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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by allisonm on May 7, 2002, at 10:45:00
My pdoc wants to change my cocktail again. I have been on Zoloft, Effexor XR, Remeron, lithium, Wellbutrin, Neurontin,
Celexa, and Serzone in various combinations over the last 4 years. Currently on Wellbutrin and Serzone (each 150mg 2X/day).In the past few months when under stress, my emotions have been rather unstable and anxiety has been very very high. I start
weeping at the drop of a hat -- anywhere and often in public. Some people have noticed this, which makes me all the more
anxious. Pdoc more than a month ago urged me to take the Ativan he gave me more often and whenever I feel this anxiety
coming on. It is only a stop-gap.So now he wants to wean me off the Serzone and try an SSRI again (Zoloft, Prozac, Paxil, Celexa). I haven't tolerated SSRI's
in the past and have always had to get off them. It feels as though he is running out of drugs to try.Would anyone have a theory as to why he would want to try SSRIs again after previous intolerable side effects? Is there
really any chance that an SSRI could help now? Has anyone had this happen?Thanks for listening.
Allison
Posted by Leighwit on May 7, 2002, at 12:03:29
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
I took Wellbutrin with Serzone for quite awhile, and I stopped the Serzone for reasons that quite frankly, I can't remember. Now I'm just taking WB and am feeling way too anxious. My Pdoc prescribed Xanax, but I was afraid to take something like that, for fear it would take away what little ambition I have, so I never filled the script.
I tell you this, because I think there are some similarities in our prescription backgrounds. I'm not sure why you didn't tolerate SSRIs, (?)but I've had problems with weight gain (and I'm not allowed to gain weight as an insulin-dependent diabetic, so no-one ever argued with me about stopping them). Plus, they never seemed to produce anything beyond a very-moderate partial response in me, particularly when used alone ~ but also as part of a cocktail.
I'm thinking that perhaps the Wellbutrin is the culprit rather than the solution. How does one know if anxiety (and in my case, anxiety plus agitation) is caused by the depression itself or by the Wellbutrin which is well known for it's side effects in those very areas?
I'm going to ask to try the Xanax (and admit to tossing the scprit) to alleviate the agitation during my next Pdoc visit, because I don't want to do an SSRI/WB cocktail again, and I can't imagine what else she would suggest. What I really want to do it stop the WB, but I've done that once before and it wasn't a good result. The depression symptoms worsened rather quickly.
Guess I wasn't much help ~ other to let you know you're not alone.
LW
(like Zoloft or something) again. > My pdoc wants to change my cocktail again. I have been on Zoloft, Effexor XR, Remeron, lithium, Wellbutrin, Neurontin,
> Celexa, and Serzone in various combinations over the last 4 years. Currently on Wellbutrin and Serzone (each 150mg 2X/day).
>
> In the past few months when under stress, my emotions have been rather unstable and anxiety has been very very high. I start
> weeping at the drop of a hat -- anywhere and often in public. Some people have noticed this, which makes me all the more
> anxious. Pdoc more than a month ago urged me to take the Ativan he gave me more often and whenever I feel this anxiety
> coming on. It is only a stop-gap.
>
> So now he wants to wean me off the Serzone and try an SSRI again (Zoloft, Prozac, Paxil, Celexa). I haven't tolerated SSRI's
> in the past and have always had to get off them. It feels as though he is running out of drugs to try.
>
> Would anyone have a theory as to why he would want to try SSRIs again after previous intolerable side effects? Is there
> really any chance that an SSRI could help now? Has anyone had this happen?
>
> Thanks for listening.
>
> Allison
Posted by Phil on May 7, 2002, at 12:36:37
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
Allison, He's still got 100's of things to try. What were the intolerable SE w/ SSRI's? Sex difficulties and weight gain? WAG
If you have only tried a few SSRI's, depending on what SE, you could try one more if you could stand it.
If not, maybe a tricyclic, Nortriptyline or Desipramine. Personally, I'd add 1mg Klonopin to what you're already taking. But my major in college, boy, that was a fun year, was more focused on street drug intake and mushrooms.
Posted by sid on May 7, 2002, at 13:26:02
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
You wrote:
It feels as though he is running out of drugs to try.
Would anyone have a theory as to why he would want to try SSRIs again after previous intolerable side effects? Is there
really any chance that an SSRI could help now? Has anyone had this happen?==> I don't have an answer for you, but do make sure you tell and ask your pdoc that. He's the best person to ask about the theory he may be referring to with this proposed change.
