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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by ed_uk on October 9, 2004, at 17:27:22
hello!
I have been reading the posts on psychobabble for ages but have never posted before. I suffer from anxiety and am currently taking citalopram 60mg and lofepramine 140mg daily. I've never suffered any serious side effects but do feel that the citalopram makes me feel lazy and unmotivated. Does anyone have any suggestions about which medications might improve my motivation. ed
Posted by newwife on October 9, 2004, at 18:24:10
In reply to new to psychobabble, posted by ed_uk on October 9, 2004, at 17:27:22
i am on lexapro for anxiety/mood swings. i know alot of people on xanax, but it makes me tired. lexapro made me groggy for the first 2 weeks, but i have been on it for like 8 months now and i am doing great. i dont feel like i am drugged up, actually i dont even feel like i took anything, it makes me be the person i am suppossed to be. good luck. try going to redirected lexapro section adn you can read alot of posts from the lex users. good and bad things. talk to your doc, you should never be on something that makes you tired all the time. how long have you been taking it?
Posted by Daniel Woodfield on October 9, 2004, at 18:36:54
In reply to Re: new to psychobabble, posted by newwife on October 9, 2004, at 18:24:10
Hi Ed,
Having responded to the post you sent regarding my thread i thought i would return the compliment.
I too agree that there is no point replacing anxiety with a constant tiredness, (lethargy maybe) etc. I figure, whats the point in not being anxious if it means being too tired to make full use of the relief.
I believe Lexapro as was suggested in the follow up above is called ESCITALOPRAM is the UK.
As i understand it Citalopram (Celexa for the US users) is made up of two metabolites, one of which is active, the other inactive. Escitalopram is the same medication with the inactive metabolite removed so becomes more potent, and may well benefit most Citalopram users.
then again it could just make you feel exactly the same, just that you require a smaller dose than what you currently take on citalopram.
Anyway just my two cents. Personally i think SSRI's are a gip but they do seem to help an awful lot of people. Shame the medical world can't see that most of us sufferers aren't looking to abuse medication, because if that were the case all anti-depressants would be looking to release more of the chemical it is felt to be lacking rather than blocking the uptake of it. The way i see it the current anti-depressants go about trying to achieve something in a cruder way than is necessary, but then the powers that be would rather have us under control (tired, lethargic, zoned out) whilst not complaining, than actually feeling happy.
Posted by ed_uk on October 9, 2004, at 19:03:30
In reply to Re: new to psychobabble, posted by Daniel Woodfield on October 9, 2004, at 18:36:54
Thank you both for your advice!
I've been on citalopram for about 18 months but have been on one SSRI or another since i was 14 (six years ago). Have tried paroxetine(seroxat/paxil) and fluoxetine(prozac). Basically they all have a similar effect on me- less anxious but more lazy. I've also take venlafaxine which had exactly the same effect on me, but worse withdrawal. Unfortunately, i don't think escitalopram will be the answer. Since the 60mg of citalopram that i take consists of 30mg of escitalopram and 30mg of R-citalopram, i expect the alleged differences between escitalopram and citalopram are probably more to do with marketing than anything else!! Even so it could be worth trying Cipralex(as lex is called in the uk). I did suggest it to my psychiatrist a few months ago but he didn't like the idea. I wonder whether adding a dopaminergic med would help?
thankyou for responding!
Ed
Posted by newwife on October 9, 2004, at 19:07:25
In reply to Re: new to psychobabble, posted by ed_uk on October 9, 2004, at 19:03:30
what is a depomegeric, or whatever that d word was in your last sentence. is it a word used in the UK or am i just dumb and dont know what it means?
Posted by ed_uk on October 9, 2004, at 19:40:28
In reply to Re: new to psychobabble, posted by newwife on October 9, 2004, at 19:07:25
A dopaminergic med is a drug which raises the level of the neurotransmitter dopamine in the synapses or stimulates dopamine recptors directly. Some examples are: selegiline(eldepryl) ,amineptine(survector), pramipexole(mirapexin in the uk) and methylphenidate(ritalin). They may have the ability to improve drive and motivation.
