![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Phil on January 1, 2013, at 14:28:54
Should I dump Seroquel before rapidly approaching type II diabetes hits and I get too fat to drive a car? I've never been psychotic.
Should I wean off Clonazepam to see what's underneath including a sex drive and increased energy? Is Clonazepam the main offender in lack of libido and lack of everything else associated? I think I've always had GAD.
Should I substitute other drugs depending on how this experiment goes?
My remaining meds would be Lamictal, Lithium, and Adderall XR.Should I stay the course as I'm not doing that bad but even with therapy I have no desire for moving forward in life?
Thanks
Posted by SLS on January 1, 2013, at 15:11:15
In reply to Med decisions to make. Input welcomed., posted by Phil on January 1, 2013, at 14:28:54
What conditions are you trying to treat?
- Scott
> Should I dump Seroquel before rapidly approaching type II diabetes hits and I get too fat to drive a car? I've never been psychotic.
>
> Should I wean off Clonazepam to see what's underneath including a sex drive and increased energy? Is Clonazepam the main offender in lack of libido and lack of everything else associated? I think I've always had GAD.
>
> Should I substitute other drugs depending on how this experiment goes?
> My remaining meds would be Lamictal, Lithium, and Adderall XR.
>
> Should I stay the course as I'm not doing that bad but even with therapy I have no desire for moving forward in life?
>
> Thanks
Posted by Phillipa on January 1, 2013, at 15:17:00
In reply to Med decisions to make. Input welcomed., posted by Phil on January 1, 2013, at 14:28:54
Phil what will keep the rapid cycling away? The mood stabalizer. You can't allow a med to let you get diabetes. Is the klonopin sufficient to stop the cycling it doesn't cause weight gain. Phillipa
Posted by Phil on January 1, 2013, at 16:19:00
In reply to Re: Med decisions to make. Input welcomed. » Phil, posted by SLS on January 1, 2013, at 15:11:15
Bipolar I.
Posted by Phil on January 1, 2013, at 16:27:12
In reply to Re: Med decisions to make. Input welcomed. » Phil, posted by Phillipa on January 1, 2013, at 15:17:00
I don't know. I just think it may be healthy to ask, do I really need these meds when I look like a blimp and have the worst sexual side effects of any med combo I've ever been on. Not counting Pisa Syndrome and what my doc thinks was six days of NMS and a week later I'm on another AAP.
In my heart I think I do need these meds. In my brain I think, how much am I willing to risk?
Posted by SLS on January 1, 2013, at 16:39:36
In reply to Re: Med decisions to make. Input welcomed. » SLS, posted by Phil on January 1, 2013, at 16:19:00
> Bipolar I.
One step at a time.
How often did you get manic before treatment?
How often do you get manic now?When you first began taking Seroquel, how did you benefit from it? Are you still benefiting from it?
I wouldn't stop the lithium at this point.
- Scott
Posted by jono_in_adelaide on January 1, 2013, at 16:49:14
In reply to Re: Med decisions to make. Input welcomed. » Phil, posted by SLS on January 1, 2013, at 16:39:36
What dose of Seroquel are you on?
It might be wise if your weight has become a problem and you feel that an atypical is benifiting your condition to switch from Seroquel to Geodon, as this has far less propensity to cause weight gain
Clonazepam, again, what dose? if you do decide to stop it, taper slowly, and not at the same time as Seroquel.
Benzos usualy have a fairly benign side efect profile compared to many psych drugs, so I wouldnt be too quick to blame a heaps of side effects on clonazepam
I wouldnt discontinue anything without imput from your doctor
Posted by Phil on January 1, 2013, at 17:40:51
In reply to Re: Med decisions to make. Input welcomed. » Phil, posted by SLS on January 1, 2013, at 16:39:36
jono I've been around a while and never stop treatments on my own. And would never stop two meds at once. But I mentioned sexual side effects and someone, sorry should have looked, pointed to clonazepam. Caught me off guard. My doc said I shouldn't have any at the doses I'm on.
