![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by bob on January 1, 2002, at 22:48:12
Happy New Year!
Well, it's been 10 years of medecine hell now for me, with exposure to more than 24 psychotropics. Nothing has truly worked. I guess I should qualify that: some meds have alleviated certain problems I have such as anxiety, or relieved depression for a short time. In the end however, everything becomes unmanageable. Side effects of the drugs - weakness, sedation, etc, as well as a lack of effectiveness in certain cases has led to an inability to hold down a job anymore. I am contemplating resigning from my job this week. It is just too hard to keep going on like this. This means I will lose everything - my health insurance, my income, and many social contacts. I am not sure I want to continue on in that situation, but I don't know what choice I have anymore; I simply cannot work. These med trials have taken too much out of me. I have no idea what I'll do when I resign. I can hardly do things now. I don't even know how to go about getting social security, or things like that. Sometimes I wonder whether it wouldn't be better for me to suck it up and do the deed. My family is getting torn apart by this disease I have, and I feel responsible. I have no desire to see my family collapse because of me. I really don't understand the point of going on with such a compromised lifestyle: i.e., not being able to work, being extremely unhealthy (overweight and inactive), not being able to perform any kind of sexual activity, sleeping all the time, and putting up with drug induced apathy.
It's really odd, but I think I'd rather be dead, than live another 30 or more years on these meds -- even if they made me mentally sound but I was 50lbs overweight and a bona fide mind-numbed eunuch. It's an unacceptable compromise to me.
Sorry to be spreading doom and gloom, but I'm somewhat desperate at this point.
Bob
Posted by jimmygold70 on January 2, 2002, at 3:07:41
In reply to Almost finished., posted by bob on January 1, 2002, at 22:48:12
Hi Bob,
Please state your exact diagnosis and what drugs you took over the years (ye, all the 24), what each did for you (effects and side effects) and at what dose.
I'll try to help and recommend. Don't do anything on impulse.
Jimmy
Posted by Cindylou on January 2, 2002, at 7:03:40
In reply to Almost finished., posted by bob on January 1, 2002, at 22:48:12
Please hang in there. I am feeling the same way you are right now, but I know it's depression talking and not what's really true.
I know your struggles, I share your suffering. Please let that be of some comfort, to know you are not alone.
Please hang in there and watch for posts that can bring you support, encouragement and advice.
I am so sorry for your pain.
cindy> Happy New Year!
>
> Well, it's been 10 years of medecine hell now for me, with exposure to more than 24 psychotropics. Nothing has truly worked. I guess I should qualify that: some meds have alleviated certain problems I have such as anxiety, or relieved depression for a short time. In the end however, everything becomes unmanageable. Side effects of the drugs - weakness, sedation, etc, as well as a lack of effectiveness in certain cases has led to an inability to hold down a job anymore. I am contemplating resigning from my job this week. It is just too hard to keep going on like this. This means I will lose everything - my health insurance, my income, and many social contacts. I am not sure I want to continue on in that situation, but I don't know what choice I have anymore; I simply cannot work. These med trials have taken too much out of me. I have no idea what I'll do when I resign. I can hardly do things now. I don't even know how to go about getting social security, or things like that. Sometimes I wonder whether it wouldn't be better for me to suck it up and do the deed. My family is getting torn apart by this disease I have, and I feel responsible. I have no desire to see my family collapse because of me. I really don't understand the point of going on with such a compromised lifestyle: i.e., not being able to work, being extremely unhealthy (overweight and inactive), not being able to perform any kind of sexual activity, sleeping all the time, and putting up with drug induced apathy.
>
> It's really odd, but I think I'd rather be dead, than live another 30 or more years on these meds -- even if they made me mentally sound but I was 50lbs overweight and a bona fide mind-numbed eunuch. It's an unacceptable compromise to me.
>
> Sorry to be spreading doom and gloom, but I'm somewhat desperate at this point.
>
> Bob
Posted by Cindylou on January 2, 2002, at 12:02:28
In reply to Re: Almost finished. » bob, posted by Cindylou on January 2, 2002, at 7:03:40
> but I know it's depression talking and not what's really true.
Hi again, Bob ...
Just wanted to clarify the above statement I made in the earlier post ... I didn't mean to say that what you're going through and feeling aren't "true." I know that it's all very real and a horrible thing to have to go through.I meant that you are a worthwhile, valuable person ... even if that doesn't seem "true" to you right now.
again, please hang in there,
cindyPlease hang in there. I am feeling the same way you are right now,
>
> I know your struggles, I share your suffering. Please let that be of some comfort, to know you are not alone.