Ed
Posted by newwife on October 9, 2004, at 19:58:46
In reply to Re: new to psychobabble, posted by ed_uk on October 9, 2004, at 19:40:28
is adderall? these are mainly for add or adhd correct?
Posted by ed_uk on October 9, 2004, at 20:02:29
In reply to Re: new to psychobabble, posted by newwife on October 9, 2004, at 19:58:46
yes, adderall is also dopaminergic. Its not available in england though.
Ed
Posted by newwife on October 9, 2004, at 20:05:22
In reply to Re: new to psychobabble, posted by ed_uk on October 9, 2004, at 20:02:29
are you on any meds now? just wondering, you dont have to answer.
Posted by ed_uk on October 9, 2004, at 20:08:42
In reply to Re: new to psychobabble, posted by newwife on October 9, 2004, at 20:05:22
Yes, citalopram 60mg daily and lofepramine 140mg. I take citalopram for anxiety and lofepramine for depression. Ed
Posted by newwife on October 9, 2004, at 20:13:50
In reply to Re: new to psychobabble, posted by ed_uk on October 9, 2004, at 20:08:42
well, i wish you the best of luck in life and in happiness. you are a nice and very smart person. nice chatting with you.
Posted by ed_uk on October 9, 2004, at 20:22:40
In reply to Re: new to psychobabble, posted by newwife on October 9, 2004, at 20:13:50
yes, it has been nice chatting to you!
I must go to bed now or else i won't be able to get up tommorrow. it's 2.20 am!
Ed
Posted by Daniel Woodfield on October 10, 2004, at 5:18:07
In reply to Re: new to psychobabble, posted by ed_uk on October 9, 2004, at 20:22:40
Morning people :)
Ed,
I would be interested to know who is currently treating you, are you using a GP or a psychiatrist or.......
My GP is treating me and to be honest we are coming to the end of our relationship. I wanted him to refer me to a psychiatrist for a long time but he was determined to treat me because he has know me for about 18 years but he is getting annoyed with me because i insist on doing my own research and coming up with ideas rather than just taking the mandatory SSRI that he is so desperate for me to take.
I have been on three, Cipramil, Efexor and Seroxat and hated all three of them. My GP actually scoffed at me because i didn't like the Cipramil. He told me that even Grannys could take that medication, so i was being pathetic. (Hardly helpful is it???). After our last consultation he told me that if i went back and complained about the Librium he would prefer not to see me again because the amount of meds he has prescribed for me is starting to look bad for him. (Is he worried about my health or trying his hardest to conform??? Either way some of the things he says to me are hardly helpful.)
Incidentally i too believe a medication like Ritalin would be an absolute godsend to me, but getting my doctor to even contemplate such a diagnosis of ADD (Even though he admits i exhibit many symptoms) is just too much for him. I have been communicatinjg with a psychopharmacologist from Bristol university who said he would be happy to have me on his outpatients at Bristol Hospital and evaluate me himself for ADD (and just generally) but i need a referral from my GP. If the Librium doesn't work then i think i will probably just demand that referral. ritalin combined with an anti seizure med, imo, would be the two types of med that would give me the best quality of life and i have no qualms about taking them the rest of my life.Oh and by the way, i have woke up this morning with such a hangover feeling from the librium. Originally woke up at 7:30 and went back to sleep to wake up again at 10:30, and that didn't really help at all. put bluntly i feel like shit. I'll give it time like you suggest but to be honest im not too impressed at the moment. The other problem is my withdrawal from Effexor only subsided about two weeks ago and has since returned having started the Librium. I understand a few of the early benzos inhibit the release of serotonin and i think this is probably the problem. Im sure my brain will get used to it, just hate them electric shocks. (there is a new Benzo in development that actually promotes release of serotonin which might be inetersting for the future, but i digress...)
Oh and thanks for clearing up the Lexapro = Cipralex thing. you learning something new everyday and all that. I have been walking around thinking it was Escitalopram for about a year. I think the doctor offered me Cipralex, maybe i should have tried it. Bah, i don't bother with hindsight anymore.....Have a good day!!!
Posted by ed_uk on October 10, 2004, at 7:14:03
In reply to Re: new to psychobabble, posted by Daniel Woodfield on October 10, 2004, at 5:18:07
hello- i've only just got up! I'm so lazy!
