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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 32. Go back in thread:
Posted by dick hunt on January 20, 2005, at 17:08:59
In reply to what's everyone on?, posted by dondon on January 20, 2005, at 9:48:24
PAXIL + KLONOPIN = FEEL GOOD! :)
Posted by redscarlet on January 20, 2005, at 17:43:02
In reply to what's everyone on?, posted by dondon on January 20, 2005, at 9:48:24
Zonegran, Abilify, Cymbalta, Xanax ~ Bipolar
Posted by thinkfast on January 20, 2005, at 18:13:24
In reply to Re: what's everyone on? » dondon, posted by redscarlet on January 20, 2005, at 17:43:02
gabitril, doxepin, and maybe zoloft in the near future....OCD, social anxiety, panic disorder, major depressive, maybe a mood disorder or BP? a couple of personality disorders, a couple I can't think of >>>>> and a partridge in a pear tree....
Posted by griswald on January 20, 2005, at 18:35:31
In reply to Re: what's everyone on?, posted by thinkfast on January 20, 2005, at 18:13:24
Lithium, Wellbutrin, Xanax or Ativan to sleep. Just stopped Lamictal and starting Depakote
Posted by jerrympls on January 20, 2005, at 19:17:54
In reply to Re: what's everyone on?, posted by tensor on January 20, 2005, at 14:59:39
Lexapro - 20mg
Dexedrine 15mg TID
Klonopin - 1mg am, 1mg PRN, 2mg HS
Ambien - 20mg
Oxycontin - 10mgMajor Depression/GAD - recurrent/treatment-resistant
Posted by Michael Bell on January 20, 2005, at 21:03:39
In reply to what's everyone on?, posted by dondon on January 20, 2005, at 9:48:24
Posted by pretty_paints on January 21, 2005, at 5:38:00
In reply to what's everyone on?, posted by dondon on January 20, 2005, at 9:48:24
Efexor - 225mg
Remeron - 15mg
Seroquel - 750mg
(changing to Abilify at the end of next week)
Posted by mattw84 on January 21, 2005, at 11:35:43
In reply to Why would you stop taking them? (nm) » mattw84, posted by tensor on January 20, 2005, at 15:59:09
I have no intention of either the adderall or xanax xr being 'long-term' solutions for my dx's. Though both have relatively low risk long term side effects... they really just 'mask' the actually cognitive problems thusly associated. I firmly believe that in the end learning to cope is better than depending on pharacology to solve these problems. Also, both Xanax and Adderall are considerably addictive in nature, so in the least I would prefer eventually stepping down to something with less risk thereof (Ideally nothing) -- mostly due to family history of substance abuse.
I have no doubt that these drugs have changed my life for better, but I want to learn to cope with my symptoms cognitively and be able to live without visits to doctors and remembering to take pills just to be a functional member of society... not a very short answer, and I have numerous other reasons why I would elect to discontinue.
However, I have no plan to do so in the near future. I have been on both for quite some time now, so the thought of discontinuing and having to go through withdrawals from both is quite anxiogenic in itself! Hope that made some sense =)
Matt
Posted by ed_uk on January 22, 2005, at 10:44:09
In reply to Re: what's everyone on?, posted by jerrympls on January 20, 2005, at 19:17:54
At the moment, nothing!
Ed.
Posted by jujube on January 22, 2005, at 12:34:24
In reply to Re: what's everyone on?, posted by ed_uk on January 22, 2005, at 10:44:09
Hope you are hanging in there. Are you looking into alternative med options?
Whatever you decide to do, I am thinking of you and wishing you all the best.
Take good care of you!
> At the moment, nothing!
>
> Ed.
Posted by ed_uk on January 23, 2005, at 9:02:14
In reply to Re: what's everyone on? » ed_uk, posted by jujube on January 22, 2005, at 12:34:24
Hello,
>Are you looking into alternative med options?
I'm not seeing a pdoc at the moment but a friend has agreed to give me some selegiline so I might try that in a few weeks time.
>I am thinking of you and wishing you all the best.
Thank you for your kindness :-)
Ed.
Posted by yxibow on January 24, 2005, at 1:09:04
In reply to Re: what's everyone on?, posted by Bill LL on January 20, 2005, at 12:43:28
Neurontin (gabapentin gen.) 900mg tid
Cymbalta 30mg bid
Klonopin (clonazepam gen.) ~6mg qd
<Topomax, tapering to zero>
Seroquel 1100mg qd
Ambien 20mg qdAnxiety induced visual conversion disorder or anxiety induced psychosis NOS + concommittant minor leftovers of a lifetime of OCD.
