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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on July 14, 2008, at 4:47:30
In reply to Re: California Rocket Fuel +, posted by Fivefires on July 13, 2008, at 21:39:24
Hi 5F.
I feel honored that you should think so much of me to have shared so much.
When I hear of agoraphobia, my first thought is of a tricyclic. Imipramine has shown efficacy in treating it. However, nortriptyline is closely related enough that I think it is worth a try before Wellbutrin.
Which SSRIs have you tried? Which of them felt best?
It is imperative that you reduce your anxiety load. This can happen automatically when a treatment for the depression works. You might, on the other hand, need an anxiolytic indefinitely. Most people use Klonopin for this. Ativan would make a good alternative. A third way to reduce your stress is to investigate any psychological issues that might be promoting it.
If Effexor + antidepressant#2 does not work, you can simply add antidepressant#3. It would not hurt to add Wellbutrin to Effexor + nortriptyline. I would also consider adding Lamictal to these three if you sustain any positive effect at all.
Still thinking...
Any panic attacks? How often?
- Scott
Posted by Fivefires on July 14, 2008, at 14:42:18
In reply to Re: California Rocket Fuel + » Fivefires, posted by SLS on July 14, 2008, at 4:47:30
> Hi 5F.
>
> I feel honored that you should think so much of me to have shared so much.>Well .. you're welcome.
> When I hear of agoraphobia, my first thought is of a tricyclic.
Hmmm.
>Imipramine has shown efficacy in treating it. However, nortriptyline is closely related enough that I think it is worth a try before Wellbutrin.
>I was on a tricyclic by itself a couple years(?) back maybe. Cannot remember why d.c. I was also on Wellbutrin by itself in the past and recall more discomfort w/ it and d.c.'d. But, these were all mono (one - correct?) monotherapy. I've never been on a combination. (Think I keep repeating this.)
> Which SSRIs have you tried? Which of them felt best?>
All cause more anxiety than already have, and 'black holes', these were times I did what wasn't cognitively well enough to know what I was doing. Funny w/ Zoloft; for about 3-4hrs, I felt very good, nearly elated, and then, the feeling was gone, vanished, never returned. I became very depressed.
> It is imperative that you reduce your anxiety load. This can happen automatically when a treatment for the depression works. You might, on the other hand, need an anxiolytic indefinitely. Most people use Klonopin for this.>
My pdoc has me on X-XR in a.m. and Xanax 2mg 3-4x a day. He WON'T put me on two DIFFERENT BENZOS. I would prefer Klonopin as the underlying support and Xanax as necessary, but he won't budge here.
>Ativan would make a good alternative.>
Have tried and instead of lessening anxiety so am functional, makes me 'sleepy' and unable to function.
>A third way to reduce your stress is to investigate any psychological issues that might be promoting it.>
I definitely would like to find a therapist who still believes in psycho-dynamic therapy. All this DBT, CBT, ways of ignoring it, pushing it away, don't seem to work for me. I was hurt by another person who was supposed to love me in sickness and in health. I rec'd no justice. So, yes, I need to talk, and I would relish some empathy, not 50ways to forget what your mind is thinking about! Is anyone else like me I wonder. I wonder if others are dissatisfied with this form of handling their emotions.
> If Effexor + antidepressant#2 does not work, you can simply add antidepressant#3. >
You mean three(3) meds?
>It would not hurt to add Wellbutrin to Effexor + nortriptyline.>
Oh my goodness.
>I would also consider adding Lamictal to these three if you sustain any positive effect at all.>
Wow...
> Still thinking...>
Did I ask you why you ruled our Remeron or what you fould dissatifactory with it?
> Any panic attacks? How often?>
Yes ... about one every two days. Fear I've taken extra Xanax and fear if call pdoc to tell, he'll tell me to stop med. Pdoc and therapist both, I think, think I cannot be helped by meds.
