Psycho-Babble Medication Thread 108313

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Re: more on concerta Krazy Kat

Posted by Ritch on June 5, 2002, at 13:18:09

In reply to more on concerta, posted by Krazy Kat on June 5, 2002, at 10:24:08

> ah, tis a fascinating subject, tisn't it? perhaps i will keep this thread going for years... ;)
>
> i am taking 36 mg of Concerta for the first time today. Took 18 mg for about a week. I'm having some struggle with a mild depression, and pdoc wants to see if the Concerta can handle this. I'm a little skeptical, but then I do not want to add Welbutrin (his other thought) because it made me so irritable and just plain mean the last ime i tried it.
>
> Concerta downsides - nausea, nausea, nausea. Headaches in the afternoon. Jumpiness. Desire to bawl (but I think this is the depression now).
>
> Concerta benefits thus far - am awake more and can focus somewhat better.
>
> Am still taking Depakote 1000 mg at night and 1000 mg in the morning.


KK,

Have you noticed that it lasts long enough throughout the day at the higher dose? I am a little surprised your pdoc didn't notch you up to the 27mg dose first, though. I hope it works out OK. I know what you mean about SSRI's. For me they are *instant* hypomania (*all* of them!). Effexor was even worse. Remeron made me agitated and confused/hostile. Serzone settled me down, but I was very confused (like trazodone). Wellbutrin makes me very panicky and grouchy. Dexedrine has been the weirdest experience (for a stimulant). That stuff actually makes me feel sleepy, my eyes get this relaxed-tired look to them. The thing about stimulants that I have noticed (*all* of them), is they tend to cause mood SAMENESS all day for me (that is if the blood levels are reasonable constant). Now, the SAMENESS might not be that super of a feeling. They tend to make me too nervous and jittery, but it is the SAME feeling all daylong, day after day. When I was on the dex for a month-my mood chart just shows nothing but goose-eggs (0) for mood. If I could just tolerate the anxiety..

Mitch

 

Re: more on concerta Ritch

Posted by Krazy Kat on June 5, 2002, at 13:58:24

In reply to Re: more on concerta Krazy Kat, posted by Ritch on June 5, 2002, at 13:18:09

Heh Mitch. How are you?

Re: the 27 mg. - my pdoc and I discussed this. I had been up to 25 mg. before on Ritalin and hadn't noticed a big difference between 20 and 25, so he felt that 36 would be an o.k. jump. I'm o.k. with it because I would have had to wait for yet another script if we went to 27 first.

First day, so I'll let you all know about the possible extension of benefits into the evening tomorrow. He didn't feel it would affect that and mentioned the same thing Chris did as a solution - taking 5 mg at, say, about 4:00. He said no later than that, though.

My sleep patterns are still wacky, so I imagine he wants me to try it at this level for a little while before adding any at the end of the day. Of course, I am getting impatient and want it all fixed now!!! :)

I have not tried Effexor.

Re: "Serzone settled me down, but I was very confused (like trazodone). Wellbutrin makes me very panicky and grouchy."

Boy, both of those affect me the same way. I find it fascinating that we have quite a few similarities because of our sex and age difference.

Re: "mood SAMENESS"

That would be a goal, IF, that anxiety/jitteriness can be controlled. So again, it seems as if we react similarly here.

Perhaps a small amount of something else can control that? It couldn't be sedating for me. How many meds does it take? Ug. ;0

Also, after I am on 36 mg of Concerta for a few days, I will try your suggestion of taking the Depakote at even more spaced out intervals - maybe 500 mg in the morning, 500 in early afternoon, 1000 at night.

And my mood chart/journal is a big goal...

- kk

 

Re: more on concerta Krazy Kat

Posted by Ritch on June 5, 2002, at 23:41:36

In reply to Re: more on concerta Ritch, posted by Krazy Kat on June 5, 2002, at 13:58:24

> Heh Mitch. How are you?

Well.. springtime hypomania is definitely over. I can tell because I am not buying any new music. I am listening to old vinyl instead. The imipramine is helping (good for generalized anxiety), but seems to have too much antihistaminic fog compared to nortiptyline. I still need to wait another full week to see though. Desipramine had zero effect until about 10 days into it and then things started "sharpening up". What starts to happen with the NE meds (for ADD symptoms), is a shift in perception of details. I start noticing things I hadn't noticed before, and I start marking times/dates on calendars and PLANNING things. The present moment seems to be a wider, more forgiving "space" to use my short-term memory and it doesn't feel like such a huge EFFORT to process ordinary tasks. Moderate seasonal depression will be kicking-in by the end of the month and be in full bloom by mid July.


>
> Re: the 27 mg. - my pdoc and I discussed this. I had been up to 25 mg. before on Ritalin and hadn't noticed a big difference between 20 and 25, so he felt that 36 would be an o.k. jump. I'm o.k. with it because I would have had to wait for yet another script if we went to 27 first.


That seems fairly logical-he probably didn't want to wait and go through another bump in dosage.

>
> First day, so I'll let you all know about the possible extension of benefits into the evening tomorrow. He didn't feel it would affect that and mentioned the same thing Chris did as a solution - taking 5 mg at, say, about 4:00. He said no later than that, though.

Chris's suggestion makes a lot of sense-you use the same med, but just "fill-in" the last few hours of the day.

