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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by brynb on October 23, 2012, at 9:19:11
I'm slowly crawling out of a depressive hole which lasted the past two weeks (it's varied in terms of severity with this past week being the worst, and the last few days getting better).
I currently take:
lithium 450 mg
Lexapro 20 mg
Tramadol 50 mg
Valium (prn, infrequently)This has been a good combo for me since the beginning of July, but I started to get slightly depressed at the end of August. Then I got hypomanic (or maybe it was a mixed state as I was still depressed?) and upped my Lithium dose, which smoothed things out.
My doctor put me on Lamicatal almost four weeks ago and it almost immediately made me feel flat and off, and within a week I became depressed again. I tried it in the past and remembered it wasn't right for me but forgot why, so I was willing to give it a shot. Now it's clear why I didn't like in the first place.
So, I'm meeting with my pdoc next week and speaking to him today. I still can't sleep, I'm totally apathetic, unmotivated and very OCD. Any suggestions re: tweaking my current combo or adding something in that will help?
Caveat:
I can't handle most ADS, Lexapro works best for me (mainly because I can't handle anything that hits norepinephrine too hard), and the only AP I've ever really tolerated was Invega.I don't feel like adding anything heavy in or having to deal with side effects, but I was pacing last night and I can't even watch TV right now.
Thanks in advance.
Posted by Phillipa on October 23, 2012, at 9:35:36
In reply to Need med suggestions, posted by brynb on October 23, 2012, at 9:19:11
Bryn I was told that tramadol and an SSRI could cause Sertonin Syndrome? No idea if true or not. You feel it's the lamictal? But then you are feeling better but pacing. Could the lexapro be the culprit? What happens on a lower dose? Phillipa
Posted by brynb on October 23, 2012, at 11:41:00
In reply to Re: Need med suggestions » brynb, posted by Phillipa on October 23, 2012, at 9:35:36
> Bryn I was told that tramadol and an SSRI could cause Sertonin Syndrome? No idea if true or not. You feel it's the lamictal? But then you are feeling better but pacing. Could the lexapro be the culprit? What happens on a lower dose? Phillipa
Hi Phillipa,
SS is a possibility, but it's not common with Tramadol and SRIs, and even less of a possibility with low doses.
I think I was getting depressed independent from the Lamictal, and it just made me feel worse. It definitely made me feel flat and just down, which went away when I stopped it.
I don't know about lowering my Lexapro. To add insult to injury, I have PMDD, and I'm pms-ing right now. That usually comes out as major irritability and melancholy, so it's kind of confounding things. I can't say I was really pacing, it's more like I'm not sleeping, getting out of bed, walking around and don't know what to do with myself. I'm totally unmotivated and restless and I'm over thinking. I can't even properly describe how I feel, it's just not good.
Thanks,
b
Posted by phidippus on October 23, 2012, at 15:28:45
In reply to Need med suggestions, posted by brynb on October 23, 2012, at 9:19:11
I think everything is working for you except the Lexapro. Would you be willing to try something else?
>I still can't sleep, I'm totally apathetic, unmotivated and very OCD.
I would recommend Luvox. It has no action on norepenephrine. It can help with sleep, anhedonia and OCD. It is a very strong serotogenic drug and also stimulates sigma receptors, which are implicated in depression and OCD.
I would also recommend Viibryd. It's short on side effects, even sexual ones and is 5ht1a partial agonist, which gives it some kick in treating depression and anxiety.
>I don't feel like adding anything heavy in or having to deal with side effects
You're depression is significant, you may need to add something stronger.
Eric
Posted by Phillipa on October 23, 2012, at 21:00:56
In reply to Re: Need med suggestions » brynb, posted by phidippus on October 23, 2012, at 15:28:45
Luvox (fluvoxamine maelate) only ad never had a side effect to was like sugar pills. Phillipa
Posted by phidippus on October 23, 2012, at 21:14:09
In reply to Re: Need med suggestions » phidippus, posted by Phillipa on October 23, 2012, at 21:00:56
I didn't have any side effects either. Unfortunately, it didn't do much to treat my OCD.
Eric
Posted by schleprock on October 23, 2012, at 22:08:44
In reply to Need med suggestions, posted by brynb on October 23, 2012, at 9:19:11
I've been having some success with Lyrica (150mg). It's not perfect, but I think it's been improving my ratio of good days to bad days over the past month.
Posted by jono_in_adelaide on October 23, 2012, at 22:24:00
In reply to Need med suggestions, posted by brynb on October 23, 2012, at 9:19:11
An NARI would br the obvious choice, nortriptyline, welbutrin or desipramine
Posted by Phillipa on October 23, 2012, at 23:03:35
In reply to Re: Need med suggestions » Phillipa, posted by phidippus on October 23, 2012, at 21:14:09
Eric how high was your dose? Did you take ativan also with it? Phillipa
Posted by papillon2 on October 24, 2012, at 21:10:08
In reply to Need med suggestions, posted by brynb on October 23, 2012, at 9:19:11
If Lexapro has been working well for you, why not just raise the dose if it is safe to do so?
Re: PMDD. My psychiatrist sent me to an endocrinologist about the ridiculously high anxiety I get before my period. He prescribed two treatment options:
(1) a combination of a multi-B group vitamin with at least 50mg of B6 + a supplement called Premular; OR
(2) Yaz, a contraceptive pill which is approved to treat PMDD.NB: Yaz reduces blood serum levels of Lamictal by up to 50% so dose changes may be necessary.
