11:16
Heart palpitations can be due to lots of NE, sure. But they can be other things too. oddly I find that I need -more- NE. Its almost like being hyperaroused for so long with PTSD has caused all sorts of other derangements in my system. I perceive pain more strongly. MY blood pressure sometimes drops and I get migraine. my sinuses are perpetually congested and I am fatigued. Sure many of these symptoms can come from other things but its odd that adding an NRI helps them all. As if I was missing the extra NE. It pushes the anxiety a bit, which sucks. But the alternative is worse.
Alpha and beta blockers block different andrenergic receptors. Which are involved in PTSD? Not sure because I see both used. Prazosin is common for nightmares. Maybe because of its short halflife. Clonidine is often used for helping with adrenaline rush in response to triggers. all of these meds can -cause- depression because they block NE. So youd need to be careful with them.
Posted by Zyprexa on January 27, 2011, at 6:16:00
In reply to Re: ptsd meds » Zyprexa, posted by floatingbridge on January 25, 2011, at 17:54:33
I'm taking: Zyprexa, perphenazine, bupropion sr, sertraline and cogentin. Prozac didn't work for me.
Posted by Zyprexa on January 27, 2011, at 6:27:07
In reply to Re: ptsd meds, posted by creepy on January 26, 2011, at 10:41:33
I did have diabeties for a while, but has gone away. I suspect it was geodon that made me diabetic. I did take metformin for a while and it helped keep my weight down.
Its not just severe anxiety, but also I'm schitzoaffective now.
Posted by floatingbridge on January 27, 2011, at 10:35:56
In reply to Re: ptsd meds, posted by Zyprexa on January 27, 2011, at 6:27:07
Zyprexa, do you partially attribute developing schizoaffective to experiencing severe anxiety? I understand if this isn't the thread or even if you don't care to discuss any further. Peace.
(I believe I suffered anxiety for years before depression. That the anxiety wore me down....)
Greenwillow, apologies for hijacking your thread.
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Posted by Zyprexa on January 28, 2011, at 21:25:39
In reply to Re: ptsd meds » Zyprexa, posted by floatingbridge on January 27, 2011, at 10:35:56
Yes I do. I underwent a lot of anxiety after the accident. People blamed me for the death (which was not me), and beat me up and yelled at me. I lived in fear for many years thinking someone would be on the way to kill me. Very stressfull.
Posted by phillipa on January 28, 2011, at 21:35:58
In reply to Re: ptsd meds » floatingbridge, posted by Zyprexa on January 28, 2011, at 21:25:39
Zyprexa accident? What happened so sorry. Yes Ptsd for sure. Love Phillipa
Posted by floatingbridge on January 28, 2011, at 21:46:59
In reply to Re: ptsd meds » floatingbridge, posted by Zyprexa on January 28, 2011, at 21:25:39
Zyprexa, all I can say is I am so sorry. That sounds nightmarish. Can I send some hugs?
At the very least, some very positive thoughts...
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Posted by MissThang on January 29, 2011, at 6:18:33
In reply to ptsd meds, posted by greenwillow on January 25, 2011, at 10:19:11
Wondering if nefazodone would be good for your ptsd...I've just started taking it for axiety/depression (the anxiety component of my condition has become much worse since a trial of parnate that didn't go well at all) and I've been in need of something other than a benzo to calm me down that didn't cause weight gain or sexual dysfunction and nefazodone seems to be fitting the bill...I'm only on 50mg/day at this point (just amping up) but the anxiety is already much better.
Posted by greenwillow on January 29, 2011, at 20:18:45
In reply to Re: ptsd meds, posted by MissThang on January 29, 2011, at 6:18:33
Exactly what is nefazodone?? Green Willow
> Wondering if nefazodone would be good for your ptsd...I've just started taking it for axiety/depression (the anxiety component of my condition has become much worse since a trial of parnate that didn't go well at all) and I've been in need of something other than a benzo to calm me down that didn't cause weight gain or sexual dysfunction and nefazodone seems to be fitting the bill...I'm only on 50mg/day at this point (just amping up) but the anxiety is already much better.
