Posted by Lou Pilder on May 27, 2011, at 16:01:20
In reply to Med Crisis - Lost faith in pdoc need input!, posted by Laurie1041 on May 27, 2011, at 14:50:48
> Hi,
>
> I would appreciate any insight and recommendations. I thought I posted this earlier, but it appears to have disappeared, so here goes again. I will warn you up front that it is lengthy and I feel this is because I am just traumatized by my experience and don't know what else to do. But if you do choose to read and you have some pointers, I am so thankful.
>
> I have taken Effexor and Klonopin since 2000 or so for a situational-type of depression. The Klonopin was an add-on because the start-up effects of Effexor gave me nocturnal panic attacks. I now know for myself what MDD feels like and this was certainly not MDD. I have also attempted to taper off of Effexor or other SSRI's for several years without success due to withdrawal.
>
> During the years I have added Wellbutrin (severe anxiety), low-dose Lithium (no effect), Abilify (no effect) to augment the Effexor. These were all prescribed by various providers as I tried to search for a pdoc that I could work with. My depression was vague and certainly did not meet any DSM criteria.
>
> In 2007 I went to a recommended pdoc who said that my symptoms were consistent with Shift Work Sleep Disorder (I am an RN and had started working the night shift in 2006) and prescribed Provigil along with continuing the Effexor, Klonopin. Within days, I was feeling so much better, so much so, that I racked up a huge credit card debt. I crashed and burned and became very, very anxious and depressed over what I had done and the diagnosis of BP I was somewhat relieving as it explained my behavior, or did it?
> No one ever questioned the Provigil and neither did I. The medication cocktails started and I met each new drug with side effect after side effect. I felt fine on Effexor, Klonopin and Lithium.
>
> In Jan 2009, newly widowed and devastated by my loss, (now I knew what major depression and grief were), relocated from another state to where my family lives and talking to my pdoc over the phone instead of finding a local pdoc, I was genuinely without support or guidance. I needed crisis intervention no doubt. I can almost laugh about how my crisis intervention came about and I was 5150'd under false pretenses by a well-meaning, deeply concerned sister, but this involuntary hospitalization led me to my current pdoc, and to my current situation with my meds and resulting mood instability. The new med I was discharged on in addition to those previous was Wellbutrin which I was surprised that I was not mood labile or extremely anxious while in the hospital. Within 4 days, I was so anxious I went back to the hospital. Naturally, the Wellbutrin was d/c'd.
>
> In Feb. 2009, I was discharged on Adderrall XR 30 mg. twice daily, Cymbalta 120 mg, Seroquel 50 mg at bedtime, Klonopin 1 mg at bedtime. My pdoc said he had me "squeezed" with the Adderrall and the Cymbalta, but I had no idea what he meant. I felt so good on the Adderrall that I completely stopped grieving for my husband and went through $80,000 cash (life insurance proceeds), dyed my bangs from brown to red or fushia, tattooed my abdomen and back (previously no tattoos - and I was 49 at the time), lost major weight, withdrew from my family and hung out with "fun" people (no drinking or drugs), and bought more shoes than needed in a lifetime, embarrassed my young adult daughters by my manner of dress, etc. I was euphoric on Adderrall, but did not know it AND my pdoc was seeing me weekly. Hello??? Is your patient manic???!!!
>
> I came back to earth in relatively one piece on my own a few months later and felt mood stable (still on Adderrall) and went back to work as an RN after being out of work for 2 years (private disability), unfortunately the only way I was able to re-enter the workforce was to get hired at my last place of employment which was in another state. This lasted about 2 months as I tried to commute every other week, AND work the night shift. I thought if I could just make it 1 year at my former workplace, I could then get a job anywhere near my home. I just needed 1 year of current work history. Not only did I find out that bedside nursing had only gotten worse and far more stressful than 2 years previous, but that I still was not happy doing bedside nursing due to the horrible stress. I had to resign in February 2010 and I fell into a depression where I did not even realize I was depressed. I just slept a lot.
>
> In March 2010, a friend stayed at my house for a few weeks and noticed that I was sleeping all the time. She said I might be depressed. I said I would check into the hospital. I think the only thing that changed was my SSRI. I was discharged after 17 days.
>
> In March 2011, after I told my pdoc I wanted off of Adderrall, Klonopin, and Pristiq, in whatever order he recommended. He had me discontinue the Adderrall, had me start on Nuvigil (huh?), and decrease my Klonopin (now at 2 mg. to 1.75 mg). He never mentioned I would go through Adderrall withdrawals and become severely depressed. And that tapering my Klonopin by 0.25 mg. was a big taper.
>
> In April, 2011 I told him I was severely depressed and anxious and he told me to resume Adderrall and Klonopin. Exactly 2 days after I resumed the Adderrall after being off of it for 1 month, I started becoming extremely mood unstable, enraged at my meds, the fact that I was getting worse and not better, then hopeless and suicidal. I voluntarily admitted myself. My pdoc stopped the Adderrall, started me on Depakote and said I was a "very, very sick, ill woman". Something in me clicked and I told myself that my doctor was actually making me very, very sick. The plan was to stop the Adderral and taper slowly off the Pristiq, however, obviously my pdoc has not withdrawn anyone from Pristiq yet because he dropped my dose from 100 mg. to 50 mg. (the only dosages available and they are time-released tablets). He never told me I would go into withdrawals which I did within 4 days of discharge. He added Lexapro 10 mg. to be increased to 20 mg. when stable in order to accomplish 2 things; stop the withdrawals and cross-over to a SSRI that comes in a liquid form for easier titration. 4 days ago, I became mood unstable again and I called him and he said that he wanted to get me off the Pristiq so we could begin tapering off of the Lexapro, but that the Lexapro needed to be increased to 20 mg. to lessen withdrawals when I d/c'd the Pristiq. Within 2 days of increasing the Lexapro to 20 mg. I became mood unstable again (I have read that this is a common, however, potentially dangerous situation, when increasing or decreasing SSRI's). I called my pdoc last night very, very angry and he called in an Rx for Zyprexa 5 mg. to be used as a "rescue" med until I can d/c the Pristiq.
>
> I am between a rock and a hard place. I cannot maintain any mood stability with 2 AD's on board and with dosage increases. I am understandably angry and frustrated, but most of all I am scared. I have an appt. with a Internist at a major medical research center in So Cal so I can get a referral to be seen by their mood disorders clinic and get at the very least someone who is not going to make not only me, but my family so distraught over what has happened to me since 2009. Any ideas or suggest would be most welcome. Thank you so very much. Laurie
>
> Laurie041,
You wrote,[...I would appreciate any insight and recommendations...between a rock and a hard place...]
I have read your post here and I would like to tell you my insight that what I can see clearly now. I see a cold wind that has swept into your heart. And how can you keep searching when dark clouds hide the Day.
> My insight sees that before you found yourself in your state that you describe here, there was a valley where rivers used to run. Now gone are the green fields that were kissed by the sun. My insight sees that you can be happy when you come back home, home to the green fields and life for evermore.
Lou
poster:Lou Pilder
thread:986374
URL: http://www.dr-bob.org/babble/20110515/msgs/986377.html