Posted by ed_uk on January 24, 2005, at 7:13:03
In reply to Re: what's everyone on?, posted by yxibow on January 24, 2005, at 1:09:04
Hi,
>Anxiety induced visual conversion disorder or anxiety induced psychosis NOS...
What are your symptoms?
Ed.
Posted by yxibow on January 25, 2005, at 0:51:36
In reply to Re: what's everyone on? » yxibow, posted by ed_uk on January 24, 2005, at 7:13:03
> Hi,
>
> >Anxiety induced visual conversion disorder or anxiety induced psychosis NOS...
>
> What are your symptoms?
>
> Ed.Oh its a long story but I'll try to make it as concise as possible. Ever since mid November 2001, my visual experience in the world as I knew it has never been the same. We still dont know exactly why though one can hypothesize that my extreme (it was pretty bad) hysteria after 9-11 and anthrax and every other thing that I had some sort of conversion disorder.
In short the symptoms and then in long the road taken -- in short, traffic lights (esp the LED variety which are increasingly common here), rear brake lights, etc, extremely miserably bright... fluorescent lights an intense distraction (going down supermarket aisles the soap boxes lit up almost and shopping for clothes knocking over the racks almost), patterns in clothing extremely distractive and miserable, contrast and brightness in general off, 60hz easily visible, in fact 70hz possibly, in monitors, the list went on.
Now the long story --
It was extroardinarily intense (in my view anyway) at that point, I first noticed it driving down a narrow forest highway to see the Leonids that I was nearly blinded by oncoming traffic and I couldnt find my way to a parking spot. I saw maybe one meteor and gave up and hightailed it back home as best as possible. A month passed waiting for an opthamologist's appointment, since (and there had been previous bizarre histories in the past year of unexplained fevers that werent fevers, i.e., under 100 that lasted nearly through the end of 2001 for which I had -every- battery of test and no conclusion but that I was healthy) that was about the only test left. Well, the test proved that I had two eyes and the optic nerve, etc, was fine, so I wasnt going blind. I wasnt sure what to do next.. I was getting more hysterical in general...I have been seeing a psychiatrist for general depression since I came home from college, which has been far too long.
Anyhow finally it got to a point that he reduced my experience to an overabundance or activity at the D2 receptor, and I reluctantly had little trials of Zyprexa (which made my hands shake and still probably has never completely stopped) and Risperdal (which made me crazy at night when I took it and caused one of my fingers to twich, which has never stopped, but that is all water over the dam, I give twitchy fingers for this problem these days)
Anyway new years past medicine free and then went on to Luvox which slowly started to actually downregulate the dopamine by increasing serotonin, at some point Remeron was added by chance because im an insomniac and it acted in my belief as a partial antipsychotic due to its blockade, the change was dramatic in my disorder for the better.
To assuade me, and a new GP that I had, I had an MRI done... which greatly relieved my concerns, all was normal.
A lot of therapy sessions and medication changes here and there and fast forward to the present, things are not gone, but they're more managable and I dont have the suicidality I had at the beginning where I felt at times at night that I could just obliterate things by crashing into something. I now have to deal with a large weight problem from the Remeron and the Seroquel although given the choice of lack of appetite and intense disorder and a complete cure and livin large to speak, I'd take the latter. I can always lose the weight. That's the problem now... whenever I increase my metabolism to excercise, it also revs up the visual symptoms that are left, slight electrical snow, damn irritating. But I do anyway for my health. And I suppose I continue to search for the holy grail, although I can't wait for Godot forever -- my life is in stasis at the moment and that's a whole different set of issues.
It's hard to think about working in the capacity you did before a sledgehammer came and raked your frontal cortex like this.I've probably omitted some details here and there but thats the general gist. And although I wandered on to a "visual snow" group on the web, most of their symptoms seem to be a bit different. Its hard when you dont appear in Medline.
Tidings
- J
Posted by ed_uk on January 25, 2005, at 10:00:50
In reply to Re: what's everyone on?, posted by yxibow on January 25, 2005, at 0:51:36
Hi,
Thank you for your summary. The reason that I asked was because I have had many problems which could be thought of as anxiety-induced conversion disorders eg. severe nausea and vomiting at mealtimes, muscle stiffness that made it impossible to write, difficulty speaking etc.
Do you take Seroquel at the moment?
>I have been seeing a psychiatrist for general depression since I came home from college, which has been far too long.
How old are you btw? Are you male or female?
Regards,
Ed.
