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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by g_g_g_unit on September 18, 2011, at 8:20:04
sorry to keep posting for advice, but i'm going through an extended rough patch at the moment ..
i'm taking 15mg of lexapro as well as 500mg of depakote. i'm less anxious on the combination but lose all sense of agency; i could lie in bed and stare at the ceiling for seven hours without really caring. as soon as i add in a stimulant (dexedrine) to concentrate and motivate myself, my OCD sky-rockets. for some reason, i also seem excessively sensitive and always end up with 'tunnel vision' .. it's difficult to reap any real positive effects from dex for my ADD.
i tried raising the depakote to 750mg, but became unbearably fatigued.
i've also been experiencing phobic depersonalization/derealization on top of everything else. i find that when dexedrine improves my anhedonia during the first few days of treatment, the sense of unreality (but not the accompanying anxiety) also dissipates, which makes it hard to accept that it's psychological.
i donno what i'm trying to ask here .. i suppose i wish there was some way to solve the anxiety and the anhedonia at the same time. i've been thinking about Nardil .. i tried it a couple of years ago and while it was highly motivating etc., it actually caused a lot of anxiety (i was on various doses for about 12 weeks total), but i'm not sure if i gave it enough time ..
i also keep wondering if my depression might actually fall on the BP spectrum. my pdoc said no, based on what i told him, but unless i'm questioned, i never know what stuff i'm meant to report .. i mean, depressions can seem somewhat homogenous on the surface (low-energy, anhedonia, etc.). all i know is that any 'manic-like' reactions i've had have always been provoked by drugs/substances, so i'm not sure if that's a reliable indicator?
Posted by floatingbridge on September 18, 2011, at 9:30:20
In reply to not sure what to do .., posted by g_g_g_unit on September 18, 2011, at 8:20:04
ggg, what is the depakote indicated for if not a mood stabilizer? Just curious.
fb
Posted by g_g_g_unit on September 18, 2011, at 10:35:01
In reply to Re: not sure what to do .. » g_g_g_unit, posted by floatingbridge on September 18, 2011, at 9:30:20
Anxiety, supposedly
Posted by Christ_empowered on September 18, 2011, at 10:44:17
In reply to Re: not sure what to do .., posted by g_g_g_unit on September 18, 2011, at 10:35:01
I don't know that being diagnosed with a BP spectrum disorder would change your treatment. All I can think of is switching out the Depakote for something less noxious and more tolerable, like Lyrica or maybe Neurontin. I personally didn't find these terribly "mood-stabilizing," but then again...I have to take antipsychotics. If the primary problem is depression complicated by anxiety and dips in mood and occasional drug-induced episodes, and you want to (or have to) avoid BZD drugs, then I would think a more tolerable anticonvulsant might be in order. Have you tried Lamictal?
Posted by Phillipa on September 18, 2011, at 11:33:57
In reply to Re: not sure what to do .., posted by Christ_empowered on September 18, 2011, at 10:44:17
Or trileptal? I don't know either. Phillipa
Posted by bleauberry on September 18, 2011, at 15:42:06
In reply to not sure what to do .., posted by g_g_g_unit on September 18, 2011, at 8:20:04
This stuff is so tricky and experimental it is hard to tell. Right off the bat my gut instincts questioned why lexapro and why depakote? Neither one is a top choice, in my opinion anyway, for what you are dealing with. On the other side, I understand the attempt at stimulants and that makes sense except in my experience all stimulants are different. If you are having trouble with Dex then try Ritalin. Modafinil or Adrafinil are other choices. I can think of a handful of plant medicine choices that could be very helpful.
So I don't know, I guess I'm probably not much help. It's just that my simple logic says if there are bizarre problems with whatever meds someone is taking, then the meds are advertising loudly they aren't the right ones for that person.
Hang in there and do what you think is right. For sure, the one thing we do know is you can't stay where you are now with current meds/doses. They aint cuttin it, it's that simple.
