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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by Izzy50 on August 19, 2006, at 17:11:02
My story:
female 51 years old history of unipolar depression
Started prozac in 1994, wonderful response. It stopped working about 7 years later. Non responsive to several other Ads. Finally tried Effexor and it "worked".
Shrink has recently told me he thinks I am bipolar II but I was non compliant with meds and in denial.
Recently I have history of strong anxiety,heart palpitations, mood swings,agitation but still depressed. Waking at 3 am wide awake-ready to take on the world but have to lie in bed and stare cuz nobody else is up. Sometimes I will wake at 5am or fatigue is so bad I can't get out of bed.I have to take Ambien to sleep. Sometimes I am so hyper the Ambien does not work.
I am taking Armour thyroid, compounded bio identical estrogen, testosterone and estrodial. I also take 5 mg. Deltacortril for adrenal support. My hormones are checked about every three months.No unusual results.
My shrink has me on Effexor SR 225mg., Propalonal 20 mg 3x daily takes the edge off the palps-)Ambien 10 mgs at bedtime.
Even though I sleep through the night I still wake up and feel sleep deprived all day long. I think the beta blockers(propalonol) make me tired.
I have had thalium stress test,heart ultrasound and 48 hour holter monitor. No problems.
Right now My shrink has added Lamictal to drug cocktail. I have the starter pack and am on week three at 50 mg a day. No response.
The worst problem are the heart palpitations. My heart rate never goes above 94 but it feels so strong. I have a barely detectable MVP.
All doctors, primary care, shrink, cardiologist and psychotherapist have told me the heart palps are from anxiety.
My brother is full blown bipolar I. On depakote, seroquill, and some other stuff.
I am sure I left out a bunch of stuff, but I am here to learn.
My present goals are to get off Effexor, stop the horrible palps and feel good again.
Posted by Jimmyboy on August 19, 2006, at 17:41:28
In reply to New person, posted by Izzy50 on August 19, 2006, at 17:11:02
Hi, glad you found the message board . Bipolar is a frustrating thing to deal with, but there is a lot of information here and lots of smart people around who can relate to what you are dealing with. Good luck to you!
JB
Posted by Jost on August 19, 2006, at 18:16:30
In reply to New person, posted by Izzy50 on August 19, 2006, at 17:11:02
Why BP2? having a family member might predispose you, but do you have any manic symptoms, ie highs?
I have trouble sleeping, often ambien, or ambien and xanax, doesn't work. But I;m not bipolar. Just very prone to anxiety.Has you pdoc suggested another AD?
Jost
Posted by Izzy50 on August 19, 2006, at 18:25:50
In reply to Re: New person, posted by Jost on August 19, 2006, at 18:16:30
> Why BP2? having a family member might predispose you, but do you have any manic symptoms, ie highs?
>
>
> I have trouble sleeping, often ambien, or ambien and xanax, doesn't work. But I;m not bipolar. Just very prone to anxiety.
>
> Has you pdoc suggested another AD?
>
> JostI am hypomanic and have mixed states. Agitation, anxiety,profound insomnia,irrtiability.
I just read a great book called "Why am I still depresssed" by Dr. Jim Phelps.
It really helped me understand mood disorders
and BP II.
I agree that it can very difficult to diagnose BPII with hypomania. Often it takes years.
Posted by linkadge on August 19, 2006, at 20:14:22
In reply to Re: New person, posted by Izzy50 on August 19, 2006, at 18:25:50
I would personally blame the effexor on a bunch of your current problems namely the heart palpititions and insomnia.
Sleep deprivation can cause mood swings in anybody, and if the effexor is contributing to the insomnia then I wouldn't jump to conclusions.
Work on finding medication that has you sleeping deep and feeling refreshed, and then if you are still experiencing significant mood swings then go from there.
I don't consider myself bipolar because without medication my mood is very stable. Effexor was the worst for me since it caused instability secondary to the insomnia. It also caused heart palpititions and an increase in blood pressure.I know you're not me, but I just thought I'd share.
Linkadge
Posted by Phillipa on August 19, 2006, at 21:59:52
In reply to Re: New person, posted by linkadge on August 19, 2006, at 20:14:22
Propanalol, inderal makes you very tired and slows down the pulse. Sounds like anxiety to me. Love phillipa and welcome
Posted by Izzy50 on August 19, 2006, at 23:00:54
In reply to Re: New person » linkadge, posted by Phillipa on August 19, 2006, at 21:59:52
> Propanalol, inderal makes you very tired and slows down the pulse. Sounds like anxiety to me. Love phillipa and welcome
I think it is also giving me nausea.
