![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by Lindenblüte on October 5, 2006, at 11:40:40
Crown me the Princess of Polypharmacy!!
Depression has yielded to complications from history of trauma with concommitant mood disorder.
Anti-depressant + anti anxiety = cymbalta 90mg (always had this for 5 months now) and my coffee, and 2000mg fish oil.
Intrusive thoughts, flashbacks, nightmares = seroquel 300 mg (gradually tapering up from current 50 mg)
Anti-fatigue and cataleptic yawning = provigil 200mg am (and a double espresso or 16 oz coffee :)
Mood stabilizer (see seroquel above, klonipin below)
acute anxiety and panic (klonapin, 2x day, or less, prn) This is to replace self medication with alcohol...
pdoc and I had a REALLY good appt. took over half an hour. i explained everything the best I could despite thinking that i was going to be sick or start crying.
(((pdockery)))
I'll keep you posted on how my new meds work out. particularly the benzos and the seroquel is likely to have me feeling kind of zonked out for a while. perhaps not a bad thing. That's what I wanted anyways. :)
Posted by Lindenblüte on October 5, 2006, at 21:29:36
In reply to My new meds, posted by Lindenblüte on October 5, 2006, at 11:40:40
ugh. I took my first ever benzodiazepine this afternoon. First I felt a little happy (like 2 minutes worth) then I felt kind of drunk (1 hour) then I felt kind of slow. now I feel kind of sad :( Mostly, I just feel sedated. Yawn. I can't even imagine what tomorrow's gonna be like with seroquel up and the benzodiazepine. f*ck. and I haven't finished my homework yet either.
on the bright side, I will be saving money, as I will not be buying any more alcohol for a while. lucky me...
*yawn*
-Li
> Crown me the Princess of Polypharmacy!!
>
> Depression has yielded to complications from history of trauma with concommitant mood disorder.
>
> Anti-depressant + anti anxiety = cymbalta 90mg (always had this for 5 months now) and my coffee, and 2000mg fish oil.
>
> Intrusive thoughts, flashbacks, nightmares = seroquel 300 mg (gradually tapering up from current 50 mg)
>
> Anti-fatigue and cataleptic yawning = provigil 200mg am (and a double espresso or 16 oz coffee :)
>
> Mood stabilizer (see seroquel above, klonipin below)
>
> acute anxiety and panic (klonapin, 2x day, or less, prn) This is to replace self medication with alcohol...
>
> pdoc and I had a REALLY good appt. took over half an hour. i explained everything the best I could despite thinking that i was going to be sick or start crying.
>
> (((pdockery)))
>
> I'll keep you posted on how my new meds work out. particularly the benzos and the seroquel is likely to have me feeling kind of zonked out for a while. perhaps not a bad thing. That's what I wanted anyways. :)
Posted by Phillipa on October 5, 2006, at 21:32:33
In reply to My new meds, posted by Lindenblüte on October 5, 2006, at 11:40:40
Wow a lot of changes at the same time. And do the seroquel gradually and the providgil and even klonopin. Boy you're body is going to be going through changes now. I wish you well and you know how to get me. Love Phillipa
Posted by Lindenblüte on October 5, 2006, at 21:57:37
In reply to provigil cymbalta klonopin seroquel oh my » Lindenblüte, posted by Lindenblüte on October 5, 2006, at 21:29:36
fortunately, I've been on seroquel for months now. the increase is going to be phased in over 10 days.
klonopin I'm supposed to take twice a day for a week, and then try once a day, depending on when I think I will need it.
I've been on provigil for 3 months now. It's my favorite psychopharm ever. no side effects, nothing except staying awake and getting my work done. has even helped keep my sleeping habits more regular, because I don't have to take naps in the afternoon.
-Li
Posted by Phillipa on October 5, 2006, at 22:07:46
In reply to Re: provigil cymbalta klonopin seroquel oh my » Lindenblüte, posted by Lindenblüte on October 5, 2006, at 21:57:37
Oh so really only change is the seroquel. Is that for the SI stuff and cuticles? Love Phillipa
Posted by Lindenblüte on October 5, 2006, at 22:24:08
In reply to Re: provigil cymbalta klonopin seroquel oh my » Lindenblüte, posted by Phillipa on October 5, 2006, at 22:07:46
seroquel is multi-purpose. Pdoc says there's good evidence that it is a potent antidepressant. pdoc says that it is good for nightmares. pdoc says it is good for stopping intrusive thoughts and flashbacks.