>
> - ScottTks, 5f
Posted by SLS on July 14, 2008, at 17:32:06
In reply to Re: California Rocket Fuel +, posted by Fivefires on July 14, 2008, at 14:42:18
Sorry, I thought you had made up your mind to not try Remeron. Why not give it a try?
What do you suppose would happen if you switched over from Xanax to Klonopin?
Have you ever talked about using Buspar?
I wouldn't want to shove it down your throat just yet, but you might be a responder to Nardil. Nardil is a broad spectrum psychotropic that treats depression, generalized anxiety disorder (GAD), social anxiety disorder and OCD to name a few. You might have GAD. This would explain the panic attacks.
- Scott
Posted by Fivefires on July 15, 2008, at 13:02:51
In reply to Re: California Rocket Fuel +, posted by SLS on July 14, 2008, at 17:32:06
> Sorry, I thought you had made up your mind to not try Remeron. Why not give it a try?>
I haven't made up my mind 'which' to try. I learned that Remeron, if not at high enough dose, causes fatigue, and this is a big problem for me.
> What do you suppose would happen if you switched over from Xanax to Klonopin?>
Did you happen to read my description of a 'nervous breakdown in 2005'? I know the two words are not a diagnosis, but my nervous system shut down, couldn't walk w/o holding onto something, hyperventilating all the time awake, BP drops to near pass out, hospitalized, put on Valium and brought back to life. Just prior to this I'd been on Klonopin. Unfamiliar w/ 'really how strong it is' because I couldn't 'feel it' like I can Xanax or Valium, when the pdoc cold-turkeyed 4wks before this happened, I didn't disagree. Sometimes while inpatient pdoc would forget to sign off on my meds so until they reached him the nurses couldn't give me Valium at scheduled times. At these times, I'd feel pressure on the top of my head, and, one time, just once, I became paranoid, thought everyone looking at me, talking about me. Having some medical background I talked my way through it constantly repeating to myself 'no you're just imagining it' until the doc called and they gave me the Valium. Then, when I saw the floor going out from under me, screamed for help, the staff began to pay attention to why I was there.(?) I'd prefer to be on Klonopin and Xanax prn, but pdoc refuses to prescribe two(2) benzos. Tho', I'm on Xanax-XR 1mg a.m. and Xanax 2mg 3-4x a day.(?)
After the above experience, I'm way adamate my nervous system is well-covered. Is Klonopin stronger than Xanax? This would be the only way I'd agree. I know of a woman who takes Klonopin and then Xanax prn, and does very well on this.
> Have you ever talked about using Buspar?>Tried in past and didn't alleviate anxiety.
> I wouldn't want to shove it down your throat just yet, but you might be a responder to Nardil. Nardil is a broad spectrum psychotropic that treats depression, generalized anxiety disorder (GAD), social anxiety disorder and OCD to name a few. You might have GAD. This would explain the panic attacks.>
I just finished a try of it. Because the initial side effects were hard; and I'm alone, and even phone calls are often not returned from pdoc office, I asked to go inpatient so could adjust to it w/ some assistance, but pdoc said no. I was disappointed because I think I began to feel a bit 'like my old self', 'reacting properly to situations, social or emotional or cognitive, ya' know? But, physically I needed some assistance. I hated to stop it, but had no choice as the initial side effects were too harsh w/o some support. I'm 5'5" and now down to 108lbs, but, because don't have a lot of fat and am a fast metabolizer, seem to require MORE, not LESS medication. Anyway, while here and taking it, I felt my heart rate going all over the place. I even called 911 and 8 big guys stood around me and said, 'you know if you go to the ER, they'll just send you home'. The last prob' 5x I've been to an ER here this 'has' happened. I was and am angered at this feeling 'I'm not worthy of professional care'. Almost filed a complaint, but had done once in another county and was just shunned by all in clinic. I've done my fair share of trying to right wrongs in my life. One daughter says it's time for me to think about myself. Pdoc said only suicidal, homicidal, or psychotic patients qualify for inpatient. It would be very hard for me