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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by JESSsMom on July 20, 2008, at 14:59:30
I haven't visited here for a long time. Life was pretty good, mentally, for about 2 1/2 years. Twice a year check ups with my PDoc and neurologist (headaches). Have been taking 25mg Topamax, 3mg Klonopin, and a nightly Rx antihistamine to help prevent recurring headaches.
Well, anxiety accompanied by depression have crept back in with a vengeance. I was in denial about it for a while, but can no longer be.
To make matters even worse, I have gained an enormous amount of weight over the last few years. I am shockingly obese for the first time in my life. Add to that my chronic pain problems (back and legs) and I am miserable.
I have researched Phentermine and it gives me great concern about my anxiety since it is an amphetamine. I have researched Meridia but have been down the evil Effexor road and will not go there again, since Meridia and Effexor are very similar (the norepinephrine reuptake).
I've been on Wellbutrin before and cannot tolerate the headaches and irritability.
Luvox has helped me in the past but ONLY when I was ruminating and obsessing. I am not doing those things.
Paxil makes me sleepy, hungry, and have a flat affect.
Zoloft did nothing for me in the past and neither did Lexapro, as I recall. It gets hard to remember. :(
I even considered looking into the Lap Band procedure and then getting the right meds in liquid form to help with my depression, anxiety, and chronic pain. I'll spare anyone reading this the boring details by just saying that the LB procedure is not for me either.I have a much anticipated appointment with my PDoc tomorrow afternoon. It's not just a check up anymore. I really need help. I am so depressed, anxious, in physical pain (back and legs), and very overweight.
Can someone help me with preparation for my appointment? What to hope for/ask for in the way of meds? I am thinking about a low dose of Prozac but Prozac is quite activating (my anxiety) and it does slow the metabolism/digestion of food (the last thing an obese person needs). I've taken it before and felt "weird." I don't remember a weight gain or loss. I read that it's a toss up.
My plan is to do Weight Watchers and start minimal exercise, gradually building up. I feel I can lose this weight but need to address my anxiety, depression, and chronic pain issues with medication.
Goal Number One - Tomorrow have a heart to heart with my PDoc and start the correct psych meds.
Any help or med suggestions are greatly appreciated!
Meg
Posted by Racer on July 20, 2008, at 16:08:24
In reply to Obesity - Anxiety - Depression - Headaches, posted by JESSsMom on July 20, 2008, at 14:59:30
Howdy, I'm sorry you're having trouble, and hope things improve soon.
As for the specifics of what you're asking about, here are my thoughts:
A lot of people have a good result with Topomax to mitigate weight gain, but at much higher doses than you're currently taking. As I understand it, the therapeutic dose is about 200mg. It's well worth considering, to help with your weight issue, especially since so many psych drugs can cause weight gain.
Also, as someone who has both an anxiety disorder and depression, I have found that medications which improve my depression often improve my anxiety, as well, even if they're known for activating effects. It might be worth trying medications which don't seem, on the surface, to be the best choice for an anxiety disorder. It's also worth mentioning that often times the initial adverse effects fade once you've been on a medication for a while.
I've been on Prozac a number of times. At first, it almost always leaves me feeling as though I'm going to twitch out of my skin -- but once that goes away, it's actually been pretty good for my anxiety. It's just a question of getting through those first couple of weeks. Out of all the SSRIs, though, Zoloft has been the kindest and gentlest in terms of adverse effects -- and it's been as effective as any other SSRI for me. It might be worth revisiting, and see if maybe you just didn't reach a therapeutic dose for you.
Another option might be Lamictal, which is usually weight neutral.
Finally, don't let Meridia's surface similarity to Effexor stop you from giving it a try. The similarity of mechanism doesn't necessarily imply that it will have other similarities. All of these medications are different, despite some similarities related to mechanisms of action. For instance, SSRIs all inhibit the reuptake of serotonin, right? Yet I've never heard of anyone who has exactly the same experience on ALL of them -- mostly, you hear about people (myself included) who do better on one or another; have different adverse effects from each; etc. Meridia would address two of your problems, and it might very well be a good and effective choice for you.