Klonopin is also new. I'm hoping that that will help with the self-injury issues.
gute night :)
Posted by Phillipa on October 5, 2006, at 22:38:31
In reply to Re: provigil cymbalta klonopin seroquel oh my » Phillipa, posted by Lindenblüte on October 5, 2006, at 22:24:08
Li seroquel? for depression? do you have a link to that as I've not heard that before. thanks, Love Phillipa
Posted by Lindenblüte on October 5, 2006, at 22:53:13
In reply to Re: provigil cymbalta klonopin seroquel oh my » Lindenblüte, posted by Phillipa on October 5, 2006, at 22:38:31
http://www.medicalnewstoday.com/medicalnews.php?newsid=32513
personally, I don't really care whether I have bipolar or regular ol' depression. i just wanna feel better.
my official dx is "depressive disorder not otherwise specified"
I have decided to name it Lindenblütedepression, in honor of me, the patient. It's my very own, very special diagnosis.
Lindenblütedepression (acute) is right now. falling asleep at the keyboard.
-Li
Posted by ronaldo on October 6, 2006, at 6:35:41
In reply to My new meds, posted by Lindenblüte on October 5, 2006, at 11:40:40
I trust that like Smarties they come with no artificial colours...
Posted by Lindenblüte on October 6, 2006, at 8:00:59
In reply to Re: My new meds, posted by ronaldo on October 6, 2006, at 6:35:41
> I trust that like Smarties they come with no artificial colours...
Ronaldo,
that's the best part!My little pillbox is a riot of colors and shapes and sounds. It's like jewelery for my troubled soul.
cymbalta is white and blue and makes a cool little sound when you shake the capsules. like a tiny Latin American percussion ensemble. the clonazepam (gen. for klonopin) is pale yellow. subtle, yet elegant. the seroquel is white or pink, depending on the dose du jour, and then I've got white provigil and translucent fish oil, and pink chromium tabs, and a mustard colored B-vitamin supplement. It's a RIOT
I feel like some smarties, by the way. Do you mean the Canadian/European version of smarties? I LOVE those. can't get them easily in USA, sadly.
shaky shaky... mm!
**********
this morning was really hard to get up. REALLY hard. still feeling pretty groggy. but I have a LOT of work to do. gonna get my *ss to the cafe and commence rapid caffeination. vanilla latte... mmmm (skim, 'cause I'm feeling virtuous)toodlyeoo
-Li
Posted by Crazy Horse on October 6, 2006, at 11:16:10
In reply to Re: My new meds » ronaldo, posted by Lindenblüte on October 6, 2006, at 8:00:59
It's like jewelery for my troubled soul.
Very creative/good analogy..i like it! :) I can tell by your posts you are intellegent, and i like your attitude..you know how to laugh at yourself and life, which is a very strong antidepressant/anti-anxiety tool in itself. Some people never grasp this concept.
BTW, what are you studying in School?
-Monte
Posted by ronaldo on October 6, 2006, at 14:10:50
In reply to Re: My new meds » ronaldo, posted by Lindenblüte on October 6, 2006, at 8:00:59
A psychedelic-musical pill box....what a concept! You could market that.... would pay for some of your pills.
I mean UK Smarties, didn't they start in the UK?
Posted by Racer on October 6, 2006, at 15:57:33
In reply to Re: My new meds » Lindenblüte, posted by ronaldo on October 6, 2006, at 14:10:50
>
> I mean UK Smarties, didn't they start in the UK?There are two different lollies called Smarties: the candy coated chocolates, and a kind of candy wafer in pastel colors. (http://www.smarties.com/index.html) In the US, the UK style candy coated chocs are usually called "M&Ms," since that's the most popular brand.