>
> Please hang in there and watch for posts that can bring you support, encouragement and advice.
>
> I am so sorry for your pain.
> cindy
>
> > Happy New Year!
> >
> > Well, it's been 10 years of medecine hell now for me, with exposure to more than 24 psychotropics. Nothing has truly worked. I guess I should qualify that: some meds have alleviated certain problems I have such as anxiety, or relieved depression for a short time. In the end however, everything becomes unmanageable. Side effects of the drugs - weakness, sedation, etc, as well as a lack of effectiveness in certain cases has led to an inability to hold down a job anymore. I am contemplating resigning from my job this week. It is just too hard to keep going on like this. This means I will lose everything - my health insurance, my income, and many social contacts. I am not sure I want to continue on in that situation, but I don't know what choice I have anymore; I simply cannot work. These med trials have taken too much out of me. I have no idea what I'll do when I resign. I can hardly do things now. I don't even know how to go about getting social security, or things like that. Sometimes I wonder whether it wouldn't be better for me to suck it up and do the deed. My family is getting torn apart by this disease I have, and I feel responsible. I have no desire to see my family collapse because of me. I really don't understand the point of going on with such a compromised lifestyle: i.e., not being able to work, being extremely unhealthy (overweight and inactive), not being able to perform any kind of sexual activity, sleeping all the time, and putting up with drug induced apathy.
> >
> > It's really odd, but I think I'd rather be dead, than live another 30 or more years on these meds -- even if they made me mentally sound but I was 50lbs overweight and a bona fide mind-numbed eunuch. It's an unacceptable compromise to me.
> >
> > Sorry to be spreading doom and gloom, but I'm somewhat desperate at this point.
> >
> > Bob
Posted by spike4848 on January 2, 2002, at 13:30:24
In reply to Almost finished., posted by bob on January 1, 2002, at 22:48:12
> Sorry to be spreading doom and gloom, but I'm somewhat desperate at this point.
>
> BobHey Bob,
Sounds like you have been though alot of SH*T, (excuse me Dr. Bob). Drug trials are terrible .... especially when they end in failure. I believe you will find something that will work ... I believe you are going to try nardil .... that is a great drug that often strips away anxiety and depression when other drugs have failed. Hang with the job if possible ..... otherwise you'll just be sitting around reading Psycho Babble all day .. that would be DEPRESSING. LOL.
Keep us updated!
Feel free to ask any questions!Spike
Posted by bob on January 2, 2002, at 16:02:52
In reply to Re: Almost finished. » bob, posted by Cindylou on January 2, 2002, at 7:03:40
Thanks for your concern, Cindy.
Bob
Posted by bob on January 2, 2002, at 16:05:01
In reply to clarification, posted by Cindylou on January 2, 2002, at 12:02:28
> > but I know it's depression talking and not what's really true.
>
> Hi again, Bob ...
> Just wanted to clarify the above statement I made in the earlier post ... I didn't mean to say that what you're going through and feeling aren't "true." I know that it's all very real and a horrible thing to have to go through.
>
> I meant that you are a worthwhile, valuable person ... even if that doesn't seem "true" to you right now.
>
> again, please hang in there,
> cindy
>
----------------------Cindy:
Don't worry about your wording. It's easy to tell when somebody is empathizing, and you obviously are. I didn't take it the wrong way.
Bob
Posted by bob on January 2, 2002, at 16:06:06
In reply to Re: Almost finished. » bob, posted by spike4848 on January 2, 2002, at 13:30:24
Thanks, Spike. I'll keep your thoughts in mind.
Posted by bob on January 3, 2002, at 2:38:51
In reply to Re: Almost finished. » bob, posted by jimmygold70 on January 2, 2002, at 3:07:41
Jimmy: THIS IS LONG.
I will try to put this in a nutshell, as any other attempt will end up being a novel. Even the nutshell is long though, and there are many things I had to leave out.
My original condition 11-12 years ago, was characterized by irritability, obsessive and ruminative irrational thoughts, and mild depression. I also had a severe case of something called avoidant paruresis, which in lay terms is known as "pee-shyness". I was worse at night than in the morning. I also slept too much -- often taking naps right after work. I was in excellent physical shape. Then anxiety, cycling unipolar depression, and significant anger and frustration set in. Then the medical odyssey started.
