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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Elanor Roosevelt on March 18, 2015, at 21:27:37
now i take 20mg lexapro, 300 mg lithium. ambiem, and random zanax
i've had some awful months
talking with my pdoc we are trying to figure out what to add to stop me from going to hell and back weekly, to get me out of bed, need a little bit of a sense of future, a little less self loathing, and a stop to the suicidal ideation (which is new and annoying to me). i need a mood lifter or stimulant. i feel best when the ambien is kicking in--almost at peace with the universe.
any suggestions?
Posted by fido on March 18, 2015, at 23:20:43
In reply to need help knowing what to add, posted by Elanor Roosevelt on March 18, 2015, at 21:27:37
Lamictal is often mixed with lithium.
Are you bipolar?
Stimulants are usually considered to increase suicide risk which is why many docs dont prescribe them when you already are suicidal. But I also read in a book by a professor that stimulants do not really increase suicide risk the risk is basically when the stimulants wears off and people fall back into their hole.Can you tell if your current mix is at least helping a bit?
Posted by Elanor Roosevelt on March 19, 2015, at 18:26:06
In reply to Re: need help knowing what to add, posted by fido on March 18, 2015, at 23:20:43
> Lamictal is often mixed with lithium.
> Are you bipolar?
> Stimulants are usually considered to increase suicide risk which is why many docs dont prescribe them when you already are suicidal. But I also read in a book by a professor that stimulants do not really increase suicide risk the risk is basically when the stimulants wears off and people fall back into their hole.
>
> Can you tell if your current mix is at least helping a bit?my current mix works not well. i might discuss stimulants.
thanks for your reply
Posted by SLS on March 19, 2015, at 18:47:11
In reply to Re: need help knowing what to add, posted by Elanor Roosevelt on March 19, 2015, at 18:26:06
Hi.
What about getting rid of the Lexapro? You may be having an adverse reaction to it. Pristiq or Wellbutrin are possibilities. You could use Trileptal as your mood stabilizer with Lamictal or Wellbutrin as adjuncts.
If you find lithium helpful, keep it.
Lithium
Trileptal
Lamictal (the dosage of Lamictal might be a bit higher because Trileptal is an enzyme inducer).If needed: Wellbutrin or Pristiq
Everyone has their favorites. These are the drugs that I have seen people respond to most recently.
- Scott
Posted by Elanor Roosevelt on March 23, 2015, at 20:13:50
In reply to Re: need help knowing what to add » Elanor Roosevelt, posted by SLS on March 19, 2015, at 18:47:11
> Hi.
>
> What about getting rid of the Lexapro? You may be having an adverse reaction to it. Pristiq or Wellbutrin are possibilities. You could use Trileptal as your mood stabilizer with Lamictal or Wellbutrin as adjuncts.
>
> If you find lithium helpful, keep it.
>
> Lithium
> Trileptal
> Lamictal (the dosage of Lamictal might be a bit higher because Trileptal is an enzyme inducer).
>
> If needed: Wellbutrin or Pristiq
>
> Everyone has their favorites. These are the drugs that I have seen people respond to most recently.
>
>
> - Scott
Thanks Scott. I'll talk to my doctor about the Pristiq. I've had a couple of okay days--took the Lexapro down to 20mgs and chug-a-lug a starbucks double shot along with my coffee. this i know is a temporary solution but what isn't?
Posted by phidippus on April 12, 2015, at 7:25:55
In reply to need help knowing what to add, posted by Elanor Roosevelt on March 18, 2015, at 21:27:37
What exactly is your diagnosis? If you are bipolar, the dosage of Lithium you are on is low. Have you had your levels checked? Lithiumm provides the best antidepressant response at a level of 1.0-1.2.
Is the suicidal ideation intrusive and recurrent in nature-do you have the thoughts despite not being suicidal? If this is the case, these thoughts might be obsessional and the Lexapro should be helping. I'm wondering if you should try another antidepressant. What have you been on?
It is interesting you feel so good when taking the ambien. The drug binds to GABAa y 1 receptors and is very similar to a benzodiazapine. A side effect of ambien is euphoria. A drug that might agree with you is Acamprosate-it also binds to the GABAa receptor.
Eric
Posted by Elanor Roosevelt on April 22, 2015, at 20:48:13
In reply to Re: need help knowing what to add » Elanor Roosevelt, posted by phidippus on April 12, 2015, at 7:25:55
Thanks for the suggestions.
I had an unusually long dark stretch. The suicidal ideation is new for me. I keep lowering my expectations. I now can work with going to hell and back once or twice a month as long as the bouts are brief enough for me to know that they will ease up eventually.I didn't change the lexapro yet and, honestly, i'm afraid to mess with it.
The pdoc is working withme on my sleep issues. after over 15 years on ambien, it has stopped working efficiently for me. It was taking a very long time for me to get to sleep(more time to eat ice cream, i'm up to 175 and my knees hurt) and i was waking in a daze. the pdoc added 10mg doxepin to my 10mg ambien and the change is very positive. I am still lethargic in the morning but i am working to improve this with my good morning lamp.
the falling asleep stage is quicker and gentler. We'll see if this keeps working. i think the idea is to get me off the ambien completely.
the dreaming is okay and my dream life is important to me-- lot's of conversations with people I haven't seen in a while. although the conversation about how it wouldn't be so bad to be reincarnated as a mosquito still has me wondering.
This is the end of the thread.
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