![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by pat c. on January 5, 2002, at 11:40:49
Hi.
Has anyone ever experienced shivering because they
had not taken their next dose of Neurontin within the required 6-8 hrs (after last dose)?Neurontin's half-Life is 6-8 hrs and my experience is if you don't take the next dosage within that time period, you feel totally crappy -- sick, depressed, etc. Recently, I've been experiencing the chills, shivering, shaking, and acute nervousness. I'm just wondering if it has to do with the Neurontin or the 40mg of Celexa that I've just started to take.
Any thoughts would be appreciated.
Thanks.
Pat
Posted by Mitch on January 5, 2002, at 14:22:33
In reply to Neurontin 1/2 Life Side Effects Shivering, posted by pat c. on January 5, 2002, at 11:40:49
> Hi.
>
> Has anyone ever experienced shivering because they
> had not taken their next dose of Neurontin within the required 6-8 hrs (after last dose)?
>
> Neurontin's half-Life is 6-8 hrs and my experience is if you don't take the next dosage within that time period, you feel totally crappy -- sick, depressed, etc. Recently, I've been experiencing the chills, shivering, shaking, and acute nervousness. I'm just wondering if it has to do with the Neurontin or the 40mg of Celexa that I've just started to take.
>
> Any thoughts would be appreciated.
>
> Thanks.
>
> Pat
I think it is the Celexa. Bang! 40mg to start? No wonder. You probably feel like you are coming down with a flu, right? The Neurontin may have a calming effect that covers that up some. You might ask your doctor about starting off at 20mg instead. Celexa seems to be the SSRI that seems to tweak with your temperature control mechanism the most. I sweat considerably on 5mg 2-8 hrs after taking it.Mitch
Posted by pat c. on January 5, 2002, at 14:51:54
In reply to Re: Neurontin 1/2 Life Side Effects Shivering » pat c., posted by Mitch on January 5, 2002, at 14:22:33
Wow!
I wonder about these freakin doctors.
Thanks Mitch.
Pat
Posted by Emme on January 7, 2002, at 10:45:13
In reply to Re: Neurontin 1/2 Life Side Effects Shivering » pat c., posted by Mitch on January 5, 2002, at 14:22:33
>
> I think it is the Celexa. Bang! 40mg to start? No wonder. You probably feel like you are coming down with a flu, right? The Neurontin may have a calming effect that covers that up some. You might ask your doctor about starting off at 20mg instead. Celexa seems to be the SSRI that seems to tweak with your temperature control mechanism the most. I sweat considerably on 5mg 2-8 hrs after taking it.
>
> Mitch
Huh. I've just started Celexa a couple of weeks ago and I also take Neurontin. I've only been on 4 mg Celexa (I'm super sensitive to meds) and have had some "hot flashes" but most of the time I am so freezing cold I am utterly miserable. I've been taking the neurontin for a little while, so I didn't think that was the culprit. If it is the Celexa, will this abate? I've just backed down to 2 mg and am waiting to see how I feel. If I knew it was the Celexa tweaking my thermostat and that it will go away, it'll be much easier to deal with.Also, the Celexa seems to make me simultaneously jittery/wired and tired. I'd be interested to hear other people's experiences about whether they found Celexa stimulating or sedating and how long those effects lasted. In addition to the Neurontin and a dash of Celexa and a bit of Klonopin, I'm also titrating up on Lamictal, which seems to be somewhat activating for me.
Thanks all,
Emme
Posted by Mitch on January 7, 2002, at 11:11:02
In reply to Re: Celexa Side Effects - temperature tweaking » Mitch, posted by Emme on January 7, 2002, at 10:45:13
>
> >
> > I think it is the Celexa. Bang! 40mg to start? No wonder. You probably feel like you are coming down with a flu, right? The Neurontin may have a calming effect that covers that up some. You might ask your doctor about starting off at 20mg instead. Celexa seems to be the SSRI that seems to tweak with your temperature control mechanism the most. I sweat considerably on 5mg 2-8 hrs after taking it.
> >
> > Mitch
>
>
> Huh. I've just started Celexa a couple of weeks ago and I also take Neurontin. I've only been on 4 mg Celexa (I'm super sensitive to meds) and have had some "hot flashes" but most of the time I am so freezing cold I am utterly miserable. I've been taking the neurontin for a little while, so I didn't think that was the culprit. If it is the Celexa, will this abate? I've just backed down to 2 mg and am waiting to see how I feel. If I knew it was the Celexa tweaking my thermostat and that it will go away, it'll be much easier to deal with.
>
> Also, the Celexa seems to make me simultaneously jittery/wired and tired. I'd be interested to hear other people's experiences about whether they found Celexa stimulating or sedating and how long those effects lasted. In addition to the Neurontin and a dash of Celexa and a bit of Klonopin, I'm also titrating up on Lamictal, which seems to be somewhat activating for me.
>
> Thanks all,
> EmmeHi Emme,
I am real med sensitive too. I only take approx. 2.5mg of Celexa every other day. It has a fairly long half-life of 36 hrs or so. I get the simultaneously Wired/Tired feeling, too. But the wired part comes in handy and seems to help my ADHD. It also doesn't disrupt my sleep like Prozac and Zoloft do, so that's a plus. My total mix is Neurontin 300mg/day, Klonopin .5-1.0mg/day, Wellbutrin 37.5mg/day, and Celexa 2.5mg every other day. The "hot flashing" may or may not abate. I know that if it gets the slightest bit warm I really sweat. I can be at work and my underarms can drip! Also, come to think of it--I notice that about 4-5 hrs post-dosing my chest feels all warm like it is radiating heat energy-that's ok though, if I am achy I feel better from it.
Mitch
Posted by Emme on January 7, 2002, at 12:20:32
In reply to Re: Celexa Side Effects - temperature tweaking » Emme, posted by Mitch on January 7, 2002, at 11:11:02
> > Huh. I've just started Celexa a couple of weeks ago and I also take Neurontin. I've only been on 4 mg Celexa (I'm super sensitive to meds) and have had some "hot flashes" but most of the time I am so freezing cold I am utterly miserable. I've been taking the neurontin for a little while, so I didn't think that was the culprit. If it is the Celexa, will this abate? I've just backed down to 2 mg and am waiting to see how I feel. If I knew it was the Celexa tweaking my thermostat and that it will go away, it'll be much easier to deal with.
