![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 37. Go back in thread:
Posted by Phillipa on December 13, 2008, at 18:52:57
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by crittercuddler on December 13, 2008, at 14:25:53
No after three months the l0mg of paxil side effects went away with the benzos low doses as seems not a problem for me to cut down whenever. I took for two years when nursing with benzos and my afterwork beer . Felt great went off cause Son coming to live with us and he's antimed so stopped it. They thyroid went or escalated again and pdoc changed the SSRI and never been the same again been on them all and cymbalta and effexor. Funny the cymbalta first time didn't have one side effect with benzo low dose but stopped after three months as it did nothing but did relieve backpain. OCD is why I stay with the luvox low dose. I trust it and brain seems to need it. So all docs say stay on it. Seems the lower the dose the better I do been years now and cutting down on benzos as now make me tired opposite of beginning as then gave energy. Love Phillipa
Posted by desolationrower on December 13, 2008, at 19:08:44
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 16:11:33
Well, not only would combining another med with an ssri make it work better, it could also work faster, so you might start to get some benefit within a few days. Also, the sort of symptoms you describe relating to cognition are often helped by nris. even if it doesn't help you get on an ssri, you might get some benefit for your depression at least. I guess i'm trying to think of how to get you onto an ssri in a way that doesn't bother you because they're really the gold standard, and it sounds like theyve helped you in the past. Perhaps being hospitalized for a week or two could help you? also have you tried nefazodone
Oh and inositol has shown efficacy in ocd, through soem of the same mechanisms as ssris, but with fewer side effects. buy it bulk, you need 15-20g a day. its tastes like sugar though (actually it is a sugar...). i have no idea if that would synergize with an nri as sris appear to do.
as for glutamatergics, N Acetyl cysteine would be the easiest, its an over the counter drug that is usually used to boost glutathione levels, which might be beneficial as well. Riluzole and memantine have been used as well. I'd go in order NAC->memantine->riluzole, just because of price and there isn't much data on whihc is best. Generally they have been studied as augmentation to ssris. probably need 1.5-3g of NAC a day, probably split doses. Memantine, i'd aim for 40mg.
Theres also psylocin. If you have time to go for a nice nature walk to prescribe it, its certainly the most pleasant way to reduce OCD.
Not that you asked about it, but hopefully you are doing healthy things like getting fish oil and meditating that also can help.
-d/r
Posted by azalea on December 13, 2008, at 21:51:00
In reply to SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 6:39:29
Are you currently taking any medications, prescription or over-the-counter?
Have you tried inositol supplements?
> Hello all, I am a new member. I have been reading posts for hours so I hope this comes out coherently.
>
> I have severe OCD and major depression, suicidal in nature. I have been unable to obtain relief in the last several years due to the following:
>
> 1. I USED to take Celexa, 60mg for the OCD and depression. I took it from Fall of 2001 until December of 2005 at which point I stopped it after completing a taper. I stopped it with the intention of getting on another anti-depressant because I felt the Celexa had lost its effectiveness. (I have since wondered if perhaps the fact that it went generic around the time I first noticed it was losing its effictiveness might have had something to do with it, but it is a moot point now.) When I was on it and it was "working" it only worked partially. It took the edge of my obsessions and slightly helped my depression. I was by no means cured, but it did help me function at a much higher level than I am able to without any medication.
>
> 2. Ok, SINCE getting off the Celexa I have not been able to tolerate any other SSRI for more than a couple of days and rarely, for a few weeks, before I had to stop because of the following side effects:
>
> a. awful insomnia, helped only by Seroquel ***
>
> b. severe restless feeling, but I don't feel
> well enough to do anything about it so I it is very uncomfortable
>
> c. obliterates my ability to concentrate or keep my train of thought (it feels like rocket science to straighten out my purse)
>
> d. short term memory difficulties
>
> e. myoclonic jerking when trying to sleep. (this is new and started since I have gotten off of Klonopin) The jerks whenever I try to relax or go to sleep. I will get a jerk everytime I start to drift off. This complicates the insomnia, making any chance I had of getting to sleep go away.