Posted by phillipa on January 29, 2011, at 20:27:16
In reply to Re: ptsd meds » MissThang, posted by greenwillow on January 29, 2011, at 20:18:45
The old serzone generic. Has a lot of antihistamine properties from what I know? Phillipa
Posted by floatingbridge on January 29, 2011, at 20:45:10
In reply to Re: ptsd meds » MissThang, posted by greenwillow on January 29, 2011, at 20:18:45
Hi greenwillow,
(And fellow dealing-with-ptsd people.)
I stumbled across 'guanfacine' in Wiki. Also known as Tenex (short-acting), and Intuniv (long-acting, recently endorsed for ADHD). Both are Alpha Blockers, which I think you mentioned--I don't know what that means.Prazosin (alpha blocker) is listed in Wiki as off label treatment for ptsd.
I'm interested in Intuniv because I have add, and use a stimulant. Intuniv can be used monotherapy for ADHD, but I think I read something about using it in
conjunction to stimulants. (The last bit was off topic :- / )greenwillow, hope you're doing alright.
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Posted by MissThang on January 30, 2011, at 1:28:29
In reply to Re: ptsd meds » greenwillow, posted by phillipa on January 29, 2011, at 20:27:16
Green Willow,
Philippa is right -- nefazodone is the generic of the brand name drug serzone. What I like about it is that it's one of the few serotonin drugs that doesn't cause sexual dysfunction or weight gain. It's very good for anxiety with depression. So far, I'm on a very low dose (50mg -- just titrating up) but I can tell it's been very helpful with my anxiety already. As I continue to titrate up to the minimally effective therapeutic dose (at least 200mg/day), I anticipate greater antidepressant/anti-anxiety benefits.
Serzone came under fire a few years ago because of a few rare instances of liver damage from it -- about 1 in 250,000 - 300,000 people will get liver damage, which can be remedied if noticed early, so it's important to monitor liver function while on this drug, especially at first. Apparently, if you're one of the few who's susceptible to it, you'll have the effects within the first 6 months. On askapatient.com, there are quite a few people who've been on it a decade or more with no ill effects to their livers, so the risk isn't really all that great, but, out of an abundance of caution, I plan to get my liver tests run every month the first 6 months on the med and every 3 months thereafter.
I'm really hopeful that this med continues to work for me as it has so far, however, since in addition to helping with my anxiety (and hopefully, soon, on my depression), it also seems to be helping reduce my long term problem with nearly daily headaches, which have greatly reduced since I started on nefazodone.
I don't know if it's got many anti-histamine effects though -- so far, I haven't noticed any dry mouth, constipation or other symptoms like you would typically find with a med with strong antihistamine properties. It's considered safe to take with Zyrtec and Claritin, but must be used with caution with benedryl due to the possibility of excess sedation.
My eventual goal is to add this to wellbutrin, which gave me great AD effects but increased my anxiety level a bit too much. Stahl, the famous psychiatrist, labeled the combination of nefazodone and wellbutrin as one of 12 "heroic combinations" -- combos that are particularly effective even when other meds have failed.
Anyway -- hope I've answered all your questions -- good luck!
Posted by floatingbridge on January 30, 2011, at 3:10:46
In reply to Re: ptsd meds, posted by MissThang on January 30, 2011, at 1:28:29
MissThang, best of luck on your new med plan. I'm going to Google the 12 heroic combos. Just very curious. Thanks for that tidbit.
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Posted by MissThang on January 30, 2011, at 3:30:57
In reply to Re: ptsd meds » MissThang, posted by floatingbridge on January 30, 2011, at 3:10:46
FB -- On second thought, I don't remember if there were 12 "heroic combos" or 13, but I found that post referencing Stahl's "heroic combos" right here on Pyscho-Babble, so you may just want to start looking here.
I was very intrigued when I read that since I was previously on wellbutrin for quite some time with excellent improvement in my mood, but I could tell I need some serotonin supplementation. Problem is, everytime I tried to augment with an ssri, I felt like total crap and they only added to my anxiety. I don't remember the details of your condition, but for me, I think I need a balance of serotonin, noripenephrine and dopamine to feel my absolute best, and it looks like this combo of nefazodone and wellbutrin should help me achieve that elusive balance.
