![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by zonked on April 18, 2014, at 10:29:33
Hi all:
My depression has been parked at "fairly okay" to "yuck" (but not any suicidal ideation) since I moved back to care for my mom, who has developed dementia due to brain cancer.
Some of it unquestionably is related to the stress of being a caregiver and knowing you're going to lose a parent.
I keep thinking I should ask the new doctor (after my insurance changes over, beginning of May) to re-add a stimulant, like Dexedrine or Vyvanse which I've done before successfully. The combination isn't without side effects but at least enables me not to want to consume so much caffeine. I have a lot of fatigue, and quitting caffeine (without adding a "real" stimulant) isn't an option because I can't get anything done without it.
And also I know my ADD symptoms would be helped. I procrastinate a lot, so much to be done with Mom, so little time. Waiting for the next appointment is tough.
Testosterone was ultra-low at last test. <200 ... want to try that again, too.
Don't know what to make of the Prazosin at 1mg bedtime on such a low dose yet but it has reduced my nightmares.
Hanging in there,
-zNardil 30mg t.i.d, xanax 1mg 1-2x/day, ambien 10mg and prazosin 1mg at bedtime
Posted by Phillipa on April 18, 2014, at 11:53:20
In reply to Nardil/Xanax/Prazosin/Ambien: waiting for dr appt, posted by zonked on April 18, 2014, at 10:29:33
I'm so sorry about your Mom. Is there someone who can come in and help you care for her? Phillipa
Posted by zonked on April 18, 2014, at 12:53:14
In reply to Re: Nardil/Xanax/Prazosin/Ambien: waiting for dr appt » zonked, posted by Phillipa on April 18, 2014, at 11:53:20
> I'm so sorry about your Mom. Is there someone who can come in and help you care for her? Phillipa
Yes. A hired caregiver comes in twice a week for 3.5 hours each time. The family agrees it should be for longer, and more days but Mom is resistant.
Dementia is mild and comes and goes, but she was stubborn to begin with (I'm not being critical, in that context it's a compliment) but losing some of her independence has made her more stubborn.
She's resistant to a lifealert type system, and basically anything that isn't her idea... I get that. It's sad. But for her safety it's really hard to get her to order one... I won't feel 100% okay leaving her at home until it's ordered and she chooses to use it.
At least she's fine with me giving her meds for her, she sometimes used to think she already took them, or took double doses because she forgot she took them. That would be hell, because she needs those meds especially to prevent seizures.
I have a lot of support groups coming up on my calendar, it'll be okay. Thanks Philipa. :)
Posted by SLS on April 18, 2014, at 14:08:36
In reply to Nardil/Xanax/Prazosin/Ambien: waiting for dr appt, posted by zonked on April 18, 2014, at 10:29:33
> Hi all:
Hi.
You have a very difficult life.
Prazosin is an interesting drug. It seems to abolish PTSD specific nightmares, but not nightmares in general. So, the question becomes whether or not there is any type of PTSD that contributed to the evolution or persistence of your mental illness. PTSD with comorbid mood illness is not uncommon. Studies are showing that high dosages of prazosin throughout the day can act as an antidepressant in such cases. I haven't settled on a final dosage just yet, but I am taking 30 mg/day given in three divided doses. Published case studies have gone up to 45 mg/day. 40 mg/day is the maximum recommended dosage stated in the prazosin (Minipress) package label. Prazosin has helped me a great deal, including an increase in energy.
I experience a nice increase in energy by using Focalin (dexmethylphenidate) 10 mg as a PRN. It takes 30 - 60 minutes to begin working, but lasts for about 5 hours. For me, the loss of effect at the end of a dosing period is relatively mild. Taking Focalin as 10 mg twice a day is a reasonable treatment. I like Focalin much better than Ritalin.
- Scott---------------------------------------------
High-dose prazosin for the treatment of post-traumatic stress disorder
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896131/
---------------------------------------------
DOSAGE AND ADMINISTRATION
The dose of MINIPRESS should be adjusted according to the patient's individual blood pressure response. The following is a guide to its administration:
Initial Dose1 mg two or three times a day (see WARNINGS.)
Maintenance DoseDosage may be slowly increased to a total daily dose of 20 mg given in divided doses. The therapeutic dosages most commonly employed have ranged from 6 mg to 15 mg daily given in divided doses. Doses higher than 20 mg usually do not increase efficacy, however a few patients may benefit from further increases up to a daily dose of 40 mg given in divided doses. After initial titration some patients can be maintained adequately on a twice daily dosage regimen.
------------------------------------------
Posted by jono_in_adelaide on April 18, 2014, at 18:42:42
In reply to Nardil/Xanax/Prazosin/Ambien: waiting for dr appt, posted by zonked on April 18, 2014, at 10:29:33
Have you considered adding nortriptyline at bedtime? It would help ypu sleep, help lift the residual depression, and you could even combine it with an amphetamine if you still felt the need
Start off with 25mg at bedtime, and build up to 75mg at bedtime over a week, then give it a few weeks and see. Most people do well on 75mg, a few need upto 150mg
Posted by Phillipa on April 18, 2014, at 20:19:13
In reply to Re: caregiving for my mom » Phillipa, posted by zonked on April 18, 2014, at 12:53:14
So glad you have help. Yes longer would be much better. You are a wonderful example of a child (grown) that cares about their Mother first. I wish there were more people in the world such as you. Phillipa
Posted by ed_uk2010 on April 19, 2014, at 7:11:58
In reply to Re: Nardil/Xanax/Prazosin/Ambien: waiting for dr appt » zonked, posted by SLS on April 18, 2014, at 14:08:36
>I like Focalin much better than Ritalin.