> >
> > Also, the Celexa seems to make me simultaneously jittery/wired and tired. I'd be interested to hear other people's experiences about whether they found Celexa stimulating or sedating and how long those effects lasted. In addition to the Neurontin and a dash of Celexa and a bit of Klonopin, I'm also titrating up on Lamictal, which seems to be somewhat activating for me.
> >
> > Thanks all,
> > Emme
>
> Hi Emme,
>
> I am real med sensitive too. I only take approx. 2.5mg of Celexa every other day. It has a fairly long half-life of 36 hrs or so. I get the simultaneously Wired/Tired feeling, too. But the wired part comes in handy and seems to help my ADHD. It also doesn't disrupt my sleep like Prozac and Zoloft do, so that's a plus. My total mix is Neurontin 300mg/day, Klonopin .5-1.0mg/day, Wellbutrin 37.5mg/day, and Celexa 2.5mg every other day. The "hot flashing" may or may not abate. I know that if it gets the slightest bit warm I really sweat. I can be at work and my underarms can drip! Also, come to think of it--I notice that about 4-5 hrs post-dosing my chest feels all warm like it is radiating heat energy-that's ok though, if I am achy I feel better from it.
>
> MitchHi Mitch,
Your mix sounds very similar to mine except that instead of the Wellbutrin I'm trying Lamictal. So I'm not the only one who gets the tired/wired feeling! Problem is, I can't stand it - makes me need to lie down. I generally have to tame it with Klonopin. It sounds like you really are sensitive if you're sweating that much on such a tiny dose. The hot flashes have in fact decreased a little bit for me, though I suppose they might come back if I should have to raise the dose. But feeling cold all the time has really been getting me down - I've even been too chilly to do things around my apt because I want to stay under a blanket. I sit with my back against my warmest radiator and read. I've been wondering what was wrong with me - my last thyroid check in the summer was normal but I am thinking another test wouldn't hurt. I do feel less worried hearing that others have thermal regulation problems with this drug.
I too have felt the warm feeling in the center of my body. I thought maybe it was heartburn - I've never had heartburn so I don't really know what it feels like, but I thought perhaps that was it. The timing made me think it was related to the Celexa.
How do you feel when you wake up? I wake up around 6 feeling unrested and a bit anxious/jittery. So it makes me wonder if my quality of sleep is very good. If I wait a while on the weekends I can often go back to sleep for a few more hours. I'm going to keep the 36 hour half life in mind. Maybe every-other day dosing would be an option for me if I need to decrease it more. Or even try 1.5 mg daily. I'm good with the little syringe. :) Stuff tastes like Scope, doesn't it?
Thanks for your input.
Emme
Posted by Mitch on January 7, 2002, at 23:24:28
In reply to Re: Celexa Side Effects - temperature tweaking » Mitch, posted by Emme on January 7, 2002, at 12:20:32
> Your mix sounds very similar to mine except that instead of the Wellbutrin I'm trying Lamictal. So I'm not the only one who gets the tired/wired feeling! Problem is, I can't stand it - makes me need to lie down. I generally have to tame it with Klonopin. It sounds like you really are sensitive if you're sweating that much on such a tiny dose. The hot flashes have in fact decreased a little bit for me, though I suppose they might come back if I should have to raise the dose. But feeling cold all the time has really been getting me down - I've even been too chilly to do things around my apt because I want to stay under a blanket. I sit with my back against my warmest radiator and read. I've been wondering what was wrong with me - my last thyroid check in the summer was normal but I am thinking another test wouldn't hurt. I do feel less worried hearing that others have thermal regulation problems with this drug.
>
> I too have felt the warm feeling in the center of my body. I thought maybe it was heartburn - I've never had heartburn so I don't really know what it feels like, but I thought perhaps that was it. The timing made me think it was related to the Celexa.
>
> How do you feel when you wake up? I wake up around 6 feeling unrested and a bit anxious/jittery. So it makes me wonder if my quality of sleep is very good. If I wait a while on the weekends I can often go back to sleep for a few more hours. I'm going to keep the 36 hour half life in mind. Maybe every-other day dosing would be an option for me if I need to decrease it more. Or even try 1.5 mg daily. I'm good with the little syringe. :) Stuff tastes like Scope, doesn't it?
>
> Thanks for your input.
>
> EmmeHi Emme,
I feel okeedokee when I get up. It is very strange, but with my current combo if I stay up an extra hour or two I still wake up about eight hours later regardless. I think they are making a liquid Celexa (Chloe is this correct?). However, what I do is get out a utility razor and take a 10mg halftab and bisect it once and then bisect the two halves yet again. I take the approx. 2.5mg chunk every other day. I *was* crushing 10mg and adding a few milliliters of vodka (citalopram is freely soluble in ethanol), and a little juice, doing the math-you get the picture.
Yeah, I would first try cutting the Celexa back and see if you sleep better. BTW-Celexa gives me the worst heartburn of the SSRI's (I mean reflux heartburn, yuck), but I can sleep OK (which is screwed up on Prozac and Zoloft), don't feel like puking (like Luvox), and I don't feel too numbed (like Paxil). Pick your poison.
Oh, here's a simple trick for sleep that helps. If you *can* take all of your daily Klonopin at bedtime. Also toss in 25mg of Benadryl with it. That works great for me.Mitch
Posted by Emme on January 8, 2002, at 7:01:35
In reply to Re: Celexa Side Effects - temperature tweaking » Emme, posted by Mitch on January 7, 2002, at 23:24:28
> > Your mix sounds very similar to mine except that instead of the Wellbutrin I'm trying Lamictal. So I'm not the only one who gets the tired/wired feeling! Problem is, I can't stand it - makes me need to lie down. I generally have to tame it with Klonopin. It sounds like you really are sensitive if you're sweating that much on such a tiny dose. The hot flashes have in fact decreased a little bit for me, though I suppose they might come back if I should have to raise the dose. But feeling cold all the time has really been getting me down - I've even been too chilly to do things around my apt because I want to stay under a blanket. I sit with my back against my warmest radiator and read. I've been wondering what was wrong with me - my last thyroid check in the summer was normal but I am thinking another test wouldn't hurt. I do feel less worried hearing that others have thermal regulation problems with this drug.