But I am getting headaches from the palpitations, and they are definitely getting worse. All day long.
So sometimes I have to take 2 props-they really don't help too much but any relief is better than nothing.It does not make sense to me that anxiety would give me palps ALL DAY LONG. It is not like a panic attack. I wake up and they are there, I go to sleep and they are there. I also have tighness in my throat area and it seems that breathing gets tough. I don't want xanax or I'll be a walking zombie for work.
Also, then I will 2 meds to detox from Xanax and the Effexor.
I am feeling so bad all the time. I don't know which end is up. I can't live like this, it's horrible.
Right now I have nausea, headache, tightness is throat,heart pounding.In order to sleep, I have to take the Ambien. Add to all of this chronic depression.I wake up feeling the same way, only tired. The Ambien may knock me out, but my body is not resting.
I am also in psychotherapy w/a therapist who is very expereinced with patients who have psychiatric disorders. She understands the anxious depression that is part of bipolarII. She also seems to feel that the Lamictal, if it works, will help me.
I can tolerate the depression better than the anxiety. I guess because I have had the depression my entire life. But the two together is the most horrible of feelings.
I also have a history of alcohol/drug abuse. I have been sober for 22 years. And I mean sober. Not a drug or a drink.
I hold on by hoping that the Lamictal will kick in and I will be able to go off the Prop, Effexor and Ambien.
Posted by Phillipa on August 19, 2006, at 23:06:09
In reply to Re: New person, posted by Izzy50 on August 19, 2006, at 23:00:54
I believe inderal is very short acting. how often do you take it? Love Phillipa
Posted by Izzy50 on August 19, 2006, at 23:15:52
In reply to Re: New person » Izzy50, posted by Phillipa on August 19, 2006, at 23:06:09
> I believe inderal is very short acting. how often do you take it? Love Phillipa
20mg 3x per day.
40mg when needed.
Posted by Phillipa on August 19, 2006, at 23:21:03
In reply to New person, posted by Izzy50 on August 19, 2006, at 17:11:02
Mitral Valve Prolapse can cause anxiety. Love Phillipa. ps I think you really need to discuss it with your cardiologist.
Posted by Izzy50 on August 19, 2006, at 23:52:17
In reply to Re: New person » Izzy50, posted by Phillipa on August 19, 2006, at 23:21:03
> Mitral Valve Prolapse can cause anxiety. Love Phillipa. ps I think you really need to discuss it with your cardiologist.
Yes, hat's true. I checked it out.
I have a barely negligible MVP. I have had a Thallium stress test, echocardiogram and 48 hour holter monitor with in this last year. Normal results.The first cardiologist I saw 10 ten years ago said the electrical impulses that cause heart rhythem sometimes go crazy and no one knows why. He did not want to put me on beta blockers because they cause quality of life issues and my palps were not as bad back then.
Currently, both my primary and my pdoc suggested prop. I hate it, works minimally and the side effects are awful.
Posted by Izzy50 on August 19, 2006, at 23:58:38
In reply to Re: New person, posted by Jost on August 19, 2006, at 18:16:30
> Why BP2? having a family member might predispose you, but do you have any manic symptoms, ie highs?
>
>
> I have trouble sleeping, often ambien, or ambien and xanax, doesn't work. But I;m not bipolar. Just very prone to anxiety.
>
> Has you pdoc suggested another AD?
>
> JostSee, this is a perfect example of my problem. It is 12AM and I am doing wash, cleaning the floors, and typing on the computer. During the day I literally drag my *ss around, extremely fatigued.Can't sleep either. Now, I can think of a million things to do.Not good for my job
OR I may be exhusted, go to bed at 10PM sleep like a rock for 8 hours and wake up exhausted. Feel sleep deprived all day.
What the hell is that? Clearly I am not going into rem sleep. Is it the Ambien? the heart palps? my crazy mind?
Who knows...
Posted by linkadge on August 20, 2006, at 0:25:51
In reply to Re: New person, posted by Izzy50 on August 19, 2006, at 23:00:54
Tachycardia and elevated blood pressure are documented side effects of effexor. The medication increases the levels of norepinephrine which can result in these side effects.