(Gee, I really hope no one notices how much I know about candy... {blush})
Posted by alexandra_k on October 6, 2006, at 18:28:55
In reply to Re: My new meds » ronaldo, posted by Lindenblüte on October 6, 2006, at 8:00:59
after one week your body will have built up a tolerance and if you miss your *PRN* dose you will feel anxiety. that anxiety is called *withdrawal*.
if you dropped the coffee and your t started teaching you coping strategies in the present you might have better luck.
i mean...
therapy to bring up stuff
benzos to numb it
coffee to keep you awake
thats a lot of antagonistic physiology...
Posted by Phillipa on October 6, 2006, at 19:16:21
In reply to Seroquel as effective AD for bipolar depression » Phillipa, posted by Lindenblüte on October 5, 2006, at 22:53:13
I like that you're personal illness. And why have I never asked you what that PHD is in? Love Phillipa
Posted by Lindenblüte on October 6, 2006, at 19:59:57
In reply to Re: My new meds, posted by alexandra_k on October 6, 2006, at 18:28:55
> after one week your body will have built up a tolerance and if you miss your *PRN* dose you will feel anxiety. that anxiety is called *withdrawal*.
I'm not convinced that the anxiety I feel after missing my prn dose will be much different from the anxiety I've had since January. You know, the one where you forget to breathe? Or the one where you realize that you're sitting in a room full of your friends and you're shaking? Or the one where you have to give a doctor you're medical history, but your mouth feels like it's filled with cotton. Or the one where you don't want to ride your bike, because you might get freaked out/triggered and have an accident.
I'm glad that I asked my pdoc about this specifically. He says that I shouldn't expect any problems, especially with this one, because it has a long half-life. Short-term regular use is warranted at the moment because I'm going through some pretty wicked stuff right now. After a week or so, I'm going to be reevaluated. Pdoc and T both say I need to take care of myself in the present.
> if you dropped the coffee and your t started teaching you coping strategies in the present you might have better luck.
I'm not sure why you think that my T is not teaching me coping strategies. Frankly, you sound somewhat judgemental of my treatment. My former T taught me a lot of coping strategies. Some of these coping strategies include coping with overwhelming suicidal thoughts. That is one reason why I have been able to stay out of the hospital. Some of these coping strategies concern dealing with difficult colleagues and relationships. I think my relationships are stronger now than when I began therapy. As far as coping with anxiety, I'm trained in Insight Meditation and that has not seemed very helpful. Exercise has been recommended (you can lead a horse to water, but you can't make her drink). Another thing that I see as a positive coping strategy is that my procrastination habit is much more under control than at any time in the last 10 years. I think that is a wonderful effect of therapy.
I have experimented being on and off caffeine at various phases during my illness and recovery. In my experience, 3 weeks off of caffeine is not a very happy time for me. My mood is down, my productivity is down, my frustration and anxiety that I'm not getting work or life done is up. Coffee really provides a tangible mood boost to me, and an excuse to find my friends to take a walk outside on a nice day to the cafe.
> i mean...
>
> therapy to bring up stuffno, Alex, Lindenblüte brings up stuff. In fact, sometimes it is in her mind even without her wanting to have it there!
>
> benzos to numb itI'll keep you posted on this- jury's still out. I was kind of hoping for the benzos to take the place of self-medicating with alcohol. And perhaps to give me a little more resilience so that I won't have to immediately distance myself from every single anxiety-provoking or flashback-triggering episode I encounter during my day. pdoc says that benzos are much safer than alcohol.
>
> coffee to keep you awakeyou forgot that it's also to help me wash down my morning muffin. :) and keep my hands warm on these increasingly chilly days :) and the TASTE mmm!
>
> thats a lot of antagonistic physiology...I'm not sure that it's all that antagonistic. Antagonistic might be to take inderal (propanolol) for anxiety, and albuteral for asthma. That wouldn't make much sense, especially for the poor alpha-2 adrenergic receptors in the bronchi and heart.
It is complicated, however. I think the current goal is to try to keep my mood somewhat stabilized, but not depressed. To try to limit the intensity of flashbacks and intrusive thoughts (including those that lead me to self-injure). To try to limit my over-generalized anxiety to things, because my psyche is kind of reorganizing itself as we speak, and the unfortunate trend is that I'm learning a lot of fear reactions to things that do not warrant fear. Lastly, to keep me awake, so that I can finish my freaking dissertation. Each chemical in my regimine acts in different ways, on different systems, and on different time scales. I wish it weren't that complicated. This is what happens when I tell my pdoc what I've been experiencing for the last 2 months or so. Things get a little more complicated. I hope it works out, but ultimately, I view the brain as a remarkably plastic organ. Since I haven't ever used illegal drugs, and I don't have many bad habits (I don't even get drunk anymore! and I never smoked) I figure I might as well give pdockery a shot.