> >
> > I too have felt the warm feeling in the center of my body. I thought maybe it was heartburn - I've never had heartburn so I don't really know what it feels like, but I thought perhaps that was it. The timing made me think it was related to the Celexa.
> >
> > How do you feel when you wake up? I wake up around 6 feeling unrested and a bit anxious/jittery. So it makes me wonder if my quality of sleep is very good. If I wait a while on the weekends I can often go back to sleep for a few more hours. I'm going to keep the 36 hour half life in mind. Maybe every-other day dosing would be an option for me if I need to decrease it more. Or even try 1.5 mg daily. I'm good with the little syringe. :) Stuff tastes like Scope, doesn't it?
> >
> > Thanks for your input.
> >
> > Emme
>
> Hi Emme,
>
> I feel okeedokee when I get up. It is very strange, but with my current combo if I stay up an extra hour or two I still wake up about eight hours later regardless. I think they are making a liquid Celexa (Chloe is this correct?). However, what I do is get out a utility razor and take a 10mg halftab and bisect it once and then bisect the two halves yet again. I take the approx. 2.5mg chunk every other day. I *was* crushing 10mg and adding a few milliliters of vodka (citalopram is freely soluble in ethanol), and a little juice, doing the math-you get the picture.
> Yeah, I would first try cutting the Celexa back and see if you sleep better. BTW-Celexa gives me the worst heartburn of the SSRI's (I mean reflux heartburn, yuck), but I can sleep OK (which is screwed up on Prozac and Zoloft), don't feel like puking (like Luvox), and I don't feel too numbed (like Paxil). Pick your poison.
> Oh, here's a simple trick for sleep that helps. If you *can* take all of your daily Klonopin at bedtime. Also toss in 25mg of Benadryl with it. That works great for me.
>
> MitchHi Mitch,
Well, after a few days now at 2 mg Celexa, I am no longer miserably freezing cold all the time. Just back to my *normal* cool-blooded self. So that's better, but it's hard to say yet if it's helping my mood - probably too soon to tell, and I'm busy titrating the lamictal. If I decide to increase the Celexa again, I'll have to do it extremely slowly. Yeah, they do make a liquid, which is what I'm using. I like the ease and control over dosing. But I'm all too familiar with performing microsurgery on tablets of various drugs. :) My two-dollar pill splitter made that easier.
I seem to need Klonopin in the morning. I can fall asleep but I wake up jittery and with my heart pounding. It's probably the Lamictal making me more stimulated and I need to offset it. I wonder if the extra Klonopin at night would carry through till morning so I'd wake up more relaxed. I might try the Benadryl thing - good idea. I guess I could also try extra Neurontin at night. In the past I've also used a dash of Seroquel to help my sleep. Yep, many poisons to pick from. I'll start tyring them out. I just hate being on so many things at the same time and I'm hoping to be able to drop one or two out at some point.
So how do you feel on your current mixture?
Emme
Posted by Mitch on January 8, 2002, at 9:55:13
In reply to Re: Celexa Side Effects - temperature tweaking, posted by Emme on January 8, 2002, at 7:01:35
> > I feel okeedokee when I get up. It is very strange, but with my current combo if I stay up an extra hour or two I still wake up about eight hours later regardless. I think they are making a liquid Celexa (Chloe is this correct?). However, what I do is get out a utility razor and take a 10mg halftab and bisect it once and then bisect the two halves yet again. I take the approx. 2.5mg chunk every other day. I *was* crushing 10mg and adding a few milliliters of vodka (citalopram is freely soluble in ethanol), and a little juice, doing the math-you get the picture.
> > Yeah, I would first try cutting the Celexa back and see if you sleep better. BTW-Celexa gives me the worst heartburn of the SSRI's (I mean reflux heartburn, yuck), but I can sleep OK (which is screwed up on Prozac and Zoloft), don't feel like puking (like Luvox), and I don't feel too numbed (like Paxil). Pick your poison.
> > Oh, here's a simple trick for sleep that helps. If you *can* take all of your daily Klonopin at bedtime. Also toss in 25mg of Benadryl with it. That works great for me.
> >
> > Mitch
>
> Hi Mitch,
>
> Well, after a few days now at 2 mg Celexa, I am no longer miserably freezing cold all the time. Just back to my *normal* cool-blooded self. So that's better, but it's hard to say yet if it's helping my mood - probably too soon to tell, and I'm busy titrating the lamictal. If I decide to increase the Celexa again, I'll have to do it extremely slowly. Yeah, they do make a liquid, which is what I'm using. I like the ease and control over dosing. But I'm all too familiar with performing microsurgery on tablets of various drugs. :) My two-dollar pill splitter made that easier.
>
> I seem to need Klonopin in the morning. I can fall asleep but I wake up jittery and with my heart pounding. It's probably the Lamictal making me more stimulated and I need to offset it. I wonder if the extra Klonopin at night would carry through till morning so I'd wake up more relaxed. I might try the Benadryl thing - good idea. I guess I could also try extra Neurontin at night. In the past I've also used a dash of Seroquel to help my sleep. Yep, many poisons to pick from. I'll start tyring them out. I just hate being on so many things at the same time and I'm hoping to be able to drop one or two out at some point.
>
> So how do you feel on your current mixture?
>
> Emme
Well, it has been the best mix I have been on thus far. I feel like there is such a complicated "envelope" I have to deal with. I just can't seem to handle higher doses of *anything*. Too much of this or that and I am hostile, or I can't sleep, or my guts are wrenching, or can't concentrate, ..... So, it is tiny doses of several things. That's just how it settled out. What I am "lean" on is mood stabilizer. My seasonal depression is lifting away now and I am looking at the BIG rollercoaster that is going to come March-May. I think I can handle it fine if I just drop back the Wellbutrin or maybe stop it. The Wellbutrin is there just to combat the fatigue from the seasonal depression (which it did quite well).Mitch
Posted by Chloe on January 8, 2002, at 18:14:28
In reply to Re: Celexa Side Effects - temperature tweaking » Emme, posted by Mitch on January 8, 2002, at 9:55:13
Hi Emme,
I have not been following PB too closely lately. But I like to read about other microdosers!I am glad you found the Celexa liquid. Currently I am taking 1.7 mgs or .85 cc's. I find if I push the dose up much more than that I get one day of feeling a little racy and "good", followed by days of irritability. So I just stay at the lowest dose that doesn't make me irritable!