As far as anxiolytics go, the best one for me was BuSpar, but a lot of people don't find it helpful at all.
Best luck, and I hope your appointment goes well. And, of course, that your next medication works beautifully.
Posted by JESSsMom on July 20, 2008, at 20:51:00
In reply to Re: Obesity - Anxiety - Depression - Headaches, posted by Racer on July 20, 2008, at 16:08:24
Racer, thank you for your kind words and for taking the time to address specific medications. I appreciate your thoughts and will carry them with me tomorrow.
Upping my Topomax is definitely a consideration. I am on that tiny dose from way back when the headaches started and were migraines (they no longer are migraines but still painful headaches - down to two or three times/month). There is a possibility that that small 25mg/night dose is keeping the headaches from becoming migraines and has been helping just a bit to stabilize my mood all this time. I know that when I started taking it 2 1/2 years ago I felt my mood elevate, my depression lift, and my anxiety diminish.
At one point during the trial and error migraine therapy the Topomax dose was upped to 50mg/night and I got a case of the "stupids" the next day. That was hard to tolerate. I have also watched a friend take it at a much higher dose for seizures and really get the "stupids." You know, "Dopamax." It's so true. Word finding problems, memory problems - lots of cognitive stuff.
I am not adverse to discussing a very, very slow titration up of Topomax with my doctor, though. There's one idea. :)
I know exactly what you mean about feeling as though you will twitch out of your skin with Prozac. Horrible feeling. I *think* this only happens to depressed people with a coexisting anxiety disorder. Deeply depressed people without anxiety are thankful for the activation. Also, as you said, Zoloft is worth talking to my PDoc about but Zoloft is a known weight gainer.
Lamictal, as I understand it, would be a replacement for Topomax, but without getting the dreaded "stupids?" I don't really know much about it. I need to read up.
Regarding Meridia - I, too, thought it was the perfect med for me in that it would address two of my problems (obesity and depression) but the reading I have done on it says that it is pretty much a failure as far as treating depression (just reporting what I have read when googling - I have never tried it). This might very well not be the case for me, although I have to say that I don't read much about Meridia success in treating depression. Mostly small amount of weight loss info comes up when googling. It is worth a try. Anything is. We are all so different. It's another option to have in mind when I see my PDoc tomorrow. That would just be the best thing ever - a med that lifted my depression (in turn helping my anxiety) and helped me lose weight.
Taking notes here when it comes to your success with Buspar, too.
I really appreciate your time and good suggestions.
Meg
Posted by Phillipa on July 21, 2008, at 0:11:09
In reply to Re: Obesity - Anxiety - Depression - Headaches, posted by JESSsMom on July 20, 2008, at 20:51:00
You mentioned luvox and it's not just for OCD for anxiety depression also. I've been on it for years and at one time a high dose and no weight gain. It's the most sedating of the SSRI's. Also my Sister and Neice do well on zoloft. As a matter of fact my Sister Switched from Paxil to Zoloft as Paxil is what caused her to gain weight. Are Benzos out for you as they work well and xanax has a slight mood elevating advantage to it. I've been on benzos for 37 years and have never gone up in dose actually at a lower dose and at times have been completely off them. Good luck tomorrow. Phillipa
Posted by mbluett on July 21, 2008, at 3:43:51
In reply to Obesity - Anxiety - Depression - Headaches, posted by JESSsMom on July 20, 2008, at 14:59:30
> I haven't visited here for a long time. Life was pretty good, mentally, for about 2 1/2 years. Twice a year check ups with my PDoc and neurologist (headaches). Have been taking 25mg Topamax, 3mg Klonopin, and a nightly Rx antihistamine to help prevent recurring headaches.
>
> Well, anxiety accompanied by depression have crept back in with a vengeance. I was in denial about it for a while, but can no longer be.