Yes, wouldn't it be wonderful if I didn't have to take all these drugs?
to quote a line from "This Boy's Life"
"Wish in one hand. Sh*t in the other. Which one fills up first?"
-Lindenblüte
Posted by Lindenblüte on October 6, 2006, at 20:02:22
In reply to Re: Seroquel as effective AD for bipolar depression » Lindenblüte, posted by Phillipa on October 6, 2006, at 19:16:21
Lindenblütedepression is indeed very special :)
My PhD is in my future.
I believe the topic is... oh wait, I forgot it again... hold on? huh?
oh well. I guess it'll come back to me one of these days ;o)
do you have a special condition too Phillipa?
-Li
Posted by Phillipa on October 6, 2006, at 20:32:16
In reply to Re: Seroquel as effective AD for bipolar depressio » Phillipa, posted by Lindenblüte on October 6, 2006, at 20:02:22
Crazy with depression and severe anxiety thrown in. Plus old age. Love Phillipa
Posted by Lindenblüte on October 6, 2006, at 21:29:57
In reply to Re: Seroquel as effective AD for bipolar depressio » Lindenblüte, posted by Phillipa on October 6, 2006, at 20:32:16
> Crazy with depression and severe anxiety thrown in. Plus old age. Love Phillipa
Oh,
CwD-SA-advanced
I get it :)
Posted by alexandra_k on October 6, 2006, at 22:57:16
In reply to Re: My new meds » alexandra_k, posted by Lindenblüte on October 6, 2006, at 19:59:57
> I'm not convinced that the anxiety I feel after missing my prn dose will be much different from the anxiety I've had since January.
It won't be the anxiety that you have had since January plus the anxiety that you have from withrdawal?
If you have had the anxiety since January then this prescription isn't just something to get you through a temporary hard patch. If you take it for a week then you are going to have a tolerance to it. You won't feel so zonked on it anymore, but if you stop taking it then isn't it likely that you will have the anxiety of withdrawal but the initial anxiety that led you to take the med in the first place?
____________________________________
Some people say that they have been taking the same dose for a number of years and they never have increased it.
They also say that it manages their anxiety fine and they don't have negative side effects from it.
What I wonder is... Is that right? Is reaction time slowed? Is cognition slowed?
___________________________________So I'm concerned, yeah.
That being said, I'm sorry if what I said struck you as unsupportive. I didn't mean to be unsupportive. Concerned, yeah. Maybe I should have just left this alone... But if you have had the anxiety since January then I don't see what is going to change over the next week...
> As far as coping with anxiety, I'm trained in Insight Meditation and that has not seemed very helpful.
How often do you meditate?
What kind of meditation do you do?I'm doing some mindfulness meditation with Deneb and Clearskies over on social if you would like to join us:
http://www.dr-bob.org/babble/social/20060922/msgs/691416.html
Posted by alexandra_k on October 6, 2006, at 23:32:12
In reply to Re: My new meds, posted by alexandra_k on October 6, 2006, at 22:57:16
i'm sorry.
my sh*t.
you remind me of me a great deal and i see you... kind of walking the same path...
and i often get to thinking 'things could be very different (much better) for me now if only i hadn't gone that way'
but of course everyone needs to walk their own path
and you aren't me you are you
and it isn't my path it is yours
and i'm probably overidentifying or something.
i should be more careful.
Posted by Lindenblüte on October 7, 2006, at 9:54:05
In reply to Re: My new meds, posted by alexandra_k on October 6, 2006, at 22:57:16
> > I'm not convinced that the anxiety I feel after missing my prn dose will be much different from the anxiety I've had since January.