>
> My sleep patterns are still wacky, so I imagine he wants me to try it at this level for a little while before adding any at the end of the day. Of course, I am getting impatient and want it all fixed now!!! :)

Have your sleep "patterns" always been "wacky"? Or is this a phenomenon of stimulant use? Can you explain the "wackiness"? I noticed during major depression that Adderall stabilized and made my sleep *more* consistent*. However, with dexedrine I noticed an overall reduced sleeptime (but no interruptions), Focalin did the same thing. But those two trials were during my hypomanic time of year. The Adderall was tried during a major depressive episode-I slept 7 hrs a day instead of the typical 10hrs. at that time of year.

>
> I have not tried Effexor.

I wouldn't be excited about trying it-if I were you. The only thing I really liked about it was-if I was experiencing a very major depressive dip, I could take just 12.5mg and snap out of it in a matter of hours and that would last for a few days! But, it was just too destabilizing overall, and made me itch.

>
> Re: "Serzone settled me down, but I was very confused (like trazodone). Wellbutrin makes me very panicky and grouchy."
>
> Boy, both of those affect me the same way. I find it fascinating that we have quite a few similarities because of our sex and age difference.

I liked Serzone because it didn't send me pacing all around like SSRI's did. In fact, I felt physically rested and calm sitting still. I just had trouble focusing mentally and I also have trouble with my eyes crossing and difficulty keeping them both aimed straight (exotropia). Interestingly, meds that help with *mental* focus also keep my eyes straightened out. Serzone also made me itch, too!

>
> Re: "mood SAMENESS"
>
> That would be a goal, IF, that anxiety/jitteriness can be controlled. So again, it seems as if we react similarly here.
>
> Perhaps a small amount of something else can control that? It couldn't be sedating for me. How many meds does it take? Ug. ;0

That's what I am hoping the imipramine will do for me. I know it has been effective for ADD symptoms, and panic/generalized anxiety.

>
> Also, after I am on 36 mg of Concerta for a few days, I will try your suggestion of taking the Depakote at even more spaced out intervals - maybe 500 mg in the morning, 500 in early afternoon, 1000 at night.
>
> And my mood chart/journal is a big goal...
>
> - kk


I saw some guidelines for Depakote dosing (can't remember the source) that mentioned that you should avoid single doses greater than 500mg. In your case you would need to take 500mg tabs 4x daily. Are you taking the Depakote ER 500mg instead of the regular Depakote CR 500mg? You just *might* be able to take get by with 1500mg Depakote a day instead if you were taking 500mg ER 3x daily-possibly. You can ask your pdoc if you aren't already taking the ER version.

Mitch

 

Re: Concerta Update - Mitch and Anyone

Posted by Schuyler on June 6, 2002, at 11:23:22

In reply to Re: Concerta Update - Mitch and Anyone Ritch, posted by Krazy Kat on June 2, 2002, at 16:43:34

I did not like Metadate CD, which I think is just like Concerta, because it began to wear off after 9 or 10 hours (like the package insert said it would). I'm going to try Methylphenidate SR (slow release) instead: one dose when I wake up, another about 2 in the afternoon, so I'm covered for 16 hours or so.

Schuyler

> thanks! what do you think about Concerta wearing off after about 10 hours? I know its half-life is 12 hours, but I will need something that lasts a good 12-14 hours to handle "real life" eventually. :) If I up the dose to 27 mg., does that extend the half-life as well?

 

thanks for the input! (nm) Schuyler

Posted by Krazy Kat on June 6, 2002, at 11:53:13

In reply to Re: Concerta Update - Mitch and Anyone, posted by Schuyler on June 6, 2002, at 11:23:22

 

Re: more on concerta Ritch

Posted by Krazy Kat on June 6, 2002, at 12:14:48

In reply to Re: more on concerta Krazy Kat, posted by Ritch on June 5, 2002, at 23:41:36

>> Well.. springtime hypomania is definitely over. I can tell because I am not buying any new music. I am listening to old vinyl instead.

Is this good or bad?

>> I start noticing things I hadn't noticed before, and I start marking times/dates on calendars and PLANNING things.

Yes, that's the first thing my husband said he noticed when I started Ritalin - I was "scheduling" again. I used to be responsible for scheduling in publishing, so the loss of that skill has been an evident one.

>> it doesn't feel like such a huge EFFORT to process ordinary tasks.

That's a little better for me, as well.

>> Moderate seasonal depression will be kicking-in by the end of the month and be in full bloom by mid July.

Do your meds help with this, or is this something you have come to work through on your own?

> Have your sleep "patterns" always been "wacky"?

Yes. I imaigine all of "ours" have been. :)

>> Can you explain the "wackiness"?

Even though I get really tired after about 10 hours on Ritalin, I usually can't sleep. But, regardless and prior to the Ritalin, for about a month I've been falling asleep between 1:00 and 2:00 am and sleeping until about 10:00. Alarms do not wake me up. Or I turn them off.

Now this is less in hours than it was before, but the time frame drives my husband crazy. And he hates having ti wake me up. I feel "guilty", as if I should be sleeping 10:00 pm - 7:00 am. Maybe it's more of a relationship issue...

The great thing is I am not constantly afraid I will fall asleep during the day like I was on Topamax. I couldn't take the train home from NYC without having a panic attack the whole time that I would fall asleep and miss my stop. Ridiculous. Caffeine did nothing to help. And it took my pdoc months to accept that was a problem. That's when a Major depression hit, and I said "I won't take Topamax anymore and I'm going into the hospital if you can't fix this." ;)

It would be hard to convince me to try Effexor. I don't want to belittle its use, since I've seen posters here who benefited from it, but I just Know it would be a horror story for me.


>> I liked Serzone because it didn't send me pacing all around like SSRI's did.