Oh, Lithium 900, Seroquel 300, Clonazepam 1.5, Lamictal 300.Scott those questions are hard for me to answer. I had one major manic episode but my doctor thinks I've been bipolar all the way back to Amitrip 30 years ago or further. I think that Seroquel has helped with depression and mania but I just can't quantify it. I've had much more depression than mania.
Most of the time, since bipolar DX, others are much better at spotting my problems than I am.
But I do see anger and other issues flare up.
I think that Seroquel has been positive and I don't think that it's had any kind of lessening of effect.
Sorry people, I'm poor at self-observation and with the blur of meds for so long frankly I get lost.
If this were depression alone I could say I'm getting more depressed. Bipolar confuses me.
Posted by Phil on January 1, 2013, at 18:08:21
In reply to Re: Med decisions to make. Input welcomed., posted by Phil on January 1, 2013, at 17:40:51
Jono, not trying to be difficult. The reason my doctor thinks I have been bipolar so long is when I went through a few drugs initially my doc at the time put me on Amitriptyline. I told my current doctor that when I noticed it working that I could remember exactly where I was.
The trees took on this amazing beauty and the song I was listening to by Janet Jackson, a singer I didn't care for, it was so amazing. I told him so this is the other half lives. He said I think you were manic. I thought, oh.
And I made a rookie mistake after being on it for a few weeks I thought this isn't working and quit taking it. A couple of days later I woke up highly manic, called my mother at 6:30 am telling her I knew the answer to the worlds problems. My brother called I gave him the same story. I started getting sick at my stomach, clamming feeling and thought, I'm in withdrawal. Called my doc, got yelled at and started back on it.I'm 99% sure I've had ADD all of my life and without a doubt, GAD.
Posted by jono_in_adelaide on January 1, 2013, at 19:32:16
In reply to Re: Med decisions to make. Input welcomed., posted by Phil on January 1, 2013, at 18:08:21
Hi Phil
I'd be inclined to ask the doc if you could go from Seroquel to one of the atypicals with less propensity to cause weight gain and metabolic syndrome (eg geodon)
As for the clonazepam, you could either slowly discontinue, or try swaping to one of the genteler benzos (Ativan/lorazepam, Valium/diazepam)
If you stopped the Seroquel, a 4 week course of phentermine would help you drop a heap of weight, provided your doctor was comfortable with you using itBest of luck!
Posted by Phil on January 1, 2013, at 21:55:19
In reply to Re: Med decisions to make. Input welcomed., posted by jono_in_adelaide on January 1, 2013, at 19:32:16
Thanks jono...Do any of my meds scream sexual side effects to you?
Posted by Phil on January 1, 2013, at 21:56:00
In reply to Re: Med decisions to make. Input welcomed. » Phil, posted by SLS on January 1, 2013, at 16:39:36
Thanks Scott.
Posted by jono_in_adelaide on January 1, 2013, at 22:04:50
In reply to Re: Med decisions to make. Input welcomed. » jono_in_adelaide, posted by Phil on January 1, 2013, at 21:55:19
I'm not sure about the sexual side effects thing phil, to be honest - it might be that the combination of those meds is the issue?
Posted by Phil on January 1, 2013, at 22:38:46
In reply to Re: Med decisions to make. Input welcomed., posted by jono_in_adelaide on January 1, 2013, at 22:04:50
I guess. I went to the ultimate authority, Crazy Meds(love that guy), and read up a bit on Geoden. We'll see.
Posted by SLS on January 1, 2013, at 23:48:06
In reply to Re: Med decisions to make. Input welcomed., posted by jono_in_adelaide on January 1, 2013, at 19:32:16
> Hi Phil
>
> I'd be inclined to ask the doc if you could go from Seroquel to one of the atypicals with less propensity to cause weight gain and metabolic syndrome (eg geodon)I was thinking Latuda (lurasidone). It is probably less apt to produce anxiety and insomnia, and has been shown to have antidepressant effects sufficient that it will probably be given an indication for depression similar to Seroquel.