>
>
> *** I tried 5mg of Prozac and it made me tired. Isn't that odd as it is supposed to be stimulating, right? I discontinued the 5mg because I was getting the other side effects that I mentioned.
>
> I have tried tiny doses of the SSRIs and I get the same awful side effects, even at 5mg of Zoloft, 5mg of Paxil, 2.5mg of Celexa... It is insane.
>
> The fact that I can no longer tolerate an SSRI is very strange considering the fact that I took one for several years. Yes? As soon as I finished my Celexa taper I tried a new one and I couldn't handle it. Since then I have been banging my head up against the wall trying them to get on any one of them over and over and over again. What on earth happened?
>
> I desperately need to get stabilized on a medicine, but I have been trying unsuccessfully for 3 miserable years now to do so because of what I mentioned above. I am not able to work or go to school and my functioning has been all but reduced to zero. I am persistently suicidal and living in utter misery. My OCD is out of control. And on top of all that I am still suffering from benzodiazepine withdrawal syndrome.
>
> I am hoping that someone on this forum has had a similar experience and might be able to offer some advice on what medicines I might consider other than the SSRIs as they seem to not be an option for me. Please keep in mind my diagnoses of OCD and major depression.
>
>
>
>
>
Posted by raisinb on December 13, 2008, at 21:53:41
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by crittercuddler on December 13, 2008, at 14:14:22
I don't know a lot about the other meds I mentioned, as I haven't been on them. Others on this board have.
On Remeron, I *did* experience mild hallucinations and crazy, crazy dreams that were hard to get--mentally or emotionally--out of once I was awake. This was on a 30 mg dosage. These are common side effects and not necessarily dangerous, though if they freak you out a good deal, I can see why you wouldn't want to take it. Take things you read online with a grain of salt. People's experiences vary so widely. One person's wonder drug can send another person into major psychosis or suicidal depression, or cause terrible side effects.
Posted by crittercuddler on December 14, 2008, at 3:54:43
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 13, 2008, at 19:08:44
d/r -
I see you mentioned an NRI could help an SSRI work faster and better. My next question would be, would it also help me tolerate the SSRI better? Also, when you say NRI, you don't mean an SNRI (like Cymbalta or Effexor), do you? Are you considering Serzone an NRI? I read that it does inhibit NE uptake, but it is also described by other terms as well so I wasn't sure. I am guessing that you were suggesting Serzone as an NRI since you mentioned it in the same paragraph.
I must say that looking at Dr. Bob's fact sheet on nefazadone is encouraging where he mentions that is seems to not cause insomnia, or as he put it "sleep disturbances". Of course, I wouldn't count on that to be true for me. I guess I would just have to see. Also, I of course like how you said NRIs can help congnition. Of course, they also say SSRIs are supposed to help with memory and concentration by alleviating depression! Perhaps that would be the case were I able to get back on one and stay on it long enough. I will ask my doctor about it.
I have been hospitalized three times this year, each for a week, already. Each time I was titrated up quickly or started on a dose of an SSRI I couldn't handle. I spent all three weeks with terrible insomnia. The acute hospitalization strategy has not worked for me. With my sensitivity issues, it is just not practical. This year was the first time I had ever had to go to a hospital for the depression and OCD being so out of control.
Do the glutamatergics show efficacy in alleviating depression, or just in OCD?
I do remember reading about inositol last year. I had forgotten about it though. I get so wrapped up in trying to get an a prescription drug since one had worked for me in the past.
I know, I am stuck on the desire to want back on an SSRI myself, as well. I have been endlessly trying being driven by that desire for three years now. It is so frustrating.
Posted by crittercuddler on December 14, 2008, at 3:57:59
In reply to Re: SSRI insomnia, restlessness, poor concentratio » crittercuddler, posted by azalea on December 13, 2008, at 21:51:00
azalea,
OTC - I take fish oil and a organic whole food multi vitamin daily. I have been doing that for only a couple of weeks. I often miss days though because I am in bed not wanting to live, much less get up and take a vitamin. I also have been taking gingko biloba for that same amount of time hoping it would help with my tinnitus.