to switch from the 'supposedly best pdoc here' to another right now. I'm not going to see my T here anymore, as our relationship is uncomfortable. Last saw she sat with arms crossed in a defensive manner. The initial empathy I felt from her went away when I said 'no doc has ever dx'd me borderline and to tell me I am and nothing will ever help me is wayyy wrong'. I'm afraid my pdoc is of the same opinion but doesn't speak of it. I think this is wrong. The first time I'd ever even heard of it, was from a case manager who said, 'have you ever been dx'd borderline (I think I've already told you this! Sorry!) Financially, I'm just above the poverty level so I'm NOT entitled to the free health care to those who receive $30 less than I a month and can see practically one. I'm in the grey area - too much for help, too little to pay out of pocket for help. And, unfortunately, my support is limited to my children. After father passed away now 4yrs, the rest of my fam' of origin sorta' went w/ him; currently calling me 'exhausting'. Siblings have security/partners and mother financially well-to-do. I, with my Dad, were very kindred, and wonder this is why I've sort of been ostracized now. Ya' know, you had the most of him while he was here; now you get nothing. Our home there was sold. My home here was sold so another could build another home, and I was sort of moved .. to a very isolated area which is way not good for me. All I knew, all of my life, but my children, *gone*.
A year later I had the not-a-real-dx 'nervous breakdown'. I'd been dc'd w/o titration from Klonopin (Thought I'd said something here, but don't see it on quick look-over. Anyway, because I'd been used to Xanax, Valium, even Librium, Klonopin didn't 'feel strong' to me, so this is why I didn't object to the cold turkey.) and at the same time I'd been asked to remove my things from a storage bldg back home, another state; which hit me hard. I'd been told this storage bldg was being kept to 'keep the family together'.
Another unfunny; I find myself wondering if people truly can die from a broken heart. Unplug the love and what is left - I dunno - always bounced back from losses in past - not this time. I cannot keep food in my body. Spirit (I'd always been high-spirited and had a strong personality.) nil to none now. Even children, who used to enjoy being w/ me, don't come over unless I specifically ask or there is a holiday. Dunno. Googled it once and just got confusing silly stories; nothng serious.
But, no Scott, Remeron, nortriptyline, and Wellbutrin, all three balls in the air, not sure which one might help Eff-XR flip my switch back to 'on'. Surprised I'm tolerating the 300mg okay this nearly midday. Can't complain much about the hot, then freezing, feels. Hope will abate. Eff-XR, is the only psych med which has ever been effective. (Well, didn't get a chance w/ Nardil really.) Why didn't I stay on it before? Becaue I got scared when it was time to go to 300mg! Afraid of brain damage. o_o I began to disdain that long long thread about it.
My fam has told me they'll not help me $ wise, just in case you are wondering.
Just went to Eff-XR 300mg this a.m. (repeating self huh?), but waited until AFTER losing every bit of nourishment I'd put into my body yesterday, upon awakening. Could be from Provigil.(?)
> - Scott>
Appreciate you keeping in touch and sharing your education and/or experiences.
5f
Posted by Phillipa on July 15, 2008, at 20:18:16
In reply to Re: California Rocket Fuel +, posted by Fivefires on July 15, 2008, at 13:02:51
ON a positive note you say the effexor at the higher dose is helping right? Maybe don't take providgil two days a week to get the effect back. Others know much more. Phillipa
Posted by Fivefires on July 16, 2008, at 11:38:06
In reply to Re: California Rocket Fuel + » Fivefires, posted by Phillipa on July 15, 2008, at 20:18:16
Just let pdoc's secretary know I'm
bedridden
could eat but dont, no food here really
feel like skin and bones
feel like wasting
at 300mg Eff-XR
need 2 Provigil or will fall back to sleep
cold
hermit
no loss of cognitionIs there something, a medication, which might be added in here and help?
Is it time to stop Effexor?
Am I 'not wanting to live'?? From bottom of heart, tell you 'I am not deliberately letting go', but about this I wonder. Guess you can tell.