> As for the clonazepam, you could either slowly discontinue, or try swaping to one of the genteler benzos (Ativan/lorazepam, Valium/diazepam)
Good idea. Clonazepam can be depressogenic. If someone were to tell me that they experienced a reduction in libido with clonazepam, I wouldn't be surprised. The drug somehow affects serotonin neurotransmission - exactly how is not well understood. I sometimes think clonazepam is more difficult to discontinue because of this.
Perhaps now is the time to add Trileptal. It is helpful for BZD withdrawal and is a relatively clean mood stabilizer.
- Scott
Posted by SLS on January 2, 2013, at 0:12:35
In reply to Re: Med decisions to make. Input welcomed. » jono_in_adelaide, posted by Phil on January 1, 2013, at 22:38:46
Phil, your manic reaction to abruptly discontinuing amitriptyline is not without precedent, and probably indicates bipolarity. Even if depression is your only problem now, its biological underpinnings might be closer to being bipolar than unipolar.
> I guess. I went to the ultimate authority, Crazy Meds(love that guy), and read up a bit on Geoden. We'll see.
Geodon and Latuda are chemical cousins, and are both less likely to produce weight gain than the other APs. Geodon can produce an antidepressant effect, perhaps by acting as a mild SNRI along with its AP effects. However, some people become activated or agitated on it. In fact, according to Stephen Stahl, a low dosage of 20 mg/day is more likely to do this than higher dosages. Anxiety and insomnia can occur at any dosage. Latuda is less apt to produce these side effects, perhaps because it has no SNRI properties. Both drugs also blocks serotonin 5-HT7 receptors. This receptor is increasingly being seen as important in the pathogenesis of depression. Risperdal is another drug that does this.
I would probably try Geodon first. If anxiety and insomnia become problems, you can cross over to Latuda. If that drug proves unsuitable, then I would try Saphris (asenapine) before circling back to Seroquel. I have seen this drug act to energize a friend of mine, while reducing delusions and ruminations. She sleeps very well. It hits a bunch of receptors.
- Scott
Posted by jono_in_adelaide on January 2, 2013, at 0:43:54
In reply to Re: Med decisions to make. Input welcomed. » Phil, posted by SLS on January 2, 2013, at 0:12:35
Good points Scott.
I wonder, are Zyprexa and Seroquel any better (or better tolorated) than Geodon and the other weight neutral atypicals? There mustbe some reason that drugs witha significantly worse side effects profile are the most popular in class.
Posted by Phil on January 2, 2013, at 8:58:49
In reply to Re: Med decisions to make. Input welcomed. » Phil, posted by SLS on January 2, 2013, at 0:12:35
All three options may be out, no insurance. At least the Quetiapine immediate release is doable. Unfortunately it's even worse than XR in the metabolic stuff or at least appetite. My doctor said to not trust my body as far as eating. I'm trying but I can eat a full meal and 5 minutes later feel like I'm starving to death. I think I can do better though.
I will print out all of your replies and take them to my next appt. I remember when I was at 150 on Seroquel I was really pushing for 300. As is so often the case, I like the drug but the side effects are really nasty.
He added stims recently and I know by the length of my posts and occasional flash temper that I'm getting a bit manic on them. This too is getting better. But if I dropped Quetiapine maybe Adderall could help with the depression. It wasn't a crushing depression without Seroquel but it was there.
I need to do some research since you guys have some great ideas.
I think I've read and I know someone who has done it that I can taper to one mg without much trouble on Clonazepam. But when you hit 1 mg the fun starts, or it can.
Thanks again and if y'all have more to add I'm a motivated student.
Posted by jono_in_adelaide on January 2, 2013, at 17:09:47
In reply to Re: Med decisions to make. Input welcomed., posted by Phil on January 2, 2013, at 8:58:49
Risperidone is generic now and it is better than Seroquel for weight gain/metabolic syndrome etc - though it isnt weight neutral, so it might be worth trying that.
Posted by Phil on January 2, 2013, at 18:22:50
In reply to Re: Med decisions to make. Input welcomed., posted by jono_in_adelaide on January 2, 2013, at 17:09:47
Thanks for giving me more research jono. :)
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.