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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by UgottaHaveHOPE on May 9, 2006, at 15:18:37
I was taking 25mg of Seroquel and 1mg of Klonopin for Generalized Anxiety Disorder during the last eight months and felt decent. Then, all of sudden, in the month of April I had some financial problems, which sent me into the stratosphere. It is hard to calm down, The pdoc increased my dosage to 300mg of Seroquel, and I am still hyper, A few days later, my pdoc also added Paxil 20mg.
My questions are ...
1. Do you think it is a good idea to add the Paxil when I was feeling decent so long without it?
2. Any other medicinal suggestions?Thanks so much, Michael
Posted by curtm on May 9, 2006, at 15:50:59
In reply to I need your opinion, if you have the time, posted by UgottaHaveHOPE on May 9, 2006, at 15:18:37
I have the time, but I don't have an opinion for you because I don't know anything about those meds. So I guess I'm just checking in to say "Hi."
Posted by Racer on May 9, 2006, at 16:39:56
In reply to I need your opinion, if you have the time, posted by UgottaHaveHOPE on May 9, 2006, at 15:18:37
I'm offering my opinions here, with the clear understanding that they are only that -- the opinions of someone who is not a medical professional.
> My questions are ...
> 1. Do you think it is a good idea to add the Paxil when I was feeling decent so long without it?I do, because no matter how decent you felt for so long without it, you're not feeling decent now. Things change, circumstances change, and when things change, sometimes meds have to change, too.
Remember that all of these mood and anxiety disorders require two factors: genetic vulnerablity, and psychosocial stressors. You've obviously got the first one, now the second has been added to the mix, resulting in an expression of a mood/anxiety disorder. It does sound to me as though you probably go from anxiety to depression, but you've got both going on, and Paxil treats them both.
> 2. Any other medicinal suggestions?
No. But I would suggest therapy, if you're not already in it, because therapy will address the psychosocial factors that the medications do not.
>
> Thanks so much, MichaelI hope that helps.
Posted by blueberry on May 9, 2006, at 17:56:51
In reply to I need your opinion, if you have the time, posted by UgottaHaveHOPE on May 9, 2006, at 15:18:37
It's tough I know. I'm so sorry things aren't working as effectively as they were before. Seems to happen a lot around here. :-(
If you have any kind of a sex life, I would call your doctor back and ask for lexapro instead of paxil.
I personally would avoid going higher on the seroquel. It's just that it seems fairly easy over time to creep up in dose, but if you ever have to come back down in dose, it will be extremely hard. Antipsychotics are very hard to come off of.
Another thing about seroquel...one of its strong actions is as an a-2 antagonist...it causes a stimulated release of more norepinephrine (like adrenaline). At lower doses it wasn't doing much of that. The higher you go on dose, the more noradrenaline is being stimulated. Higher doses might actually make things worse.
Paxil seems like a decent option to tone down the norepinephrine with a wash of serotonin, and its norepinephrine reuptake (slight) will also squash it down, after a couple weeks of maybe increased anxiety at first.
Other possibilities...lamictal, in case of too much glutamate (excitatory) stimulating all the other neuros. Depakote is usually calming.
See if paxil can help. If not, maybe temporarily raise klono dose for relief and rethink another strategy. There are some types of mania that look like and feel like anxiety. If that's the case, depakote can shut it down in a few days. If you tried it for a week or two and it wasn't helpful, you could drop it knowing it wasn't the one. No long trial needed.
Sorry so long. Just opinion and just trying to help. Some counseling if you can afford it and church could be very very helpful too.
Posted by UgottaHaveHOPE on May 9, 2006, at 19:33:15
In reply to Re: I need your opinion, if you have the time » UgottaHaveHOPE, posted by blueberry on May 9, 2006, at 17:56:51
Are you saying the higher doses I take of Seroquel, the less effective it is?
Actually that kind of makes sense. When I first started taking the drug, I was at 200mg/day, then weened myself down to 25mg and was just as tired. However, once I got worked up this time about some financial things, not 25 or 300 has done very well at slowing me down.
Posted by Phillipa on May 9, 2006, at 22:26:46
In reply to Blueberry, let me get this straight ..., posted by UgottaHaveHOPE on May 9, 2006, at 19:33:15
I think Blueberry is right as when they gave me 12.5mg of seroquel it knocked me out. they raised the dose meaning the hospital to 50mg at betime and then another 50mg during the night. I almost fainted in the am. And I didn't sleep either. Love Phillipa
Posted by blueberry on May 10, 2006, at 17:52:25
In reply to Blueberry, let me get this straight ..., posted by UgottaHaveHOPE on May 9, 2006, at 19:33:15
Actually UGottaHaveHOPE, I didn't mean to imply higher doses are less effective. What I was trying to say is that the higher dose you go, several things will happen...stronger blockade of serotonin receptors, stronger blockade of dopamine receptors, but stronger stimulation of noradrenaline release...and there is no blockade going on to block out that extra noradrenaline.
At lower doses it was primarily serotonin and dopamine blockade with very little noradrenaline stimulation, which is probably what helped you so much. At higher doses though, the noradrenaline stimulation becomes more pronounced than at lower doses. The serotonin and dopamine blockade won't do a thing to protect you from any anxiety from that extra noradrenaline.
Purely theoretical opinion though.
> Are you saying the higher doses I take of Seroquel, the less effective it is?
>
> Actually that kind of makes sense. When I first started taking the drug, I was at 200mg/day, then weened myself down to 25mg and was just as tired. However, once I got worked up this time about some financial things, not 25 or 300 has done very well at slowing me down.
Posted by UgottaHaveHope on May 11, 2006, at 0:27:30
In reply to Re: Blueberry, let me get this straight ... » UgottaHaveHOPE, posted by blueberry on May 10, 2006, at 17:52:25
If the pdoc has added 20mg of Paxil, does that mean that it will be even harder now for the Seroquel to block serotonin? In other words, will Paxil help or hurt the effect of the Seroquel?
This is the end of the thread.
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