Prozac: eventual agitation, restlessness, and panic
Welbutrin: anxiety, agitation
Anafranil: Eventual control of some obsessive symptoms and some depression at the expense of my physical health: 45lb weight gain, dizzyness, sweating, total sexual dysfunction, jitteriness, etc... hard to tolerate.
Zoloft: controlled ruminations and anxiety at the expense of weight gain, sexual dysfunction, jitteriness, and diurnal variation.
Paxil: controlled ruminations and anxiety at the expense of me sleeping 18hrs per day.
Effexor: initial response was excellent in all respects! degraded into weight gain, oversleeping, anger, and severe diurnal variation. probably don't need to mention the ridiculous withdrawal other than to say i don't know if i was ever the same
Serzone: took for about 1.5 weeks and could not get past the dizzyness, nausea, and headaches
Depakote: took away anxiety, but did almost nothing for motivation of any sort. possibly helped a little with ruminations. this med was not acceptable without an energizing adjuct, as it caused intractable drowsiness -- thus, Welbutrin was always concurrently taken, and eventually Ritalin and Dexedrine were also tried on top of that, since Welbutrin was not doing enough. the stimulants i developed a rapid tolerance to and then i started getting physical fatigue from them. the effect was very short lived. Depakote also caused weight gain.
Celexa: by itself was not very effective -- it got rid of mental anxiety, but i was left with a general physical discomfort (something like muscle tightness) that Celexa didn't seem to address. This, as with all other heavily serotonergic drugs, caused severe diurnal variation. I played around with thyroid augmentation on this med and got some excellent results for about 1 week, after which the effect started to become unreliable and less intense. eventually I got mired in symptoms of hyperthyroidism and could not stand it any longer. My physical condition by this time was quite degraded -- the muscle tension/discomfort, and the weight gain were hard to deal with.
Lamicatal: showed promise in that I felt refreshed in the mornings for the first time ever since SSRIs. Developed a rash and my Pdoc told me to discontinue.
Topomax: I took a big chance here and transitioned to monotherapy with a drug from an entirely new class. Initially this drug showed promise as it gave me some hypomania and I was able to wake up in the morning somewhat refreshed. It also helped with ruminations. However, it came with a host of very nasty side effects, such as cognitive dysfuntion, cold and pain in my hands, rash, sore throat, cold body temp at times... the list goes on. I was willing to endure it because it was energizing and I felt so much better physically than I had on SSRIs. There was much less sexual effects, and I was losing weight also. It exploded into a nervous breakdown and coming off of it was the most harrowing experience (mentally of my life). I was never closer to suicide for a longer period. Klonopin was added to the mix here, and has never been removed.
Remeron: excellent sleep at night, didn't wake up in the morning, didn't seem to touch my depression.
Tegretol and Luvox: sweating, tired, added to muscle discomfort -- hard to tolerate
Trileptal and Luvox: similar to Tegretol - but induced agitation
Geodon and Luvox: induced agitation and akathisia within 2 days.
Luvox and Klonopin: what I'm currently on -- 50mg at bedtime. Klonopin .5mg qid. It has taken about 6 months since my near death experience with Topomax, but I have nearly returned to the typical response I used to get from SSRIs (I thought for awhile I had been rendered untreatable by Topomax). My anxiety is reasonably well controlled at the expense of oversleeping and severe dirurnal variation. I don't tend to overeat quite as much with the other SSRIs, but am noticing bingeing creeping back in. The antidepressant effect is not very robust. Sexual dysfunction is present as with all the other SSRIs. The therapeutic effects of the medecine don't seem to be very reliable anymore. I now experience things on a regular basis I couldn't have imagined 11 or 12 years ago: muscle tension/discomfort, horrific despondency, agitation, cold hands, alternating hot and cold body, sweating. These things all cycle in their own way.
I've also tried Lithium, trazodone, and buspar. The latter two seemed to do almost nothing. The former made me sick to my stomach, my hair started falling out, and of course there was the weight gain. I wasn't on it long enough to know if any true benefit would have been realized.