Posted by g_g_g_unit on September 19, 2011, at 8:49:08
In reply to Re: not sure what to do .., posted by Christ_empowered on September 18, 2011, at 10:44:17
heh, well, my therapist chided me for being too hung up on diagnoses (i've become obsessed with whether or not i have BP), but the fact of the matter is .. i'm just a little perplexed about some of the reactions i have to certain drugs, including my lack of an efficacious response to stimulants (despite overtly exhibiting all the inattentive ADD symptoms since childhood).
part of what drives my uncertainty is not knowing whether everyone (with clinical anxiety/ depression that is) is potentially prone to drug-induced states of agitation; because other than that, there aren't really any BP-like episodes in my history. i've had racing thoughts, agitation etc. but they've mostly been substance-induced.
the reason it affects my course of treatment is because i find depakote, like you say, "noxious" and am only on it for "anxiety". since i've been either crippled with apathy or intently suicidal for weeks on end, it's clear my treatment isn't working. i'd like to try Nardil again, which is the only thing that really lifted my a** out of depression, but i donno if it really was just hypomania the whole time. there's also clomipramine, since my OCD is so overwhelming, but it caused a tonne of agitation last time. i suppose i'm just after a diagnosis to explain why.
i tried neurontin, but found it too strong. left me plastered to the couch. is lamictal more 'mood-brightening'?
i have nothing against BZDs. my pdoc tried me on xanax IR, but the prescribed dose had no noticeable effect (0.5mg 3x day) and he didn't offer to increase it.
so i can stay on Lexapro - which reduces the physical symptoms of my depression, such as fatigue, but does little for mood or OCD, and makes me more apathetic - and try something like nortriptyline or reboxetine as well (plus maybe a benzo instead of depakote)?
or switch to like Nardil or Effexor ..
or Lamictal with..?
> I don't know that being diagnosed with a BP spectrum disorder would change your treatment. All I can think of is switching out the Depakote for something less noxious and more tolerable, like Lyrica or maybe Neurontin. I personally didn't find these terribly "mood-stabilizing," but then again...I have to take antipsychotics. If the primary problem is depression complicated by anxiety and dips in mood and occasional drug-induced episodes, and you want to (or have to) avoid BZD drugs, then I would think a more tolerable anticonvulsant might be in order. Have you tried Lamictal?
Posted by g_g_g_unit on September 19, 2011, at 8:54:31
In reply to Re: not sure what to do .., posted by bleauberry on September 18, 2011, at 15:42:06
Thanks, you're right, what I'm on clearly isn't doing much ... but, I might nearly be out of options.
Depakote was originally added to Zoloft because it was causing panic-like symptoms, but I came off the Zoloft due to a worsening of my OCD. Lexapro seems to be the only SSRI so far (other than Luvox) that doesn't really increase anxiety/akathisia/insomnia. I couldn't handle Ritalin either. I thought Dex would be more benign, but it really isn't.
off meds though, and I'm a mess - severe, physically-crippling depression and anxiety - so going off everything completely isn't an option unfortunately
> This stuff is so tricky and experimental it is hard to tell. Right off the bat my gut instincts questioned why lexapro and why depakote? Neither one is a top choice, in my opinion anyway, for what you are dealing with. On the other side, I understand the attempt at stimulants and that makes sense except in my experience all stimulants are different. If you are having trouble with Dex then try Ritalin. Modafinil or Adrafinil are other choices. I can think of a handful of plant medicine choices that could be very helpful.
>
> So I don't know, I guess I'm probably not much help. It's just that my simple logic says if there are bizarre problems with whatever meds someone is taking, then the meds are advertising loudly they aren't the right ones for that person.
>
> Hang in there and do what you think is right. For sure, the one thing we do know is you can't stay where you are now with current meds/doses. They aint cuttin it, it's that simple.
Posted by floatingbridge on September 19, 2011, at 9:27:06
In reply to not sure what to do .., posted by g_g_g_unit on September 18, 2011, at 8:20:04
> sorry to keep posting for advice, but i'm going through an extended rough patch at the moment ..
>ggg, keep posting. You are very welcome here.
> i'm taking 15mg of lexapro as well as 500mg of depakote. i'm less anxious on the combination but lose all sense of
agency; i could lie in bed and stare at the ceiling for seven hours without really caring. as soon as i add in a stimulant (dexedrine) to concentrate and motivate myself, my OCD sky-rockets. for some reason, i also seem excessively sensitive and always end up with 'tunnel vision' .. it's difficult to reap
any real positive effects from dex for my ADD.
>
> i tried raising the depakote to 750mg, but became unbearably fatigued.
>
> i've also been experiencing phobic depersonalization/derealization on top of everything else. i find that when dexedrine improves my anhedonia during the first few days of treatment, the sense of unreality (but not the accompanying anxiety) also dissipates, which makes it hard to accept that it's psychological.