I go to a psychiatrist (have done since i was about 12) but i get repeat prescriptions from my gp in manchester. Last time i got a repeat i went to a different gp at the practice who seemed convinced i was trying to kill myself because my records said i had endogenous depression in the past.
All the doctors i have ever seen have loved the ssri's and nothing else. If they don't work you have to beg for something else. My pdoc has never prescribed nardil in his entire career and has never had a patient on two antidepressants at once until me. The pharmacist nearly had a seizure when she saw my prescription. I take diazepam(valium) occasionally but my doc insists that i never take it for more than a couple of days at a time.
Its strange how doctors seem to think that everyone can tolerate ssri's, you would think that they would have learnt by now. They all say:
they don't cause weight gain and they don't cause dependence. mmmm!I def think you should get a new doc who is more concerned about you and less concerned about himself. Whether his other patients can tolerate cipramil really isn't relevent to you. You could ask to see a pdoc or maybe a psychologist for cognitive behavioral therapy(waiting list about one year where i live).
Personally i don't have ADD but i sometimes feel like i do when i'm on an ssri. I don't pay attention to what's going on around me. Well, i guesss i always have been a day dreamer. When i was little my anxiety in social situations was severe so i'd just shut myself off from the environment. Now i don't pay much attention to my surroundings, i think it's deeply ingrained into my personality.You mentioned antiseizure meds- were you thinking of trying gabapentin(neurontin) or pregabalin(lyrica). Both have been studied to some extent for anxiety but neither is licensed for that purpose.
Maybe the librium will work when the venlafaxine withdrawal ends- could be a few weeks yet. My withdrawal lasted about three weeks i think but its much longer for some ppl.
I have wondered about trying ritalin personally but it can make anxiety much worse for some ppl and that has always concerned me. Have you ever tried a stimulant before?
In the uk, low doses of antipsychotics are sometimes prescribed for anxiety, particularly by docs who don't use the benzos. I'd be interested to know whether you have ever tried one. I took chlorpromazine(largactil/thorazine) once and it landed me in the emergency department very quickly. It caused such severe akathisia(restlessnes) that i threatened to jump out of the window if they didn't treat me quickly. It took 50mg of valium to calm me down. I will not be taking it again!!
If you ever get confused about brand names this may help(you probably know this anyway but i thought i'd post it just in case) :mirtazapine(remeron but zispin in uk)
trazodone(molipaxin in uk)
citalopram(celexa but cipramil in uk)
escitalopram(lexapro but cipralex in uk)
fluvoxamine(luvox but faverin in uk)
fluoxetine(prozac everywhere)
paroxetine(paxil but seroxat in uk,imported brand called deroxat)
sertraline(zoloft but lustral in uk, imported brand called aremis)
venlafaxine(effexor in us, efexor in uk. english efexor XL is the same as americas effexor XR)Ed
Posted by ed_uk on October 10, 2004, at 7:19:53
In reply to Re: new to psychobabble, posted by ed_uk on October 10, 2004, at 7:14:03
Daniel, i just posted you a babblemail, hope you get it. Ed
Posted by Daniel Woodfield on October 10, 2004, at 9:42:00
In reply to Re: new to psychobabble, posted by ed_uk on October 10, 2004, at 7:19:53
Hey Ed,
yep got your mail, will text you my number over the next few days, when your phone is recharged. Would be nice to have someone to correspond with.
I think the next time i see my GP i will ask to get a referral, im sick of him looking at me as if im doing him some kind of disservice when all i want is to get better, is that too much to ask???
So it appears i was right in my thinking that Lexapro was Escitalopram, i just can't keep up with the generic and marketed names all the time. TOO CONFUSING.
I am VERY interested in the Pregabalin, as i have always been interested in Neurontin but my doctor just gets irritated when i come at him with names of medication. (he was only too happy to give me the Largactil btw, had me on that with my very first prescription along with the Citalopram. I didn't take it too long, not for any adverse reaction but it just felt like a sugar pill and i figured, whats the point.)
I have been doing some research on the Pregabalin this morning, i hear many people have a good anxiety effect, both social and general, on Neurontin so if Pregabilin (Lyrica??) is just a more powerful version, it definitely sounds like its worth a good shot.