>
> It won't be the anxiety that you have had since January plus the anxiety that you have from withrdawal?>
> If you have had the anxiety since January then this prescription isn't just something to get you through a temporary hard patch. If you take it for a week then you are going to have a tolerance to it. You won't feel so zonked on it anymore, but if you stop taking it then isn't it likely that you will have the anxiety of withdrawal but the initial anxiety that led you to take the med in the first place?I have read that the tolerance develops in people who take the medication for insomnia. That after about 2 weeks, it is no longer an effective sleeping pill. I don't think that there is good evidence that tolerance develops for the anxiolytic/anticonvulsant properties (did I mention my dad's history of epilepsy, btw?)
And yes, it is likely that when I stop taking the med in a week or two that my anxiety will return. I can deal with anxiety that comes with certain situations. Predictable anxiety- like the anxiety of waiting for a bus in the middle of the night, or when there is a raging thunderstorm, or when I ave to go to a party where I don't know anyone. The overgeneralized anxiety with the hypervigilance and flashbacks and all that good stuff is a fairly recent development. So, I think THAT is what we are trying to deal with here. I am not expecting a miracle- that my anxiety will *poof* go back to some baseline which the fearless among us seem to take for granted. Nope, my expectations are that I will have to take this drug when I am going through a rough patch. There have been a lot of rough patches lately, but also, when I was on my summer vacations, I noticed that my anxiety didn't really hamper my enjoyment of life. I'm fully prepared to be more cautious and more reactive than 80% of people out there in the world today. I've learned to deal with that stuff. Heck, I've even performed solo violin recitals and given lectures to big crowds and have engaged in some pretty extreme skiing. I just don't like seeing what's been happening to me in the last few weeks, where I don't feel safe, and I'm isolating myself and not allowing myself to go out and live. This is a fairly recent development. I figured that when the depression lifted, so would the anxiety, but it never did. I'm also hoping to train my body not to react with such extreme panic to certain circumstances. For example, for 5 years, I would take inderal (beta-blocker) before all of my solo violin performances. This REALLY helped with my stage fright, and I grew a lot as a musician and a performer. In the last two years, I have noticed that I do not *need* to have this drug to perform well. I still get nervous, but somehow the really strong fear-conditioning has been broken. I even did an audition last year with nothing more than a couple of bananas (anecdotally good for acute stage fright). I really surprised myself that I played so well despite a feeling of terror!.
I also am realizing for the first time that I don't have to live with this tonic level of anxiety. I just assumed that everyone felt like this all the time. kind of tight in their chest. vigilant. reactive. It's really quite fascinating. Iv'e felt like this much of my life. Not all the time, but usually during periods of stress, like at the end of the semester, or when I have a lot of deadlines. I think this drug is making me realize that there are alternatives.
I'd love to explore other ways of experiencing a low-tension lifestyle. I have a feeling that yoga and exercise and meditation will certainly be beneficial. I think I will use those types of strategies in the maintenence phase of managing my anxiety. It really is striking, though. I had NO idea that I was so tense.
> ____________________________________
>
> Some people say that they have been taking the same dose for a number of years and they never have increased it.
>
> They also say that it manages their anxiety fine and they don't have negative side effects from it.
>
> What I wonder is... Is that right? Is reaction time slowed? Is cognition slowed?
> ___________________________________
>
> So I'm concerned, yeah.
>
> That being said, I'm sorry if what I said struck you as unsupportive. I didn't mean to be unsupportive. Concerned, yeah. Maybe I should have just left this alone... But if you have had the anxiety since January then I don't see what is going to change over the next week...
>
> > As far as coping with anxiety, I'm trained in Insight Meditation and that has not seemed very helpful.
>
> How often do you meditate?
> What kind of meditation do you do?
>
> I'm doing some mindfulness meditation with Deneb and Clearskies over on social if you would like to join us:
>
> http://www.dr-bob.org/babble/social/20060922/msgs/691416.html
>thanks for this link. I'll pop over later today. first I need to do some errands. my fridge is BARE. I think I'm up for something calming this afternoon. sounds nice :)
-Li
Posted by Lindenblüte on October 7, 2006, at 10:06:42
In reply to Re: My new meds, posted by alexandra_k on October 6, 2006, at 23:32:12
It's okay Alex,
I also feel that you and I are similar in many ways. So, if you have a caution for me, I appreciate you bringing it to my attention.I'm just trying to do the best job that I can. I've got a really good T now, and we're going through a lot of old history. I've got a pdoc that has worked with me for 6 months now and has seen my transition from deep dark depression to the fall-outs of my childhood trauma. And, I'm trying my best to be honest to both of them about what I'm going through.