Tks Phillipa re: Provigil 2-day off tip, but thing here is wkends only time can see kids.
Secretary will give pdoc message when sees sometime today.
No one here, alone
Angry, inside, pdoc say I don't meet criteria for inpatient care earlier, a month ago?, 2 months ago?, ... I've lost count.
I know time just keeps moving on and I'm NOT ...
What is this?
Its crazy. I want to live. This is the reason I couldn't get help. I'm not crazy enough?
tks anyone, 5f
try check back ... hard to get up and sit here and wish there were someone here, ya' know, someone who lived w/ me, I guess. Maybe then I'd be more of a fighter ? Am I a quitter? If so, would be ashamed of myself.
Posted by Fivefires on July 16, 2008, at 13:40:20
In reply to Re: California Rocket Fuel + » Fivefires, posted by Phillipa on July 15, 2008, at 20:18:16
Just checking in here.
I huddle in covers, hot and cold, back and forth.
Cannot keep food in, every morning ... been taking Imodium
Have made all IRL pp I know, know.
I suppose pdoc may call tonight and he's going to be trying to figure out if I'm better or worse. Well, I just posted my current state. There is one thing I am noticing and that is the absence of anxiety, which I've had in the past with Effexor-XR, and was wondering when it would kick in this time or if it even would. So, that's about it for now.
I'll check back in an hour or so.
I really don't know which ...
Remeron, or
nortriptyline, or
Wellbutrin,
to speak to pdoc about. ???
Or, shall I agree w/ pdoc if says, quit Eff ???
tks, 5f
Posted by mknight on July 16, 2008, at 14:42:53
In reply to Re: California Rocket Fuel +, posted by SLS on July 14, 2008, at 17:32:06
What are your thoughts on Nardil being listed as hepatotoxic in a prescriber guide? I would like to try the drug but do not want to damage my liver.
Posted by Phillipa on July 16, 2008, at 20:22:27
In reply to Re: California Rocket Fuel - No fuel. Crash?, posted by Fivefires on July 16, 2008, at 13:40:20
Five Fires it's time for you to eat and I feel is effexor has taken away your anxiety that there is maybe no reason to take another med and the two days off could be any two of the week. Love Phillipa
Posted by SLS on July 16, 2008, at 22:01:05
In reply to Re: California Rocket Fuel + » SLS, posted by mknight on July 16, 2008, at 14:42:53
> What are your thoughts on Nardil being listed as hepatotoxic in a prescriber guide? I would like to try the drug but do not want to damage my liver.
Of course, I don't know everyone who ever took Nardil, but I have never actually seen anyone have a problem. I really can't quantify how often it happens. It would be a good idea to have your liver enzymes checked before starting Nardil, and then perform a follow-up test or tests after being on it for a while.
Terrence Ketter, MD, an investigative clinician at Stanford University, rarely prescribes Nardil as the first MAOI to be tried. He prefers to use Marplan. Marplan is in the same chemical family as Nardil, but is not as hepatotoxic. I have been taking Nardil off and on for 25 years. I have been on it steadily at 90mg for two years. My liver enzymes are normal.
It is a difficult decision to make. I took Marplan for a few weeks many years ago. I was too impatient when I felt no positive results after 2 weeks. So, actually, I have not really tried it to be able to compare the two for you. Side effects with Marplan are generally milder.
Good luck.
- Scott
Posted by SLS on July 16, 2008, at 22:14:20
In reply to Re: California Rocket Fuel - No fuel. Crash?, posted by Fivefires on July 16, 2008, at 13:40:20
Feeling cold is definitely a symptom of severe depression. However, it is also a symptom of hypothyroidism. Current thought on the subject is that antidepressants won't work unless the thyroid is operating properly. Maybe you should be tested just for the halibut.
- Scott
Posted by Fivefires on July 16, 2008, at 22:19:29
In reply to Re: California Rocket Fuel - No fuel. Crash? » Fivefires, posted by Phillipa on July 16, 2008, at 20:22:27
No food prepared. Nothing ez to put together.