I am not taking any prescriptions right now.
Posted by crittercuddler on December 14, 2008, at 4:01:56
In reply to Re: SSRI insomnia, restlessness, poor concentratio » crittercuddler, posted by raisinb on December 13, 2008, at 21:53:41
raisanb - Thank you for the reminder. :-)
All the possible drug combinations overwhelm me very much. I am constantly obsessing about how endless my search will ultimately be to find the "perfect" combo and I just end up spiraling deeper into depression. Whatever I am prescribed, through research and much obsessing I soon decide it would probably be a better idea that I be on something else. I spend 30 minutes trying to pick out boxed tea in the grocery store... so you can imagine the difficulty I have with a decision like this. I am just convinced that I will make the wrong decision and be miserable forever. I am so caught up in the OCD thinking cycle. :-(
Posted by crittercuddler on December 14, 2008, at 6:58:21
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 13, 2008, at 19:08:44
So, should I try inositol or N Acetyl cysteine?
Or can I try both of them together?
Posted by Racer on December 14, 2008, at 10:51:06
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by crittercuddler on December 14, 2008, at 4:01:56
>I have been hospitalized three times this year, each for a week, already. Each time I was titrated up quickly or started on a dose of an SSRI I couldn't handle. The acute hospitalization strategy has not worked for me. With my sensitivity issues, it is just not practical.
A lot of times I read things on this board about people being "medication sensitive," with a negative implication involved. The way I see it, being sensitive to a medication can be a very, very good thing -- it means that one is sensitive to the effects of a medication, which is a necessary component for any medication to be effective. If you're not sensitive to its effects, after all, it isn't likely to work.
And while there are a lot of good arguments in favor of a slow, gradual upward titration on medications, the argument I use with my psychopharmacologist is the opposite: since I'm going to experience adjustment effects every time a dosage is increased, let's titrate more quickly and get it over with. I don't mean going from 0 to 60 at NASCAR speeds, but I do mean not cutting pills into quarters to start with. It's hard, but again -- the strategies we have in place to help me tolerate the adjustment phase work to minimize my distress at a faster titration schedule.
> All the possible drug combinations overwhelm me very much. I am constantly obsessing about how endless my search will ultimately be to find the "perfect" combo and I just end up spiraling deeper into depression. Whatever I am prescribed, through research and much obsessing I soon decide it would probably be a better idea that I be on something else.It sounds as though you're aware that your obsessiveness in this area is not serving you well. Aside from all the psychological aspects, it also seems to be preventing you from staying with any course of treatment long enough to benefit from it.
Can you think of anything you might try to improve your ability to tolerate these adjustment periods?
It also sounds to me as though you may be getting into a vicious circle of expecting bad side effects, which creates anxiety about whether you'll experience them, leading to symptoms which might be the anxiety and might be side effects of the medication, and so on. Do you think there might be an element of the self-fulfilling prophecy there?
I do wish you luck.
Posted by Phillipa on December 14, 2008, at 17:57:58
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 14, 2008, at 6:58:21
Personally I'd try the nefedazone as one pdoc here started me on it and no anxiety. And believe me meds make if anxious. He the pdoc did start at low doses so as to alleviated anxiety. Might be useful for you. Love Phillipa
Posted by desolationrower on December 14, 2008, at 19:18:44
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 14, 2008, at 3:54:43
> d/r -
>
> I see you mentioned an NRI could help an SSRI work faster and better. My next question would be, would it also help me tolerate the SSRI better? Also, when you say NRI, you don't mean an SNRI (like Cymbalta or Effexor), do you? Are you considering Serzone an NRI? I read that it does inhibit NE uptake, but it is also described by other terms as well so I wasn't sure. I am guessing that you were suggesting Serzone as an NRI since you mentioned it in the same paragraph.