>
> To make matters even worse, I have gained an enormous amount of weight over the last few years. I am shockingly obese for the first time in my life. Add to that my chronic pain problems (back and legs) and I am miserable.
>
> I have researched Phentermine and it gives me great concern about my anxiety since it is an amphetamine. I have researched Meridia but have been down the evil Effexor road and will not go there again, since Meridia and Effexor are very similar (the norepinephrine reuptake).
>
> I've been on Wellbutrin before and cannot tolerate the headaches and irritability.
>
> Luvox has helped me in the past but ONLY when I was ruminating and obsessing. I am not doing those things.
>
> Paxil makes me sleepy, hungry, and have a flat affect.
>
> Zoloft did nothing for me in the past and neither did Lexapro, as I recall. It gets hard to remember. :(
>
> I even considered looking into the Lap Band procedure and then getting the right meds in liquid form to help with my depression, anxiety, and chronic pain. I'll spare anyone reading this the boring details by just saying that the LB procedure is not for me either.
>
> I have a much anticipated appointment with my PDoc tomorrow afternoon. It's not just a check up anymore. I really need help. I am so depressed, anxious, in physical pain (back and legs), and very overweight.
>
> Can someone help me with preparation for my appointment? What to hope for/ask for in the way of meds? I am thinking about a low dose of Prozac but Prozac is quite activating (my anxiety) and it does slow the metabolism/digestion of food (the last thing an obese person needs). I've taken it before and felt "weird." I don't remember a weight gain or loss. I read that it's a toss up.
>
> My plan is to do Weight Watchers and start minimal exercise, gradually building up. I feel I can lose this weight but need to address my anxiety, depression, and chronic pain issues with medication.
>
> Goal Number One - Tomorrow have a heart to heart with my PDoc and start the correct psych meds.
>
> Any help or med suggestions are greatly appreciated!
>
> MegHi Meg. After years of trial and error I can you give the results I experienced on a few drugs which might be of help to you. Topamax and Klonopin are known to CAUSE depression in some people and might be the reason you're feeling that way. For chronic pain I would highly recommend Lyrica. It has a very versatile dosing regimen a you will almost certainly find a dose and timing to suit you. It is also very helpful with anxiety and sleep (when taken at night). I think Lamictal would a very good drug for your depression and mood stabilization. For your weight gain I would recommend Metformin. It is not a quick fix, but will stabilize your blood sugar and you will start to lose weight over time. Give it 3 to 6 months.
I hope this helps. Feel free to ask any questions as I have dealt with some of the issues you mention.
Posted by Racer on July 21, 2008, at 9:07:25
In reply to Re: Obesity - Anxiety - Depression - Headaches, posted by JESSsMom on July 20, 2008, at 20:51:00
Hey, Meg,
This has to be very quick this morning, as there's some freshly scoured Wensleydale lambswool waiting for my attention right now, and -- well, frankly, that's something I'd rather think about than think about psych meds, you know? ;-) (And if anyone knows about Wensleydale wool, they'll tell you that I've just expressed a very healthy thought...)
First, MBluett is right about metformin as another option for the obesity. It's also known as Glucophage, and is used to help control blood sugar in Type II diabetes. It's also been used to help control weight gain from psych meds. It's worth discussing with your doctor.
Topomax is said to cause less cognitive impairment if taken with bicarbonate of soda. I can't say it's true or not, but that's what my former pdoc said when I asked him about trying it to control weight gain for me. Since that's a pretty benign option, it might be worth trying. I gotta say, though -- I'm having word finding difficulties, and feel stupid, enough that it's noticeable to others, and it can't be Topomax since I've never taken it. Perimenopause has been mentioned as one possible cause for that. Anxiety is brought up regularly as another explanation. It's possible the Topomax wasn't really the cause of the problem, you know?