Posted by rainbowlight on May 7, 2002, at 17:40:45
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
I also tolerate SSRI's poorly. After years of getting sick on different meds I found out I was a bad metabolizer. I have found that if I start out on a really low dose that I have fewer side effects. I also require a much smaller dose than your average person. Maybe you just need to try a smaller dose to begin with, might make it easier to tolerate.
Posted by katekite on May 7, 2002, at 20:26:18
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
If you haven't been on all of them in conjunction with wellbutrin, it could be worth a try, since wellbutrin may influence how you respond and even the initial side effects. Maybe just try the least bad one for a short time to see if you tolerate it better than before. -- kate
Posted by allisonm on May 7, 2002, at 23:35:45
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again » allisonm, posted by Leighwit on May 7, 2002, at 12:03:29
LW,
Thanks for writing. I couldn't tolerate Zoloft because it made my brain race, my heart and body race, and I had bad tremor. Effexor was similar but worse. Celexa gave me big tremor but turned off absolutely all energy so it was hurting my life because I could not do anything.
REmeron worked for awhile, but everything I have always taken has need augmentation. Added the WB and felt a lot better. Got off the Rem because over time the combo didn't seem to be doing the trick. WB has seemed to be the best drug I've been on. It just can't do the job by itself either. Weight gain on Remeron and lithium was really bad. Once I got off Rem and stayed on WB, I lost about 30 lbs.
You make good points on the Wellbutrin. I wish I had an answer.
I hope the Xanax helps.
Take care and thanks again for writing.
Allison
Posted by allisonm on May 7, 2002, at 23:45:13
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again » allisonm, posted by Phil on May 7, 2002, at 12:36:37
Hi Phil,
SE with Zolofft was racing mind and body, big tremor. Celexa was complete opposite. Felt I had the flu: NO energy and tremor on top.
Think I have had inorgasmia for years, although before it didn't matter. Now it does matter. Don't know what causes that. Not even so concerned about it as I am getting rid of these bad feelings.
Yeah, finals start Friday, and I'm too old to do mushrooms anymore. Just don't spring back like I used to . Oh, those days when we were indestructible. :-)
I'll ask him about alternatives. He's alreadyy kinda said I don't have to go in this direction... I'm even thinking about giving in to MAOIs and doing the 2-week washout and giving up the tofu and soy (I'm vegetarian, so it will be a loss).
I dunno. I am tired of being mentally ill. I am very afraid that my professors will find out -- especially my advisor. They say nothing will change in their opinions but it always does. You can see it in their eyes and the way they talk.
A>
Posted by allisonm on May 7, 2002, at 23:46:21
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again » allisonm, posted by sid on May 7, 2002, at 13:26:02
Posted by allisonm on May 7, 2002, at 23:48:10
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again, posted by rainbowlight on May 7, 2002, at 17:40:45
My pdoc did mention starting at a very small dose and working up. Maybe it will work as it does for you. I'll ask him about it again.
Thanks!
Posted by allisonm on May 7, 2002, at 23:52:01
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again, posted by katekite on May 7, 2002, at 20:26:18
Good point, also.
I did try Celexa with Wellbutrin, but not Zoloft with WB. I was hesitant at the thought of putting two activating ADs together, but maybe their interactions would be different together.
Thanks!
Posted by Janelle on May 8, 2002, at 2:16:27
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
Sorry to hear how you are suffering ... I can relate. Anxiety is a BIG problem for me.
From what I know (which admittedly isn't a whole heckuva lot!) it sounds like the combo you are on is pooping out but has been a good one in terms of BALANCE: Serzone, which is supposed to be a more sedating, calming AD could be offsetting the Wellbutrin, which is a more activating AD (it causes heart palpitations and agitation in a considerable segment of people).
Has your pdoc told you WHY/what his reason(s) are for wanting to wean you off the Serzone and try an SSRI again? If anything I would have thought he'd want to do the opposite - wean you off the activating AD (Wellbutrin) and maintain the Serzone. Hmm ...!
I can offer a theory (probably not a very good one, but I'll give it a whirl) as to why your pdoc would want to try SSRIs again after previous intolerable side effects and it is precisely what you happened to mention: YES, there is really a chance that an SSRI could help now! I think this is possible because your body chemistry has probably changed since the times you were on SSRI's and had the bad SE's, and perhaps what your body couldn't tolerate then it WILL be able to tolerate now.