>
nri would be probably desipramine, nortryptiline, atomoxetine, or reboxetine. they can be energizing and nort is the most sedating so maybe that one, though the cleaner ones can sedate some people too. you said you took it before, what symptoms did it make you feel more deprssed? They might help somehwat with your depression, prevent/counteract the cognitive side effects you experience on sris, and make make an sri more effective and work faster. Pfizer put a patent on reboxetine+pindolol treatment for OCD. I suppose that have some chance of working. Oh, and there was that one study with buspirone+pindolol without a ssri that had a faster response too. I guess i forgot about pindolol; noone uses it because it only hastens response, not increases no. of responders. But thats important for you. all these were tested for depression not ocd btw. Don't know why you doctors didn't add that. don't be easy on the pindolol most studies didn't use enough for it to have an effect.nefazodone is a weak serotonin and norepinin reuptake inhibitor, but a stronger 5ht2 antagonist, so its an unusual drug. i wouldn't say thats a best option, but it might help depression somewhat.
> I must say that looking at Dr. Bob's fact sheet on nefazadone is encouraging where he mentions that is seems to not cause insomnia, or as he put it "sleep disturbances". Of course, I wouldn't count on that to be true for me. I guess I would just have to see. Also, I of course like how you said NRIs can help congnition. Of course, they also say SSRIs are supposed to help with memory and concentration by alleviating depression! Perhaps that would be the case were I able to get back on one and stay on it long enough. I will ask my doctor about it.
>
> I have been hospitalized three times this year, each for a week, already. Each time I was titrated up quickly or started on a dose of an SSRI I couldn't handle. I spent all three weeks with terrible insomnia. The acute hospitalization strategy has not worked for me. With my sensitivity issues, it is just not practical. This year was the first time I had ever had to go to a hospital for the depression and OCD being so out of control.ouch, that sounds bad.
> Do the glutamatergics show efficacy in alleviating depression, or just in OCD?
hm, not sure about rizulwhatever, but both of the others have some positive evidence, i think added to other ADs for treatment resistant people.
> I do remember reading about inositol last year. I had forgotten about it though. I get so wrapped up in trying to get an a prescription drug since one had worked for me in the past.
>
> I know, I am stuck on the desire to want back on an SSRI myself, as well. I have been endlessly trying being driven by that desire for three years now. It is so frustrating.oh, i just realized too to ask: what sleep drugs did you try when on an ssri? its the 5ht2 receptors that are thought to cause the agitation/insomnia; high dose cyproheptadine, mirtazapine or a trycyclic (and which one, i don't think they all count)? some drug with strong 5ht2a/c blockade. fluoxetine is a decent 5ht2c antagonist, so the fact it caused less insomnia might be b/c of that.
theres no reason you couldn't start inositol and NAC together, along with another drug too...usually doing one thing at a time you know what is doing what, but i'm impatient so i don't like that...
have you talked to your pdoc about bipolar? the reaction to antidepressant could possibly be because of that.
-d/r
Posted by NewQuestions on December 15, 2008, at 14:31:12
In reply to SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 6:39:29
See this thread: "Strange shift in 5HT tolerances" started by zzz7. Also, see anything posted by me.
I am experiencing similar sensitivities after years of SSRI use. I have tried almost every drug I can think of. I don't know what the resolution is. I have found a handful of people with similar experiences. If you need more details, I am happy to provide them. These drugs have left me unbalanced, and yet I can't take them anymore. I am very frustrated.
Posted by crittercuddler on December 15, 2008, at 21:47:56
In reply to Re: SSRI insomnia, restlessness, poor concentration » crittercuddler, posted by Phillipa on December 14, 2008, at 17:57:58
Thank you Phillipa. I have Nefazodone on my list of meds to talk to my doctor about tomorrow.
Posted by crittercuddler on December 15, 2008, at 22:07:30
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 14, 2008, at 19:18:44
d/r - Thank you so much for your wonderfully detailed and thoughtful posts. You are giving me so much help! Thank you so much!!! :-)
"you said you took it before, what symptoms did it make you feel more deprssed?"