The Librium is becoming increasingly more ineffective. I took a dose about two hours ago because my morning dose hadn't seemed to even rid me of my physical symptoms today, alas even the second dose hasn't made any headway. Thinking about taking my third of four doses at 15:30 can't be a good thing and is only going to set me up for problems im sure. I will continue but my confidence in either the med or the dosing is waning. The rebound anxiety seems more uncomfortable that just the irritation and agitation i feel when off Meds. My palpiatations are under control however, so im glad about that.
Anyhoo, i will persevere, and i need to make some big decisions over the coming weeks, its pointless to consider them now really because maybe as the Librium builds up in my system it will all work itself out.
Hope all is well, and have a good day.
(Oh im from Birmingham by the way. Cheers. Dan.)
Posted by ed_uk on October 10, 2004, at 13:00:25
In reply to Re: new to psychobabble, posted by Daniel Woodfield on October 10, 2004, at 9:42:00
Hello!
My mobile will be recharged later this evening so text me whenever you like. I will look forward to it. What are you studying in birmingham?Sorry if i confused you about escitalopram, this is how it is:
The drug citalopram(celexa, cipramil) consists of TWO chemicals, S-citalopram(escitalopram) and R-citalopram in a 50:50 ratio. eg. 20mg of citalopram consists of 10mg S-citalopram(escitalopram) and 10mg R-citalopram. S-citalopram is the mirror image of R-citalopram and so they are difficult to separate. Most, if not all of the activity of citalopram resides in the S-enantiomer: S-citalopram. As a result, the manufacturer has isolated S-citalopram(escitalopram) and sold it on its own under the brand names lexapro and cipralex.
So, the drug cipralex/lexapro consists of only ONE chemical, unlike cipramil/celexa.
In theory, 20mg of citalopram should have pretty much the same effect as 10mg of escitalopram/lexapro. From their clinical trials the manufacturer(lundbeck) claims that 10mg of lexapro/cipralex is equivalent to 40mg of citalopram(cipramil/celexa). In practice, I think this is dubious because 40mg of citalopram actually contains 20mg of escitalopram. In order for the manufacturers to be correct in their statement then R-citalopram must in some way inhibit the efficacy of escitalopram, I did see a study in a journal that suggested this was the case but it was not entirely convincing.
In the UK you will pay the same price for 28 citalopram 20mg as for 28 cipralex 10mg so it doesn't really matter which gets prescribed to be honest. Lundbeck, of course wants docs to prescribe cipralex because almost alll of the citalopram dispensed from uk pharmacies is generic( not the Cipramil brand made by lundbeck). So it's really in Lundbeck's interests to make everyone think that cipralex/lexapro is better than citalopram. When i worked in a pharmacy over the summer hols we never dispensed any cipramil- only generic citalopram. Never dispensed any seroxat/paxil or prozac either, it was ALWAYS the generics- basically every other prescription had fluoxetine on it!! A drug rep came from lundbeck to try and convince us that cipralex was the best ssri, to be honest though the only thing that did surprise me was that lundbeck is selling cipralex in the uk at the same price as generic citalopram ( ie. each 10mg cipralex is the same price as a 20mg citalopram tablet). I doubt this applies in other countries though but i could be wrong! Anyway i hope i haven't bored you about cipralex!Here is that study i was talking about, animal studies never were that helpful though because you never know whether what happened in a rat would happen in a human!
Pharmacol Biochem Behav. 2003 Jul;75(4):903-7. Related Articles, Links
R-citalopram counteracts the effect of escitalopram in a rat conditioned fear stress model of anxiety.Sanchez C, Gruca P, Bien E, Papp M.
Neuropharmacological Research, H. Lundbeck A/S, Copenhagen-Valby, Denmark. cs@lundbeck.com
LOOK WHO DID THE STUDY!!