I recall having one of those epiphanies on Serzone one morning, feeling more optimistic than I had in years while walking to work. But then, that could have been a reaction to my seeking help. It didn't really touch my depression at that time, though.

>> Interestingly, meds that help with *mental* focus also keep my eyes straightened out.

That is interesting - I wonder if there's a physical connection?

>> That's what I am hoping the imipramine will do for me. I know it has been effective for ADD symptoms, and panic/generalized anxiety.

Ah, O.K. So this will be a good trial! I'll be intereseted to hear.

I haven't seen the Depakote guidelines you mentioned, but now I'm very curious. It certainly can't hurt to break up the doses. My pdoc was comfortable with my 1000mg at night and then 1000mg in the morning. I was taking it all at night to counteract the initial heavy sedation.

I'm not on ER. He wasn't "into" that option - I asked about it last time. I don't recall why he was against it. Maybe because he didn't feel it worked as well? I don't know.

Yeah, with his permission, I'd like to drop back to 1500 mg, but my blood level is low compared to others. My liver enzymes were up last time, not horrifically, but noticably, so maybe I can use that as an "excuse". It's odd, because I've taken it off and on for a year without there ever being an increase. AND, prior to that, I was drinking quite heavily at times, and tests were fine. So, I don't know.

I write too much in my responses to you. Sorry. :)

- kk

 

First Day of Concerta into Second Day...

Posted by Krazy Kat on June 6, 2002, at 12:21:28

In reply to thanks for the input! (nm) Schuyler, posted by Krazy Kat on June 6, 2002, at 11:53:13

Boy, was I more chipper yesterday than I have been in a long time. I didn't accomplish much, but then I haven't had internet access for about a week, and I was able to use hubby's computer. So I wrote a lot of emails.

Focus must be a little better. My spelling and editing abilities are returning to normal.

I felt myself getting tired after about 10 hours again. Big thunderstorms so had to stay up with scared old dog until about 1:00 am, so am not sure if I would have dozed off without that distraction.

Today, at 36 mg again, still feeling more chipper. Nothing hypomanic, just more energy, more optimism. It takes about an hour to kick in. So, I guess it's lasting about 9 hours for me.

Slept late again, though - nothing could wake me. I keep the concerta by my bed, and the IDEA is for me to take it when the alarm goes off, but I don't. I need a solution to this.

All in all, decent two days thus far.

Also, jitteriness doesn't set in until later in the day. Must be a reaction to the med's downslide.

No caffeine yesterday.

- kk

P.S. Should I mention that I'm 31, female, about 145 pounds so that others can see what my make-up is?

 

Re: more on concerta Krazy Kat

Posted by Ritch on June 6, 2002, at 13:06:57

In reply to Re: more on concerta Ritch, posted by Krazy Kat on June 6, 2002, at 12:14:48

> >> Well.. springtime hypomania is definitely over. I can tell because I am not buying any new music. I am listening to old vinyl instead.
>
> Is this good or bad?


It is bad, because it means that I am slowing down steadily. It is the blah few weeks before the depression will strike. Yuck, I am going to ramp up AD's, do whatever. I want to wade through this as quickly as possible!



> >> Moderate seasonal depression will be kicking-in by the end of the month and be in full bloom by mid July.
>
> Do your meds help with this, or is this something you have come to work through on your own?

Meds are absolutely necessary. Eeek, without meds I would probably lose my job. So far, only Adderall completely wiped one out, but the anxiety (yuck). If it gets bad enough I may have to bug my pdoc about some anyhow (for a few weeks).


> > Have your sleep "patterns" always been "wacky"?
>
> Yes. I imaigine all of "ours" have been. :)
>
> >> Can you explain the "wackiness"?
>
> Even though I get really tired after about 10 hours on Ritalin, I usually can't sleep. But, regardless and prior to the Ritalin, for about a month I've been falling asleep between 1:00 and 2:00 am and sleeping until about 10:00. Alarms do not wake me up. Or I turn them off.
>
> Now this is less in hours than it was before, but the time frame drives my husband crazy. And he hates having ti wake me up. I feel "guilty", as if I should be sleeping 10:00 pm - 7:00 am. Maybe it's more of a relationship issue...
> I haven't seen the Depakote guidelines you mentioned, but now I'm very curious. It certainly can't hurt to break up the doses. My pdoc was comfortable with my 1000mg at night and then 1000mg in the morning. I was taking it all at night to counteract the initial heavy sedation.
>
> I'm not on ER. He wasn't "into" that option - I asked about it last time. I don't recall why he was against it. Maybe because he didn't feel it worked as well? I don't know.
>
> Yeah, with his permission, I'd like to drop back to 1500 mg, but my blood level is low compared to others. My liver enzymes were up last time, not horrifically, but noticably, so maybe I can use that as an "excuse". It's odd, because I've taken it off and on for a year without there ever being an increase. AND, prior to that, I was drinking quite heavily at times, and tests were fine. So, I don't know.
>


Hmmm. That sounds like oversleeping due to the that big Depakote dose at bedtime to me! I can reliably change my sleep duration by adjusting my bedtime Depakote dose up or down. You also must realize that your Depakote blood level is the lowest of the day right before you take your dose at nite. It is going to take a few hours for that dose to peak, that's why you can't get to bed until later. Then it kicks in big time while you are sleeping and you are a zombie when you try to wake up. I really think you might try 500mg 4x daily, that sounds like a pain in the arse, but I wonder if you will get to sleep earlier, not sleep as heavily-because your lowest blood level would be shifted to wakeup time. Hey, then if you are still too tired during the day then drop the dose to 500mg 3x daily (evenly spaced). My guess is that your pdoc doesn't write for the ER because it is probably a lot more expensive for the same thing and he thinks it is just a gimmick that won't really help all that much-it may very well be :).