>I have come to believe that me feeling more depressed and odd while on nortriptyline the time I tried it was because I was also taking Remeron with it... which I think I have discovered I don't tolerate well. It was comforting to read about other people who had the same experience with Remeron.
"Pfizer put a patent on reboxetine+pindolol treatment for OCD. I suppose that have some chance of working."
>I live in the United States and Reboxetine is not available here. I read that the reason for that is that there was conflicting evidence as to its efficacy compared to more established treatments.
"Don't know why you doctors didn't add that."
>The doctor that I had back when I was still on medicine was incompetent. I wish I would have had a good doctor that kept up with her research. Perhaps I could have been augmented properly and avoided these last three years of misery. Even the doctor I have now, while much better, admits that he doesn't have time to keep up with research. It is so frustrating that while being so sick I have to take up the slack for my doctor... doing my own research. It makes me so angry. =( I mean, I get it... they are human and after a long day of seeing patients the last thing they want to do is go home and do research. BUT, I think that is something you have to be prepared for if you are going to be a competent doctor. You are going to have to make that sacrifice. Is is the nature of the job. Right? It is just crazy how these doctors don't know what I can go look up so easy in a book- and this information is critical to my care- it is not like it is some random fact. Ugh. I am going to go to the doctor tomorrow and talk to him about 5HT2A antagonists. All this time I have been expressing how I don't understand this mystery of me being intolerant to SSRIs and that might help me. I don't know why he didn't mention it. Also, we talked about how I can tolerate Seroquel, which works on Serotonin, and his answer for that was that Seroquel just hits Serotonin the least of the atypicals. He didn't even mention that the reason I was likely to tolerate it was because of 5HT2A antagonism. Ugh!!!
"have you talked to your pdoc about bipolar?"
>It had been postulated by my last doctor that I might be biploar 2, but it was more like a soft bipolar. My reaction to SSRIs is physical, not mental. I don't get mania or hypomania in a mental sense. It seems like a purely physical thing. I don't have insomnia because my mind is racing... you know? My current doctor does not think I am bipolar... but of course he is not going to rule it out 100%.
"what sleep drugs did you try when on an ssri?"
>I tried a low dose Trazadone for one dose while in the hosptial. At a low dose it didn't help me sleep. Seroquel does help me sleep when on an SSRI, but at the 25mg I have used for that purpose it doesn't help with the other symptoms. I haven't desired to be on Seroquel more than a PRN basis.
Posted by crittercuddler on December 15, 2008, at 22:14:07
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by NewQuestions on December 15, 2008, at 14:31:12
New Questions-
Thank you so much. It is comforting to know there are others like me out there. Maybe we can figure this out together.
Did augmenting an SSRI with a 5HT2A antagonist not help? That is what people have been encouraging me to do.
I will look up that post. Thank you. Keep me updated, okay?
Posted by yxibow on December 15, 2008, at 23:22:12
In reply to Two comments » crittercuddler, posted by Racer on December 14, 2008, at 10:51:06
> A lot of times I read things on this board about people being "medication sensitive," with a negative implication involved. The way I see it, being sensitive to a medication can be a very, very good thing -- it means that one is sensitive to the effects of a medication, which is a necessary component for any medication to be effective. If you're not sensitive to its effects, after all, it isn't likely to work.Its a curious opposite view I haven't seen, but unfortunately medication sensitivity for me hasn't brought good things. I am unusually sensitive to some side effects, which may be genetic, somatic, its hard to say, but definitely very real.
>
> And while there are a lot of good arguments in favor of a slow, gradual upward titration on medications, the argument I use with my psychopharmacologist is the opposite: since I'm going to experience adjustment effects every time a dosage is increased, let's titrate more quickly and get it over with. I don't mean going from 0 to 60 at NASCAR speeds, but I do mean not cutting pills into quarters to start with. It's hard, but again -- the strategies we have in place to help me tolerate the adjustment phase work to minimize my distress at a faster titration schedule.
