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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by ChicagoKat on November 11, 2012, at 20:29:31
I really need help. Any advice would be so appreciated. I really feel like I should be in the hospital right now, but I just cannot be...I have to go to Arizona on Sat. for a week to see my family, and I really HAVE to go; my ticket cost 800 bucks, and what's more important, my family will disown me if I don't go. I've already cancelled two trips this past year b/c I was feeling so bad.
Until this past tuesday, I was on Nardil 60mg/day + Nortriptyline...I honestly forget the dose of that one...but I was experiencing bad anxiety (which is weird, I know), plus absolutely no relief from my dysphoria. So pdoc suggested we switch to Parnate and drop the Nortryp. since it didn't seem to be doing anything. So I stopped the Nardil and Nortryp, but the pharmacy had to order the Parnate, said next day, no prob. This was Tuesday. They finally get it in, I think it was Friday, but then it turns out my insurance won't cover it. By this time I was going through hell withdrawing from Nardil. So over the weekend I started it back up, but only at 30mg/day, a dose which does seem to help my anxiety. But obviously not my dysphoria, which has become extreme. On top of that, I'm just not sleeping, period. I have ambien which does jack for me, and I have gabapentin which also does nothing for me; I just build up tolerance to drugs so quickly. I have no benzos, but even if I did, same story, I'm tolerant. The *only* thing that helps me sleep is Elavil, at least 50mg hs...but if I go back on that, what do I do for my unrelenting dysphoria, which is quite frankly crippling atm? I obviously don't have time for a wash before Sat, and I wouldn't be able to handle a wash if I couldn't be in the hospital or at home. The ONLY thing that has helped my dysphoria at all this past year is Ritalin, but there's no way my pdoc is gonna go for Nardil plus Ritalin plus Elavil. Knowing him, he probably would not go for even Nardil plus just Ritalin.
So I'm desperate; I have no idea what to do. I cannot make this trip in the shape I'm in right now, but I've just got to find a way to manage it. Obviously, I'm gonna call my pdoc about this tomorrow, but if anyone has any ideas *please* share them...like I said, if it weren't for this dang trip I would go to the hospital, but I just can't, and my only hope is a one-shot call to my pdoc. It would really help if any of you have any ideas I might suggest to him. To sum it up, right now I'm on Nardil 15mg bid, and that's about it. Thanks in advance.
Kat
Posted by Phillipa on November 11, 2012, at 23:18:23
In reply to Help, Please :(, posted by ChicagoKat on November 11, 2012, at 20:29:31
Kat seriously do you feel you will be able to travel so soon if feel so bad. I agree don't think your pdoc will approve all the meds. If I had a magic wand I could help. Phillipa
Posted by Twinleaf on November 12, 2012, at 0:07:56
In reply to Re: Help, Please :( » ChicagoKat, posted by Phillipa on November 11, 2012, at 23:18:23
Such a tough situation to be in. Would an AP -possibly Zyprexa- help on a short- term basis? Just to help you through the visit while you work out a longer- term plan. If it works, it will help right away.
Posted by softheprairie on November 12, 2012, at 0:36:24
In reply to Re: Help, Please :(, posted by Twinleaf on November 12, 2012, at 0:07:56
I had the same thought as Twinleaf -- some Zyprexa to get you through temporarily. When I was in the hospital they gave me the Zydis form of it -- it dissolves in your mouth and I think it is fast-acting. When I took Zyprexa as an outpatient I had the pill form that I swallowed. I am 99% confident Zyprexa can be mixed with an MAOI, the doctor or pharmacist can check (or anyone can online, I guess) if they are not sure.
Posted by jono_in_adelaide on November 12, 2012, at 2:24:19
In reply to Re: Help, Please :(, posted by softheprairie on November 12, 2012, at 0:36:24
I'd also nix the trip and check into a hospital
Your family will get over it - you need to look after your self right now.
