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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Mary Alice on August 1, 1998, at 6:22:39
My husband has been given a number of meds by different physicians: 60mg Paxil prescribed by internist for depression; Tegetrol (200mg 4 per day), Depakote (250 mg 4 per day), clonazepam (2mg at bedtime) for seizure disorder of unknown origin by neurologist; and trazodone (100mg at bedtime) by a psychiatrist. Each doc knows what the others are prescribing and some seem to want to change or delete some of the other's meds but no one will take the responsibility to do so. In the meantime, Gary is having trouble functioning on even a minimal level. The docs can't decide if his cognitive and motor problems are med related or caused by the illness (diagnosis thus far is combat ptsd but more tests scheduled for additional organic cause as neuropsych tests show he's having bigger problems than "expected" for ptsd)as he had some of these same symptoms (disorientation, memory loss, stumbling, difficulty speaking) for short periods of time prior to initial treatment. The neurologist won't change anything until he gets results of MRI-A, lumbar puncture and EMG. That will be August 31! In the meantime he's fallen a few times and needs assistance to do even minor tasks. Any opinions about this mix of meds would be greatly appreciated.
Posted by Toby on August 7, 1998, at 11:35:58
In reply to Too many meds?!, posted by Mary Alice on August 1, 1998, at 6:22:39
I don't know how old your husband is or if he has any other medical problems that could contribute to his initial symptoms. There are many patients who take that exact combination of medication and some do fine and others have tremendous side effects. The amount and kind of side effects generally has to do with age (older patients don't process medications as well so they get more side effects), drug interactions and/or medical conditions that might make the kidneys or liver work less well. Since the only info I have is the combo of medications, let me tell you the POSSIBLE interactions: First, any of the medications could cause some or all of his symptoms or make them worse if he had them before he started taking medications. Tegretol causes Depakote blood levels to decrease. Depakote causes Tegretol blood levels to increase. Paxil causes Tegretol levels to increase. Paxil has no effect on Depakote blood levels. Paxil does not affect Klonopin levels but can increase other benzodiazepine levels. Depakote increases Klonopin levels. Tegretol decreases Klonopin levels by 25-50%. So you can see this is very complicated and this is probably why none of the doctors want to mess around with a medication someone else started: one change can drastically affect how the remaining medications work. Don't change anything yourself. Contact the neurologist and psychiatrist (the psychiatrist should be the one deciding on an antidepressant at this point, not the internist, since the case is so complicated. And the internist should not feel slighted, he should be grateful that an expert is available to your husband) and demand that they consult with each other (on the phone, in person, however they want to do it) and SOON. They need to cooperate to manage the medication side effects and to tell you how to manage the symptoms (whatever the cause) until the test results are available. In addition, once the medical stuff is cleared up, I recommend your husband see someone for EMDR (see the posting on this website) to treat his PTSD. Good luck.
Posted by Mary Alice on August 15, 1998, at 8:15:19
In reply to Re: Too many meds?!, posted by Toby on August 7, 1998, at 11:35:58
Thanks for your advice. I'd heard of EMDR before but have now begun to learn more about it. Gary is interested in trying it and is willing to do anything to get better. I have to admit we'd already begun reduction of the meds when I read your post. Gary simply couldn't tolerate sleeping 19-20 hours a day and stumbling around in a fog the other 4 or 5. BTW, he's 48 years old and thus far has no firm diagnosis of any organic illness although tests are ongoing. We lowered the Paxil to 40mg from 60, the Trazadone from 100mg to 50 at bedtime and the Klonipin from 2mg to 1 at night. We didn't change the Tegretol or Depakote other than to adjust the times he took them. Within a couple of days he "woke up". He's not in great shape but he's able to function on a much higher level. And, here's the greatest thing we've found a new psychiatrist who has experience with PTSD and he agrees with what we did though not particularly how we did it. He seems to have a good rapport with Gary - he doesn't just hand out drugs and say "go fishing and relax" like the last doc did. He's going to start real therapy! Things are looking up! Thanks again for your interest.
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