>
> The great thing is I am not constantly afraid I will fall asleep during the day like I was on Topamax. I couldn't take the train home from NYC without having a panic attack the whole time that I would fall asleep and miss my stop. Ridiculous. Caffeine did nothing to help. And it took my pdoc months to accept that was a problem. That's when a Major depression hit, and I said "I won't take Topamax anymore and I'm going into the hospital if you can't fix this." ;)

Hey, I almost wrecked my car on Topamax (just 50mg/day), not to mention drawing complete blanks at work.


> >> Interestingly, meds that help with *mental* focus also keep my eyes straightened out.
>
> That is interesting - I wonder if there's a physical connection?


Oh, I am sure there is. I think it has to do with neurotransmitter not being available to coordinate my eyes properly. When there is enough available, I am more attentive as well. Or it is just my overall level of wakefulness. That is what my depressions are like-extended narcoleptic spells.


> I write too much in my responses to you. Sorry. :)
>
> - kk

Oh no, That's quite OK. All of these detaily things may answer somebody else's questions about something similar and save somebody else some time, too. :)

Mitch

 

a few bad days...

Posted by Krazy Kat on June 9, 2002, at 12:03:04

In reply to Re: more on concerta Krazy Kat, posted by Ritch on June 6, 2002, at 13:06:57

last two days have been very slow. i have been very tired and Concerta was no help. but then i slept badly. today i am better, though not at the point i was the first few days on it. i have a fear i react well to stims initially then they even out and don't help much. we'll see.

 

Re: a few bad days... Krazy Kat

Posted by Ritch on June 9, 2002, at 14:20:35

In reply to a few bad days..., posted by Krazy Kat on June 9, 2002, at 12:03:04

> last two days have been very slow. i have been very tired and Concerta was no help. but then i slept badly. today i am better, though not at the point i was the first few days on it. i have a fear i react well to stims initially then they even out and don't help much. we'll see.


KK,

There are a lot of posters here that have mentioned tolerance and poop-out with stimulants. I didn't have that trouble with Adderall. I started at 5mg/day and just stayed there. I felt mildy euphoric and had some insomnia the first few days, but that wore away rapidly and I just had focus-and that was it. It really wasn't mood elevating in any way. d-methylphenidate gave me zero mood elevation from the start-just an immediate focusing effect. Dexedrine was mildly mood-elevating, but didn't help me focus that well. They all make me a little too anxious. Do you think the stimulant is aggravating your cycling?

Mitch

 

cycling and stims... concerta Ritch

Posted by Krazy Kat on June 12, 2002, at 9:15:02

In reply to Re: a few bad days... Krazy Kat, posted by Ritch on June 9, 2002, at 14:20:35

re: worsening cycling - I don't know.

Concerta is definitely making me irritable/anxious/jumpy by early afternoon. It's a bad feeling.

No AD effect, but it is/was definitely helping with energy and focus.

I did not take it this morning, and I am exhausted. I wanted to leave it off for a couple of days and see what happened.

So I guess it will be adding something to counteract the side effects of the medicine I'm taking to counteract the side effects of the medicine I'm taking to keep me stable, OR try Welbutrin again, or Remeron...

- kk

 

Re: cycling and stims... concerta Krazy Kat

Posted by Ritch on June 12, 2002, at 9:48:28

In reply to cycling and stims... concerta Ritch, posted by Krazy Kat on June 12, 2002, at 9:15:02

> re: worsening cycling - I don't know.
>
> Concerta is definitely making me irritable/anxious/jumpy by early afternoon. It's a bad feeling.
>
> No AD effect, but it is/was definitely helping with energy and focus.
>
> I did not take it this morning, and I am exhausted. I wanted to leave it off for a couple of days and see what happened.
>
> So I guess it will be adding something to counteract the side effects of the medicine I'm taking to counteract the side effects of the medicine I'm taking to keep me stable, OR try Welbutrin again, or Remeron...
>
> - kk


Hi,

So you are saying the *cycling* you are experiencing is a thru-the day phenomenon? If so, it may be the sixth-hour blood level peak of the Concerta combined with the undulating levels of Depakote. Have you talked to your pdoc about a possible flip to Adderall or Adderall XR? I found Focalin to be a lot more nerve wracking than the amp. products. The least nerve-wracking of those was dexedrine. It didn't seem to help focus much, but at least I wasn't fatigued (or restless). Perhaps 2 or 3 5mg Dexedrine spansules through the day would work for you? I would try a flip to that before you add-on anything else or switch back to an AD. I definitely had much *less* of the "several days up, several days down" type of cycling with dexedrine. You really need to chart, IMO. You don't have to fill out something really complex, etc. For many years, all I did was write a positive or negative number on a calendar. I would put a number in the bottom left of that day for how I felt when I got up, then a number in the bottom right for how I felt in the evening before I went to bed (and as a gauge for how the day went). Then all you have to do is glance at it and you can see the pattern (if it is wide enough).

Mitch

 

Re: cycling and stims... concerta Ritch

Posted by Krazy Kat on June 13, 2002, at 12:28:47

In reply to Re: cycling and stims... concerta Krazy Kat, posted by Ritch on June 12, 2002, at 9:48:28

>
> So you are saying the *cycling* you are experiencing is a thru-the day phenomenon?