S-citalopram (escitalopram) mediates the serotonin reuptake inhibitory effect of the racemate, R,S-citalopram (NORMALLY JUST CALLED CITALOPRAM). The effect of escitalopram (0.5-3.9 mg/kg) was investigated in a rat conditioned fear stress model of anxiety and compared to the effects of R-citalopram (1.0-7.8 mg/kg), R,S-citalopram (4.0 and 8.0 mg/kg), and escitalopram (2.0 mg/kg)+R-citalopram (7.8 mg/kg). Diazepam (0.95 mg/kg) and buspirone (4.6 mg/kg) were included as positive controls. During an acquisition session, rats were allowed to freely explore a novel cage for 9 min. During that time, they received two inescapable footshocks through an electrifiable grid floor. Groups of nonshocked control rats were run in parallel. During an expression session on the next day, rats were treated with drug or vehicle 30 min before they were reintroduced into the test cage for a 9-min period this time without receiving footshocks and the total distance travelled was recorded. The distance travelled by vehicle-treated rats was markedly suppressed compared to a vehicle-treated group of nonshocked controls. Escitalopram produced a dose-dependent inhibition of the conditioned suppression of exploratory behaviour (minimal effective dose 1.0 mg/kg). Interestingly R,S-citalopram 4.0 and 8.0 mg/kg produced significantly smaller effect than escitalopram 2.0 and 4.0 mg/kg, receptively. R-citalopram, 7.8 mg/kg, produced a significant effect. However, in spite of this, R-citalopram (7.8 mg/kg) significantly inhibited the effect of escitalopram (2.0 mg/kg). The activity in drug-treated nonshocked groups was similar to the vehicle-treated group, except for the buspirone-treated group where a significant reduction was observed. The finding that R-citalopram inhibits the effect of escitalopram may be relevant to the improved clinical efficacy seen with escitalopram compared to R,S-citalopram in the treatment of anxiety and depression.So who knows? Maybe cipralex really is better for anxiety but ther is little reason to think that it would have less side effects than citalopram- as the rep tried to encourage us. Perhaps R-citalopram does contribute to the side effects of cipramil/celexa but if S-citalopram is the potent SSRI this seems unlikely.
Ed
Posted by Daniel Woodfield on October 11, 2004, at 7:27:37
In reply to Re: new to psychobabble, posted by ed_uk on October 10, 2004, at 13:00:25
Hey Ed,
I am waiting on my student loan before i can get any credit on my phone, one of the symptoms (if you like) of my problems is that i have absolutely no desire, nor capacity, to work. I have tried to get data entry jobs many times but no-one will be flexible with me regarding my uni hours and i really don't have the energy or physical wellness to stand up for eight hours serving beers to impateint people like so many students seem to. I would much rather play on my ps2 or watch the TV than bother with the social anxiety so.....
Anyway, my point being i have no credit to text you as of yet. The loan company has done this silly BACS thing this year also where you don't get a cheque anymore they just pay it into your bank when you are enrolled on your course, and as i didn't enrol until last friday i don't anticipate getting the money for at least another week, i will text then.
I thought i was making a breakthrough with the librium yesterday, felt a bit clamer, so i went into uni today (its one of my days off) to get some of my dissertation prep done, lasted thre hours before starting to feel uncomfortable with the amount of people in the room before leaving. (God i feel so pathetic. I'd give my little pinky to have a week when i didn't go through that rubbish).
Then i proceeded to do a very odd thing. I don't seem to have any anxieties or feel uinwell when i am one on one with someone who seems to be in authority. for example when i go to the doctors i talk four ages, getting quite animated and hyper actually, before he tells me i have to leave. Similarly if i go to a choropodist or something similar (homeopath etc), i can't stop talking and for about an hour after leaving i feel quite liberated. (What the hell is all that about.) Anyway, so i went around university trying to arrange as many appointments as i possible could where i know i will be in a similar situation. I have two one hour sessions booked for tomorrow, one with a counsellor on campus, and one with a career advisor. I also have an hour session booked in with my personal tutuor. I have absolutely no idea what im going to say to these people when i meet with them at all. I dont even know why i made the appointments. Probably for the hour of liberation following them after i have spoken at someone for an hour each time. God im starting to really worry about myself.
Im sick of being at home alone, feel the need to be around people, involved in the world, then when i get there i feel totally uneasy to the point of feeling physically unwell. Im so sick of it.
Bah im rambling again, i do that a lot.
Cheers for listening, Dan.
(Sod it im gonna go check to see if my loan has gone through, it won't have but im bored.)