FYI, Celexa is the ONLY ssri that hasn't given me trouble with temp regulation and sweating. Prozac and Zoloft were awful. I would sweat, then feel chilled from being so "moist". Don't miss that. But I too wonder how such a small amount of an ssri can be useful. But I think Celexa is more potent, cleaner and targeted, so less is needed for particular folk like us.
Hang in there trying to figure this whole med thing out!
Take care,
Chloe
Posted by Chloe on January 8, 2002, at 18:29:27
In reply to Re: Celexa Side Effects - temperature tweaking » Emme, posted by Mitch on January 8, 2002, at 9:55:13
> >What I am "lean" on is mood stabilizer.
Mitch, ME TOO! Have you ever in your trials over the years tried verapamil? That one was recommended to me. But, I can't seem to tolerate any mood stablizers anymore. Even the "gentle" neurontin at 400 mgs is giving me the same problem they all do, intense scalp burning and hair pain.
Though I don't really think Neurontin does anything as an MS, it's very good for keeping anger and frustration at bay. Just keeping things calmer. But I am desperate for something for my cycling. My pdoc wants to add back 75 mgs of Lithium. But I am not optimistic this small amount will help(because I really needed about 600 mgs of lithobid to feel a stabilizing, AD effect), AND I don't fancy the non-extended release formula. I have heard that people who have responded well to Li can also have good luck with Calcium Channel Blockers...
Just wondering if you have had any experience with this one...
Many thanks and glad you are doing well with the WB!
Chloe
Posted by Mitch on January 8, 2002, at 23:24:38
In reply to Re: Neurontin/MS's-Mitch, posted by Chloe on January 8, 2002, at 18:29:27
> > >What I am "lean" on is mood stabilizer.
>
> Mitch, ME TOO! Have you ever in your trials over the years tried verapamil? That one was recommended to me. But, I can't seem to tolerate any mood stablizers anymore. Even the "gentle" neurontin at 400 mgs is giving me the same problem they all do, intense scalp burning and hair pain.
>
> Though I don't really think Neurontin does anything as an MS, it's very good for keeping anger and frustration at bay. Just keeping things calmer. But I am desperate for something for my cycling. My pdoc wants to add back 75 mgs of Lithium. But I am not optimistic this small amount will help(because I really needed about 600 mgs of lithobid to feel a stabilizing, AD effect), AND I don't fancy the non-extended release formula. I have heard that people who have responded well to Li can also have good luck with Calcium Channel Blockers...
>
> Just wondering if you have had any experience with this one...
> Many thanks and glad you are doing well with the WB!
> Chloe
Hello Chloe,Nope, I must say I haven't dealt with either verapamil or nimodipine. You do realize that Neurontin blocks voltage-dependent calcium-ion channels *selectively* whereas the others are generally a shotgun with more side-effects? It really sounds like from what you have posted that Lithium has done you more good than anything else (without having to take AP's and deal with dystonia, etc.). You did say that your TSH went up when you were on Lithium and there was a delay from the time you felt better on the Li to the time you started to experience the scalp stuff. Just my opinion...but I think that if you simply started to add back the lithium (say 150mg/bedtime) AND a *little* thyroxine (T4) to compensate AND work those up together maintaining your TSH within normal levels but in the hyperthyroid "half" of the bellcurve (instead of the hypothyroid half), your skin might be more forgiving and might find your way back to 600mg/day of lithium with your Neurontin *without* the scalp trips...might be worth considering. An important note: I remember you mentioning your *DAD* saying something about how the Li positively helped you. That is an important thing when someone else notices an improvement (whether or not you are aware of it).
Mitch
Posted by Emme on January 9, 2002, at 12:23:05
In reply to Re: Celexa liquid Emme, posted by Chloe on January 8, 2002, at 18:14:28
>
>
> Hi Emme,
> I have not been following PB too closely lately. But I like to read about other microdosers!
>
> I am glad you found the Celexa liquid. Currently I am taking 1.7 mgs or .85 cc's. I find if I push the dose up much more than that I get one day of feeling a little racy and "good", followed by days of irritability. So I just stay at the lowest dose that doesn't make me irritable!
> FYI, Celexa is the ONLY ssri that hasn't given me trouble with temp regulation and sweating. Prozac and Zoloft were awful. I would sweat, then feel chilled from being so "moist". Don't miss that. But I too wonder how such a small amount of an ssri can be useful. But I think Celexa is more potent, cleaner and targeted, so less is needed for particular folk like us.
> Hang in there trying to figure this whole med thing out!
> Take care,
> ChloeHi there Chloe,
I've been on and off following things on the board over the last few months. Often too tired or busy to write anything. That's amazing that you've got your Celexa so precisely figured out. Thank god for the liquid form, huh? I wonder how many doctors are creative enough to try their patients on really tiny doses when they have trouble with side effects. I think using a few drugs at very low doses is a good strategy for people like us and Mitch who are so sensitive to meds.Maybe I'd get more noticeable benefit from Celexa at a slightly higher dose - if I inch the dose up in slow teensy bits maybe I wouldn't feel too awful. At the moment I'm working on a rechallenge of Lamictal and want to see how that pans out before changing Celexa (one thing at a time). I have had one rash recurrence, for just one day - it had faded to very faint within a few hours. A dermatologist felt it was safe to continue the titration - and it's a damn slow titration. We will probably continue with it with careful superivision as long as any rashes continue to be brief and are not raised or otherwise menacing. And a little Neurontin's still on board for me.
Good luck finding mood stabilization options - I see Mitch's suggestion above. I cannot recall - have you had a dermatologist on board to offer opinions on how to handle the scalp/skin problems the anticonvulsants give you? Good luck.