Well that works for some people, but titrating up on Anafranil at 75 and then going up to 100 because I sort of insisted that well, that might be good because I prefer more changes in medication, as though that will make things better -- it doesn't always, in fact it backfired with me being in a very wierd wired, jumpy, and not pleasant place.
Went back to 75, and its going to percolate for a while. The way the brain responds to psychotropics isn't overnight, which is why I always wonder when I see people ditching a medication a week after taking it because it either did nothing or it had a side effect. Medications will always have side effects.I mean, if its something life threatening or life reducing, it may have to be stopped to be prudent, but sometimes focusing on improving yourself in other ways while the medication takes its time is equally valuable.
-- tidingsJay
Posted by desolationrower on December 15, 2008, at 23:56:18
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 15, 2008, at 22:07:30
hey no problem. couple things:
reboxetine is just an nri, the other ones such as tcas would likely work as well; reboxetine is nice b/c it is less potent in bringing side effects.
5ht2 antagonists somtimes worsen OCD, so be aware of that; you seem to have different reactions to 5ht meds though, so its hard to tell
good luck with your apointmnet
-d/r
Posted by zzz7 on December 16, 2008, at 3:05:05
In reply to SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 6:39:29
Hi CC,
I had jerks like that when I tapered Klonopin 5mg. They went away after a few weeks.
Lamictal seems to be doing a good job for me right now, but only 12.5 mg daily.
Good luck.
Posted by crittercuddler on December 16, 2008, at 3:31:48
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 15, 2008, at 23:56:18
How do 5HT2A antagonists sometimes worsen OCD? I remember reading that the atypical anti-psychotics can do that when used alone and not in conjunction with an SSRI (not sure how)... but I wasn't planning on using one alone.
That would be really lousy if that happened to me because I don't see any other options for me other than to try an augment an SSRI or a SNRI with an SARI, the TCA nortriptyline, or an atypical anti-psychotic in order to help the agitation, anxiety, insomnia, muscle jerks... etc.... and ALL of those have some kind of 5HT2A antagonism.
From what I read, the SARIs are the strongest 5HT2A antagonists (nefazodone and trazadone) and I after that I don't know where the atypicals (like Seroquel, Risperdal, or Zyprexa) and the TCA nortriptyline would fall into order at.
All the drugs I am left to work with (if I cut out SSRIs and SNRIs all together) have 5HT2A antagonism to some degree. Except Buproprion and I don't see that helping me by itself with major depression and OCD.
Ugh... I am so tired. My brain is fried. No more research or thinking about this tonight. I have been looking at this stuff so long my understanding is starting to regress because I am so exhausted.
I will let you all know how it goes at the doctor tomorrow.
Oh, btw, I made some suggestions to NewQuestions.... maybe you could swing by that thread to check them and see if they are right.
????? Thanks. :-)
Posted by desolationrower on December 16, 2008, at 11:20:54
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 16, 2008, at 3:31:48
Sorry, i didn't mean to say 5ht2a blockade definatly worsens OCD. It might well reduce it. This book has a summary of some of the evidence http://books.google.com/books?id=Kxi2JiBgNGoC&pg=PA79&lpg=PA79&dq=5ht2a+ocd+antagonist&source=web&ots=ydUPgmFxMF&sig=0zhUB2irck2IE2jI2Icng172aGc&hl=en&sa=X&oi=book_result&resnum=7&ct=result#PPA79,M1
desipramine is a tca nri that doesn't really affect 5ht2a. its more likely to cause insomnia though. Protriptaline too (i cannot find its binding value at 5ht2a), though it has some extra side effects. atomoxetine also.