I could stop Provigil but then I will not be able to communicate.
The IRL pp have ignored my pleas for Imodium, some food.
Dr didn't call.
I don't understand. :(
5f
Posted by Fivefires on July 16, 2008, at 22:26:22
In reply to Re: California Rocket Fuel - No fuel. Crash? » Fivefires, posted by SLS on July 16, 2008, at 22:14:20
I agree, but so weak, now becoming scared will fall and break >-o.
On levothyroxine .075(?). What think if I double this here on own? Don't know how going to 'get anywhere'.
Also wonder other hormones, all lab prob' right on the edge of abnormal. Estrogen patches, I'm small but need twice the normal dosage. Age 56; have had no testosterone or progesterone since 1992.
Scott .. thank you so very much.
truly, 5f
Posted by Phillipa on July 17, 2008, at 20:13:15
In reply to Re: California Rocket Fuel - No fuel. Crash?, posted by Fivefires on July 16, 2008, at 22:26:22
No!!!!! you don't just change a thyroid dose the thyroid is very sensitive and you know from our writing that when they regulate or try to regulate mine it is only like break a pill in half once a week for eight weeks or some six and then retest. Lost 31 pounds since surgery without any diet changes same excercise but thyroid will not stabalize and seen two different endos. Call you doc and get it tested. And Scott no wonder my pdoc says nothing will work with my thyroid off. I knew it as when working most of the psych patients did have thyroid disease as I always checked their labs and read histories Love Phillipa
Posted by Fivefires on July 18, 2008, at 18:39:06
In reply to Re: California Rocket Fuel - No fuel. Crash? » Fivefires, posted by Phillipa on July 17, 2008, at 20:13:15
I won't just do that P. Pdoc gave more samples of Provigil but has not added in anything. I'm still not feeling 'a feeling of relief or well-being', but am tolerating the 300mg Eff-XR, but for the hot and cold feelings and isolating. Anxiety has diminished as a recall in past; already said. I began levothyroxine about 5yrs ago when I asked for a cc of my lab test results. It was okay but just below okay. I asked for some thyroid to see what would happen. Nothing happened really; just been on it ever since as a friend said everyone who has emotional problems needs thyroid. Duh. What to do now? They don't even do blood tests out here in the boondocks.
5f
Posted by elanor roosevelt on July 22, 2008, at 15:47:41
In reply to Re: California Rocket Fuel +, posted by Fivefires on July 10, 2008, at 14:44:21
I am on Xanax2mg 3-4x a day, Xanax-XR 1 a.m., levothyroxine .75, and Provigil 150-200mg, besides Effexor-XR.
have been reading through these posts and have on comment and one question
comment: provigil-- I am trying to figure out which med is f*cking me up in which way and I have identified provigil as the offender of a nasty side effect--do you know when you kind of get ahead of yourself--when you think you are focused but really you want to focus on one stupid little thing and let the rest of the world fade away--don't feel like going out but there's always an excuse?
i stopped the provigil and now i am managing to get more doneso you might want to try giving the provigil a rest for a few days and see if it gets a bit easier to get out
the question: i am thinking about going back to effexor which i took forever ago
i don't like XR anything does anyone take plain effexor anymore?
Posted by Fivefires on July 22, 2008, at 21:08:10
In reply to Re: California Rocket Fuel +, posted by elanor roosevelt on July 22, 2008, at 15:47:41
Hi Elenor.
I used to want to take the old ones myself, but never did. I never felt like the XR stayed in my body through an entire day, in fact, I'm just realizing now doing this right now.
Hey, I couldn't read all but last statement. Very upset, ask for talk-down on Social 'cuz abuse and no one, no one loves me and supports me but one daughter. The rest are ignoring me and I'm so scared. Guess he's in jail. Will keep this in inbox and get back to you. Sorry. Only comfort curling up in bed. Start to hyperventilate if sit here too long right now.
takecare, 5f
Posted by West on July 25, 2008, at 7:59:54
In reply to Re: California Rocket Fuel +, posted by Fivefires on July 22, 2008, at 21:08:10
I think wellbutrin is a (significant) 2D6 inhibitor and because of that will raise levels of effexor inceasing its toxicity. It's already one of the most toxic of the modern antidepressants so be careful.