Now for some general comments:
Drugs with significant SRI action always seem to end up giving me the same predicament: the severe diurnal variation I referred to previously. By this I mean I eventually am so sedated in the morning, that I literally don't even hear my alarm clock. If am awoken by something, I hardly remember it. It's hard to live my life when I don't truly wake up until 2 in the afternoon. I'm not exaggerating here -- it's truly that extreme. My mood progressively lifts throught the remainder of the day and I stay up late into the night. Nothing... and I mean NOTHING I have ever done on any of the SRI meds has changed this response. It is the one thing that I can point to as an absolutely unacceptable side-effect. I can't hold down a job or live much of a life with that type of response. It happened on Paxil, Zoloft, Effexor, Celexa, Luvox, and Anafranil. Depakote I slept every chance I got, it seemed. There wasn't necessarily a diurnal variation, but it didn't matter.
I've also tried many supplements at times with little or no effect: Omega-3, 5-HTP, St. Johns Wort, to name a few.
MAOIs have been suggested to me, but I literally don't know if I'd survive the washout period without wacking myself. I am a dangerously unstable mess without meds now. I'd also probably have to deal with withdrawal effects from Luvox at this point.Maybe ECT with maintenance treatments? Medication trials are really getting to be too much at this point. There are obviously myriad combinations left to try, but I'm really not sure I'm up to it anymore. It takes too much out of me. I'm tired. Putting up with side effects and then finding out that 3 to 6 months down the road I can't live with the drug is becoming unacceptable at this point.
Anyway... sorry this is so long.
Posted by Cindylou on January 3, 2002, at 6:42:08
In reply to Re: Almost finished. » jimmygold70, posted by bob on January 3, 2002, at 2:38:51
Hi bob,
Wondering about that Lamictal rash ... was it severe? Did you start out at a high dose? If the rash wasn't too severe, and if you started at too high of a dose, perhaps you could try it again and titrate up slowly ... it seems to be the one med that helped you.There are still others out there as well, however I definitely understand your hesitation at trying even more meds when your reactions to them are so severe.
But, keep on keeping on ...
and keep us posted,
cindy> Jimmy: THIS IS LONG.
>
> I will try to put this in a nutshell, as any other attempt will end up being a novel. Even the nutshell is long though, and there are many things I had to leave out.
>
> My original condition 11-12 years ago, was characterized by irritability, obsessive and ruminative irrational thoughts, and mild depression. I also had a severe case of something called avoidant paruresis, which in lay terms is known as "pee-shyness". I was worse at night than in the morning. I also slept too much -- often taking naps right after work. I was in excellent physical shape. Then anxiety, cycling unipolar depression, and significant anger and frustration set in. Then the medical odyssey started.
>
> Prozac: eventual agitation, restlessness, and panic
>
> Welbutrin: anxiety, agitation
>
> Anafranil: Eventual control of some obsessive symptoms and some depression at the expense of my physical health: 45lb weight gain, dizzyness, sweating, total sexual dysfunction, jitteriness, etc... hard to tolerate.
>
> Zoloft: controlled ruminations and anxiety at the expense of weight gain, sexual dysfunction, jitteriness, and diurnal variation.
>
> Paxil: controlled ruminations and anxiety at the expense of me sleeping 18hrs per day.
>
> Effexor: initial response was excellent in all respects! degraded into weight gain, oversleeping, anger, and severe diurnal variation. probably don't need to mention the ridiculous withdrawal other than to say i don't know if i was ever the same
>
> Serzone: took for about 1.5 weeks and could not get past the dizzyness, nausea, and headaches
>
> Depakote: took away anxiety, but did almost nothing for motivation of any sort. possibly helped a little with ruminations. this med was not acceptable without an energizing adjuct, as it caused intractable drowsiness -- thus, Welbutrin was always concurrently taken, and eventually Ritalin and Dexedrine were also tried on top of that, since Welbutrin was not doing enough. the stimulants i developed a rapid tolerance to and then i started getting physical fatigue from them. the effect was very short lived. Depakote also caused weight gain.
>
> Celexa: by itself was not very effective -- it got rid of mental anxiety, but i was left with a general physical discomfort (something like muscle tightness) that Celexa didn't seem to address. This, as with all other heavily serotonergic drugs, caused severe diurnal variation. I played around with thyroid augmentation on this med and got some excellent results for about 1 week, after which the effect started to become unreliable and less intense. eventually I got mired in symptoms of hyperthyroidism and could not stand it any longer. My physical condition by this time was quite degraded -- the muscle tension/discomfort, and the weight gain were hard to deal with.