When I went off wellbutrin a few months ago, it was to give parnate a shot since it also should have delivered a pretty strong balance of all 3 major neuro's, but it ended up being a horrible med trial for me. Once I got off the parnate, my anxiety level increased to well above what it had been previously, making it difficult to return to wellbutrin. Despite my anxiety, I resumed taking it at just 150mg/day and by day 3, I noticed a definite uplift in my mood, but the anxiety level was just too much (I had been on 450mg of wellbutrin previously). But with the addition of serzone, I finally have great hopes that I'll be able to achieve something close to total remission due to a much better overall balance of neuro's.
I wish you luck with your current med combo. Have you ever tried nefazedone or wellbutrin before? What were your results?
Posted by phillipa on January 30, 2011, at 18:35:30
In reply to Re: ptsd meds, posted by MissThang on January 30, 2011, at 3:30:57
Miss Thang thanks for thee very informative thread. A few years back a doc here where I live wanted me to take nefedazone and got scared off it from what I read here so didn't take it. Now I know I should have tried as luvox and lexapro do nothing. I also found wellbutrin so stimulating the pdoc thought I was hypomanic pulled me off. Thanks Phillipa
Posted by floatingbridge on January 30, 2011, at 22:12:30
In reply to Re: ptsd meds, posted by MissThang on January 30, 2011, at 3:30:57
MissThang,
What was so awful about your parnate trial? Sounds grueling. Med trials...ugh.
I have not tried serzone. I've heard of it, but don't really know what it is (I can find out). I am glad it's working for you.
Right now I'm tapering off cymbalta. I've
just started Lyrica (chronic pain!), and it's the honeymoon right now. I don't know about pain relief, but my mood is more pleasant--for myself and others :)Wellbutrin worked wonders about 11 years ago. Two years ago, blech. Nothing. Good luck to you--when the Wellbutrin worked, it was magic.
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Posted by 23sgrrl on January 31, 2011, at 3:14:04
In reply to ptsd meds, posted by greenwillow on January 25, 2011, at 10:19:11
A friend who posts here, Willyee, took to searching online patent applications for med info, which proved to be very informational. one could Google patent ptsd or patent ocd or whatever. Some pretty dry reading at times, but yeilding rather novel ideas or interesting results, at times, for example, the acne antibiotic minocycline happens to be a fairly significant nmda receptor antagonist. Who knew? Good luck
Posted by MissThang on January 31, 2011, at 3:50:55
In reply to Re: ptsd meds » MissThang, posted by phillipa on January 30, 2011, at 18:35:30
FB,
My parnate trial? Well, to start with, it gave me the rare side effect of increased blood pressure (as opposed to experiencing a reduction in blood pressure as most people get while on MAOI's). I was put on beta blockers to lower my bp, but it still routinely ran in the 150's/90's, up from 130's/70's prior to taking the drug, with peaks after each dose that often reached even higher. I also had hypertensive events which intaking virtually anything considered even moderately questionable on an MAOI diet. Most frozen foods (small amounts of soy derivatives), pizza with only mozerella cheese on top canned soups all caused a significant spike in bp, with the worst reaction coming from a sandwich made with 2-day old turkey from Thanksgiving dinner (tyramine levels build up in cooked meat when refrigerated, but not usually to a problematic level for most people). A few bites of that turkey sandwich sent my bp jumping up to 160/120 in virtually no time, and it appeared to be headed much higher but I gobbled down some thorazine (letting some dissolve under my tongue) and arrested the event before I had a stroke. It seems whereas so many people on MAOI's say, "Oh, I eat most anything I want and never have a problem", even minute levels of tyramine were triggers for me. Most problematic, however, has been the fact that my bp has remained elevated, even after nearly 6 weeks off the drug.
Because of my easily-triggered hypertensive crisis, I ended up limiting my diet to mostly cereal and ice cream, and in the nearly 2 months I was on parnate, I put on 15 lbs, which I'm now struggling to take off.
The other thing that has been very troubling is that a few days after I stopped taking parnate, my anxiety level skyrocketed to previously unseen levels and has pretty much remained there ever since. I would understand if it had only been a few days, but again, it's now been more than 5 weeks since I stopped taking the med and my baseline anxiety level has been awful ever since. It's like parnate did something to totally reset my neurotransmitter levels to a different set point than I was at prior to taking parnate and I can't get my body to change back. Prior to parnate, I was on 450mg wellbutrin, plus a stim plus caffeine all day and had only minor problems with anxiety. Now, I've given up caffeine entirely and still feel anxious most of the time, culminating in periodic panick attacks (something I haven't experienced in over 20 years).