Emme
Posted by Chloe on January 9, 2002, at 17:24:04
In reply to Re: Neurontin/MS's-Mitch » Chloe, posted by Mitch on January 8, 2002, at 23:24:38
Hi Mitch,
Yeah, I know lithium really works for me. But this scalp thing is no longer lithium related. After I d/c'd the lithium, the scalp burning came back, perhaps because I raised the Neurontin by 100 mg/day. SO, I have some neuropathy on my scalp. A dermatologist saw no rash or psoriasis, so he said that all these med trials have made my hair hypersensitive to pain...So, now I am on 20 mgs of amitriptyline for the pain. And I have to say there is a MILD reduction of the burning. I like the amitrip. Finally, I am sleeping at night! Wow, what a luxury that is! Low dose TCA's are underrated, IMHO.So I called my pdoc for her to call in some regular lithium. I really need to start something that will help with the suicidal thoughts. And I am sure Li will...If I can tolerate a high enough dose.
I will bring up the issue of watching my TSH my next appt.
I am just so discouraged and tired of feeling ok for about 36 hours, and then diving into a psychotic suicidal depression for a good 36 hours. I am finding that I am unsafe at times. And since I can't take the AAP's I am really in trouble.
Ho hum. I hope I hear from my pdoc so I can start the Li soon. But hey, what's the rush? I really don't want the bad side effects, esp the dried up and falling out hair. It is just starting to get a little shine back...Thanks for writing
Chloe
> Nope, I must say I haven't dealt with either verapamil or nimodipine. You do realize that Neurontin blocks voltage-dependent calcium-ion channels *selectively* whereas the others are generally a shotgun with more side-effects? It really sounds like from what you have posted that Lithium has done you more good than anything else (without having to take AP's and deal with dystonia, etc.). You did say that your TSH went up when you were on Lithium and there was a delay from the time you felt better on the Li to the time you started to experience the scalp stuff. Just my opinion...but I think that if you simply started to add back the lithium (say 150mg/bedtime) AND a *little* thyroxine (T4) to compensate AND work those up together maintaining your TSH within normal levels but in the hyperthyroid "half" of the bellcurve (instead of the hypothyroid half), your skin might be more forgiving and might find your way back to 600mg/day of lithium with your Neurontin *without* the scalp trips...might be worth considering. An important note: I remember you mentioning your *DAD* saying something about how the Li positively helped you. That is an important thing when someone else notices an improvement (whether or not you are aware of it).
>
> Mitch
Posted by Chloe on January 9, 2002, at 17:45:40
In reply to Re: Celexa liquid (and Lamictal rechallenge) » Chloe, posted by Emme on January 9, 2002, at 12:23:05
> > I've been on and off following things on the board over the last few months. Often too tired or busy to write anything. That's amazing that you've got your Celexa so precisely figured out. Thank god for the liquid form, huh? I wonder how many doctors are creative enough to try their patients on really tiny doses when they have trouble with side effects. I think using a few drugs at very low doses is a good strategy for people like us and Mitch who are so sensitive to meds.
Hi Emme,
I often think initial doses of meds are too high for the average person. I think it is so important to see how a person reacts to a small amouont of a med, before snowing a person with it. Smaller titrations lets the patient have a gentle introduction to a chemical. And a person is less likely to prematurely ditch a decent med if they don't get hit too hard by it's effects all at once. IMHO.> > Maybe I'd get more noticeable benefit from Celexa at a slightly higher dose - if I inch the dose up in slow teensy bits maybe I wouldn't feel too awful.
I go up by drops! I feel good between 1.65 and 1.75 mgs. This is less than twenty drops. It seems like nothing, but a little too much or too little has profound ramifications. (When you are ready), Since you have a syringe, you can be very exact about how much you measure out for each dose. You are the chemist!
> >At the moment I'm working on a rechallenge of Lamictal and want to see how that pans out before changing Celexa (one thing at a time). I have had one rash recurrence, for just one day - it had faded to very faint within a few hours. A dermatologist felt it was safe to continue the titration - and it's a damn slow titration. We will probably continue with it with careful superivision as long as any rashes continue to be brief and are not raised or otherwise menacing. And a little Neurontin's still on board for me.
ONe thing at a time is best! I am glad you are being closely watched by your doc and a derm. I wish I could have had a derm appointment 3 months ago when I was having the awful burning scalp on the lithium. If I could have been told THEN that it's a neuropathic path, I could have meerly added a TCA for the pain and kept the Li on board. BUt being a new patient at a dermatologists office made it so I could not get an appointment for 10 weeeks. I called every derm in the area. EVeryone had a huge waiting list. I was even willing to not use insurance and just pay cash! no dice. So I finally did get my appointment and it looks like I will resume the lithium...
> > Good luck finding mood stabilization options -
Thanks, Emme
Good luck with the Lamictal. Take it slow!
Chloe
Posted by Mitch on January 9, 2002, at 23:05:02
In reply to Re: Neurontin/MS's-Mitch » Mitch, posted by Chloe on January 9, 2002, at 17:24:04
> Hi Mitch,
> Yeah, I know lithium really works for me. But this scalp thing is no longer lithium related. After I d/c'd the lithium, the scalp burning came back, perhaps because I raised the Neurontin by 100 mg/day. SO, I have some neuropathy on my scalp. A dermatologist saw no rash or psoriasis, so he said that all these med trials have made my hair hypersensitive to pain...So, now I am on 20 mgs of amitriptyline for the pain. And I have to say there is a MILD reduction of the burning. I like the amitrip. Finally, I am sleeping at night! Wow, what a luxury that is! Low dose TCA's are underrated, IMHO.
>
> So I called my pdoc for her to call in some regular lithium. I really need to start something that will help with the suicidal thoughts. And I am sure Li will...If I can tolerate a high enough dose.
> I will bring up the issue of watching my TSH my next appt.
> I am just so discouraged and tired of feeling ok for about 36 hours, and then diving into a psychotic suicidal depression for a good 36 hours. I am finding that I am unsafe at times. And since I can't take the AAP's I am really in trouble.
> Ho hum. I hope I hear from my pdoc so I can start the Li soon. But hey, what's the rush? I really don't want the bad side effects, esp the dried up and falling out hair. It is just starting to get a little shine back...
