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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by B2chica on February 14, 2008, at 9:42:09
i am currently on:
ritalin 20mg bid
lexapro 15
topamax 50
zyprexa 5 or 10PRNproblem is i am having breakthrough depression every other week and breakthrough "highs" every other week. i guess that's rapid cycling? anyway Dx psychotic depression with bipolar features ESPECIALLY RE medication.
the lexapro just makes me so tired. i switched to night but that might be whats caused this breakthrough stuff? not certain though ive been trying to track it and its show up before i did that.
i want to ask my pdoc for a new AD and not sure what to ask for. i was on Wellbutrin XL successfully for several years then after pregnancy it just didn't seem to work. i'm looking for something similar to WEllbutrinXL, something a little more stimulating, NOT to make me tired like lexapro does. i'm already tired enough dont need more of that!
however the only other two that i tried that i had HORRIBLE results with was Effexor and prozac....
any other suggestions would be great.
i'm also willing to drop topamax as it doens't seem to be helping too much. but i'm keeping it as i REALLY don't want to gain weight.thanks for any input. my appt is two weeks.
b2c.
Posted by Phillipa on February 14, 2008, at 10:38:55
In reply to need a new coctail....AD Advice?, posted by B2chica on February 14, 2008, at 9:42:09
Maybe a med expert will pop in and give you some good advise. Yes wanted you to know you're not being ignored. Phillipa I hear you but don't know that much about that condition
Posted by polarbear206 on February 14, 2008, at 11:01:51
In reply to need a new coctail....AD Advice?, posted by B2chica on February 14, 2008, at 9:42:09
> i am currently on:
>
> ritalin 20mg bid
> lexapro 15
> topamax 50
> zyprexa 5 or 10PRN
>
> problem is i am having breakthrough depression every other week and breakthrough "highs" every other week. i guess that's rapid cycling? anyway Dx psychotic depression with bipolar features ESPECIALLY RE medication.
>
> the lexapro just makes me so tired. i switched to night but that might be whats caused this breakthrough stuff? not certain though ive been trying to track it and its show up before i did that.
> i want to ask my pdoc for a new AD and not sure what to ask for. i was on Wellbutrin XL successfully for several years then after pregnancy it just didn't seem to work. i'm looking for something similar to WEllbutrinXL, something a little more stimulating, NOT to make me tired like lexapro does. i'm already tired enough dont need more of that!
> however the only other two that i tried that i had HORRIBLE results with was Effexor and prozac....
> any other suggestions would be great.
> i'm also willing to drop topamax as it doens't seem to be helping too much. but i'm keeping it as i REALLY don't want to gain weight.
>
> thanks for any input. my appt is two weeks.
> b2c.The Ritalin could be exacerbating your cycling. I would be very cautious. Why don't you decrease it and see if that helps.
Posted by Racer on February 14, 2008, at 11:19:00
In reply to need a new coctail....AD Advice?, posted by B2chica on February 14, 2008, at 9:42:09
The Ritalin could be contributing to it, so it's probably worth trying to lower that a little bit as an experiment. See if maybe 10mg BID could do the trick, and limit the breakthroughs.
As far as ADs go, though, since Wellbutrin helped, I think I'd suggest considering Cymbalta. It's got the benefit of targeting both serotonin and norepinephrine, which might be more helpful than a medication which only targets serotonin. Otherwise, Remeron is another option, unless you want to try a TCA. The TCAs are pretty potent medications, and quite helpful for many people. The trade off, of course, is side effect profile: they often have more anticholinergic side effects, which means you'd probably want to add in a cholinergic agent to counter those. Personally, I opt for sub-optimal effectiveness in order to avoid those side effects, so that's not the way I'd go. Then again, I'd bet you and I have very different responses to medications, so that probably shouldn't influence you. (For instance, on 10mg Lexapro, I was nearly catatonic -- didn't even speak, since it wasn't worth the effort it would have cost me. It wasn't fatigue, wasn't amotivation, nothing like that -- it was feeling as though I was locked deep inside myself, and couldn't get to the surface. I only ate when my husband put food in front of me, and sometimes not even then. Slightly different from your experience, huh? lol)
Another thought is to give EMSAM a try -- it would mean dropping the Ritalin, but you probably wouldn't miss it. You'd also probably need to try something for sleep -- I used Rozerem, which was great and I highly recommend if sleep is an issue. Otherwise, it did seem like a helpful medication.
I do hope that helps.
Posted by B2chica on February 14, 2008, at 11:20:12
In reply to Re: need a new coctail....AD Advice?, posted by polarbear206 on February 14, 2008, at 11:01:51
your probably right but it helps my concentration so much at work that its hard for me to change the one med that works.
(sorry forgot to mention ADD)
Posted by B2chica on February 14, 2008, at 11:26:05
In reply to Re: need a new coctail....AD Advice? » B2chica, posted by Racer on February 14, 2008, at 11:19:00
thanks racer,i'll keep cymbalta in mind.
i've been on remeron before and it did nothing for me. and tried one TCA that did nothing for depression either.i'm not sure what the anticholinergic SE is? could you clarify?
and at this rate i don't need ANYTHING for sleep i'm so tired all the time. before i switched to lex at night i was going to bed around 8/8:30!
now i can at least make it till 10. (taking meds around 9.)
Posted by B2chica on February 15, 2008, at 8:34:05
In reply to Re: need a new coctail....AD Advice? » B2chica, posted by Racer on February 14, 2008, at 11:19:00
i was just reading a bit about cymbalta and im concerned that it may be too similar to effexor. i was on that and that to date was probably one of the worst meds for me. i cycled about everyother day on that med. in extremes. it was bad, i attributed it to the norepinephrine aspect.
should i be concerned?
Posted by Racer on February 15, 2008, at 9:45:29
In reply to cymbalta like effexor? » Racer, posted by B2chica on February 15, 2008, at 8:34:05
Cymbalta and Effexor are both in the same class, but you've been around here long enough to know that that doesn't actually mean you can predict your response. They both inhibit the reuptake of both serotonin and norepinephrine, but having been on both of them, I'd have to say that was about the only thing they had in common. (Although I could tolerate both, so different from your reaction, it sounds like. Anyway, I'm unipolar, so that's different right there.)
I do think it's a nice little drug, and worth trying. If it doesn't work out for you, you can stop it -- and stop it much more easily than Effexor, at least in my experience.
Good luck.
Posted by B2chica on February 15, 2008, at 11:41:48
In reply to Re: cymbalta like effexor? » B2chica, posted by Racer on February 15, 2008, at 9:45:29
Posted by rskontos on February 16, 2008, at 2:08:04
In reply to thnx (nm) » Racer, posted by B2chica on February 15, 2008, at 11:41:48
Cymbalta works on a third one too according my neuro, and of course i forget which one because my brain no longer hold information in complete form just fragments. rsk
Posted by Dopamine123 on February 21, 2008, at 17:28:23
In reply to need a new coctail....AD Advice?, posted by B2chica on February 14, 2008, at 9:42:09
You could try an anti-inflammatory drug. They have shown some success in reducing mental illness symptoms.
See my post in this other forum.
http://www.abolitionist-society.com/forum/viewtopic.php?p=3710&highlight=#3710
Curcumin
http://www.abolitionist-society.com/forum/viewtopic.php?t=1191&highlight=My neuroscience/neurotechnology blog:
http://brainstimulant.blogspot.com
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