Zoloft is known as a medication which can cause some people to gain weight. ALL SSRIs can cause some people to gain weight. The only AD I know of which is pretty weight neutral would be Wellbutrin, and that's not an option for you. If the serotinergic medications have helped you in the past, I strongly suggest you consider taking one and then taking a second medication to address and mitigate the weight gain.
Best luck, and I'm sorry I cant' think yet today. I'm sure I'm leaving something important out here...
Posted by JESSsMom on July 21, 2008, at 21:13:44
In reply to Obesity - Anxiety - Depression - Headaches, posted by JESSsMom on July 20, 2008, at 14:59:30
OK, gang. Thanks for your responses. Had my appointment today. PDoc was clear in no uncertain terms that he is a Pdoc and not a bariatric doctor or a pain management doc when I brought my obesity and Meridia up, along with my chronic pain. Meridia is no longer classified under ADs, it's under controlled meds as a weight loss med only now. <rolls eyes> Darn.
Lamictal was a no go. Upping my Topomax was not an option either.
While my PDoc appreciates my weight problem and does not wish to prescribe anything that might exacerbate it, he is not going to prescribe anything to help with it either. Same with chronic pain.
I will have to see a bariatric doc and a pain management doc in addition to my PDoc.
In the meantime, for depression, anxiety, and any compulsive thinking/behaviors, he prescribed 50mg 2x/day to start of Luvox. Phillipa, you and I have discussed Luvox on here before.
You are SO right about it being a very sedating SSRI. I have been on it before at all different doses (max was 300 mgs) and could barely keep my eyes open in the late afternoon. I'm talking about falling over asleep on the couch at Oprah time. That is not a side effect I can have at this point in my life and I KNOW from experience that I will get. Long story short - I have to be "UP" in the late afternoon to drive and pick DD up from school, help with homework, make dinner, and then take her to her extracurricular activities. I know it is summer time now but I also know that this rotten somnolence doesn't go away - it's with me as long as I am on Luvox.
However, something must be done and now regarding the anxiety and depression and what my PDoc sees as compulsive eating, although I don't. I see it as making terrible food choices and being sedentary.
So I am going to take the Luvox but the question becomes when and how much. As of today I have 100mg tablets that can be cut into 25mg pieces. I have to somehow time the taking of Luvox so that the late afternoon exhaustion doesn't happen. If I take it at night before bed, I am certain to get this side effect in the late afternoon - that I remember for sure.
It's been a while since I have "played" with the timing and dosage of Luvox but I can't remember when the best time to take it is. It has a very short half life and the effects (good and bad) are felt quickly.
I agree it is not a weight gainer and can even be a weight loser. The only benzo I can take is Klonopin (I have my own personal Xanax horror story). Although I am prescribed 3mgs/day I have been getting by on 2mgs/night to sleep. As Mbluett says, I am keenly aware that Klonopin can cause a sort of low energy depression that cannot be shaken until any large amount of Klonopin has cleared the system.
I also want to look into the Metformin you mentioned, Mbluett and Racer. I need to see another doc for my weight but not one that simply prescribes Phentermine, etc. as they do at many clinics. I could look into Metformin with a bariatric doc. With my anxiety, amphetamines are out of the question.
Racer, we must be in the same age group if we are both talking about perimenopause - I think that's coming soon on my end. Of course I had to google Wensleydale lambswool and figure you are a knitter. :)
I also want to see a pain specialist and discuss Lyrica. I've unsuccessfully taken Neurontin before and at times feel that I am THE candidate for prescribed narcotic pain relief. In other words, if someone said to me, "Aren't you afraid that you will need to take "whatever narcotic" twice a day for the rest of your life?" I would answer, "No, I am afraid of living the rest of my life WITHOUT taking a strong prescribed pain med regularly with this terrible quality of life." Hope that makes sense.
So for now, just for today, I tried to tackle one set of problems - the mental health ones. I am going to skip the Luvox tonight and take either 25 or 50mgs tomorrow morning. *Maybe* this will eliminate the strong late afternoon somnolence? I don't know.