Posted by jono_in_adelaide on November 12, 2012, at 2:44:39
In reply to Re: Help, Please :(, posted by jono_in_adelaide on November 12, 2012, at 2:24:19
Damn, this message disapeared
My two suggestions were
* Push the amitriptyline to 150mg a day and see if this helps
or
* Either pay cash for the Parnate, or see if there is some sort of appeal mechanism where your insurance will cover it because of extenuating circumstances
Also ask for a benzo for a week or so
Posted by jedi on November 12, 2012, at 2:48:18
In reply to Help, Please :(, posted by ChicagoKat on November 11, 2012, at 20:29:31
So sorry you are going through this. In the past I've taken high dose(for me about 6mg) of clonazepam, short term, while waiting for Nardil to kick in. Felt really drugged and clumsy, but it got me there. Might be hard on a family trip, but so will debilitating anxiety. I've used Benadryl for years for sleep, with no tolerance. But I am really susceptible to the histamine meds. Not everyone is. I remember one time I almost had to get off a plane because of terrible anxiety. I'll never fly again without a few milligrams of a benzo on board. And I used to be a private pilot. Things change. 30mg of Nardil won't touch a major depression for me. That takes at least 60mg for me, but I am a large male. Ramping up on any medication can be just a bitch.
You may have to skip the family trip again. I would think that hospitalization would be almost a relief at this point. Sorry Kat, most of these comments are off the cuff. I don't know your background or history, so I'm just throwing out some ideas that have worked for me in the past.
I've never tried Nardil and Ritalin, but it is on my short list. The first time I used Nardil was in 1998 and I had some hypomania. I'm guessing methylphenidate might precipitate that condition again, for me.
Sincerely,
Jedi> I really need help. Any advice would be so appreciated. I really feel like I should be in the hospital right now, but I just cannot be...I have to go to Arizona on Sat. for a week to see my family, and I really HAVE to go; my ticket cost 800 bucks, and what's more important, my family will disown me if I don't go. I've already cancelled two trips this past year b/c I was feeling so bad.
>
> Until this past tuesday, I was on Nardil 60mg/day + Nortriptyline...I honestly forget the dose of that one...but I was experiencing bad anxiety (which is weird, I know), plus absolutely no relief from my dysphoria. So pdoc suggested we switch to Parnate and drop the Nortryp. since it didn't seem to be doing anything. So I stopped the Nardil and Nortryp, but the pharmacy had to order the Parnate, said next day, no prob. This was Tuesday. They finally get it in, I think it was Friday, but then it turns out my insurance won't cover it. By this time I was going through hell withdrawing from Nardil. So over the weekend I started it back up, but only at 30mg/day, a dose which does seem to help my anxiety. But obviously not my dysphoria, which has become extreme. On top of that, I'm just not sleeping, period. I have ambien which does jack for me, and I have gabapentin which also does nothing for me; I just build up tolerance to drugs so quickly. I have no benzos, but even if I did, same story, I'm tolerant. The *only* thing that helps me sleep is Elavil, at least 50mg hs...but if I go back on that, what do I do for my unrelenting dysphoria, which is quite frankly crippling atm? I obviously don't have time for a wash before Sat, and I wouldn't be able to handle a wash if I couldn't be in the hospital or at home. The ONLY thing that has helped my dysphoria at all this past year is Ritalin, but there's no way my pdoc is gonna go for Nardil plus Ritalin plus Elavil. Knowing him, he probably would not go for even Nardil plus just Ritalin.
>
> So I'm desperate; I have no idea what to do. I cannot make this trip in the shape I'm in right now, but I've just got to find a way to manage it. Obviously, I'm gonna call my pdoc about this tomorrow, but if anyone has any ideas *please* share them...like I said, if it weren't for this dang trip I would go to the hospital, but I just can't, and my only hope is a one-shot call to my pdoc. It would really help if any of you have any ideas I might suggest to him. To sum it up, right now I'm on Nardil 15mg bid, and that's about it. Thanks in advance.