>
> Lamicatal: showed promise in that I felt refreshed in the mornings for the first time ever since SSRIs. Developed a rash and my Pdoc told me to discontinue.
>
> Topomax: I took a big chance here and transitioned to monotherapy with a drug from an entirely new class. Initially this drug showed promise as it gave me some hypomania and I was able to wake up in the morning somewhat refreshed. It also helped with ruminations. However, it came with a host of very nasty side effects, such as cognitive dysfuntion, cold and pain in my hands, rash, sore throat, cold body temp at times... the list goes on. I was willing to endure it because it was energizing and I felt so much better physically than I had on SSRIs. There was much less sexual effects, and I was losing weight also. It exploded into a nervous breakdown and coming off of it was the most harrowing experience (mentally of my life). I was never closer to suicide for a longer period. Klonopin was added to the mix here, and has never been removed.
>
> Remeron: excellent sleep at night, didn't wake up in the morning, didn't seem to touch my depression.
>
> Tegretol and Luvox: sweating, tired, added to muscle discomfort -- hard to tolerate
>
> Trileptal and Luvox: similar to Tegretol - but induced agitation
>
> Geodon and Luvox: induced agitation and akathisia within 2 days.
>
> Luvox and Klonopin: what I'm currently on -- 50mg at bedtime. Klonopin .5mg qid. It has taken about 6 months since my near death experience with Topomax, but I have nearly returned to the typical response I used to get from SSRIs (I thought for awhile I had been rendered untreatable by Topomax). My anxiety is reasonably well controlled at the expense of oversleeping and severe dirurnal variation. I don't tend to overeat quite as much with the other SSRIs, but am noticing bingeing creeping back in. The antidepressant effect is not very robust. Sexual dysfunction is present as with all the other SSRIs. The therapeutic effects of the medecine don't seem to be very reliable anymore. I now experience things on a regular basis I couldn't have imagined 11 or 12 years ago: muscle tension/discomfort, horrific despondency, agitation, cold hands, alternating hot and cold body, sweating. These things all cycle in their own way.
>
> I've also tried Lithium, trazodone, and buspar. The latter two seemed to do almost nothing. The former made me sick to my stomach, my hair started falling out, and of course there was the weight gain. I wasn't on it long enough to know if any true benefit would have been realized.
>
> Now for some general comments:
>
> Drugs with significant SRI action always seem to end up giving me the same predicament: the severe diurnal variation I referred to previously. By this I mean I eventually am so sedated in the morning, that I literally don't even hear my alarm clock. If am awoken by something, I hardly remember it. It's hard to live my life when I don't truly wake up until 2 in the afternoon. I'm not exaggerating here -- it's truly that extreme. My mood progressively lifts throught the remainder of the day and I stay up late into the night. Nothing... and I mean NOTHING I have ever done on any of the SRI meds has changed this response. It is the one thing that I can point to as an absolutely unacceptable side-effect. I can't hold down a job or live much of a life with that type of response. It happened on Paxil, Zoloft, Effexor, Celexa, Luvox, and Anafranil. Depakote I slept every chance I got, it seemed. There wasn't necessarily a diurnal variation, but it didn't matter.
>
> I've also tried many supplements at times with little or no effect: Omega-3, 5-HTP, St. Johns Wort, to name a few.
>
>
> MAOIs have been suggested to me, but I literally don't know if I'd survive the washout period without wacking myself. I am a dangerously unstable mess without meds now. I'd also probably have to deal with withdrawal effects from Luvox at this point.
>
> Maybe ECT with maintenance treatments? Medication trials are really getting to be too much at this point. There are obviously myriad combinations left to try, but I'm really not sure I'm up to it anymore. It takes too much out of me. I'm tired. Putting up with side effects and then finding out that 3 to 6 months down the road I can't live with the drug is becoming unacceptable at this point.
>
> Anyway... sorry this is so long.
Posted by jimmygold70 on January 3, 2002, at 15:39:27
In reply to Re: Almost finished. » jimmygold70, posted by bob on January 3, 2002, at 2:38:51
> My original condition 11-12 years ago, was characterized by irritability, obsessive and ruminative irrational thoughts, and mild depression. I also had a severe case of something called avoidant paruresis, which in lay terms is known as "pee-shyness". I was worse at night than in the morning. I also slept too much -- often taking naps right after work. I was in excellent physical shape. Then anxiety, cycling unipolar depression, and significant anger and frustration set in. Then the medical odyssey started.