>
> Thanks for writing
> Chloe
>
Low-dose TCA's *are* underrated. I was on 10mg amitriptyline twice daily for about a year or so. It knocked me out big time for sleeping. After about three weeks or so I felt an energizing effect during the day without any anxiety which was nice. Get this.. it seemed to have the most *mood stabilizing* effects of any TCA that I have tried! The only reason I stopped taking it was because I had friends that liked my hypomanic personality and they complained that I wasn't as goofy and eccentric anymore.Mitch
Posted by Chloe on January 10, 2002, at 19:36:21
In reply to Re: Neurontin/MS's-Mitch » Chloe, posted by Mitch on January 9, 2002, at 23:05:02
Mitch,
You took half your ami in the morning? How long did it take you to adjust? I think I might like the calming effect during the day...Oh, I am finding I am much more amiable to food. I can't tell if I am just less depressed and intouch with my body, or if it's the med. Did you notice an appetite increase on the ami?And gee, I hope I don't get "energized". But if it's without the anxiety I guess it would be ok. But I am so riddled with anxiety and angst at the moment, energized sounds awful!
I got a dew drop of lithium, 75 or so milligrams last night. I can't really tell, because the pill turned to dust when I tried to cut it into quarters. Why can't I just tolerate the whole damn thing??? But pdoc doesn't want to get my scalp all upset with a big slug of lithium. SO I think I probably took about 100 mgs HS, and I couldn't sleep very well. I forgot about how energizing lithium is initially for me. AND I think since it's regular release, it all got dumped into my system at once and really disrupted my sleep. I took todays lithium chip at lunch!
I am starting to blab a bit, but, I think I am going to switch brands and cut up the Eskilith CR pills into quarters. Those break evenly, and I can take 112.5 per day for a while and get a sustained release as well...It seems to make more sense to me to take a little higher, but consistant dose and get the controlled release. Any thoughts on this Li obsession of mine???
Take care,
Chloe
> Low-dose TCA's *are* underrated. I was on 10mg amitriptyline twice daily for about a year or so. It knocked me out big time for sleeping. After about three weeks or so I felt an energizing effect during the day without any anxiety which was nice. Get this.. it seemed to have the most *mood stabilizing* effects of any TCA that I have tried! The only reason I stopped taking it was because I had friends that liked my hypomanic personality and they complained that I wasn't as goofy and eccentric anymore.
>
> Mitch
Posted by Mitch on January 10, 2002, at 23:44:20
In reply to Re: Ami daytime dose?/Li » Mitch, posted by Chloe on January 10, 2002, at 19:36:21
> Mitch,
> You took half your ami in the morning? How long did it take you to adjust? I think I might like the calming effect during the day...Oh, I am finding I am much more amiable to food. I can't tell if I am just less depressed and intouch with my body, or if it's the med. Did you notice an appetite increase on the ami?Nope, I took 10mg at bedtime and 10mg at lunch the next day just before I went to work (I have nearly always worked 2nd shift jobs-even now!). There essentially was no adjustment really. I just got a little sedated and mellow in the afternoon. That worked out really well, because I noticed that it reduced grouchiness (hey, an AD that *reduces* grouchiness, that is the exception rather than the rule with me). I had to work with my DAD at the time, so dysphoria was something I was really trying to avoid as much as possible! Oh, any AD that is sedative will make you a little spacey for a while. Very little appetite change (not so with Remeron).
>
> And gee, I hope I don't get "energized". But if it's without the anxiety I guess it would be ok. But I am so riddled with anxiety and angst at the moment, energized sounds awful!
Oh, BTW, on TCA's you won't notice much antidepressant effect until you get the full two weeks worth of taking it. They are really strange that way. Anyhow, don't worry about getting energized! When I say that, what I really meant is that I am alert and attentive-I didn't feel the least agitated in any way. That happened on the amitriptyline after the 2 week period on it.>
> I got a dew drop of lithium, 75 or so milligrams last night. I can't really tell, because the pill turned to dust when I tried to cut it into quarters. Why can't I just tolerate the whole damn thing??? But pdoc doesn't want to get my scalp all upset with a big slug of lithium. SO I think I probably took about 100 mgs HS, and I couldn't sleep very well. I forgot about how energizing lithium is initially for me. AND I think since it's regular release, it all got dumped into my system at once and really disrupted my sleep. I took todays lithium chip at lunch!
>
> I am starting to blab a bit, but, I think I am going to switch brands and cut up the Eskilith CR pills into quarters. Those break evenly, and I can take 112.5 per day for a while and get a sustained release as well...It seems to make more sense to me to take a little higher, but consistant dose and get the controlled release. Any thoughts on this Li obsession of mine???>
> Take care,
> Chloe
I would say that is something of an obsession :-)
If you chop stuff you are going to lose sustained release characteristics generally. You know what I would do? Forget the Eskalith crap-there might be dyes that are in there that you may be reacting to-remember? Just get your generic immediate release lithium tabs and crush up a few of them and put them in some OJ. Real simple, and just pour out the milligrams you want and drink it-simple. I've done that before-it's easy-you are good at math.Mitch
Posted by Emme on January 11, 2002, at 15:04:41
In reply to Re: Celexa liquid (and Lamictal rechallenge) » Emme, posted by Chloe on January 9, 2002, at 17:45:40
> Hi Emme,
> I often think initial doses of meds are too high for the average person. I think it is so important to see how a person reacts to a small amouont of a med, before snowing a person with it. Smaller titrations lets the patient have a gentle introduction to a chemical. And a person is less likely to prematurely ditch a decent med if they don't get hit too hard by it's effects all at once. IMHO.
>
> > > Maybe I'd get more noticeable benefit from Celexa at a slightly higher dose - if I inch the dose up in slow teensy bits maybe I wouldn't feel too awful.
>
> I go up by drops! I feel good between 1.65 and 1.75 mgs. This is less than twenty drops. It seems like nothing, but a little too much or too little has profound ramifications. (When you are ready), Since you have a syringe, you can be very exact about how much you measure out for each dose. You are the chemist!
>
> > >At the moment I'm working on a rechallenge of Lamictal and want to see how that pans out before changing Celexa (one thing at a time). I have had one rash recurrence, for just one day - it had faded to very faint within a few hours. A dermatologist felt it was safe to continue the titration - and it's a damn slow titration. We will probably continue with it with careful superivision as long as any rashes continue to be brief and are not raised or otherwise menacing. And a little Neurontin's still on board for me.