Linkadge
Posted by linkadge on August 20, 2006, at 0:27:47
In reply to Re: New person, posted by Izzy50 on August 19, 2006, at 23:58:38
Seems as though your sleep wake cycle has been thrown completely out of whack.
Work to reduce the effexor, you might find that an atypical antipsychotic could help with that for the time being.
Linakdge
Posted by Racer on August 20, 2006, at 0:45:08
In reply to Re: New person, posted by Izzy50 on August 19, 2006, at 18:25:50
There's a newish idea out there that most people who have depression AND anxiety are actually bipolar. I don't agree, because I think it's very possible to have both anxiety and depression -- they've been known to buddy up, you know?
As for what you're describing, I'd say it's mostly medication related -- the fuggy feeling during the day? I got that from Effexor, it's why I rarely take Ambien anymore, and propranalol knocked me out -- I could barely get enough adrenaline going to sit up on the sofa, let alone move off of it. Insomnia? Effexor is known for that, too. Effexor is also known for blood pressure and other cardiac effects. And it did help me get in touch with my inner witch...
I think I'd advise talking to your doctor about swapping the Effexor for something more friendly, maybe even trying Cymbalta, which has a similar mechanism of action. Or one of the other SSRIs, which might work better for you than the ones you've tried.
Here's the thing: the SSRIs do often stop working. They'll work for a few years, and then stop working -- at which point another SSRI often will work, and you can rotate through the two or three or four meds that work. By this time, Prozac might work for you again, for that matter.
Of course, Lamictal has shown good results for a lot of people. It knocked me out, but that's me and I'm weird. (Hey, this aluminium hat really does protect me from space aliens and reality shows...) It's well worth giving it a solid try. I noticed an effect at 150 mg, and again at 200mg.
Good luck, and I hope this helped.
Posted by Izzy50 on August 20, 2006, at 0:45:15
In reply to Re: New person, posted by linkadge on August 20, 2006, at 0:25:51
> Tachycardia and elevated blood pressure are documented side effects of effexor. The medication increases the levels of norepinephrine which can result in these side effects.
>
> LinkadgeI was thinking about that myself-I don't have elevated blood pressure. But I don't doubt the EffexorSR is related.
I read about Effexor and did not see anything about tachycardia. Another good reason to get off it. What great hope I have that I won't need a beta blocker the rest of my life.
Posted by Izzy50 on August 20, 2006, at 0:48:46
In reply to Re: New person, posted by linkadge on August 20, 2006, at 0:25:51
> Tachycardia and elevated blood pressure are documented side effects of effexor. The medication increases the levels of norepinephrine which can result in these side effects.
>
> LinkadgeIt's funny you should say that. Last time I was at my shrink, I told him I felt as though I was "hemmerogaing adrenaline." That is exactly what it feels like.
Posted by Izzy50 on August 20, 2006, at 0:53:17
In reply to Re: New person » Izzy50, posted by Racer on August 20, 2006, at 0:45:08
> There's a newish idea out there that most people who have depression AND anxiety are actually bipolar. I don't agree, because I think it's very possible to have both anxiety and depression -- they've been known to buddy up, you know?
>
> As for what you're describing, I'd say it's mostly medication related -- the fuggy feeling during the day? I got that from Effexor, it's why I rarely take Ambien anymore, and propranalol knocked me out -- I could barely get enough adrenaline going to sit up on the sofa, let alone move off of it. Insomnia? Effexor is known for that, too. Effexor is also known for blood pressure and other cardiac effects. And it did help me get in touch with my inner witch...
>
> I think I'd advise talking to your doctor about swapping the Effexor for something more friendly, maybe even trying Cymbalta, which has a similar mechanism of action. Or one of the other SSRIs, which might work better for you than the ones you've tried.
>
> Here's the thing: the SSRIs do often stop working. They'll work for a few years, and then stop working -- at which point another SSRI often will work, and you can rotate through the two or three or four meds that work. By this time, Prozac might work for you again, for that matter.
>
> Of course, Lamictal has shown good results for a lot of people. It knocked me out, but that's me and I'm weird. (Hey, this aluminium hat really does protect me from space aliens and reality shows...) It's well worth giving it a solid try. I noticed an effect at 150 mg, and again at 200mg.
>
> Good luck, and I hope this helped.I have an apt at the end of the month-follow up on the lamictal. I will definitely insist on trying to get off Effexor. It's a real bitch to do. If I miss more than one dose I feel like I've been hit with Electric Malaria.