>
> i donno what i'm trying to ask here .. i suppose i wish there was some way to solve the anxiety and the anhedonia at the same time. i've been thinking about Nardil .. i tried it a couple of years ago and while it was highly motivating etc., it actually caused a lot of anxiety (i was on various doses for about 12 weeks total), but i'm not sure if i gave it enough time .Your case is complicated ggg, as you know. Anxiety is so difficult to treat (I know this personally). I can't advise. If you think Nardil has merit, well, it could be worth trying. The anxiety you felt may be part of start up on it. But then, on Nardil, your stimulant use would be very limited. There is also parnate, which may or may not cause you anxiety, but it might give you enough mental focus. I have tried neither of these medications.
I still don't understand why you are being given depakote. Have you asked your doc? It's for your anxiety?
>
> i also keep wondering if my depression might actually fall on the BP spectrum. my pdoc said no, based on what i told him, but unless i'm questioned, i never know what stuff i'm meant to report .. i mean, depressions can seem somewhat homogenous on the surface (low-energy, anhedonia, etc.). all i know is that any 'manic-like' reactions i've had have always
been provoked by drugs/substances, so i'm not sure if that's a reliable indicator?I know you have relocated in the past year. Could it be time for a second opinion? Maybe you are on the BP spectrum. Maybe you are ultra sensitive and have an ADD condition. I hate to say this, because it's hypocritical of me at the moment, me being on benzos, but anxiety can be lessened with the right type of therapy. So maybe you could takeva more stimulating med and work with a anxiety specialist in therapy.
I just don't see the depakote serving you. I don't know.
fb
Posted by creepy on September 19, 2011, at 13:08:55
In reply to not sure what to do .., posted by g_g_g_unit on September 18, 2011, at 8:20:04
As far as anxiety and OCD that sounds like a good choice. depakote is pretty tough on anxiety and hypomania. Not so good on depression for most.
You could try a more energizing SSRI like zoloft or prozac which also get some use in OCD. Perhaps even paxil.. but its not something I would take.
Id give luvox or clomipramine a go if you havent already.
Failing those you may want to look at AAP's.
lamictal might be a little tough on anxiety especially when titrating up.
Posted by Christ_empowered on September 19, 2011, at 13:12:51
In reply to Re: not sure what to do .. » Christ_empowered, posted by g_g_g_unit on September 19, 2011, at 8:49:08
I'm not a doc or anything, so all I can do is throw out some suggestions for you.
OK, benzos can help OCD. So can stimulants. Maybe instead of xanax, try ativan or klonopin? Klonopin is easy b/c its a 2x daily medication. Ativan I think is like 3-4 times a day, but, hey, its not xanax, so docs are more willing to Rx it and get it to an effective dose (here in the US, docs seem to have problems with xanax and valium. Everything else is a-OK, I guess).
I really, really wouldn't take depakote anymore. That is some rough stuff right there. I like Lamictal a lot. I found it mood-elevating, but without the apathy of an antidepressant.
Personally, I don't like reuptake inhibitors. They make me feel flat and they cause more problems than they solve. If you could get a decent benzo dose, keep the dexedrine, and maybe throw in some lamictal, that would seem like a decent combo, to me anyway. I mean, its 3 drugs, but 4-6 drug combos are so common these days...
I hope this all works out for you. Please keep posting.
Posted by g_g_g_unit on September 21, 2011, at 9:30:38
In reply to Re: not sure what to do .. » g_g_g_unit, posted by floatingbridge on September 19, 2011, at 9:27:06
> > sorry to keep posting for advice, but i'm going through an extended rough patch at the moment ..
> >
>
> ggg, keep posting. You are very welcome here.
>thanks :-/ i feel guilty because i don't really contribute much outside of asking for advice ..
> Your case is complicated ggg, as you know. Anxiety is so difficult to treat (I know this personally). I can't advise. If you think Nardil has merit, well, it could be worth trying. The anxiety you felt may be part of start up on it. But then, on Nardil, your stimulant use would be very limited. There is also parnate, which may or may not cause you anxiety, but it might give you enough mental focus. I have tried neither of these medications.
i've tried parnate before. it improved my cognition and anhedonia initially, but then sleep just became a disaster and i started to feel really bizarre and detached on it.
i felt more emotionally expansive on nardil, but i guess it won't do my attention any favors and my doc won't prescribe stimulants with it. i guess i'm trying to find a combo where i'm calm, motivated, creative, focused, etc. - the holy grail in other words - and wonder if i should just accept like a 50, 60% improvement.