Also, I have read and have a friend who has actually had it happen - a med that previously didn't help or had bad SE's did wind up helping and being tolerated on a later re-try.
Hope this helps. Good luck.
Posted by allisonm on May 8, 2002, at 10:55:42
In reply to Re: Bad SSRI side FX/trying again, my take: » allisonm, posted by Janelle on May 8, 2002, at 2:16:27
Hi Janelle,
Thanks for writing.
I am reluctant to get off the Wellbutrin because I have had the best response with it. I think the pdoc thinks the same.
He did put me on the Serzone to help me sleep. I have insomnia. That's also why I was on the Remeron for so long. I am concerned that something like Zoloft will exacerbate the sleep problem. I cannot recall what Celexa did.
I just have a feeling that the WB and the Serzone aren't enough for the increased stress I have been under. Or maybe it is poop-out. I can never tell if poop-out is happening. Every circumstance has so many variables.
I see my pdoc Thursday and will ask the good questions you and others have posed. It's good to know that somebody has benefited by trying a drug a second time.
Thanks for your help!
Allison
Posted by kid47 on May 8, 2002, at 11:59:55
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
Hi Alli. Have you ever tried Trazodone. It is an older AD with some similarities to Serzone. I think Serzone is supposed to be a more refined version. Might be worth a look. With SSRI's start low & go slow. Maybe if you titrate up real slow you'll have better luck. Haven't talked to you in a while. Take care
kev
Posted by Janelle on May 8, 2002, at 19:51:14
In reply to Re: Bad SSRI side FX/trying again, my take: » Janelle, posted by allisonm on May 8, 2002, at 10:55:42
I have TERRIBLE insomnia, and have been tossing around the possiblity of going on one of the more sedating AD's, e.g. Remeron (but the weight gain scares me) or Serzone. So, I'm curious to know, has the Serzone taken care of your insomnia?
Thanks!
-Janelle
Posted by Janelle on May 8, 2002, at 19:56:33
In reply to Re: Bad SSRI side FX/trying again, my take: » Janelle, posted by allisonm on May 8, 2002, at 10:55:42
Do you find that Serzone gives you any kind of "hang-over" effect the next day after taking it the previous night? If so, how *bad* is it? And what dose of Serzone do you take?
Thanks!
Posted by allisonm on May 8, 2002, at 22:40:23
In reply to P.S. Oops forgot some stuff re Serzone: » allisonm, posted by Janelle on May 8, 2002, at 19:56:33
Janelle,
Remeron was tremendous when I started it. It put me right to sleep and I didn't wake up in the night. (I used to wake up every 2-3 hours and often could not go back to sleep. Got little sleep. Over time became exhausted.)
Weight gain was a problem and for that reason I would not go on Remeron again.
Serzone doesn't affect weight, and it puts me to sleep, albeit not as sound a sleep as the Remeron did. It works enough, though, so that I can sleep through the night. I find no hangover with Serzone. With Remeron, there always was a degree of fog depending on the dose. I had to have coffee in the morning to break it.
I take 150mg Serzone in the morning with 150mg Wellbutrin. Then 150mg Wellbutrin around 3 p.m., and then 150mg Serzone around 9 pm. One thing is that if I do take the Serzone later than 9 or 10, I find it harder to wake up and I am more apt to fall asleep after I shut off the alarm. Then invariably I am late to school or work, which I really hate because I tend to be a perfectionist. Taking it early enough works well. It is not so strong that it will make you sleepy and turn bleary and useless if you still are working on stuff (Remeron did do that; I couldn't really take it until just before I went to bed.)
Hope this helps.
Posted by Janelle on May 9, 2002, at 2:32:29
In reply to Serzone and insomnia » Janelle, posted by allisonm on May 8, 2002, at 22:40:23
Posted by allisonm on May 9, 2002, at 6:26:05
In reply to Re: Bad SSRI side FX; now pdoc wants to try them again, posted by kid47 on May 8, 2002, at 11:59:55
Posted by katekite on May 9, 2002, at 10:21:20
In reply to Re: Bad SSRI side FX » katekite, posted by allisonm on May 7, 2002, at 23:52:01
I think its impossible to know what any drug will do, for sure, in combination with any other. We are all so completely different. But you would know pretty soon -- a week maybe, after you started if the side effects were going to be just as bad as before. So maybe worth a shot.
kate
Posted by allisonm on May 9, 2002, at 22:48:44
In reply to Bad SSRI side FX; now pdoc wants to try them again, posted by allisonm on May 7, 2002, at 10:45:00
Now this is getting a little interesting. My pdoc first gave me the Remeron because I was depressed and had bad insomnia. A while later after I was off the Remeron and had tried a couple other things, he put me on the Serzone because of the insomnia thing.