>
> ONe thing at a time is best! I am glad you are being closely watched by your doc and a derm. I wish I could have had a derm appointment 3 months ago when I was having the awful burning scalp on the lithium. If I could have been told THEN that it's a neuropathic path, I could have meerly added a TCA for the pain and kept the Li on board. BUt being a new patient at a dermatologists office made it so I could not get an appointment for 10 weeeks. I called every derm in the area. EVeryone had a huge waiting list. I was even willing to not use insurance and just pay cash! no dice. So I finally did get my appointment and it looks like I will resume the lithium...
>
> > > Good luck finding mood stabilization options -
>
> Thanks, Emme
> Good luck with the Lamictal. Take it slow!
> ChloeHi Chloe,
So you're gonna go back to Li again. Yeah! I know you had success with that before - I hope it works out with the TCA added and that your scalp won't suffer too much.
I agree with you about starting people on low doses. Yeah, some people can jump right in at a higher dose, but I've known of people to give up on drugs due to side effects that might have been minimized if their doctors had started them off more slowly.
Your scalp problem also illustrates how important it is to have other doctors on board when treating a patient with a mood disorder. It is a whole body/soul illness and the medicines also affect the whole body. A good pdoc won't hesitate to get other opinions on board. I was lucky in the dermatology dept. My internist saw me right away, then made a phone call and sent me down the street a half an hour later to a dermatologist just to be safe - the words "lamictal" and "rash" get them moving pretty fast even if they are busy.Good news is, I think the lamictal may be starting to help. I'm a couple of steps back from the edge and also have some more energy. I made it to the gym 3 times this week for mild workouts, which feels like a miracle!
Keep us posted on your retrial with Li and the TCA.
Emme
P.S. You must be psychic. Yes, I'm a chemist (geochemist actually). After using syringes in the lab for so many things, it's funny to use one to squirt stuff into my mouth. :) Thanks for your support. My thanks also to Mitch for his earlier comments.
Posted by Chloe on January 11, 2002, at 16:09:22
In reply to Re: Ami daytime dose?/Li » Chloe, posted by Mitch on January 10, 2002, at 23:44:20
Mitch,
Ok, now you have done it, fueled my obsession!!:)Eskilith CR vs Lithobid:
The Eskilith CR is the hard yellowish tablet (450 mgs) that is scored. From what I have read about it, it's just very densely pressed Li and just breaks up slower on it's way out, so to speak.The lithobid (300 mgs), (which I prefer, since I don't seem to have the yucky side effects of increased sweating, nausea...) is the pink enteric coated tablet that isn't even digested in the stomach. This one I know I can't cut up. And you might be right about the dye causing some skin problems...I am so sensitive. I can't even use any creams or soaps with perfume, so a little dye might really be a culprit!
Anyway, So I think it's safe to cut a scored 450 Eskilith CR in half without messing with the potency or absorbtion, do you?...I did NOT know that you could dissolve the reg lithium in juice. Why don't pdocs tell me these things? I am glad you are there to mention it!...
However, I really do prefer the CR. I seem to have problems with reg. lithium and my blood sugar. I seem to get a surge of ?energy, jazziness?, and feel shaky. Then about 4 hours later, I have an energy, mood and BS crash. If I don't eat right away, I really lose it! That happened yesterday about 4 pm. Have you heard of the BS thing? I think I remember this from years ago, and that was one of the reason I didn't want to retry it...But I am glad I did. Li works very quickly for me. And there was some urgency as my therapist is headed out of town this week. I have been extremely needed related to my rapid cycling. I am so hoping that this small amount of li and the TCA will smooth things out so I can get through a day or two without a crisis...
Question? Why not retry the Amitriptline if it was really stabilizing for you? I think you said you are on Nortriptyline. How does that compare to Ami for you? My pdoc suggested that one as well. BUT I was on Ami in the eighties and liked the calming sedative effect. I recall that Nort. is more activating???
Thanks
Chloe
Posted by Mitch on January 11, 2002, at 22:26:50
In reply to Re: Eskilith CR/Lithobid, etc. » Mitch, posted by Chloe on January 11, 2002, at 16:09:22
> Mitch,
> Ok, now you have done it, fueled my obsession!!:)
>
> Eskilith CR vs Lithobid:
> The Eskilith CR is the hard yellowish tablet (450 mgs) that is scored. From what I have read about it, it's just very densely pressed Li and just breaks up slower on it's way out, so to speak.
>
> The lithobid (300 mgs), (which I prefer, since I don't seem to have the yucky side effects of increased sweating, nausea...) is the pink enteric coated tablet that isn't even digested in the stomach. This one I know I can't cut up. And you might be right about the dye causing some skin problems...I am so sensitive. I can't even use any creams or soaps with perfume, so a little dye might really be a culprit!
>
> Anyway, So I think it's safe to cut a scored 450 Eskilith CR in half without messing with the potency or absorbtion, do you?...I did NOT know that you could dissolve the reg lithium in juice. Why don't pdocs tell me these things? I am glad you are there to mention it!...
>
> However, I really do prefer the CR. I seem to have problems with reg. lithium and my blood sugar. I seem to get a surge of ?energy, jazziness?, and feel shaky. Then about 4 hours later, I have an energy, mood and BS crash. If I don't eat right away, I really lose it! That happened yesterday about 4 pm. Have you heard of the BS thing? I think I remember this from years ago, and that was one of the reason I didn't want to retry it...But I am glad I did. Li works very quickly for me. And there was some urgency as my therapist is headed out of town this week. I have been extremely needed related to my rapid cycling. I am so hoping that this small amount of li and the TCA will smooth things out so I can get through a day or two without a crisis...
>Oh, yes I have *done* so many different types of lithium it is ridiculous. Oh, except lithium *citrate*, have you done that one? I haven't tried it yet. It is supposed to be easier on your GI tract. I had a pdoc ask me about it once. Never went there, never done it.