Posted by linkadge on August 20, 2006, at 2:01:30
In reply to Re: New person » Izzy50, posted by Racer on August 20, 2006, at 0:45:08
I don't agree with that theory too. They base the theories on how people respond to meds. So, if the antidepressants make people anxious, then they change the categories around not the meds.
Depression and anxiety have always occured together. Even our earlies accounts of what we consider depression have often been comorbid with anxiety.
That asside, you can give meds from other classes a try, and if they work, then who cares about the exact diagnosis.
Linkadge
Posted by Izzy50 on August 20, 2006, at 6:50:49
In reply to Re: New person » Racer, posted by linkadge on August 20, 2006, at 2:01:30
> I don't agree with that theory too. They base the theories on how people respond to meds. So, if the antidepressants make people anxious, then they change the categories around not the meds.
>
> Depression and anxiety have always occured together. Even our earlies accounts of what we consider depression have often been comorbid with anxiety.
>
> That asside, you can give meds from other classes a try, and if they work, then who cares about the exact diagnosis.
>
> Linkadge
>Exactly.
Posted by Racer on August 20, 2006, at 15:01:59
In reply to Re: New person, posted by Izzy50 on August 20, 2006, at 0:53:17
> >
> I will definitely insist on trying to get off Effexor. It's a real bitch to do. If I miss more than one dose I feel like I've been hit with Electric Malaria.Been there, done that, burned the t-shirt...
We have a whole withdrawal board here, with a lot of information about what's helped other people get off these drugs with a minimum amount of discomfort. One thing to remember is that tapering down isn't like missing a dose, so it's not *as* horrible. (I remember being sick in the bathtub when I ran out for a couple of days, once -- I was so weak and miserable that I only made it as far as the tub before I gave up. Tapering down wasn't anything like as awful.)
And if your doctor is helping you, a dose or two of Prozac at the end will help a lot with the last little bit, once you get there. Prozac has such a long half life, it's kinda like taking a self-tapering medication.
Take care, and good luck.
Posted by linkadge on August 20, 2006, at 15:08:02
In reply to Re: New person, posted by Izzy50 on August 20, 2006, at 0:53:17
Take your time, and go slowly. This medication can cause complete and utter adrenal exhaustion (It did in me at least).
As you come off, you may want to supplement with things like vitamin C.
Linkadge
Posted by SLS on August 20, 2006, at 15:23:47
In reply to Re: New person, posted by linkadge on August 20, 2006, at 15:08:02
> Take your time, and go slowly. This medication can cause complete and utter adrenal exhaustion (It did in me at least).
Was the adrenal exhaustion something that occurred while taking the drug or a result of the drug withdrawal?
- Scott
Posted by linkadge on August 20, 2006, at 16:36:33
In reply to Re: New person, posted by SLS on August 20, 2006, at 15:23:47
I found that effexor made me always on edge. It seemed to accentuate the adrenaline rushes I would get from stressfull situations.
Over time, I felt increasingly exhausted, and my tollerance for stress decreased significantly.
While adrenal exhaustion is not exactly something there are specific tests for, its just what I have come to believe was happening. The same thing happened to me after methylphenidate use.
Effexor, and the TCA's, were really the ones that seemed to accentuate the adrenaline.
Linkadge
Posted by llrrrpp on August 20, 2006, at 17:36:33
In reply to Re: New person, posted by linkadge on August 20, 2006, at 16:36:33
Hi Izzy, I've been reading this post with some interest. I'm not on Effexor, but I'm on a somewhat high dose of cymbalta (90mg), which is also an SNRI. A few times a week I get a lot of heart thumping palpitations (pulse rate around 90-100, my normal pulse rate is about 70). I got palpitations a LOT when I first started cymbalta at 30 mg, and they have gradually decreased, except for the few days after I increase my dose.I take cymbalta in pm. I also have been taking seroquel 25 mg in the pm, because the cymbalta makes me ever so slightly hyperactive. When do you take Effexor? Have you tried taking it at different times during the day?
Perhaps as you taper the Effexor, you will find that you can get a good response with a lower dose.
In the meanwhile, it sounds like you could really do with something to help you get a good night's sleep. I HIGHLY recommend seroquel. Although it's approved for use as a mood-stabilizer/ antipsychotic, it also augments the AD response from the SNRI (according to my pdoc). You will know the very first night if it's strong enough to calm your busy mind!
best of luck to you & welcome,
-ll
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