Posted by Ed_uk on October 11, 2004, at 8:59:42
In reply to Re: new to psychobabble, posted by Daniel Woodfield on October 11, 2004, at 7:27:37
Hello!
I'm really glad you replied because i just got to a computer in the pharmacy block. It would be nice if you would send me a babble mail with your mobile no. then i could send you a message to cheer you up- who knows it might work! I'm not sure how to read babblemail though because i've never got one- hope you can explain. Don't worry, i won't call you out of the blue because i know it might make you nervous.
I'm really glad i don't get the social phobia anymore, it's a very lonely place to be. When you have an appointment you feel less lonely but it doesn't last,you need good friends to make you feel better in the long run, at least i do. You need someone who's understanding and who doesn't judge you (ie. probably a girl!) With social anxiety it can be so difficult to make friends in the first place.
I don't think what you did was odd at all, it can be easier to talk to a doctor or a career advisor because you don't need to worry so much about what to say. When you're with friends you try to think of something to say so that people will like you but you don't need to do that at the docs so it's more relaxing. You'll usually get asked the same questions that you've answered before- esp at the psychiatrist. Each time you answer them you end up saying a bit more about yourself.
Please can you tell me a bit more about your symptoms and the things that worry you most. Did you diagnose yourself with social anxiety or was it your GP?
I'm glad you're feeling a little bit calmer. Maybe you'll improve more over the next few days. I really hope you do.What subject are you doing by the way? What year are you in? I'm in the second year but I would have been in the third year. I was hospitalised for depression when i was 18 so i've been a year behind ever since.
Today has been an ok day. Had a lecture on drug toxicity this morning and one on infectious disease. This afternoon we had a lecture about synaptic transmission in the brain.
I've only got a few close friends on my course because i prefer to know a few people well rather than know everyone a bit, it's nice to know that if you're not there you will be missed!I didn't think you rambled at all in your post, not as much as i did about escitalopram anyway!
Please reply soon(when you have time) Ed
Posted by Daniel Woodfield on October 11, 2004, at 12:10:02
In reply to new to psychobabble, posted by Ed_uk on October 11, 2004, at 8:59:42
Ed,
I had no idea about the babble mail thing until you sent me one the other day and i checked my usual hotmail account and it was in there.
Im guessing that when you sign up for this forum you have to give an e-mail and when people send you babble mail it gets posted directly to there.
I will send you a detailed mail in a while and hopefully that will go to the e-mail account you provided when you signed up.
Posted by ed_uk on October 11, 2004, at 13:46:47
In reply to Re: new to psychobabble, posted by Daniel Woodfield on October 11, 2004, at 12:10:02
hello dan! please don't send the babble mail- i've just realised the message will go to my dad because i registered using the email address on my computer at home. I will send you a babblemail with my manchester email!
Ed
Posted by Daniel Woodfield on October 11, 2004, at 16:04:11
In reply to Re: new to psychobabble, posted by ed_uk on October 11, 2004, at 13:46:47
Ok cool, no worries,
Have sent e-mail to given adress in your new mail.
Hope its not too overwhelming!!!
Posted by Daniel Woodfield on October 11, 2004, at 16:13:47
In reply to Re: new to psychobabble, posted by Daniel Woodfield on October 11, 2004, at 16:04:11
The e-mail keeps getting returned to me actually Ed, i have tried to send it three times now, something about an unroutable address.
It keeps turning stud into student, i dont know if that has anything to do with it, either way im not really sure what to do about it.
I would rather not post it on here because its quite a personal mail, i have it saved though so....
Posted by ed_uk on October 12, 2004, at 5:09:10
In reply to Re: new to psychobabble, posted by DynaUnity333 on October 11, 2004, at 16:13:47
Hey, i just found out we've all been given new email addresses now that manc uni has merged with umist. I've sent you a babblemail with my new address. Hope it works this time!
Ed
Posted by DynaUnity333 on October 12, 2004, at 6:53:57
In reply to Re: new to psychobabble, posted by ed_uk on October 12, 2004, at 5:09:10
Ed,
Have resent my message, thanx for listening.
Have checked my bank account btw and still no loan, bummer.
Cheers,
Dan.
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