Posted by Petra on January 25, 2005, at 12:22:55
In reply to what's everyone on?, posted by dondon on January 20, 2005, at 9:48:24
Paxil - 12.5 mg
Risperdal - 1.5 mg
Oxazepam - 10 mg
Posted by yxibow on January 25, 2005, at 19:49:20
In reply to Re: Conversion disorders » yxibow, posted by ed_uk on January 25, 2005, at 10:00:50
> Hi,
>
> Thank you for your summary. The reason that I asked was because I have had many problems which could be thought of as anxiety-induced conversion disorders eg. severe nausea and vomiting at mealtimes, muscle stiffness that made it impossible to write, difficulty speaking etc.They definately could be though of as conversion disorders or more likely some other disorder within the DSM classifications called somatiform disorders.
The most common kind of conversion disorder is a pseudo-seizure, very real seizure like conditions but with the absence of any organic condition. Some views of conversion or somatiform disorders may say that the person is aware or the like leading one to conclude that its hysteria or malingering but in general it can be very disturbing for the person and hard to change from what I understand.
>
> Do you take Seroquel at the moment?
>Yes, as posted before, probably one of the largest doses seen, 1100mg/day. Started down at the 400mg level somewhere between a year and 2 years ago, I forget.
>
> How old are you btw? Are you male or female?Male, 29.
>
> Regards,
> Ed.
Posted by ed_uk on January 26, 2005, at 14:05:35
In reply to Re: Conversion disorders, posted by yxibow on January 25, 2005, at 19:49:20
Hello!
>Male, 29.
I'm 20 :-)
Do you find the Seroquel very helpful for your conversion disorders?
Ed.
Posted by yxibow on January 27, 2005, at 1:51:21
In reply to Re: Conversion disorders » yxibow, posted by ed_uk on January 26, 2005, at 14:05:35
> Hello!
>
> >Male, 29.
>
> I'm 20 :-)I remember 20.... :)
> Do you find the Seroquel very helpful for your conversion disorders?
>
> Ed.(as usual there's a short and a long answer :)
Well, its hard to say whether a drug is targeting the conversion disorder (if it is conclusively one, there isnt a 100% sureness of anything about this blasted mess), or merely acting as a palleative (if you remove it, things come back).
But I can say that the ramp up of Seroquel and the reduction of symptoms for me show that Seroquel (among the other medications I take) has some effectiveness, and maybe the D2 theory is a probability (Seroquel being primarily a antipsychotic, dopamine antagonist, etc.).
So yes.. in a short sense, its helpful.. but I also had been taking Remeron in the past, which was helpful, Luvox, which was initially helpful, and a Klonopin / Neurontin mix which also is helpful. Polypharmacy can get confusing because its hard to tease out the drugs and their effects except to watch when you've started a new one or stopped an old one.
Symptom reduction has slowed down over time, probably if any reason that the leaps and bounds may be less dramatically noticeable.
But I wouldnt suggest to anyone a massive dose of Seroquel unless a) they're schizophrenic/schizoaffective or bipolar or b) their p-doc has some reason to believe that a dopamine antagonist may have some help (which for some off label purposes it does, such as SSRI augmentation in OCD). Seroquel certainly is the mildest of current neuroleptics but even at that I can say that there is a general feeling of "blunting" that is typical of them, for me. Only Clozaril is milder (yet unique in some ways.)
Posted by Phillipa on January 27, 2005, at 19:52:47
In reply to Re: what's everyone on?, posted by tensor on January 20, 2005, at 14:59:39
Just started new pdoc. Meds are now 50mg of zoloft, l5mg remeron, Xanax .5BID, decreasing doses of klonopin, and chloral hydrate. Phillipa
Posted by pretty_paints on January 28, 2005, at 10:44:40
In reply to Re: Conversion disorders, posted by yxibow on January 27, 2005, at 1:51:21
But I wouldnt suggest to anyone a massive dose of Seroquel unless a) they're schizophrenic/schizoaffective or bipolar or b) their p-doc has some reason to believe that a dopamine antagonist may have some help (which for some off label purposes it does, such as SSRI augmentation in OCD). Seroquel certainly is the mildest of current neuroleptics but even at that I can say that there is a general feeling of "blunting" that is typical of them, for me. Only Clozaril is milder (yet unique in some ways.)
Hiya, I just wondered what you meant about Seroquel being the mildest neuroleptic. What does this mean? Does it mean it is used in milder cases? But you say Clozaril is milder. I thought Clozaril was the "gold standard" in AP's! Have I got the wrong end of the stick, are you talking about potency? Ie: whether you need a high or low dose. Ie: Risperidone is prescribed in like 4mg/6mg type doses, Zyprexa and Abilify it's 20mg like doses, but for Seroquel it's things like 800mg. Is that what you mean, you need more of it to have the same effect?Thanks a lot, Kate :)
Posted by ed_uk on January 28, 2005, at 13:42:38
In reply to Re: Yxibow, posted by pretty_paints on January 28, 2005, at 10:44:40
Hi!