Hi Scott,
What differences do you notice, and why do you think Focalin works better for you?
Posted by zonked on April 19, 2014, at 8:28:36
In reply to Re: Nardil/Xanax/Prazosin/Ambien: waiting for dr appt » zonked, posted by SLS on April 18, 2014, at 14:08:36
> > Hi all:
>
> Hi.
>
> You have a very difficult life.
>Somebody has to do this, so she doesn't end up in a home with people 20-30 years her senior. I get frustrated a lot, because she complains about home hospice (30m visits twice a week), being told what to do (like secure the rugs), and her relief professional caregiver (7 hours a week) every day; but I know part of that is dementia. She's frustrated at the loss of independence.
Re: Focalin it is interesting that you mention that. I felt a very clean increase in energy and attention span, WITHOUT a crash or increase in blood pressure, that I experienced with Ritalin and Concerta (in combo with Nardil). Dexedrine is okay, too.
So, the Prazosin doesn't make you drowsy during the day? Are you still on Nardil?
And are you still doing better (relatively speaking) like the last time I heard from you in 2013?
Thanks for your kind post and support over the years.
One thing I considered yesterday is that, due to being off Rx stimulants which work much better for my ADD, I crave energy drinks all day long. Caffeine like that isn't good for me, anxiety wise or energy wise, but my body feels something "missing" not to be lethargic and all over the place, and get tasks done. I'll keep my head above water until then - I guess it's sort of like when you have children, I guess. You have to.
Posted by SLS on April 19, 2014, at 9:13:57
In reply to Re: Nardil/Xanax/Prazosin/Ambien: waiting for dr appt » SLS, posted by ed_uk2010 on April 19, 2014, at 7:11:58
> >I like Focalin much better than Ritalin.
>
> Hi Scott,
>
> What differences do you notice, and why do you think Focalin works better for you?Hi Ed.
I need to say this: Your presence here is very important to the community. You are by far the most educated person when it comes to pharmaceuticals, and your breadth of knowledge amazes me.
Okay, enough of that. :-)
I found Ritalin to be "harsh". It caused me to become irritable and hyperlocomotive in an agitated kind of way. It really didn't help give me functional mental energy. By comparison, Focalin feels "smoother" and is more predictable. I get a nice energy lift that helps me function better, despite the persistence of other depressive symptoms. I have better "focus". Anhedonia and lack of interest really aren't improved. As Zonked noted, there is very little "let down" when the Focalin wears off.
I am having trouble getting the generic Focalin (dexmethylphenidate). My CVS pharmacy tells me that it has been on back order for several months. Maybe I should try another pharmacy. Since raising my dosage of prazosin, I don't seem to need it as much.
I hope you are doing well. When you visit Psycho-Babble and begin posting in volume, I worry that you are experiencing difficulties.
Take care.
- Scott
Posted by zonked on April 19, 2014, at 9:24:05
In reply to Re: Nardil/Xanax/Prazosin/Ambien: waiting for dr appt » ed_uk2010, posted by SLS on April 19, 2014, at 9:13:57
My ex was able to get generic Focalin (in Seattle, mind you) the same day no problem a few months ago at Walgreens.
I usually don't use Walgreens because they have too much business and too little help to handle it. Worth a shot. The 24-hour Walgreens and CVS stores seem to carry a larger variety of things.
I have at various times been either informed about a CII being in stock, or told it's against the law to say over the phone (I think they are more worried about robberies). Your jurisdiction/pharmacy may vary. :)
-z
Posted by SLS on April 19, 2014, at 10:13:12
In reply to Re: Nardil/Xanax/Prazosin/Ambien: waiting for dr appt » SLS, posted by zonked on April 19, 2014, at 8:28:36
> So, the Prazosin doesn't make you drowsy during the day?
No. My energy level has increased. Prazosin can be somewhat soporific in the beginning. There is also a noticeable dizziness. Both of these things resolved with continued treatment. I would be interested to see how well you do with a gradual dosage titration towards 12 - 15 mg/day. I hope your doctor will consent to this experiment.
> Are you still on Nardil?
After switching back and forth a few times, I have settled on Parnate 100 mg/day. I am doing better since bringing my dosage of prazosin up from 25 mg/day to 30 mg/day. I did this last month. I am feeling better than the 35% improvement that I had been quoting for a few years. I don't think I'm up to 50%, but I appear to be getting there. I am trying to be optimistic that I won't plateau.
Caffeine can be a blessing and a curse. Now that I'm off of it, I try to stay away from coffee.
- Scott
Posted by ed_uk2010 on April 19, 2014, at 10:25:29
In reply to Re: Nardil/Xanax/Prazosin/Ambien: waiting for dr appt » ed_uk2010, posted by SLS on April 19, 2014, at 9:13:57
Thanks Scott, you'll be giving me an ego ;)
I'm OK thanks but I've had more time due to being off a few days over Easter.
Perhaps it's worth trying a different pharmacy if the generic will save you a lot of money. They might be able to obtain some stock from a different supplier. I must admit it's not something I can say much about because we don't have dexmethylphenidate here in any brand.
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.