Psychopharm is very much an empirical investigation with a sample size of one (ME!) and given that my history is so complicated and long, and that I only sought treatment for the first time a few months ago, well... I'm still experimenting with a lot of different things. Maybe the latest drugs won't work out that well, who knows? I just try to keep an open mind. Wait and see. Given the power of the placebo effect, a lot of the effects/side effects of the drugs are in the eye of the beholder. If my pdoc says do this, I think it's going to help, but keep in touch. Well, that's what I'm going to do.
Given the choice of optimism with potential placebo effects, or pessimism with potentially failing to recognize an actual benefit, I think I'd take the former. Since I want to feel better.
Don't feel bad Alex,
I know you weren't trying to hurt or be unsupportive. I'm sorry that you have a bad perspective on this particular approach my pdoc and I are taking. Ultimately, though, I think you'll realize that if it works it works, and if it ain't broke, don't fix it.-Li
Posted by alexandra_k on October 8, 2006, at 17:33:02
In reply to Re: My new meds » alexandra_k, posted by Lindenblüte on October 7, 2006, at 9:54:05
> > > I'm not convinced that the anxiety I feel after missing my prn dose will be much different from the anxiety I've had since January.
> >
> > It won't be the anxiety that you have had since January plus the anxiety that you have from withrdawal?
>
>I don't think that there is good evidence that tolerance develops for the anxiolytic...There is. The 'high' / drunk feeling. You will develop a tolerance for that and... Will it be an adequate substitute for alchohol then?
You are trying to medicate the hypervigilance and flashbacks away?
> I also am realizing for the first time that I don't have to live with this tonic level of anxiety. I just assumed that everyone felt like this all the time. kind of tight in their chest. vigilant. reactive. It's really quite fascinating. Iv'e felt like this much of my life. Not all the time, but usually during periods of stress, like at the end of the semester, or when I have a lot of deadlines. I think this drug is making me realize that there are alternatives.
Benzo's? A treatment for lifelong anxiety?
> I'd love to explore other ways of experiencing a low-tension lifestyle. I have a feeling that yoga and exercise and meditation will certainly be beneficial. I think I will use those types of strategies in the maintenence phase of managing my anxiety.Typically people try those first and when they are doing those they find they can manage their anxiety. But sometimes people... Would rather take a pill and have a high instead of drinking and having a high. I'm concerned about you because your descriptions of what you are trying to do with taking the benzo... Put you at high risk of addiction.
But I guess you have made your choice.
I really hope it works out for you.
PS. The reason people typically try exercise etc first is because sometimes the benzo's are counter-productive and make things worse. How come? Take a look at these 'commonly experienced' withdrawal effects (I don't mention the 'less common' or 'rare'):
Abdominal pains and cramp
Agoraphobia
Anxiety
Breathing difficulties
Blurred vision
Changes in perception (faces distorting and inanimate objects moving)
Depression
Distended abdomen
Dizziness
Extreme lethargy
Fears
Feelings of unreality
Flu-like symptoms
Heavy limbs
Heart palpitations
Hypersensitivity to light
Indigestion
Insomnia
Irritability
Lack of concentration
Lack of co-ordination
Loss of balance
Loss of memory
Muscular aches and pains
Nausea
Nightmares
Panic attacks
Rapid mood changes
Restlessness
Severe headaches
Shaking
Seeing spots before the eyes
Sore eyes
Sweating
Tightness in the chest
Tightness in the head
Posted by Phillipa on October 8, 2006, at 19:17:40
In reply to Re: My new meds » Lindenblüte, posted by alexandra_k on October 8, 2006, at 17:33:02
Alex I've been on benzos for over 30 years but at the time they didn't know what they do now. Just like before benzos. It was barbituates dangerous. So for me it's too late my body could never get off them. I think the fact that I'm holding steady at my dose is pretty good. But I'm getting and have agoraphobia and fear of people in general so now I have to work backwards, try to find a therapist and do something. Any ideas? I need help and I know it and the ad's don't do the anxiety bit with me. Love Jan
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