So when I saw him today, I brought up the question re' switching Serzone and trying an SSRI again and what about this insomnia we've treating for 4 years, which has been a symptom of this insomnia. He didn't seem to think there was a problem not having an AD w/o having sleep aid as part of it. Said my sleep hygiene was not good and I should be working on that. Grr. We have gone around re' sleep hygiene and I know I need to practice better methods there, but even then I still seemed to have the insomnia. Don't know how eliminating Serzone for an SSRI is going to help the situation. Sorry, just venting a little.
Posted by Janelle on May 10, 2002, at 2:57:54
In reply to Insomnia..., posted by allisonm on May 9, 2002, at 22:48:44
Interesting discussion you had with your pdoc regarding insomnia ... what did he/you mean by "sleep hygiene"? I am guessing it refers to sleep habits, perhaps including going to sleep what might be considered *too late*?
IMHO there's only so much one can do or try to do with their sleep habits and patterns and if insomnia persists, it would seem to be a biochemical type problem (beyond the scope of behavioral techniques) and necessitate medical assistance!
The only thing I can come up with for how eliminating Serzone for an SSRI is going to help your sleep (or lack thereof!) situation is that some of the SSRI's *supposedly* help with insomnia.
Now here's an interesting contrast: Both I and a friend of my sister's are on EffexorXR for AD; she said that ever since she got on it she sleeps like a baby, whereas me, I have extreme difficulty falling asleep/major insomnia. Same med, two very different scenarios! Argh ... it's so frustrating!
Posted by beardedlady on May 10, 2002, at 10:54:31
In reply to Re: Insomnia... I understand your frustration! » allisonm, posted by Janelle on May 10, 2002, at 2:57:54
Janelle:
Do you have a pdoc? It's hard to believe you have insomnia but don't know about sleep hygiene. It's the very first thing most docs (and articles and news stories) try to fix before putting you on meds. It's about going to bed and waking up at the same time, following a routine, using the bed for sleeping and sex only (not t.v. watching or eating), doing something relaxing--not stimulating--before bed, etc.
Sometimes changing sleep hygiene does, indeed, work, especially if you're a person who sits in front of the computer all night, instead of winding down with a warm bath, then getting into bed to close your eyes and completely relax. Insomnia is a common problem, and it's not always one that needs meds thrown at it. In my case, however, I already had good sleep hygiene and probably got insomnia due to hormonal problems and grief. When the insomnia is a side effect of other meds, there's really nothing you can do about it without a new or additional medicine.
beardy : )>
Posted by beardedlady on May 10, 2002, at 10:56:16
In reply to Insomnia..., posted by allisonm on May 9, 2002, at 22:48:44
I'm on 250 of Serzone (more than 300 doesn't work for sleep as well) AT NIGHT, and I take an occasional Sonata for help when I need it. Ask your pdoc?
beardy : )>
Posted by allisonm on May 10, 2002, at 20:23:04
In reply to Re: Insomnia... » allisonm, posted by beardedlady on May 10, 2002, at 10:56:16
Thanks, beardy,
I might be wrong, but I have the impression that he thinks I can deal with the insomnia by myself now with better "sleep hygiene."
According to a little handy-dandy chart I've been given, that would mean:
1. Arise at the same time daily
2. Limit daily in-bed time to the usual amount present before the sleep disturbance.
3. Discontinue CNS-acting drugs, (caffeine, nicotine, alcohol, stimulants).
4. Avoid daytime naps (except when sleep chart shows they induce better night sleep).
5. Establish physical fitnes by means of a graded program of vigorous exercise early in the day.
6. Avoid evening stimulation; substitute radio or relaxed reading for television.
7. Try very hot, 20-minute, body temperature-raising bath soaks near bedtime.
8. Eat at regular times daily; avoid large meals near bedtime.
9. Practice evening relaxation routines, such as progressive muscle relaxion or meditation.
10. Maintain comfortable sleeping conditions.Makes sense, I guess, in a perfect world.
I know, I'm whining...
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