> Kat
Posted by ChicagoKat on November 12, 2012, at 8:15:59
In reply to Re: Help, Please :(, posted by jedi on November 12, 2012, at 2:48:18
thanks everyone for your responses. if anything i am feeling worse today i am so scared of how awful i am feeling and i have absolutely nothing that will help it was prob a stupid thing to do but i went down furrther on my nardil b/c if i can get off it maybe my pdoc will let me take ritalin with elavil with a benzo. i think that combo may get mme through this. but a lot of you have said i should cancel my trip again and im actually starting to agree but i am so damn afraid of how my stepmom is going to react. my sweet husband said he would call her for me and that would be better,, she might actually believe the situation is serious hearing it from him instead of me cos she's gotten fed up with me being sick. guess what, i'm fed up too.
anyways, can't take zyprexa, it gives me akathisia. i'm definitely gonna get my pdoc to at least give me some elavil so i can sleep i think not sleeping is my biggest problem right now. and hopefully he will agree to some low dose ritalin too. i'll just go through hell and stop the nardil. it's not doing anything for me anyways. it's weird, i was on nardil once before, about a year ago, and i stopped it and had absolutely no withdrawal problems, and now here i am going through hell. like someone said, i guess things change.
thank you all again, ii'll let you know what pdoc says. but i really appreciate your responses. don't know what i'd do without you guys.
kat
Posted by gadchik on November 12, 2012, at 10:28:27
In reply to Re: Help, Please :(, posted by ChicagoKat on November 12, 2012, at 8:15:59
Kat, dont know if youve tried it but remeron and klonopin taken at night,low doses,finally made me sleep after months of not,and took my anxiety away. Good luck to you.
Posted by ChicagoKat on November 12, 2012, at 11:38:59
In reply to Re: Help, Please :( » ChicagoKat, posted by gadchik on November 12, 2012, at 10:28:27
> Kat, dont know if youve tried it but remeron and klonopin taken at night,low doses,finally made me sleep after months of not,and took my anxiety away. Good luck to you.
Thanks gadchik, you are always so nice :) Remeron used to work great for me, but for some reason it turned on me and now makes me more agitated. I swear my brain has just given up on everything, it's so weird.
BUT, good news is I talked to my pdoc and I'm gonna taper off the rest of my Nardil, but he's giving me lovely Ritalin and Elavil and Klonopin. So I know I will sleep tonight..yay...and hopefully over the next couple of days I'll feel better.
In the meantime, my BP monitor is gonna be my best friend lol
Thanks to you, gadchik, and to everyone!!!!!
Kat
Posted by gadchik on November 12, 2012, at 11:54:04
In reply to Re: Help, Please :( » gadchik, posted by ChicagoKat on November 12, 2012, at 11:38:59
I did get agitation on remeron after a awhile,as well as weight gain,but those first few weeks on it were just pure relief! Benadryl also does that to me,and gives me restless legs. I hope your travels go well.
Posted by SLS on November 12, 2012, at 13:16:01
In reply to Help, Please :(, posted by ChicagoKat on November 11, 2012, at 20:29:31
Just an idea...
Maybe you should reinstate Nardil at 45 mg/day and add to it full therapeutic dosages of Elavil to be taken at night. A rapid titration to 150 mg/day would be a good place to start. You could probably tolerate this because you are already taking Elavil, and have accommodated to higher dosages of nortriptyline.
- Scott
Posted by ChicagoKat on November 12, 2012, at 14:47:17
In reply to Re: Help, Please :( » ChicagoKat, posted by gadchik on November 12, 2012, at 11:54:04
> I did get agitation on remeron after a awhile,as well as weight gain,but those first few weeks on it were just pure relief! Benadryl also does that to me,and gives me restless legs. I hope your travels go well.
i remember when i first started remeron, it was blissful!! and i'm the same as you with benadryl too. really the only thing in the world that helps me sleep anymore is elavil, i'm so glad i'm gonna have some tonight. ambien used to work so well for me, but no more...i even tried taking 30mg the other night and i was still staring at the ceiling. thanks gadchik, as always. i hope you are well
kat
Posted by ChicagoKat on November 12, 2012, at 14:53:59
In reply to Re: Help, Please :( » ChicagoKat, posted by SLS on November 12, 2012, at 13:16:01
hi Scott! thanks for posting, i always love to hear your advice! you know, i'm considering asking my pdoc if it's ok if i just take a really low dose of nardil, only 15 - 30mg/day, and adding a low dose of ritalin to that. that combo in the past has been the best. but i really do need elavil, at least 50mg, to sleep at night. i'm not sure if the combo of the 3 would be too much....what do you think? i'm gonna ask my pdoc, but i think your advice is just as good.
how are you btw? i had read you had achieved remission and i was so happy, are you still feeling better?