Baclofen might help with anxiety, sleep, and muscle jerks...i don't think its helpful iwth OCD.
don't worry too much about the meds...theres a million options...good luck with the doctor
-d/r
Posted by crittercuddler on December 16, 2008, at 17:26:57
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 16, 2008, at 11:20:54
Things went okay at the doctor today. I typed up a summary of all the things I have learned here over the last few days along with medication combos that we might try based on them. My psychiatrist is very willing to collaborate with me and hear my ideas, which I like. Sometimes though he might be all to willing to go along with my lead though which might be neutralizing my OCD. Perhaps I could use a bit more control on his part. We have detailed discussion about how drugs work, etc... He appears to be the most competent doctor I have had so far. Often times I am not the only one who causes our appointment to go long because he too always has a lot to say and examples to give, etc...
For now, based on what we talked about he wants me to try Risperdal .25mg and see if I can tolerate it, and then we will look at anti-depressants. He is basing this approach on the belief that my system needs a kind of salve if you will, which is the same line of thinking he was using when perscribing AEDs to me in order to premedicate me. BUT, I wasn't able to stay on Gabapentin, Depakote, Trileptal, or Lamictal for any length of time though.... so perhaps this will work instead.
To be honest I am not hopeful. :-(
We didn't talk too much about anti-depressants today because he doesn't want to prescribe two meds at once based on my fear and reactions. But, he has my list for when we do.
Hopefully we will get there and can discuss those soon.
Doesn't Baclofen work on GABA? Isn't it a GABA reuptake inhibitor or something? I don't want any medicine that works on GABA. After my terrible experience from using Klonopin long term and the withdrawal I suffered and perhaps am still suffering from I am more than happy to leave my GABA alone. At least by direct methods.
Thank you again d/r.
Posted by desolationrower on December 16, 2008, at 22:26:07
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 16, 2008, at 17:26:57
> Things went okay at the doctor today. I typed up a summary of all the things I have learned here over the last few days along with medication combos that we might try based on them. My psychiatrist is very willing to collaborate with me and hear my ideas, which I like. Sometimes though he might be all to willing to go along with my lead though which might be neutralizing my OCD. Perhaps I could use a bit more control on his part. We have detailed discussion about how drugs work, etc... He appears to be the most competent doctor I have had so far. Often times I am not the only one who causes our appointment to go long because he too always has a lot to say and examples to give, etc...
That sounds like its working well. Sometimes i'm not sure how much to talk about drug actions with my pdocs, i'm not sure if i need to explain why something might work/how it works, or if they know already. I like my current one but it is weird he knows i'm taking memantine but not what it is for. It sounds like you're well organized. I just show up, I actually don't really talk about gsk-3 or whatever with my doc.
> For now, based on what we talked about he wants me to try Risperdal .25mg and see if I can tolerate it, and then we will look at anti-depressants. He is basing this approach on the belief that my system needs a kind of salve if you will, which is the same line of thinking he was using when perscribing AEDs to me in order to premedicate me. BUT, I wasn't able to stay on Gabapentin, Depakote, Trileptal, or Lamictal for any length of time though.... so perhaps this will work instead.
Hopefully it will be helpful. Low dose risperidone is a pretty clean medication. I noticed a decrease in pressure of self-harming thoughts and better sleep.
> To be honest I am not hopeful. :-(
I am!
> We didn't talk too much about anti-depressants today because he doesn't want to prescribe two meds at once based on my fear and reactions. But, he has my list for when we do.
>
> Hopefully we will get there and can discuss those soon.Did you include the OTC options?
> Doesn't Baclofen work on GABA? Isn't it a GABA reuptake inhibitor or something? I don't want any medicine that works on GABA. After my terrible experience from using Klonopin long term and the withdrawal I suffered and perhaps am still suffering from I am more than happy to leave my GABA alone. At least by direct methods.
it is a GABA-B agonist (benzos affect GABA-A). So it is similar but not exactly the same. Perhaps it is too close.
-d/r
Posted by crittercuddler on December 18, 2008, at 1:21:53
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 16, 2008, at 22:26:07
"That sounds like its working well. Sometimes i'm not sure how much to talk about drug actions with my pdocs, i'm not sure if i need to explain why something might work/how it works, or if they know already. I like my current one but it is weird he knows i'm taking memantine but not what it is for. It sounds like you're well organized. I just show up, I actually don't really talk about gsk-3 or whatever with my doc."