The nefazodone seems to be helping, though I still have to take more xanax than either I or my dr would like...hoping that as I titrate up with the nefaz that my anxiety will continue to decrease, enabling me to resume taking the wellbutrin soon. I briefly restarted 2 weeks after stopping parnate and found that while I was feeling a definite improvement in mood after only 3 days on 150mg/day, my anxiety level was unacceptably high and by the time I tried increasing to 300mg/day, my anxiety just got out of control, so I vowed to stop taking it until I was on something that was addressing my anxiety first.
Nefazodone has also had the somewhat rare side effect of lowering my bp to normal levels again (as long as I don't go too long between doses), so I've been able to go off beta blockers and am working hard to further reduce my bp by exercising/losing weight.
I feel like I gave parnate a fair trial, since I forced my way up to 50mg/day and was on the med for over 6 weeks with absolutely no improvement in mood -- it's absolutly been the worst AD experience I've ever had. Between the increase in bp, horrible rebound anxiety and weight gain, it's obvious that parnate is not the drug for me...even at this point, I'm too scared to eat cheese or other high tyramine foods, despite the fact that I know logically that it would be impossible to have a tyrmaine reaction at this stage of the game-- it's like PTSD experience...I can't turn off the awful memories of panick I felt of a hot, tingling effect rushing through my head as my bp was shooting up sky-high and I was struggling to keep my diastolic level less than 120 so I didn't die...it was just awful.
Anyway, I feel like I've hijacked the thread. I'm having some minor side effects with nefazodone right now that I'm hoping will pass (loss of appetite and some odd itching that isn't accompanied by a rash or anything like that...just hoping these SE's pass soon enough and I can increase my dose so I can try for the combo of nefaz/wellbutrin...in my head, that combo seems like it would be a great one for me, but I'll just have to wait things out on the nefaz for a while first to see if it continues to decrease my anxiety, making it possible to add back the wellbutrin, which seems to help my mood a lot. Perhaps if wellbutrin is balanced in my body with a selective increase in serotonin, the wellbutrin won't poop-out on me again and I'll live happily ever after -- wish me luck!
Posted by floatingbridge on January 31, 2011, at 4:02:13
In reply to Re: ptsd meds, posted by MissThang on January 31, 2011, at 3:50:55
MissThang, I do wish you luck. Wow, I do. Oh man, what an experience. I'm really sorry.
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Posted by creepy on January 31, 2011, at 8:39:57
In reply to Re: ptsd meds » MissThang, posted by floatingbridge on January 31, 2011, at 4:02:13
I suggested nefazodone to my doc awhile back, when I was getting fed up of SSRIs pushing me into mild mixed states.
Have you gotten any sedation on nefazodone and if so has it improved over time?
Posted by MissThang on January 31, 2011, at 8:54:42
In reply to Re: ptsd meds, posted by creepy on January 31, 2011, at 8:39:57
Creepy,
The nefazodone has helped my overall anxiety level, but I still have a ways to go in the anxiety/help with sleep department. On the positive side, I can tell you that it has helped to restore my sex drive somewhat (when I'm in the pits of depression, it evaporates), which is definitely the opposite of the effect that ssri's have on me...it's not as big of a boost to my libido as wellbutrin, but I least I can function on nefazodone.
I'm only taking 50mg/day and the minimally suggested effective dose is 200mg/day, so I should get more relief as I titrate up. It also potentiates the xanax I'm taking, so between its effect on anxiety on its own and the potentiation of the xanax, I've been able to cut down on my xanax intake (almost) to the level I want...I do think I'll have an easier time cutting down and maybe even eliminating the xanax with the help of nefazodone, which would be very good and I'm hoping I can stop taking any additional sleep aid if the nefazodone works out (I've been using either xanax, ambien or lunesta to help me sleep for years). If I understand correctly, nefazodone actually helps restore REM sleep, which I'm probably lacking after years of taking other sleep meds which mess with your sleep cycle.
What are you currently taking? What's your diagnosis?
Posted by floatingbridge on January 31, 2011, at 9:49:07
In reply to Re: ptsd meds, posted by MissThang on January 31, 2011, at 8:54:42
MissThang,
Have you given any thought to turning on your babblemail? I thought to write more to you yesterday, but didn't want to hijack thread.
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