Kat> Just an idea...
>
> Maybe you should reinstate Nardil at 45 mg/day and add to it full therapeutic dosages of Elavil to be taken at night. A rapid titration to 150 mg/day would be a good place to start. You could probably tolerate this because you are already taking Elavil, and have accommodated to higher dosages of nortriptyline.
>
>
> - Scott
Posted by ChicagoKat on November 12, 2012, at 14:57:49
In reply to Help, Please :(, posted by ChicagoKat on November 11, 2012, at 20:29:31
i just want to thank everyone who has posted to my cry for help from yesterday, i really, really appreciate *everyone's* advice. i know i haven't replied to each of you personally, but i was in probably the darkest place i've ever been in last night...and you all probably understand when i say that that's saying a lot.
i am feeling better today, and i think with the meds my pdoc has given me i'll continue to improve. but i just wanted to say THANK YOU to all of you, you are the best. hoping you are all doing ok...
Kat
Posted by SLS on November 12, 2012, at 16:01:04
In reply to Re: Help, Please :( » SLS, posted by ChicagoKat on November 12, 2012, at 14:53:59
> hi Scott! thanks for posting, i always love to hear your advice!
I see that Jono gave you similar advice regarding the dosing of Elavil.
> you know, i'm considering asking my pdoc if it's ok if i just take a really low dose of nardil, only 15 - 30mg/day, and adding a low dose of ritalin to that.
That is certainly a valid alternative. Don't be resistant to taking three medications. I take seven. Nardil + Elavil + Ritalin sounds like it would be good for you.
> how are you btw?
I am doing pretty well. Thanks. I have not reached remission yet, but things continue to improve. Increasing the dosage of prazosin has helped a great deal. If things continue at this pace, I might be able to return to work next Spring. We'll see.
- Scott
Posted by SLS on November 12, 2012, at 16:05:34
In reply to Re: Help, Please :(, posted by ChicagoKat on November 12, 2012, at 14:57:49
> i just want to thank everyone who has posted to my cry for help from yesterday, i really, really appreciate *everyone's* advice. i know i haven't replied to each of you personally, but i was in probably the darkest place i've ever been in last night...and you all probably understand when i say that that's saying a lot.
>
> i am feeling better today, and i think with the meds my pdoc has given me i'll continue to improve. but i just wanted to say THANK YOU to all of you, you are the best. hoping you are all doing ok...
> Kat
It is difficult to resist reacting to mood swings by wanting to change treatments. I hope that maintaining your current treatment regime works for you.
- Scott
Posted by ChicagoKat on November 12, 2012, at 16:26:37
In reply to Re: Help, Please :( » ChicagoKat, posted by SLS on November 12, 2012, at 16:05:34
> It is difficult to resist reacting to mood swings by wanting to change treatments. I hope that maintaining your current treatment regime works for you.
>
>
> - ScottThanks Scott. You are completely right; very sage advice about continuing my current treatment and not reacting overmuch to mood swings. But, oh, how I'd love to be on an even keel and not up and down like a see-saw...but that's just me dreaming the impossible dream
So glad to hear you are heading up, here's to you hitting remission!
Kat
Posted by jono_in_adelaide on November 13, 2012, at 20:29:11
In reply to Re: Help, Please :( » SLS, posted by ChicagoKat on November 12, 2012, at 16:26:37
Hey Kat, how you doing?
Posted by ChicagoKat on November 14, 2012, at 8:50:16
In reply to Re: Help, Please :(, posted by jono_in_adelaide on November 13, 2012, at 20:29:11
> Hey Kat, how you doing?
