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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Tabitha on July 22, 2016, at 14:13:24
I've been off the SNRI for at least a week now. Just on lamictal+lithium. It's hard to decide whether I feel better or worse since the taper. I thought I felt calmer, less agitated. I was finally making progress on some projects. I was convinced I could finish those projects and finally feel useful and functional again, and have a thing to say to the question "what do you do?" or "what's new?" or whatever. I realized how important work is to me for personal satisfaction and a sense of pride.
Then the last couple days I was very upset and crying all day long. My thinking had latched onto a problem in my life and made it huge and horrible. It seemed very real. I wrote about it, and my writing seemed clear-headed and solid, making me more convinced it was a real thing and not a distortion. I mean, it felt like my dog died or something, just to make an analogy, just an awful thing I would start crying about if I even thought about it at all. Then the state abated and the huge horrible thing started seeming like a small to medium problem again, not even worth bringing up.
I'm really discouraged. I see my pdoc next week, and I don't want to describe this, because what will he do anyway? I feel like it's just a meds merry-go-round at this point. Just trial and error, maybe he'll use some new med he's come across, maybe nothing. Then new side effects, and possible new effects, or no effects. It's so difficult (impossible?) to even tell what the new med is doing versus what's just my condition fluctuating.
Not even sure why I'm posting. Just describing things to people who might recognize such experiences I guess.
Posted by jonhed on July 22, 2016, at 14:47:18
In reply to Bad couple of days, posted by Tabitha on July 22, 2016, at 14:13:24
Hang in there tabitha!
I will post some things in this thread late tonight, now i have to eat.
Maybe i can give you some tips if you want to?
Or do you want to try to be medication-free for a while?
You're strong and you are going to get through this! :-)
But i feel with you, sometimes it feels pointless to tell my pdoc about things to cause it just ends up in a spiral of medications anyway.
But one day you will find the right one, so please dear you, don't give up!
We want you here on the forum to :-D
Posted by Tabitha on July 22, 2016, at 15:27:23
In reply to Re: Bad couple of days, posted by jonhed on July 22, 2016, at 14:47:18
> Hang in there tabitha!
>
> I will post some things in this thread late tonight, now i have to eat.
>
> Maybe i can give you some tips if you want to?Yes, I would love to hear some tips. Even if they don't work for me it helps to know other people have come up with ways to manage
>
> Or do you want to try to be medication-free for a while?Unfortunately I have proven over and over and over that is a bad idea for me. I sink into depression sooo slowly that I don't see that it is happening. I go a long time functioning poorly and fighting suicidal ideation, give in and go back on meds, and kick myself for letting so much time pass while suffering and handicapped.
>
> You're strong and you are going to get through this! :-)
>
> But i feel with you, sometimes it feels pointless to tell my pdoc about things to cause it just ends up in a spiral of medications anyway.
>
> But one day you will find the right one, so please dear you, don't give up!
>
> We want you here on the forum to :-DThanks for the pep-talk and warmth
Posted by SLS on July 22, 2016, at 17:52:10
In reply to Bad couple of days, posted by Tabitha on July 22, 2016, at 14:13:24
Why did you discontinue the antidepressant?
Which one was it?
What dosage?
Why would you not want to go back on the same drug?
You must be very disappointed.
- Scott
Posted by Tabitha on July 22, 2016, at 20:13:34
In reply to Re: Bad couple of days » Tabitha, posted by SLS on July 22, 2016, at 17:52:10
Was fetzima 40mg to 20mg to 0. Discontinued it since I've added lithium and upped lamictal, so we thought it might no longer be necessary, plus of course it had side effects, and it was the most expensive med I'm on @ $50 copay. I'd probably go back to cymbalta or effexor before starting it again. The only difference among them is slightly different side effect combo.It's just not making sense to me that an AD would have been helping mood stability in combo with the supposed "mood stabilisers". I thought if anything my baseline mood would drop without it.
Posted by SLS on July 22, 2016, at 21:05:32
In reply to Re: Bad couple of days » SLS, posted by Tabitha on July 22, 2016, at 20:13:34
>
> Was fetzima 40mg to 20mg to 0. Discontinued it since I've added lithium and upped lamictal, so we thought it might no longer be necessary, plus of course it had side effects, and it was the most expensive med I'm on @ $50 copay. I'd probably go back to cymbalta or effexor before starting it again. The only difference among them is slightly different side effect combo.
>
> It's just not making sense to me that an AD would have been helping mood stability in combo with the supposed "mood stabilisers". I thought if anything my baseline mood would drop without it.Can you describe how you experience mood instability as opposed to stability?
How long were you taking Fetzima before you discontinued it?
How long after discontinuation did this instability appear?
The descent into depression after drug discontinuation is not always quick or linear. I would not be surprised if there were more anxiety than you expected. You describe a more insidious emergence of depression, which is why you found it difficult to recognize it quickly. A partial relapse can be a bumpy ride.
Which of the SNRIs are you leaning towards?
Hang in there.
- Scott
Posted by Horse on July 22, 2016, at 22:18:05
In reply to Re: Bad couple of days » SLS, posted by Tabitha on July 22, 2016, at 20:13:34
The experience of mistaking a small thing for a large threat or unhappiness is common, but from what I read, that mistake involved more extremes of mood. Is that near what you're describing as mood lability?
>It's just not making sense to me that an AD would have been helping mood stability in combo with the supposed "mood explanation". I thought if anything my baseline mood would drop without it.
Do you suspect any obsessive spectrum issues? That might be one explanation for the symptom you describe and how an AD could provide what seems like mood stability. Or there could be ADHD or ADHD like symptoms which can be expressed as mood lability. Is Fetzima anything like Strattera?Something else to consider is the time taken to taper. Sometimes hurrying that last flippin little bit of medication can result in quite a negative destabilization. You could go back up to 10 mg for awhile before discontinuing.
I've never done very well without medication that included an AD. I thought I could do it, and tried a number of times. I'm curious why you discontinued as well. Not to say, I hope, that you shouldn't discontinue if you want. Would you talk a bit more about your reasonings?
Posted by Tabitha on July 23, 2016, at 10:01:31
In reply to Re: Bad couple of days » Tabitha, posted by Horse on July 22, 2016, at 22:18:05
Thanks, people. I have an idea of what happened. I'd started a diet and ate really low calories for a few days, lower than normal dieting for me. I think that maybe triggered hypomania, followed by the inevitable crash. I say this because I've had similar reaction to having my sleep disrupted for too long, or from getting too much novel stimulation from travel. I just never had it happen from sudden diet changes before.
I feel more stable now and I see my pdoc next week.
To answer questions about why I discontinued it, I started on lamictal, relapsed, added AD, relapsed, added lithium, then was doing well (so on all three meds at that point). The lithium helped so much I thought I might not need both of the others anymore. Pdoc recommended keeping lamictal and trying tapering the AD. He also increased lamictal slightly before starting. I went a month for each change (increase lamictal, AD down to 1/2, AD down to 0).
The underlying idea was that I like to take as few meds as possible (I'm on more stuff than just psych meds), I like to avoid expensive ones if I can (this one was $50/month compared to all my others $5/month or $30), and I wasn't sure the AD was still helping since I'd relapsed while on it anyway. Does that make sense?
This is the end of the thread.
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