>Have I got the wrong end of the stick?
No! Clozaril isn't mild... but it is a low-potency AP. Because it isn't very potent, high doses are necessary. Seroquel is also low-potency, but Clozaril is probably more effective than Seroquel.
Ed.
Posted by yxibow on January 28, 2005, at 14:24:28
In reply to Re: Yxibow » pretty_paints, posted by ed_uk on January 28, 2005, at 13:42:38
> Hi!
>
> >Have I got the wrong end of the stick?
>
> No! Clozaril isn't mild... but it is a low-potency AP. Because it isn't very potent, high doses are necessary. Seroquel is also low-potency, but Clozaril is probably more effective than Seroquel.
>
> Ed.
My reference to mild was both in terms of potency mg for mg, but also in terms of their transmitter profile and more to the point their potential to cause EPS, especially akathisia. From my personal experience and general guessing of other agents, the latter (EPS) there would be (Older agents)->Risperdal->{Geodon, Abilify}->Zyprexa->Seroquel->Clozaril.Sertindole, Amisulpride, and Sulpride somewhere in the middle of it, for those out of the US, I can only guess.
In terms of how much of a grip an agent could put on your system, Clozaril, is correctly not a "mild" agent, it was the first atypical and because it shares an almost completely different transmitter profile it is considered the "gold standard" for hard to treat schizophrenia cases.
Posted by ed_uk on January 29, 2005, at 17:17:32
In reply to Re: Yxibow, posted by yxibow on January 28, 2005, at 14:24:28
Hello!!
>My reference to mild was both in terms of potency mg for mg, but also in terms of their transmitter profile and more to the point their potential to cause EPS, especially akathisia. From my personal experience and general guessing of other agents, the latter (EPS) there would be (Older agents)->Risperdal->{Geodon, Abilify}->Zyprexa->Seroquel->Clozaril.
>Sertindole, Amisulpride, and Sulpride somewhere in the middle of it, for those out of the US, I can only guess.
>In terms of how much of a grip an agent could put on your system, Clozaril, is correctly not a "mild" agent, it was the first atypical and because it shares an almost completely different transmitter profile it is considered the "gold standard" for hard to treat schizophrenia cases.
An excellent summary :-)
Have you ever had akathisia?Best Regards,
Ed.
Posted by yxibow on January 30, 2005, at 1:43:21
In reply to Re: Atypicals » yxibow, posted by ed_uk on January 29, 2005, at 17:17:32
> Hello!!
>
> >My reference to mild was both in terms of potency mg for mg, but also in terms of their...
> An excellent summary :-)
> Have you ever had akathisia?Thanks :) Again, YMMV as they say... and not having schizophrenia, but rather an affective (or mood) disorder, EPS is / can be more pronounced.
(the short and the long...:)
Most definately I have had akathisia...
The worst was from Compazine IV (prochlorperazine edisylate) when I had a severe fever and uninteruptable vomiting (which is one of its indications besides psychosis) and was given it in the hospital. About 30 minutes later still strapped to an IV with fluids and all I was pacing the ER room feeling like I wanted to hurtle myself through the walls. Finally paged the call button and they gave me Benadryl IV. Unfortunately this wore off after I was determined recovered, but out of the hospital... I had to call a taxi to take me back to my apartment. I think I probably wanted to either simultaneously scratch or grab the seats of the taxi or hurtle myself out the window. Finally I arrived back home and writhed on my couch. I think at that point I paged my p-doc who I had been seeing at the time and thats when I began taking Klonopin. I didn't even know this was "akathisia" until I did some research and it noted that in "males around 25 years (or something like that) this was common with Compazine.".
UGH. Don't give me that stuff again unless there's no substitute for the condition. I wonder if today's 5HT3 drugs like ondansetron (Zofran) would work as well.
Risperdal probably gave me minor akathisia but the dose I was taking was really small since I was reluctant at the beginning of this major disorder I still face to go the neuroleptic route.
Geodon made me want to run through walls, though not like Compazine... just kinda writhing at times.
I had hopes for Abilify not doing any of the above but it too produced akathisia, maybe not quite as much as Geodon, its hard to recall.
Both could be solved to some extent with propranolol.
Other than that I've experienced maybe one day spikes of pseudo-akathisia with SSRI combinations or the like, but nothing severe.
Seroquel has been relatively free of strong EPS but it has produced some other tremulousness and temporary facial oddities but they've come and gone, it varies.
There, the long story again in a nutshell :)
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