>
> I still don't understand why you are being given depakote. Have you asked your doc? It's for your anxiety?anxiety, yeah, but it seemed to control the RLS i get from SSRIs, so my doc kept me on it
>> I know you have relocated in the past year. Could it be time for a second opinion? Maybe you are on the BP spectrum. Maybe you are ultra sensitive and have an ADD condition. I hate to say this, because it's hypocritical of me at the moment, me being on benzos, but anxiety can be lessened with the right type of therapy. So maybe you could takeva more stimulating med and work with a anxiety specialist in therapy.
>
> I just don't see the depakote serving you. I don't know.this is actually the third pdoc i've seen since relocating. he's really great, and i'm seeing him for psychotherapy as well - i'd be a little hesitant about seeking out another opinion just yet, though i admit i'm still really shy and meek around him.
i guess i'll press him more about my dx. i'm really bad at asserting myself.
the thing that has me puzzled is that i took zolpidem to sleep last night, for example. then today i have a coffee. at first i'm a little euphoric and more motivated; then by 2pm, i'm agitated, feeling like i utterly despise everyone on the planet, wanting to strangle our dogs, confused, planning suicide, etc. i thought it could be benzo withdrawal, but don't plenty of people take ambien, etc. could it be that acutely disruptive? or is it the coffee? i thought if it was just unipolar depression, 15mg lexapro would've covered those kinds of reactions. dexedrine has been doing the same thing - i go from an SSRI zombie to 'king of the world' to murderous rage .. but again, these are always reactions to drugs, i've never really experienced that kind of 'mania' otherwise
Posted by g_g_g_unit on September 21, 2011, at 9:36:10
In reply to hey again, posted by Christ_empowered on September 19, 2011, at 13:12:51
> I'm not a doc or anything, so all I can do is throw out some suggestions for you.
>
> OK, benzos can help OCD. So can stimulants. Maybe instead of xanax, try ativan or klonopin? Klonopin is easy b/c its a 2x daily medication. Ativan I think is like 3-4 times a day, but, hey, its not xanax, so docs are more willing to Rx it and get it to an effective dose (here in the US, docs seem to have problems with xanax and valium. Everything else is a-OK, I guess).
>
> I really, really wouldn't take depakote anymore. That is some rough stuff right there. I like Lamictal a lot. I found it mood-elevating, but without the apathy of an antidepressant.
>
> Personally, I don't like reuptake inhibitors. They make me feel flat and they cause more problems than they solve. If you could get a decent benzo dose, keep the dexedrine, and maybe throw in some lamictal, that would seem like a decent combo, to me anyway. I mean, its 3 drugs, but 4-6 drug combos are so common these days...
>
> I hope this all works out for you. Please keep posting.thanks for your support.
i'll think about lamictal - is it useful for anxiety?
my pdoc said he isn't against klonopin, but he seemed a little bit hesitant - i think it's mostly recommended for epilepsy over here ..i just would dread becoming tolerant and/or psychologically dependent. don't you have to keep upping the dose to get an effect?
i donno about dexedrine. being on it's such a trip - like i wrote in my post to fb, i get these wild fluctuations from being really optimistic, etc. to profound rage and anxiety when the dose wears off. i used to be obsessed with getting stimulants to prescribed, but now i realize they're kind of a two-edged sword..
i've noticed that i just can't handle anything NE-related. i donno if it's just a sensitivity, or mood-issue. i guess i'll put together some proper notes and talk to my doc more thoroughly.
Posted by floatingbridge on September 21, 2011, at 11:47:25
In reply to Re: hey again » Christ_empowered, posted by g_g_g_unit on September 21, 2011, at 9:36:10
I would get very dysphoric crashes on dex. It became barely worth it.
But I am still to figure this out. Because it so helped my baseline cognition. I am usually very lethargic unless a mood strikes. And that's like waiting for weather or something like that.
You probably have overlapping dx's. I'm guessing.
A mood stabilizer and vyvanase? Like I know what I'm talking about here. Sorry ggg.
No idea about the ambien. I do know that that other z drug sonata stopped putting me to sleep, but put me in a fab mood. But since this would be in the middle of the night, there would be hell to pay the next day.
:-/
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