OK, you have anxiety disorder, obsessive - intrusive thoughts, anger. Seems like some form of Borderline Personality Disorder.
Bob's SSRIs
------------
> Prozac: eventual agitation, restlessness, and panic
> Anafranil: Eventual control of some obsessive symptoms and some depression at the expense of my physical health: 45lb weight gain, dizzyness, sweating, total sexual dysfunction, jitteriness, etc... hard to tolerate.
> Zoloft: controlled ruminations and anxiety at the expense of weight gain, sexual dysfunction, jitteriness, and diurnal variation.
> Paxil: controlled ruminations and anxiety at the expense of me sleeping 18hrs per day.
> Celexa: by itself was not very effective -- it got rid of mental anxiety, but i was left with a general physical discomfort (something like muscle tightness) that Celexa didn't seem to address. This, as with all other heavily serotonergic drugs, caused severe diurnal variation. I played around with thyroid augmentation on this med and got some excellent results for about 1 week, after which the effect started to become unreliable and less intense. eventually I got mired in symptoms of hyperthyroidism and could not stand it any longer. My physical condition by this time was quite degraded -- the muscle tension/discomfort, and the weight gain were hard to deal with.Bob's Serotonergic/Noradrenergic drugs
--------------------------------------
> Effexor: initial response was excellent in all respects! degraded into weight gain, oversleeping, anger, and severe diurnal variation. probably don't need to mention the ridiculous withdrawal other than to say i don't know if i was ever the same
> Welbutrin: anxiety, agitation
> Serzone: took for about 1.5 weeks and could not get past the dizzyness, nausea, and headaches
> Remeron: excellent sleep at night, didn't wake up in the morning, didn't seem to touch my depression.
Bob's Mood stabilizers
----------------------
> Depakote: took away anxiety, but did almost nothing for motivation of any sort. possibly helped a little with ruminations. this med was not acceptable without an energizing adjuct, as it caused intractable drowsiness -- thus, Welbutrin was always concurrently taken, and eventually Ritalin and Dexedrine were also tried on top of that, since Welbutrin was not doing enough. the stimulants i developed a rapid tolerance to and then i started getting physical fatigue from them. the effect was very short lived. Depakote also caused weight gain.> Lamicatal: showed promise in that I felt refreshed in the mornings for the first time ever since SSRIs. Developed a rash and my Pdoc told me to discontinue.
> Topomax: I took a big chance here and transitioned to monotherapy with a drug from an entirely new class. Initially this drug showed promise as it gave me some hypomania and I was able to wake up in the morning somewhat refreshed. It also helped with ruminations. However, it came with a host of very nasty side effects, such as cognitive dysfuntion, cold and pain in my hands, rash, sore throat, cold body temp at times... the list goes on. I was willing to endure it because it was energizing and I felt so much better physically than I had on SSRIs. There was much less sexual effects, and I was losing weight also. It exploded into a nervous breakdown and coming off of it was the most harrowing experience (mentally of my life). I was never closer to suicide for a longer period. Klonopin was added to the mix here, and has never been removed.
> Tegretol and Luvox: sweating, tired, added to muscle discomfort -- hard to tolerate
> Trileptal and Luvox: similar to Tegretol - but induced agitationBob's antipsychotics
--------------------
> Geodon and Luvox: induced agitation and akathisia within 2 days.Bob's Benbzodiazpeines
----------------------
> Luvox and Klonopin: what I'm currently on -- 50mg at bedtime. Klonopin .5mg qid. It has taken about 6 months since my near death experience with Topomax, but I have nearly returned to the typical response I used to get from SSRIs (I thought for awhile I had been rendered untreatable by Topomax). My anxiety is reasonably well controlled at the expense of oversleeping and severe dirurnal variation. I don't tend to overeat quite as much with the other SSRIs, but am noticing bingeing creeping back in. The antidepressant effect is not very robust. Sexual dysfunction is present as with all the other SSRIs. The therapeutic effects of the medecine don't seem to be very reliable anymore. I now experience things on a regular basis I couldn't have imagined 11 or 12 years ago: muscle tension/discomfort, horrific despondency, agitation, cold hands, alternating hot and cold body, sweating. These things all cycle in their own way.Supplements
-----------
> I've also tried many supplements at times with little or no effect: Omega-3, 5-HTP, St. Johns Wort, to name a few.Others
-------
> I've also tried Lithium, trazodone, and buspar. The latter two seemed to do almost nothing. The former made me sick to my stomach, my hair started falling out, and of course there was the weight gain. I wasn't on it long enough to know if any true benefit would have been realized.