Meg
Posted by Racer on July 22, 2008, at 9:40:45
In reply to Re: Obesity - Anxiety - Depression - Headaches, posted by JESSsMom on July 21, 2008, at 21:13:44
> PDoc was clear in no uncertain terms that he is a Pdoc and not a bariatric doctor or a pain management doc when I brought my obesity and Meridia up, along with my chronic pain.
>
>
> I will have to see a bariatric doc and a pain management doc in addition to my PDoc.
Meg, I hope you'll thank your pdoc for me. The anger I felt when I read your post woke me up better than coffee would this morning. That's a good service he provided.And at the risk of breaking some of the rules that I help enforce around here, I'm going to offer my opinion. And I will do my best to remain civil while doing so.
I am not impressed by this doctor's attitude. I've read a lot of things written by doctors where they discuss the practice of some psychiatrists to prescribe medications which impact other body systems, without addressing that impact. Many of the articles describe that practice in less than complimentary terms. Some use words like "irresponsible" to describe that practice. I am singularly unimpressed by the behavior you've reported here.
I realize that there are often practical considerations which impact decisions regarding choice of doctors. My advice would be to find another doctor, if that is at all possible for you. Even if it's inconvenient for you, if it is possible, it's probably worth it. EVERY pdoc I've seen for years now has told me, when I brought it up, that we would address weight gain from meds if it occurred. They have described the ways that they would address it. They have offered lists of medications they would use to mitigate weight gain, and they have described ways to address other adverse effects -- such as sedation -- as well. And they've followed up on it. If your pdoc has simply said, "That's not my specialty," I am -- at the risk of sounding ridiculous for repeating myself -- singularly unimpressed.
I'm very sorry that you have run into this, and I wish I could send you my pdoc -- who would NOT dismiss your legitimate concerns in this manner.
I wish you the best, and hope that you receive the care you deserve.
Posted by JESSsMom on July 22, 2008, at 12:10:35
In reply to Re: Obesity - Anxiety - Depression - Headaches » JESSsMom, posted by Racer on July 22, 2008, at 9:40:45
Thanks, Racer. ITA. It was a discouraging visit. My Pdoc is old fashioned and stubborn, yet still somehow up on new meds. He is also getting up there in age and I foresee a change in docs anyway. One thing he is not is benzophobic, which I've always been grateful for.
But we are not just brains, we are entire systems. So frustrating. I wish you could send me your Pdoc, too! Seriously.
I took 25mg Luvox this morning and am so damn tired..........ugh.
I will have to see two more docs for each problem -
- Depression/anxiety (Pdoc)
- Headaches (I already see a neurologist for this prob)
- Obesity
- Chronic PainI do think that expecting one doc to treat ALL of the above is unrealistic. But some med help for my weight from my Pdoc would have been very beneficial and certainly doable. Sigh.
Meg
Posted by Phillipa on July 22, 2008, at 19:37:10
In reply to Re: Obesity - Anxiety - Depression - Headaches » Racer, posted by JESSsMom on July 22, 2008, at 12:10:35
Meg best to take the luvox at night and it clears your system by morning. Could be lowering the klonopin could be the answer as when I got to 250mg of luvox a long time ago it made me feel slightly manic. Pdoc said I just didn't remember what normal felt like. Right now I'm lowering my valium and only on 50mg of luvox taken at bedtime all meds. Want to also cut the luvox to 25mg in the future. Funny that none of the SSRI's SNRI's have ever made me tired the opposite. But we are all different. Here in Charlotte it is the same with docs if it's not their speciality you are referred to another doc to treat that. Happened today with a brown thingy on my leg that possibly could be cancer not likely though but doc gave me a refferal to a dermatologist who would then refer me to a plastic surgeon if a biopsy proved positive and this was an internist who will not prescribe psych meds for me Hence My full day trip to the one I see. I guess depends on part of the country don't know as the pdoc had before would give me antibiotics if I needed them. So try the luvox at night??? Love Phillipa
Posted by JESSsMom on July 22, 2008, at 22:07:40
In reply to Re: Obesity - Anxiety - Depression - Headaches » JESSsMom, posted by Phillipa on July 22, 2008, at 19:37:10
Thanks, Phillipa. Yes, Luvox is such a different SSRI. Can't stand the sedation it gives me. I am going to take it at night the next time I do take it. Going to skip it tonight and ssee how I feel tomorrow.
