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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 38. Go back in thread:
Posted by SLS on August 10, 2009, at 6:16:51
In reply to My current cocktail, posted by maxime on August 9, 2009, at 19:27:24
> Right now I am taking the following:
>
> 60 mg Cymbalta
> 300 mg Wellbutrin XL
> .5 mg Clonazepam
> 100 mg Largactil
>
> I want to feel better than I am now. Currently I am thinking about suicide a lot. I also have a lot of trouble getting up in the morning. I am anxious a lot.You know that suicidality (feelings of suicide not necessarily the result of reasonable thoughts) has a neurobiological substrate. Much work has been done in this area. The depressive illness can trigger episodes of suicidality. So can drug treatment. Please take this into consideration as you evaluate your suicidal feelings and ideations.
> Any suggestions on which meds I might add?
Not at the moment.
Well, maybe one. Seroquel.
I'll think about it some more.
- Scott
Posted by tonyz on August 10, 2009, at 8:39:00
In reply to My current cocktail, posted by maxime on August 9, 2009, at 19:27:24
Sorry that you are feeling so poorly; I know this doesn't sound like much but many have been exactly where you are now and have gotten better. Don't give up hope and please don't make any adjustments without talking to your doctor. Were you stable when you left the hospital? Have you made any medication changes since then?
SSRIs and Wellbutrin can be stimulating. Maybe if you are taking those in the am, the stimulating effects will diminish for you by the evening. Potentially you can go up on the clonazepam, but the benzos can be very addictive so caution is advised. Seroquel can be an effective adjunct to an AD. I don't know largactil, and not knowing one medication in the mix, lends serious credibility to any of my comments.
Another option is the tricyclics, Seroquel works well as an adjunct with some of these. They generally are more sedating - side effect profiles are somewhat more severe but varies from person to person and you probably adapt over time.
If you think you need stronger help, maybe considering going back in the hospital is something to think about. Were you in-patient or out-patient? Can you go back as an out-patient. Often the combination of the drug therapy, and group environment is very helpful. I think the nursing staff also gives constant feedback to the doctors and that helps them in deciding what you need. Please don't look at hospitalization as a failure. I know no one likes to go, but if you need it, you need it.
I can't speak for others, but I don't like to take drugs and am always tweaking things and looking for alternatives. Sometimes that can get you in trouble.
Do you like the pdoc you are seeing now. If not then find another one. When you are in the hospital the nursing staff usually get you hooked up with someone when you leave or assume that you will be seeing the same person before you went in. You can call them for a referral. Usually, they can get you in more quickly.
Lastly, please don't make any adjustments w/o discussing with your doctor. Wish you well, everyone is wishing you a prompt recovery.
Posted by bulldog2 on August 10, 2009, at 10:36:44
In reply to My current cocktail, posted by maxime on August 9, 2009, at 19:27:24
> Right now I am taking the following:
>
> 60 mg Cymbalta
> 300 mg Wellbutrin XL
> .5 mg Clonazepam
> 100 mg Largactil
>
> I want to feel better than I am now. Currently I am thinking about suicide a lot. I also have a lot of trouble getting up in the morning. I am anxious a lot.
>
> Any suggestions on which meds I might add?
>
> Thank you.Lithium
Posted by Maxime on August 10, 2009, at 12:57:24
In reply to Re: My current cocktail » maxime, posted by rvanson on August 9, 2009, at 20:04:25
I am actually on a low dose of clonazepam. I used to take 4mg. I don't think .5mg would make me more depressed.
I see my pdoc at the end of the month.
Posted by Maxime on August 10, 2009, at 12:58:37
In reply to Re: My current cocktail, posted by Phillipa on August 9, 2009, at 20:11:58
I really don't think it's the klonopin. I have been on it for years. He won't let me try Xanax claiming that it's too addictive.
Posted by Maxime on August 10, 2009, at 13:00:04
In reply to Re: My current cocktail, posted by Sigismund on August 9, 2009, at 20:19:56
The largactil is my mood stabiliser. I like it a lot. It makes me feel calm. I've tried to go without the Wellbutrin and it made me worse.
Posted by Maxime on August 10, 2009, at 13:03:28
In reply to Re: My current cocktail, posted by Justherself54 on August 10, 2009, at 1:24:31
> For me, Wellbutrin caused horrible anxiety and cymbalta caused rage episodes.
>
> I'm really sorry you're going through this Maxime.
>
> Were you feeling OK for a bit on your current cocktail, was something recently added? Keep posting..we're all here for you.Thank you. I've been on this cocktail for over a year now. But meds never last long with me. Thanks for your support.
Posted by Maxime on August 10, 2009, at 13:04:26
In reply to Re: My current cocktail, posted by manic666 on August 10, 2009, at 4:57:18
> thats a lot of meds well it is in my eyes , maby just maby one of them is wrong for you, an screwing the rest , i dont no much as you can see but i have been where you are many times , stay safe
I've been on these meds for over a year now and this is the worst I have felt.
I will do my best to stay safe.
Posted by Maxime on August 10, 2009, at 13:06:32
In reply to Re: My current cocktail » maxime, posted by softheprairie on August 10, 2009, at 5:46:49
> I'm sorry it's gotten this awful for you. I noted you supplied references on a different thread that supported use of MAOIs combined with a TCA and/or stimulants. Is that something you've tried? Or have you just been interested in trying such an agressive strategy, but not been able to find a prescriber to agree to it? I imagine most patients would really have to doctor-shop to find a willing psychiatrist for that strategy. (I'm sorry if you've talked about this already recently on the board; I haven't read as much here of late.) I wanted to let you know I'm really pulling for you, even if I don't know the best words or med coctail for you.
I've been on many different cocktails. I was taking Parnate with Adderall at one point and that worked well.Maybe it's time to try it again.