> I like to go to my appointments with a bulleted outline of what I want to talk about, although I don't have the motivation very often to make one. This time I had so much I wanted to talk about that I felt it was definitely necessary to organize my thoughts and give us any chance of getting through it all. Also, if I make one it helps me worry less that I will forget to mention something important. I am not shy about bringing things up with my doctor. I figure it won't hurt if he does know. I think he knows that I am bringing it up in order to explain my reasoning and not challenging his authority or expertise as a doctor. I am glad I have a doctor that I can do that with. It is important that I feel like we are collaborating... a meeting of the minds if you will. A few times I have told him stuff he didn't know about. After reading my paper he got out his drug book and said he wanted to "look up some things". I don't know whether to be happy or concerned about that.... He looked up stuff for quite a bit.
"i'm taking memantine"
> Namenda, right? So do you have OCD too? What are you taking it for?"Hopefully it will be helpful. Low dose risperidone is a pretty clean medication. I noticed a decrease in pressure of self-harming thoughts and better sleep."
> The first night I took it, and tonight, it kicked in and I started to feel sleepy. Not as sleepy as Seroquel, but still it was pronounced. When I tried to sleep though, both nights, I haven't been able to. It kind of feels like it is activating me and making me drowsy at the same time. It is an uncomfortable feeling. :-( Very uncomfortable. I hope it does help with the suicidal thoughts, because I still have them very often. I am having them bad tonight.
"Did you include the OTC options?"
> I told him I was taking NAC now. It didn't seem like he had heard of it. He asked me what supplements I took. I told him fish oil and my multi-vitamin. He suggested that I try inositol. I was pleased that he brought that up himself. He said he had always wanted to suggest it, but the opportunity hadn't presented itself. I ordered some of it and will get it in a few days. Should I split it up in two doses?"it is a GABA-B agonist (benzos affect GABA-A). So it is similar but not exactly the same. Perhaps it is too close."
> Yeah, too close for comfort.
I am worried about the Risperdal making my OCD worse using it alone. My OCD is already incredibly bad so I can't risk that. I popped a fluvoxamine 50mg tonight because I am worried. I also took it because of the suicidal thoughts.
You said nortriptyline was shown to help an SSRI work faster for OCD. Can you send me links to the studies? I wanted to send them to my doctor.
Well, bye for now.
-michelle
Posted by crittercuddler on December 18, 2008, at 1:43:01
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 18, 2008, at 1:21:53
Racer-
I just wrote you a long reply and it is not showing up. I clicked on one of your replies earlier in my history in order to do this. Is it not working because I did it that way? Should I just have clicked on the last post? Do you know?
Anyway, I just wanted to briefly, right now, thank you so much for your wonderful suggestions and apologize that I somehow overlooked replying to you before.
When I feel better I will retype it. Blah. :o(
Posted by crittercuddler on December 18, 2008, at 1:51:02
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 18, 2008, at 1:43:01
Racer-
Maybe I can summarize it....
Some questions for you,
1. Can you describe to me how your OCD flares up when you are trying to get on a medicine? Specifically, like what kind of thoughts?
2. How do you draw the line between assurance from the doctor and neutralizing?
3. Why do you like Zoloft the best?
4. What specific things was your doctor able to do that kept you going on a medicine when you were scared?
I have access to my doctor through email and at first he would reply promptly to me. The longer I have seen him though I have noticed that he now either doesn't reply at all or he takes like a week when before it would only take a day. Many times I am asking him to write me a different prescription though when I email him because I am convinced I shouldn't be taking whatever it is that I just started taking. So, I am thinking he is not replying because he realizes he is contributing to my neutralizing or because he just doesn't think anything he is going to say will help because it never does, or I am just emailing him too much and he is trying to make a point...?
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