Yes, Mitch, it's thru-the-day - sorry if that wasn't clear.

> If so, it may be the sixth-hour blood level peak of the Concerta combined with the undulating levels of Depakote.

You had mentioned that so I'm taking the Dep. in the afternoon now - I can't remember it more than twice a day.

All the others are good suggestions. Thanks for your continued support.

- kk

 

Re: cycling and stims... concerta Krazy Kat

Posted by Ritch on June 13, 2002, at 22:12:07

In reply to Re: cycling and stims... concerta Ritch, posted by Krazy Kat on June 13, 2002, at 12:28:47

> >
> > So you are saying the *cycling* you are experiencing is a thru-the day phenomenon?
>
> Yes, Mitch, it's thru-the-day - sorry if that wasn't clear.
>
> > If so, it may be the sixth-hour blood level peak of the Concerta combined with the undulating levels of Depakote.
>
> You had mentioned that so I'm taking the Dep. in the afternoon now - I can't remember it more than twice a day.
>
> All the others are good suggestions. Thanks for your continued support.
>
> - kk


No problema. It looks like you have to really *work* on getting your med levels smoothed out the best you can during the daytime, IMO. Also, intraday cycling can also be responsive to thyroid T3/T4 augmentation. Hmm.. You might talk about that to your pdoc.

Mitch

 

adding t3 Ritch

Posted by Krazy Kat on June 17, 2002, at 19:20:14

In reply to Re: cycling and stims... concerta Krazy Kat, posted by Ritch on June 13, 2002, at 22:12:07

thanks mitch - nice idea. i have taken it before and it might have helped. i'm not certain. that was when i was going manic so everything was out of wack.

i have been taking 1000 depakote and 18 mg of concerta upon rising - 8:00 - 9:00 am (on good days :)), and then same doses at about 2:00 pm. this is helping. I get tired some days at about 8:00 pm, And I have added a little "left over" Neurontin, not consistently but when I feel anxious at a certain point during the day. it seems to help the anxiety.

Where are you with your regime?

- kk

 

Re: adding t3 Krazy Kat

Posted by Ritch on June 18, 2002, at 9:54:01

In reply to adding t3 Ritch, posted by Krazy Kat on June 17, 2002, at 19:20:14

> thanks mitch - nice idea. i have taken it before and it might have helped. i'm not certain. that was when i was going manic so everything was out of wack.
>
> i have been taking 1000 depakote and 18 mg of concerta upon rising - 8:00 - 9:00 am (on good days :)), and then same doses at about 2:00 pm. this is helping. I get tired some days at about 8:00 pm, And I have added a little "left over" Neurontin, not consistently but when I feel anxious at a certain point during the day. it seems to help the anxiety.
>
> Where are you with your regime?
>
> - kk


Hi,

I noticed you backed off the single 36mg dose of Concerta and are taking two 18mg doses-that is probably a LOT smoother. I have never tried T3/T4 augmentation. My endocrinologist is very conservative and is against it-since my TSH was 1.4 last time we checked it. He is worried about loss of bone mass. I was just thinking of "tweaking" it down to about 1.0. Well, the imipramine bombed because it was too sleep disruptive. After taking it just two days I started having early morning awakenings. I kept up with it for a full two weeks, and the EMA's kept happening (and associated with increased daytime fatigue). I can't handle the antihistaminic effects of TCA's or Remeron, for that matter. Tiny doses just completely wreck my ability to focus and concentrate. The Depakote, Neurontin, and Klonopin I take are all low-dose and pretty much a permanent fixture in my med regime. I still need a low-dose of a stimulant or an AD so I can focus and go through the day without yawning, napping, etc. So..I am now back on a low dose of Effexor (just 12.5mg in the AM). Much more than that will make me hypomanic. I just started it yesterday. My sleep duration was shortened, but it wasn't broken. ALL SSri's shorten my sleep. No reflux like the Celexa caused. I'll probably have to stick with the low-dose Effexor through this depressive spell-I don't have the time to stop and start crap like I had earlier.

Mitch

 

sometimes maintenance is best...

Posted by Krazy Kat on June 18, 2002, at 11:55:55

In reply to Re: adding t3 Krazy Kat, posted by Ritch on June 18, 2002, at 9:54:01

isn't it? especially during a depressive episode. i am sorry you are not feeling well, and appreciate your continued correspondence despite it.


> I noticed you backed off the single 36mg dose of Concerta and are taking two 18mg doses-that is probably a LOT smoother.

It does seem to be. My pdoc was O.K. with it. He wants the depakote all taken at once for some reason. I said i'd try it in the afternoon, but if it doesn't work, i'm going to be sneaky and divide it again. actually, i don't think he really cares. who knows what his thinking is...

>> I have never tried T3/T4 augmentation. My endocrinologist is very conservative and is against it-since my TSH was 1.4 last time we checked it. He is worried about loss of bone mass.

Hmmm, I don't know about that.

>> Well, the imipramine bombed because it was too sleep disruptive. After taking it just two days I started having early morning awakenings. I kept up with it for a full two weeks, and the EMA's kept happening (and associated with increased daytime fatigue).

That's a good trial, I would think. Aren't you sick of trials? :)

>> I can't handle the antihistaminic effects of TCA's or Remeron, for that matter. Tiny doses just completely wreck my ability to focus and concentrate.

This is good for me to know b/c Remeron has been on my "list".