>
> Now for some general comments:
>
> Drugs with significant SRI action always seem to end up giving me the same predicament: the severe diurnal variation I referred to previously. By this I mean I eventually am so sedated in the morning, that I literally don't even hear my alarm clock. If am awoken by something, I hardly remember it. It's hard to live my life when I don't truly wake up until 2 in the afternoon. I'm not exaggerating here -- it's truly that extreme. My mood progressively lifts throught the remainder of the day and I stay up late into the night. Nothing... and I mean NOTHING I have ever done on any of the SRI meds has changed this response. It is the one thing that I can point to as an absolutely unacceptable side-effect. I can't hold down a job or live much of a life with that type of response. It happened on Paxil, Zoloft, Effexor, Celexa, Luvox, and Anafranil. Depakote I slept every chance I got, it seemed. There wasn't necessarily a diurnal variation, but it didn't matter.
Unsidcovered options
--------------------
> MAOIs have been suggested to me, but I literally don't know if I'd survive the washout period without wacking myself. I am a dangerously unstable mess without meds now. I'd also probably have to deal with withdrawal effects from Luvox at this point.
>
> Maybe ECT with maintenance treatments? Medication trials are really getting to be too much at this point. There are obviously myriad combinations left to try, but I'm really not sure I'm up to it anymore. It takes too much out of me. I'm tired. Putting up with side effects and then finding out that 3 to 6 months down the road I can't live with the drug is becoming unacceptable at this point.
>OK, let's make some order in your disorder
1) Serotonergic drugs are effective for your depression, but worsen your tendancy (in my opinion) for cyclothymia or Borderline PD mood swings
2) You don't tolerate noradrenergic drugs
3) You have hard time with mood stabilizers
4) Good response to benzodiazepines
5) Little experience with antipsychoticsOK, my recommendations:
1) Stay on Luvox + Klonopin. You seem to tolerate them relatively well. Anything is relative, said the one who didn't read the theory of relativeness (-:
2) You must add an antipsychotic - Risperdal, I suggest. Very little weight gain.
3) Depakote. Yes. You can't be on an AD without a mood stabilizer, and your cyclotimic disorder warrants a use of a stabilizer. This is one of the best tolerated and seems to fit your condition.
4) Psychotherapy - Find a good therapist who treats with DBT (Dialectical Behaviour Therapy)
Alternatives to each proposal
-----------------------------
1) Parnate - a MAO inhibitor. With respect to your past experience, I don't believe you'll ever tolerate it. ECT is an option. Stay with Klonopin, anyway. Don't mess with psychostimulants !!!2) Alternative APs: Haldol at a very low dose, chlorpromazine at a low dose, Seruquel, Zyprexa (the latter two will cause weight gain). Start with zyprexa as a first alternative.
3) You haven't tried Neurontin, but try to stick to depakote. It's well proven and worth the side effects.
4)Psychotherapy - no alternatives !!!
It seems like depression is your smallest problem. Try to find a good psychiatrist with specialization in Borderline Personality Disorder who can give DBT as well.
Al the best, report on your progress,
Jimmy
Posted by bob on January 4, 2002, at 15:23:38
In reply to Re: Almost finished. » bob, posted by jimmygold70 on January 3, 2002, at 15:39:27
Jim:
I can't thank you enough for your suggestions. I really appreciate your help.
Where is all of this coming from? Are you a doctor, a fellow sufferer with a great deal of knowledge, both, or neither?
Bob
P.S. Thanks again. I will inevitably have at least a few questions about what you've recommended.
Posted by jimmygold70 on January 5, 2002, at 2:43:25
In reply to Re: Almost finished. » jimmygold70, posted by bob on January 4, 2002, at 15:23:38
> Jim:
>
> I can't thank you enough for your suggestions. I really appreciate your help.It's my pleasure.
> Where is all of this coming from? Are you a doctor, a fellow sufferer with a great deal of knowledge, both, or neither?
Fellow sufferer, student and researcher of biological and cognitive psychology, lots of reading of course.
Tell me if you want some reading references. I'll post you.
All the best !
Feel free to ask whatever comes to mind...
This is the end of the thread.
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