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Can't tolerate meds,TIRED all the time, + Deplin

Posted by zatar on October 19, 2011, at 9:03:21

I have been diagnosed with Fibromyalgia and CFS. Doxepin 10mg was my mainstay for sleep for years but doesn't do much for my panic, anxiety and atypical depression. I can't tolerate any SSRIs due to mild serotonin syndrome; tried various SSRIs in low doses - all worsen insomnia, increase anxiety and cause agitation, increased muscle tension (which exacerbates FMS pain).

Amitriptyline 5mg caused too much fatigue. Nortriptyline didn't do much. Neurontin/Lyrica added to sleep med MAYBE gave a little better sleep and had a mild anti-anxiety effect, but seemed to poop out quickly. Wellbutrin increased anxiety. Provigil increased anxiety. Was on Desyrel years ago without many side effects, but did not get deep sleep and was still fatigued. BTW, I use a CPAP for sleep apnea and UARS and still feel tired all the time.

The best I felt was on clonazepam and propranolol after I was prescribed them for non-stop panic attacks induced by a trial of Topamax (for pain control). But then my pdoc at that time wouldn't refill the clonazepam after things quieted down for me.

The funny thing is that years ago, when I was first diagnosed, I could tolerate usual doses of amitriptyline and Remeron. Recent trials showed that I can't tolerate even 1/10th the dose. So I'm thinking it's not drug metabolism related, but the receptors have changed somehow.

So I recently went off 10mg Doxepin and tried mirtazapine after reading that those with SSRI intolerance might be able to handle it. WRONG. On 7.5 mg, I slept 15 hours straight, then kept falling asleep all day. Cut down to 1/4 and 1/8 tablet and was still super tired. I felt like a slug, not to mention that my appetite ran amuck.

Now I started back on 3 mg. doxepin (Silenor) for about a week or so but I'm still so TIRED!!! And panic attacks are increasing.

To add to the confusion, I started on 15mg Deplin about two months ago. I am homozygous for the MTHFR 677C polymorphism, so my pdoc and I thought we would give it a try.

I am just so sensitive to meds that it seems like I can't take anything, but I need deep sleep and something for anxiety, panic and atypical depression. It's sort of moderate, but it feeds into the pain cycle.


- Could Deplin be revving up my system too much and causing increased anxiety and fatigue?

- Since I do not have elevated homocysteine levels and did not have difficulty getting pregnant, do I even need Deplin? (Maybe there are redundancies in the folic acid pathway and I make enough. I don't feel like the Deplin is doing anything positive).

- What other meds can I try for insomnia (no deep sleep)?

- What other meds can I try?

Thanks in advance for any insights.


(Just an anecdote: generic 10mg doxepin used to cost me $4 and some change per month. Silenor 6mg costs over $200 per month....don't get me started on this one. If I need 6mg, I'll ask for generic doxepin liquid).




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