Posted by brynb on October 25, 2012, at 14:04:44
In reply to Re: Need med suggestions, posted by papillon2 on October 24, 2012, at 21:10:08
> If Lexapro has been working well for you, why not just raise the dose if it is safe to do so?
>
> Re: PMDD. My psychiatrist sent me to an endocrinologist about the ridiculously high anxiety I get before my period. He prescribed two treatment options:
> (1) a combination of a multi-B group vitamin with at least 50mg of B6 + a supplement called Premular; OR
> (2) Yaz, a contraceptive pill which is approved to treat PMDD.
>
> NB: Yaz reduces blood serum levels of Lamictal by up to 50% so dose changes may be necessary.
Hi papillon,My pdoc originally wanted to do that (raise Lexapro) only during the time I have PMS. Because I have other things happening, we opted out of that approach for now.
I like the vitamin/supplement idea; I typically don't like oral contraceptives, and that sounds very doable.
Thanks for your input =).
-b
Posted by phidippus on October 25, 2012, at 15:30:05
In reply to Re: Need med suggestions » phidippus, posted by Phillipa on October 23, 2012, at 23:03:35
My dose of Luvox? 300 mg. I did not take Ativan-I took Lyrica.
Eric
Posted by Phillipa on October 25, 2012, at 21:05:44
In reply to Re: Need med suggestions » Phillipa, posted by phidippus on October 25, 2012, at 15:30:05
Eric you hit the maximum. And it stopped working? Lyrica instead of ativan did it work for anxiety? Phillipa
Posted by phidippus on October 25, 2012, at 21:34:15
In reply to Re: Need med suggestions » phidippus, posted by Phillipa on October 25, 2012, at 21:05:44
Luvox just wasn't as effective as it could have been. Clomipramine ended being a stronger choice for me-however, Viibryd ended up being the best choice for me.
Lyrica ended up being very good for anxiety, but I would compare it (at 600 mg) to .5 mg of Ativan.
Eric
Posted by Phillipa on October 25, 2012, at 23:12:20
In reply to Re: Need med suggestions » Phillipa, posted by phidippus on October 25, 2012, at 21:34:15
Eric in simple terms in what ways is viibryd different? Is it stronger weaker less/more side effects? And how the heck did you get off luvox. Seems it sure has a hold on me. Thanks Phillipa
Posted by brynb on October 26, 2012, at 12:18:53
In reply to Re: Need med suggestions » phidippus, posted by Phillipa on October 25, 2012, at 23:12:20
> Eric in simple terms in what ways is viibryd different? Is it stronger weaker less/more side effects? And how the heck did you get off luvox. Seems it sure has a hold on me. Thanks Phillipa
Eric,
I was wondering the same thing (as in how is Viibryd different, better, etc.?).
I don't want to keep playing around with meds and doses; I've been on Lexapro for a while and don't really notice any side effects, and my side effects with lithium are negligible. I gave it a lot of thought and approached my pdoc with the idea of using Klonopin (as a stabilizer and an anxiolytic), but as I had abuse issues in the past, he didn't want me on a benzo regularly.
We settled on Suboxone, which he thinks is unconventional (I get that), but I understand his reasoning behind using it and I've been on it before. We'll see.
Posted by phidippus on October 26, 2012, at 16:24:57
In reply to Re:Eric, posted by brynb on October 26, 2012, at 12:18:53
>I was wondering the same thing (as in how is Viibryd different, better, etc.?).
Viibryd is very much a typical SSRI, but the major difference is Viibryd is a potent 5ht1a partial agonist. This means it has a little more kick when it comes to treating depression and anxiety. Initial clinical trials also showed that vilazodone did not cause significant weight gain or decreased sexual desire/function.
Its a very clean drug.
>We settled on Suboxone, which he thinks is unconventional
I've been on Suboxone and it helped with depressive symptoms.
Eric
Posted by phidippus on October 26, 2012, at 16:56:51
In reply to Re: Need med suggestions » phidippus, posted by Phillipa on October 25, 2012, at 23:12:20
Viibryd is a typical SSRI except it has the added benefit of being a 5ht1a partial agonist. This gives it a little kick when treating depression and anxiety.
Also, Viibryd has less side effects than most SSRIs, including sexual ones.
Why do you want to get off the Luvox?
Eric
Posted by Phillipa on October 26, 2012, at 20:47:59
In reply to Re: Need med suggestions » Phillipa, posted by phidippus on October 26, 2012, at 16:56:51
Eric always trying to learn something new. Not sure at this time what I want to do. Phillipa
Posted by phidippus on October 26, 2012, at 21:25:16
In reply to Re: Need med suggestions » phidippus, posted by Phillipa on October 26, 2012, at 20:47:59
Well, if you switch from one SSRI to another, you normally just stop one and start the other. No need to cross-taper.
Eric
Posted by Phillipa on October 26, 2012, at 21:28:52
In reply to Re: Need med suggestions » Phillipa, posted by phidippus on October 26, 2012, at 21:25:16
Eric that I usually did. I read in a google it's expensive the viibrd. But must say the reviews from others were excellent. I think $200 vs $8? Phillipa
Posted by phidippus on October 26, 2012, at 21:38:33
In reply to Re: Need med suggestions » phidippus, posted by Phillipa on October 26, 2012, at 21:28:52
LOL, there's no need to switch from Luvox to Viibryd. Both ric
are equally powerful ADs. What's wrong with your Luvox?E
This is the end of the thread.
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