Posted by Maxime on August 10, 2009, at 13:08:38
In reply to Re: My current cocktail » maxime, posted by SLS on August 10, 2009, at 6:16:51
You know that suicidality (feelings of suicide not necessarily the result of reasonable thoughts) has a neurobiological substrate. Much work has been done in this area. The depressive illness can trigger episodes of suicidality. So can drug treatment. Please take this into consideration as you evaluate your suicidal feelings and ideations.
>
> > Any suggestions on which meds I might add?
>
> Not at the moment.
>
> Well, maybe one. Seroquel.
>
> I'll think about it some more.
>
>
> - ScottI will keep it in mind. But I am not taking anything new. I've been on these meds since February 2008.
Thanks Scott.
Posted by Maxime on August 10, 2009, at 13:09:42
In reply to Re: My current cocktail, posted by bulldog2 on August 10, 2009, at 10:36:44
> > Right now I am taking the following:
> >
> > 60 mg Cymbalta
> > 300 mg Wellbutrin XL
> > .5 mg Clonazepam
> > 100 mg Largactil
> >
> > I want to feel better than I am now. Currently I am thinking about suicide a lot. I also have a lot of trouble getting up in the morning. I am anxious a lot.
> >
> > Any suggestions on which meds I might add?
> >
> > Thank you.
>
> LithiumI've tried lithium and at every dosage (even low ones) I was toxic on it. I don't want to try that med again.
Posted by SLS on August 10, 2009, at 16:35:47
In reply to Re: My current cocktail, posted by bulldog2 on August 10, 2009, at 10:36:44
> > Any suggestions on which meds I might add?
> >
> > Thank you.
>
> Lithium
Good thought.
- Scott
Posted by SLS on August 10, 2009, at 16:49:32
In reply to Re: My current cocktail » softheprairie, posted by Maxime on August 10, 2009, at 13:06:32
> I've been on many different cocktails. I was taking Parnate with Adderall at one point and that worked well.Maybe it's time to try it again.
Try to sneak some nortriptyline in there.
A couple of more thoughts. You can simply add these as adjuncts to what you are currently taking. You won't be able to try Geodon once you start and MAOI. It inhibits the reuptake of serotonin.
All three drugs are 5-HT1a partial agonists, and might work synergistically with the Cymbalta. Abilify has the added benefit of stabilizing the DA postsynaptic receptors through partial agonism.
1. Geodon
2. Abilify
3. BuspironeI realize that a great many ideas expressed here will mirror things that you have already tried. But don't think that you are frustrating us. We will all keep trying.
- Scott
Posted by floatingbridge on August 10, 2009, at 17:05:58
In reply to Re: My current cocktail » Maxime, posted by SLS on August 10, 2009, at 16:49:32
Abilify at a small dose was helpful for me--2.5 mg.
fb
parnate and stim might be good, too--but that's wholesale change.
hoping you're getting some good info / brainstorming here!
Posted by Maxime on August 10, 2009, at 18:27:26
In reply to Re: My current cocktail » Maxime, posted by SLS on August 10, 2009, at 16:49:32
I wish Abilify was available in Canada.
Posted by Zyprexa on August 10, 2009, at 19:25:53
In reply to My current cocktail, posted by maxime on August 9, 2009, at 19:27:24
How about a mood stabilizer?
Posted by Phillipa on August 10, 2009, at 20:20:06
In reply to Re: My current cocktail » maxime, posted by Zyprexa on August 10, 2009, at 19:25:53
Maxime if you don't want to change the meds what about raising the cymbalta? Phillipa
Posted by floatingbridge on August 10, 2009, at 20:33:32
In reply to Re: My current cocktail » SLS, posted by Maxime on August 10, 2009, at 18:27:26
Abilfy --not available online? (It's really expensive!)
Posted by floatingbridge on August 10, 2009, at 20:35:17
In reply to Re: My current cocktail » maxime, posted by Zyprexa on August 10, 2009, at 19:25:53
lamictal?
Posted by Maxime on August 11, 2009, at 18:27:11
In reply to Re: My current cocktail » maxime, posted by Zyprexa on August 10, 2009, at 19:25:53
> How about a mood stabilizer?
THe thorazine is my mood stabiliser at the moment.
Posted by Maxime on August 11, 2009, at 18:27:42
In reply to Re: My current cocktail, posted by Phillipa on August 10, 2009, at 20:20:06
> Maxime if you don't want to change the meds what about raising the cymbalta? Phillipa
I've tried doubling it and it did nothing.
Posted by Maxime on August 11, 2009, at 18:28:25
In reply to Re: My current cocktail » Zyprexa, posted by floatingbridge on August 10, 2009, at 20:35:17
> lamictal?
Makes me more depressed. :(
Posted by floatingbridge on August 11, 2009, at 22:04:13
In reply to Re: My current cocktail » floatingbridge, posted by Maxime on August 11, 2009, at 18:28:25
Maxime,
When do you see your pdoc again? Do you have a sense of direction yet how you'd like your treatment to go? Any hunches?
fb
Posted by Phillipa on August 11, 2009, at 23:15:56
In reply to Re: My current cocktail » Maxime, posted by floatingbridge on August 11, 2009, at 22:04:13
Maxie figured that. What about requip? Low dose it's doing wonders for an old babbler. Phillipa
Posted by elanor roosevelt on August 11, 2009, at 23:47:34
In reply to Re: My current cocktail » floatingbridge, posted by Maxime on August 11, 2009, at 18:28:25
Maxine
Please remember that meds might work for a while and then turn around on you. Consider re-evaluating the meds you are taking. My experience has been that once i get to a bad spot i never do well with adding even more--there is always something i have to get rid of.
Good luck and take good care of yourself
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