>> The Depakote, Neurontin, and Klonopin I take are all low-dose and pretty much a permanent fixture in my med regime. I still need a low-dose of a stimulant or an AD so I can focus and go through the day without yawning, napping, etc. So..I am now back on a low dose of Effexor (just 12.5mg in the AM). Much more than that will make me hypomanic. I just started it yesterday. My sleep duration was shortened, but it wasn't broken.

I do like Neurontin. I don't think I've taken it with Dep. before - it certainly has more of a calming effect for me than alone. So, for now, this regime will at least help you get those everyday tasks accomplished. ;)

Take care.

- kk


 

Re: Your cocktail...Mitch, kk or anyone Ritch

Posted by MomO3 on August 2, 2002, at 16:42:43

In reply to Re: adding t3 Krazy Kat, posted by Ritch on June 18, 2002, at 9:54:01

Hey kk & Mitch..

How are you? Are you guys still taking the same cocktails?

In reference to the post below...Tell me about the depakote in this combination.???.. I think that's where I will be next month (make that later this month)..

After a few weeks of hellbutrin, I finally got the pdoc to prescribe Effexor along with my Neurontin, Klonopin, and Ritalin (I chose ritalin because it's easier for me to regulate the dose, and although I liked the Concerta it interfered with my sleep).

At my last appt, he tried to switch me from Neurontin to Trileptal, but I could find very few positive responses... so I told him I wouldn't take it. I am thinking of outright asking for depakote because as I am ramping up on the Effexor, I am brimming with hypomania (which is a nice change after a seemingly endless depression). My dad says don't mess with a good upswing, but I am just looking for an even keel.

I have not taken depakote before so I am wondering about the pros/cons of taking both depakote and neurontin? Do you really need both? Do they work on different things?

Thanks for any input from anyone!!

Mom (Holly)

> >
> > i have been taking 1000 depakote and 18 mg of concerta upon rising - 8:00 - 9:00 am (on good days :)), and then same doses at about 2:00 pm. this is helping. I get tired some days at about 8:00 pm, And I have added a little "left over" Neurontin, not consistently but when I feel anxious at a certain point during the day. it seems to help the anxiety.
> >
> > Where are you with your regime?
> >
> > - kk
>
>
> Hi,
>
> I noticed you backed off the single 36mg dose of Concerta and are taking two 18mg doses-that is probably a LOT smoother. I have never tried T3/T4 augmentation. My endocrinologist is very conservative and is against it-since my TSH was 1.4 last time we checked it. He is worried about loss of bone mass. I was just thinking of "tweaking" it down to about 1.0. Well, the imipramine bombed because it was too sleep disruptive. After taking it just two days I started having early morning awakenings. I kept up with it for a full two weeks, and the EMA's kept happening (and associated with increased daytime fatigue). I can't handle the antihistaminic effects of TCA's or Remeron, for that matter. Tiny doses just completely wreck my ability to focus and concentrate. The Depakote, Neurontin, and Klonopin I take are all low-dose and pretty much a permanent fixture in my med regime. I still need a low-dose of a stimulant or an AD so I can focus and go through the day without yawning, napping, etc. So..I am now back on a low dose of Effexor (just 12.5mg in the AM). Much more than that will make me hypomanic. I just started it yesterday. My sleep duration was shortened, but it wasn't broken. ALL SSri's shorten my sleep. No reflux like the Celexa caused. I'll probably have to stick with the low-dose Effexor through this depressive spell-I don't have the time to stop and start crap like I had earlier.
>
> Mitch
>

 

Re: Your cocktail...Mitch, kk or anyone Ritch MomO3

Posted by Ritch on August 3, 2002, at 0:16:17

In reply to Re: Your cocktail...Mitch, kk or anyone Ritch, posted by MomO3 on August 2, 2002, at 16:42:43

> Hey kk & Mitch..
>
> How are you? Are you guys still taking the same cocktails?

Hi, I am currently on:
Depakote 250mg +Clonazepam .25mg +Diphenhydramine 25mg @bedtime.
Effexor XR 12.5mg + Bupropion 12.5mg (Ok, I count granules in the capsule, crush the bupropion,etc.) +500mg L-tyrosine +500mg Vitamin C + sublingual B-complex first thing in the morning on an empty stomach. Then I do a vigorous cardiovascular workout, weight lifting, stretches, etc. for an hour.
THEN, 1G of Flaxseed oil with breakfast and then at lunch with a multivitamin and folic acid. A couple of cups of stout coffee in the afternoons with nearly an hour of bright outdoor light exposure.


>
> In reference to the post below...Tell me about the depakote in this combination.???.. I think that's where I will be next month (make that later this month)..

Depakote works great for hostility, intraday cycling, mixed states (the best uses IMO). Little efficacy for "uncomplicated" depression, so-so for anxiety, so-so for sleep. I haven't heard of anyone here yet that was happy with Depakote monotherapy for their breakthrough depressions they experience. Lithium is a far superior monotherapy for bipolar IMO (that is, if you can tolerate it OK).

>
> After a few weeks of hellbutrin, I finally got the pdoc to prescribe Effexor along with my Neurontin, Klonopin, and Ritalin (I chose ritalin because it's easier for me to regulate the dose, and although I liked the Concerta it interfered with my sleep).
>
> At my last appt, he tried to switch me from Neurontin to Trileptal, but I could find very few positive responses... so I told him I wouldn't take it. I am thinking of outright asking for depakote because as I am ramping up on the Effexor, I am brimming with hypomania (which is a nice change after a seemingly endless depression). My dad says don't mess with a good upswing, but I am just looking for an even keel.