Hi Jono, doing a bit better thanks. I'm back on my absolute favorite brand of candy (Ritalin)
So I'm on a low dose of Ritalin, a low dose of Nardil, and Elavil to sleep. I would and could if I was able to increase the Ritalin further, but as I'm sure you're aware, the combo of those 3 meds does not necessarily play well together.
So I have begun to awaken from the agonized dead. And I think I may well be able to make my trip this weekend after all. :)
Kat
Posted by SLS on November 14, 2012, at 9:36:11
In reply to Re: Help, Please :( » jono_in_adelaide, posted by ChicagoKat on November 14, 2012, at 8:50:16
> So I'm on a low dose of Ritalin, a low dose of Nardil, and Elavil to sleep. I would and could if I was able to increase the Ritalin further, but as I'm sure you're aware, the combo of those 3 meds does not necessarily play well together.
In what ways do these drugs not play well together?
Where did you encounter this information?
Sometimes, a doctor will add Ritalin to an MAOI to remediate hypotension.
I was once on a combination of Parnate, desipramine, and Ritalin. I did not experience any of the "theoretical" adverse events. More recently, I added Adderall to a combination of Parnate + nortriptyline.
- Scott
Posted by ChicagoKat on November 14, 2012, at 17:01:57
In reply to Re: Help, Please :( » ChicagoKat, posted by SLS on November 14, 2012, at 9:36:11
> > So I'm on a low dose of Ritalin, a low dose of Nardil, and Elavil to sleep. I would and could if I was able to increase the Ritalin further, but as I'm sure you're aware, the combo of those 3 meds does not necessarily play well together.
>
> In what ways do these drugs not play well together?Hi Scott...I already suffer from hypertension, and the 3 drugs make it much worse. Then there is always the fear of a true hypertensive crisis, which I've experienced and it's really scary.
Having said that, I saw my regular MD yesterday, and she increased my doses of my anti-hypertensives, so my BP and HR are much better. But I have to take *three* anti-hypertensives to combat the interaction of these 3 drugs. Guess that's what happens when you have mildly bad HTN to begin with. Thanks for being curious; it gives me hope that the combo really is a viable one.
Kat
Posted by brynb on November 16, 2012, at 1:11:32
In reply to Re: Help, Please :(, posted by ChicagoKat on November 14, 2012, at 17:01:57
Hi Kat-
So sorry you're having such a rough time. It seems you're doing a bit better though, no?
I've been in a bad place for the past month but over the last 2 weeks I've done a complete 180. Several factors take credit for this, but my pdoc and I did a few med changes that made a world of a difference.
I take 300 mg of lithium and 20 mg of Lexapro. Any dose lower or higher on either med completely screws me up (we previously had gone up on lithium to just 450 and I was so out of whack-going back down to 300 was a major positive game changer).
But, I was still in a really bad place. I know we've discussed our histories with benzos and not being allow to use them regularly, but my pdoc (who is also an addiction specialist) put me on Librium as my anxiety has been terrible and nothing (and I've tried every out-of-the-box, non-benzo med out there) works. He chose Librium for a few reasons, some of which I don't understand, but mainly because it's the only benzo I hadn't tried before so I didn't have any "association" with it.
Now, even though it's less potent than the more popular, newer benzos, it's been AMAZING. It feels cleaner and lighter. I take 25 mg twice a day and I'm so grateful my pdoc went this route.
He also added Suboxone to address my relentless depression (it's an opioid maintenance therapy typically used to help people addicted to opiates get off of them). We don't plan on using it long-term, but just as a temporary treatment until things are under control.
This new med combo/approach is rather unconventional, especially for an addiction guy, but I'm open with him and he's been monitoring me closely, and within two days, I was out of the hole! It's not the end all be all, but it's certainly an amazing solution for now.
Finally, I get the family thing; when I have obligations with mine, it often triggers really bad episodes.
I thought I'd share my experience and recent "wonder cocktail" if it helps you. Hang in there and good luck. It WILL get better :).
-bryn
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