Posted by mknight on July 30, 2008, at 13:58:46
In reply to Re: California Rocket Fuel +, posted by West on July 25, 2008, at 7:59:54
> I think wellbutrin is a (significant) 2D6 inhibitor and because of that will raise levels of effexor inceasing its toxicity. It's already one of the most toxic of the modern antidepressants so be careful.
Could you elaborate on your statement about Effexor being toxic.
Posted by West on August 1, 2008, at 12:03:18
In reply to Re: California Rocket Fuel + » West, posted by mknight on July 30, 2008, at 13:58:46
Hi
The reference is non-specific but assume it's hepatoxicity. http://www.psychotropical.com/P450_quiz_answers.shtml
Either way you will have to compensate for the raised levels of venlafaxine. Personally i've only tried bupropion. Presumably if you're already taking both then there's a good chance you'll live. Maybe have your liver checked up periodically?
Posted by Fivefires on August 11, 2008, at 15:23:28
In reply to Re: California Rocket Fuel +, posted by Fivefires on July 22, 2008, at 21:08:10
I've been down and out (even inpatient). At the suggestion of adding imipramine or nortriptyline, the issue of s*icide was brought up and I did not stay, left AMA, as the only med changes were to my anxiety meds, an issue which frightens me to death. So, ... Eff-XR on its own does not seem to be doing me any good AT ALL! Never have I been in such a long tumultuous major depressive episode, worrying if I'm ever able to pull up. Last appt to pdoc he no-showed, so I've been left alone on the Eff-XR without any augmentation for two months and my life is a mess, but I'm breathing, at least since I got home from the hospital where they had but my Xanax and replaced it w/ a low dose of Klonopin w/o titration.
Hope all well, 5f
Posted by Phillipa on August 11, 2008, at 20:15:57
In reply to Re: California Rocket Fuel +, posted by Fivefires on August 11, 2008, at 15:23:28
Five Fires which worked better klonopin or xanax? Which one are you on now. So you did or didn't go inpatient if so for how long. And what's this about suicidal thinking? Confused. Phillipa
Posted by Fivefires on August 12, 2008, at 14:58:19
In reply to Re: California Rocket Fuel + » Fivefires, posted by Phillipa on August 11, 2008, at 20:15:57
No titration from quite a lot of X to K, so, no, Klonopin wasn't working.
Going to start new thread Phillipa.
No, not suicidal.
Pls see MIND TELLING BODY TO SHUT DOWN on social(?).
5f
Posted by Phillipa on August 12, 2008, at 19:49:26
In reply to Re: California Rocket Fuel +, posted by Fivefires on August 12, 2008, at 14:58:19
Five Fires I did. Maybe klonopin depresses you like it did me when they tried to switch me from xanax to it. I had to go off it and back to xanax and was okay. Now this was years ago. Love Phillipa
Posted by Fivefires on August 17, 2008, at 16:04:53
In reply to Re: California Rocket Fuel - No fuel. Crash? » Fivefires, posted by SLS on July 16, 2008, at 22:14:20
I've heard diff' opinions re: which thyroid blood tests reveal the true state of your thyroid hormones. I went inpatient, guess 2wks ago, and in my discharge paperwork is the lab that was done. They've circled some things, but no one spoke to me about them at all.
What is circled is TSH, cortisol, estradiol, ferritin, sed rate, testosterone, total and free thyroid panel, urogram.
There are no AMOUNTS shown.
Does anyone know coding?
It's coded 244.9 and 627.9.
I have an order for blood tests from my PCP inmy purse which I've not yet had done.
Let me know, if you know, Scott or anyone, which tests 'exactly' are the tellers.
tks, 5f
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