Watch out for Effexormania! I am serious. I lately got up to just 25mg/day and I was getting loopy. I took 37.5mg of XR once (during my hypomania-prone part of the year) and I was intensely hypomanic within two hours and it lasted half the day! Raging and shouting on the phone-not good. BEWARE-watch the dose and your reaction to AD's.

>
> I have not taken depakote before so I am wondering about the pros/cons of taking both depakote and neurontin? Do you really need both? Do they work on different things?
>
> Thanks for any input from anyone!!
>
> Mom (Holly)

Neurontin settles anxiety better than any non-benzo anticonvulsant I have tried. I get some weird sfx above minimal dosages, however, and I am not even taking it all now. I have experienced good antidepressant effects from it in the past. Generally, for most folks, I think Dep+N. makes a good combo.

Mitch

 

Re: Your cocktail...Mitch, kk or anyone Ritch

Posted by MomO3 on August 6, 2002, at 10:49:26

In reply to Re: Your cocktail...Mitch, kk or anyone Ritch MomO3, posted by Ritch on August 3, 2002, at 0:16:17

> Hi, I am currently on:
> Depakote 250mg +Clonazepam .25mg +Diphenhydramine 25mg @bedtime.
> Effexor XR 12.5mg + Bupropion 12.5mg (Ok, I count granules in the capsule, crush the bupropion,etc.) +500mg L-tyrosine +500mg Vitamin C + sublingual B-complex first thing in the morning on an empty stomach. Then I do a vigorous cardiovascular workout, weight lifting, stretches, etc. for an hour.
> THEN, 1G of Flaxseed oil with breakfast and then at lunch with a multivitamin and folic acid. A couple of cups of stout coffee in the afternoons with nearly an hour of bright outdoor light exposure.

Is this working well for you? How long have you been at this regime?


> Depakote works great for hostility, intraday cycling, mixed states (the best uses IMO).

Hip! Hip! Hooray!!! I have been intraday cycling or mixed-states for several months now... started with a nasty bout of paxil... I get more depressed than manic - but the neurontin definitely doesn't control the swings. With the klonopin my anxiety is virtually nill.

> Watch out for Effexormania! I am serious. I lately got up to just 25mg/day and I was getting loopy. I took 37.5mg of XR once (during my hypomania-prone part of the year) and I was intensely hypomanic within two hours and it lasted half the day! Raging and shouting on the phone-not good. BEWARE-watch the dose and your reaction to AD's.

Already there!!! HA HAHA! My pdoc is ramping me up to 225mg effexor... with that 3rd pill I am definitely loopy... ya know - out planting flowers at 3pm and 105 degrees in Texas in August! Gotta put that energy somewhere ;-)

> Neurontin settles anxiety better than any non-benzo anticonvulsant I have tried. I get some weird sfx above minimal dosages, however, and I am not even taking it all now. I have experienced good antidepressant effects from it in the past. Generally, for most folks, I think Dep+N. makes a good combo.

I think I will have to try the combo.. maybe cut back my neurontin dosage... at 2400 I was stumbling around my house..I am much better with 1200 at night and 300-600 during the day.

So tell me about the non-prescription stuff.. what are those to treat? Why the mini-dose of wellbutrin? At theraputic levels of wellbutrin, I tried to get myself arrested in an airport..can you say hostility?!

Thanks again!
Holly

 

Re: Your cocktail...Mitch, kk or anyone MomO3

Posted by Ritch on August 6, 2002, at 12:32:24

In reply to Re: Your cocktail...Mitch, kk or anyone Ritch, posted by MomO3 on August 6, 2002, at 10:49:26

> > Hi, I am currently on:
> > Depakote 250mg +Clonazepam .25mg +Diphenhydramine 25mg @bedtime.
> > Effexor XR 12.5mg + Bupropion 12.5mg (Ok, I count granules in the capsule, crush the bupropion,etc.) +500mg L-tyrosine +500mg Vitamin C + sublingual B-complex first thing in the morning on an empty stomach. Then I do a vigorous cardiovascular workout, weight lifting, stretches, etc. for an hour.
> > THEN, 1G of Flaxseed oil with breakfast and then at lunch with a multivitamin and folic acid. A couple of cups of stout coffee in the afternoons with nearly an hour of bright outdoor light exposure.
>
> Is this working well for you? How long have you been at this regime?


Oh, I have pretty much "evolved" into this. I have two or more major depressions a year and they are seasonal and fairly predictable. I have to take something stimulant-like to keep me awake, and bupropion half-ass accomplishes that. It is strange, but if I get rid of the daytime sleepiness I am generally not depressed.


>
>
> > Depakote works great for hostility, intraday cycling, mixed states (the best uses IMO).
>
> Hip! Hip! Hooray!!! I have been intraday cycling or mixed-states for several months now... started with a nasty bout of paxil... I get more depressed than manic - but the neurontin definitely doesn't control the swings. With the klonopin my anxiety is virtually nill.


Klonopin has a fairly strong antimanic effect as well. I am trying to withdraw from it (not completely). I just want to reach a point where I just take it as needed during the daytime for situational panic. Benzos can screw up your sleep, and I think that is where most of my problems originate (not enough, too much, or poor sleep quality). Dr. Ivan Goldberg was posting here a little while back and mentioned that lifting Klonopin dosage during bipolar depression helps. It does seem to have helped me. Depakote definitely is the "key" to keeping me off the ceiling. Neurontin has worked for me before, but I didn't have as much control of my highs.