I have done the Eskalith immediate release tablets (300mg), the slow-release 450mgCR tabs you are talking about, and the Eskalith 300mg immediate release capsules, and the 300mg Lithobid "pinkie" slow-release tablets that include some sodium, whew!Excuse me-I thought you had immediate release lithium available (obviously you didn't). That's why I brought up the OJ thing. If you crush up any of the stuff you do have, obviously it becomes immediate release, sorry. The Eskalith IR "pinkie" capsules are perfect for the OJ thing. Just open up a two or three and mix with xxxML of juice and drink xxxML per day, etc. That was what was in my mind's eye when I replied last. Hey, I just thought of something. You *could* do this OJ thing with pinkie IR Eskalith caps. You probably can choose to fill your RX generic as you like, right? You might try that.. NO dyes in there.
Oh, you *really* need to take your lithium with lunch or breakfast or something. That way it doesn't blast into your bloodstream so rapidly. If you can divide it into two doses per day, taking one with lunch and the other with a big snack a couple of hours before bedtime would work the best, IMO.
> Question? Why not retry the Amitriptline if it was really stabilizing for you? I think you said you are on Nortriptyline. How does that compare to Ami for you? My pdoc suggested that one as well. BUT I was on Ami in the eighties and liked the calming sedative effect. I recall that Nort. is more activating???
>
> Thanks
> Chloe
I don't think that *now* I would like the sedative properties of the amitrip. -because of the involving stressful detaily job I have now. I did sort of rethink about it today some. Notrip. is much easier for me to tolerate. It also works in combo with SSRi's a lot better. It's the only TCA that I didn't get blurred vision and dizziness on. Yes, it is more activating. But, not in an anxious way like you might think. Nortrip. is a good med for panic disorder, too. I found it works best in combo with a pinch of Zoloft or Celexa.Mitch
Posted by Chloe on January 12, 2002, at 9:39:11
In reply to Re: Eskilith CR/Lithobid, etc. » Chloe, posted by Mitch on January 11, 2002, at 22:26:50
Mitch,
Thanks for the info, but I am a little confused! The Eskilith CR, (not IR, I don't what that one is...) is a hard pressed pill that has no coating. It is the same color and consistancy thoughout the pill. AND the pill is scored, so I think it's ok to take half of the 450 mgs. I think it was designed to be split. So I am thinking that cutting the hard packed pill from 225 mgs into 112.5 isn't going to affect the controlled release. Do you have any thoughts on this one?And yes, I did try the citrate years ago. I remember it was hard on my stomach lining. It has alcohol as a stabliizer, and I remember it giving me some upset. But I probably didn't take it with emough for or something...
Thanks again, Mitch
Chloe
Posted by Chloe on January 12, 2002, at 10:27:24
In reply to Re: Eskilith CR/Lithobid, etc. » Chloe, posted by Mitch on January 11, 2002, at 22:26:50
> I have done the Eskalith immediate release tablets (300mg), the slow-release 450mgCR tabs you are talking about, and the Eskalith 300mg immediate release capsules, and the 300mg Lithobid "pinkie" slow-release tablets that include some sodium, whew!
DAH, Eskilith IR, immediate release! I am not firing on all cylinders at the moment. I got some IR tablets last night. They are impossible to cut up into 75's. So like you said, I dissolved some in cranberry juice(that's all I have in the house, not OJ) and it didn't dissolve well. And then the mixture turned black. OH yuck. This whole Lithium microdosing has becoming beyond complicated. I should ask for the citrate if my pdoc wants me to take such small amounts. I just feel like I am living at the pharmacy and giving them all my money...
I am still hoping cutting up the Esk CR is ok...I called a pharmacist and they didn't want to comment on breaking up Li tabs. I am sure because it lithium can be toxic, etc. But toxicity is clearly not an issue when I am taking about 100 mgs day.
Sorry to go on and on about this issue. But I can't get a hold of the pdoc til monday, the pdr offers no advise, and the pharmacist won't comment. And I am not thinking terribly clearly...
Best,
Chloe
Posted by Mitch on January 12, 2002, at 11:15:16
In reply to Re: Eskilith CR/Lithobid, P.S.! » Mitch, posted by Chloe on January 12, 2002, at 10:27:24
> I am still hoping cutting up the Esk CR is ok...I called a pharmacist and they didn't want to comment on breaking up Li tabs. I am sure because it lithium can be toxic, etc. But toxicity is clearly not an issue when I am taking about 100 mgs day.
>
> Sorry to go on and on about this issue. But I can't get a hold of the pdoc til monday, the pdr offers no advise, and the pharmacist won't comment. And I am not thinking terribly clearly...
>
> Best,
> Chloe
>
>
Oh, the pharmacist probably sees you as a "walking lawsuit" :-)Oh, here's the answer (I think) about the Eskalith 450mg CR tabs: I believe that the lithium is "microencapsulated", and it would be perfectly fine to quarter them just as you had intended. Otherwise, they woudn't have scored the tablets. So, just go ahead and quarter them without worry! Liquid medication has its drawbacks-I had a jug of liquid Paxil in the fridge (when I was trying it), and it worried me that some kid would get in there and drink it.
Mitch
Posted by Chloe on January 12, 2002, at 17:49:04
In reply to Re: Eskilith CR/Lithobid, P.S.! » Chloe, posted by Mitch on January 12, 2002, at 11:15:16
Thank you, Mitch.
You are so kind to keep hammering away with this lithium dilemma of mine. (Especially when my thinking/comprehension is a bit deminished.) I concur that it is "microencapsulated". It looks the same all the way through the pill.
Thanks for putting my fears to rest.
A most appreciative ChloeBTW, is Paxil grape flavored? No kid I know would drink my liquid Celexa. It's not bad, but it's certainaly not good tasting!! IMHO "-)
> Oh, the pharmacist probably sees you as a "walking lawsuit" :-)
>
> Oh, here's the answer (I think) about the Eskalith 450mg CR tabs: I believe that the lithium is "microencapsulated", and it would be perfectly fine to quarter them just as you had intended. Otherwise, they woudn't have scored the tablets. So, just go ahead and quarter them without worry! Liquid medication has its drawbacks-I had a jug of liquid Paxil in the fridge (when I was trying it), and it worried me that some kid would get in there and drink it.
>
> Mitch
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