How difficult for you to have to make a whole day out of seeing your Pdoc. :( That's harsh. My Pdoc is a minumum 45 minute drive each way and his appointment schedule is very limited - to rush hour times only (late afternoon). Pain in the neck.
Posted by Phillipa on July 23, 2008, at 19:56:57
In reply to Re: Obesity - Anxiety - Depression - Headaches » Phillipa, posted by JESSsMom on July 22, 2008, at 22:07:40
So how do you feel today? Love Phillipa
Posted by JESSsMom on July 24, 2008, at 8:59:07
In reply to Re: Obesity - Anxiety - Depression - Headaches » JESSsMom, posted by Phillipa on July 23, 2008, at 19:56:57
Thank you for asking. :) I haven't take any more Luvox so am not feeling sedated. This may sound cliche but I don't have time to be sedated. Single parent, too much that has to be done all the time. I know - I wimped out on the Luvox.
My next move is to try to take a tiny, tiny dose of Prozac if I still have any. I have to watch it. Like was already mentioned, I want to jump out of my own skin on the normal therapeutic dose. If I have to, I'll wait to see my Pdoc again.
in the meantime I ate nothing but salads, Lean Cuisines, and Weight Watchers ice cream bars for the better part of a week with no weight change. Grrr. I cheated and had Chinese for dinner last night.
How about you? How are your meds going for you?
Posted by Phillipa on July 24, 2008, at 20:22:31
In reply to Re: Obesity - Anxiety - Depression - Headaches » Phillipa, posted by JESSsMom on July 24, 2008, at 8:59:07
Don't work but that's me. If you take a tiny dose of prozac it might be the ticket who knows? Love Phillipa
Posted by JESSsMom on July 27, 2008, at 11:01:55
In reply to Re: Obesity - Anxiety - Depression - Headaches » JESSsMom, posted by Phillipa on July 24, 2008, at 20:22:31
> Don't work but that's me. If you take a tiny dose of prozac it might be the ticket who knows? Love Phillipa
Oh shoot. I forgot to hit "Confirm Post!" Phillipa, my question to you was what doesn't work? The diet I have been trying? Or Prozac?
Thanks,
Meg
Posted by Phillipa on July 27, 2008, at 12:19:03
In reply to Re: Obesity - Anxiety - Depression - Headaches » Phillipa, posted by JESSsMom on July 27, 2008, at 11:01:55
Meg neither. Meds just don't seem to work for me anymore but I have an off thyroid which is probably why. I have heard good things about prozac and just don't cut calories too low. I myself eat helathy choice or one of those calorie counted Tv dinners. Phillipa
Posted by JESSsMom on July 29, 2008, at 12:13:11
In reply to Re: Obesity - Anxiety - Depression - Headaches » JESSsMom, posted by Phillipa on July 27, 2008, at 12:19:03
Thanks, Phillipa. I am on the fence about both - Prozac and Lean Cuisines. I haven't given either a fair shake yet. A fair shake for me (not for everyone) would be tolerating a super small dose of Prozac (5mgs), following a low calorie/low fat diet for two weeks while doing some walking, and then seeing some positive results.
Positive results would be an increase in motivation (getting some things done around here for a change) and lessening of depression *without* added anxiety and the loss of five pounds, give or take one.
That would be enough for me to feel somewhat better and motivated to continue with both things. We'll see. I'll try it soon. I'm not up on my reading and wasn't aware of your thyroid probs. That's quite an added burden for you. :(
This is the end of the thread.
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