>
> > Watch out for Effexormania! I am serious. I lately got up to just 25mg/day and I was getting loopy. I took 37.5mg of XR once (during my hypomania-prone part of the year) and I was intensely hypomanic within two hours and it lasted half the day! Raging and shouting on the phone-not good. BEWARE-watch the dose and your reaction to AD's.
>
> Already there!!! HA HAHA! My pdoc is ramping me up to 225mg effexor... with that 3rd pill I am definitely loopy... ya know - out planting flowers at 3pm and 105 degrees in Texas in August! Gotta put that energy somewhere ;-)


Be careful :) I read a post on another board about someone that was diagnosed with unipolar depression and got their dose jacked up to 300mg/day, and he just completely flipped out! He had a bunch of delusions about being in a nuclear attack and all sorts of wacky stuff. Of course, they thought he was schizophrenic. They stopped the Effexor and his symptoms went away! That's when they realized he was bipolar and that the antidepressant induced a psychotic manic state.

>
> > Neurontin settles anxiety better than any non-benzo anticonvulsant I have tried. I get some weird sfx above minimal dosages, however, and I am not even taking it all now. I have experienced good antidepressant effects from it in the past. Generally, for most folks, I think Dep+N. makes a good combo.
>
> I think I will have to try the combo.. maybe cut back my neurontin dosage... at 2400 I was stumbling around my house..I am much better with 1200 at night and 300-600 during the day.


1200mg/ of Neurontin was the max I could tolerate and still be able to do simple math. However, low doses (200-400mg/day) of the stuff seem to be somewhat alerting/stimulating (but I think that is probably just the reduction of anxiety makes you less fatigued).

>
>
>
> So tell me about the non-prescription stuff.. what are those to treat? Why the mini-dose of wellbutrin? At theraputic levels of wellbutrin, I tried to get myself arrested in an airport..can you say hostility?!
>
> Thanks again!
> Holly
>


Fuscia (another poster here) talked about using L-tyrosine (an amino acid). I had heard about it before, but I am generally skeptical about supplements. This time I decided to give it a try (I don't see how it could hurt). There have been quite a few positive reports about Omega-3 fatty acids being used for bipolar and ADHD (flax and fish oils). If it doesn't help for that, it can lower your cholesterol. I have to keep my antidepressant dosages way down, or I get tweaky, grouchy, hypomanic, ugh! I have tried increasing "mood stabilizers" to "cover" it, but it seems to be the AD's themselves being the problem rather than inadequate mood stabilizer dosages, just my personal experience anyhow.

good luck,
You'd better make sure to
water those flowers a lot!

Mitch

 

Is Falling asleep on Concerta normal????

Posted by watergirl on June 1, 2004, at 0:25:27

In reply to 12-14 hr lasting Concerta Krazy Kat, posted by IsoM on June 2, 2002, at 17:54:57

I cant stay awake on Concerta. Its the first time Ive been prescribed a stimulant. Ive been on it 1 week.

I also take:
20 mgs Lexapro
12 mgs Gabatril
.05 mgs Klonopin (bedtime)
18mgs Concerta

Sleepy,
Cindy

 

Re: Is Falling asleep on Concerta normal????

Posted by momO3 on June 1, 2004, at 11:32:06

In reply to Is Falling asleep on Concerta normal????, posted by watergirl on June 1, 2004, at 0:25:27

> I cant stay awake on Concerta. Its the first time Ive been prescribed a stimulant. Ive been on it 1 week.
>
> I also take:
> 20 mgs Lexapro
> 12 mgs Gabatril
> .05 mgs Klonopin (bedtime)
> 18mgs Concerta
>
> Sleepy,
> Cindy


welll... from what I understand, sometimes if you are ADD, that meds will have an opposite effect (ie benedryl keeps you awake sudafed makes you sleepy.)

I have had this problem recently - a cup of coffee is like a sleeping pill for me..

coffee + ritalin = naptime

so I switched back to dexadrine which is also prescribed for narcolepsy - it keeps me awake where the others fail..

concerta is also a long acting one with time released 'barrels' inside of it.. if the first dose of meds wears off before the second 'barrel' dissolves then you may have a lull in the middle of the day before the next dose of meds is released.

Another note... klonopin was tooooooo strong for me, it had a big hangover effect.. if you are dozing off in the morning that could be a contributing factor.
Holly - now mom'04

 

Re: Is Falling asleep on Concerta normal???? watergirl

Posted by blondegirl47 on June 3, 2004, at 12:30:27

In reply to Is Falling asleep on Concerta normal????, posted by watergirl on June 1, 2004, at 0:25:27

I had the same response to concerta. I was on a higher dose though. It is so time released that it never seemed to kick in for me. Maybe that dose isn't strong enough to counter act the sleepyness from the other meds you are taking. My pdoc lets me take one 12.5 adderall with my dexedrine spansules. That seems to be the only way I can get time release medication to work for me. I am not a ritalin fan at all and I believe that is what concerta is made up of. Hope this helps
Blondegirl

 

Thanks; Any more advise from stim users??

Posted by watergirl on June 6, 2004, at 17:06:38

In reply to Is Falling asleep on Concerta normal????, posted by watergirl on June 1, 2004, at 0:25:27

Thanks for the input Mom03 & Blondgirl. I scheduled an early appt to see my p-doc. I see him Fri.


> I cant stay awake on Concerta. Its the first time Ive been prescribed a stimulant. Ive been on it 1 week.
>
> I also take:
> 20 mgs Lexapro
> 12 mgs Gabatril
> .05 mgs Klonopin (bedtime)
> 18mgs Concerta
>
> Sleepy,
> Cindy

Is it normal to fall asleep on Concerta??


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