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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by vic80 on July 17, 2010, at 18:43:08
Hi,
Dx: MDD, anxiety and obsessive thoughts.
Rx: Savella - 25mg, provigil 100mg, lorazepam 0.5mgHi
I am on Savella for depression since past 2 months. I went through a rough start up which entailed ups and downs of moods... finally I was put on 50mg once daily as the morning dose was was making me feel dizzy.
On 50mg I became more calm than I should have been - a numb zombie like state, not feeling nice but just having energy, and has a lot of mental fatigue too.
So my pdoc 4 days ago made the dosage back to 25mg and added provigil to deal with the excessive numb feeling and lack of energy.On day one of provigil, I felt nothing first few hours, the usual bland dull depressed mood, and then in a while i felt nice..... felt mood elevated, felt for the first time in a while that the dysphoric veil was off me.... it lasted for well over an hour and gave way to focus..... I felt totally wired on it, felt nervous, almost a mental straitjacketed feeling..... my 0.5mg ativan helped to cut through that... but I felt very strange...
On day 2 the onset of action was early, the good mood was better,,,, not euphoric though.... was very energetic etc..... was joyous talking to people.... greeting people etc..... this gave way to just focus and finally nervous anxiety and blank mood.... in a while the energy surge came over again... i was self-confident, talkative and honest.... i was quite blatant in stating the truth and this was a good thing.... I felt like my VERY old self again..... but I guess the overwhelming feeling that something is wrong in life, that i need to change my life to come out of depression made me feel somewhat rejecting of the good mood....
anyways.... i had to take 0.5 mg ativan to counter an onset of a panic attack....
later i was at a party... first time in months I was feeling happy meeting people talking to them confidently about myself... in a little while this was replaced with just confidence and not much happiness.... slowly going down to feeling wired and irritable and snappy, getting angry easily......Also I get this feeling through out as though I am sleep deprived... this started day one itself... a sort of sleep deprived daze through out....
Day 3: felt as though nothing happened till 3-4 hours.... then mild irritability..... boos of energy... bu no mood elevation.... infact mood felt more and more down in the dumps totally..... felt tired mentally.... zoned out... lost and almost dissociated..... this was followed by the chatty talkaktive side coming up again... only to feel nervous .... 0.5mg ativan and in a while I am calm.... enjoying my walk... enjoyed tv.... feeling smily and cheerful.... sudden crash of mood to severe dysphoria and agitation..... feel like I will break something... quite angered....
in a little more while... I am calm again....I am wondering if the ativan actually somehow interacts with provigil in a way where the latter's effects get blunted or perhpas get turned around in to a dysphoric feeling.
I would really not want to miss on provigil as this has given me atleast a few hours of genuine cheerful happiness.
But I need to also weigh out the anxiety/obesssive side of me that is exacerbates....
What I absolutely cant stand are the bouts of numbing I feel - when I feel totally emotionally and mentally numbed - these were present in Milnacipran days - which is what prompted me to request for a stimulant
But if the stimulant is going to give me a fixed gaze, zoned out in to nothingness feeling then I am scared......
The severe mood swings I have noticed in past 3 days are terrible.
If nothing else there has been exacerbation in a very uncomfortable obsessive feeling of mine: that which makes me doubt if I am saying what I want, feeling what I want to etc, as though the modafinil focus turning inwards makes this obsessive trait make me feel like I am in a state of constant dissociation..... this could just be the good friend anxiety after all..
Now why would I still want to stick with this med if it is going to make me feel so terrible - I think the mood elevation I have felt is truly a welcome break from the dysphoric numbness I have been in all these weeks.
Is there any other AD which could give me the same effects like Modafinil.... withot the anxiety and numbing
Thanks.
Posted by Christ_empowered on July 17, 2010, at 22:40:01
In reply to When to add stimulant to Anti-Depressant?, posted by vic80 on July 17, 2010, at 18:43:08
Could you try some form of Ritalin a couple times daily?
Posted by bulldog2 on July 18, 2010, at 10:18:28
In reply to Re: When to add stimulant to Anti-Depressant?, posted by Christ_empowered on July 17, 2010, at 22:40:01
> Could you try some form of Ritalin a couple times daily?
I will do my best to be civil though I will certainly be blocked as you seem untouchable. I do not feel you are being civil to people.
You really need to stop lecturing people on what they need to do. When a question is asked I thought the rules stated that you answer the question. What a person asks is what should be answered. You are lecturing people when you don't know what their mindset is. How do you know what their expectations are from drugs?
After what you did when you came back to babble
you really need people teaching and helping you with some of your emotional problems. You seem to have a need to have power over people and be in a role of leadership.
You were irrepsonsible when you basically told people the path to getting better was get rid of your meds and follow Christ. Don't you realize the naive may have followed you advice and had disasterous results because they followed you.Than you reenter babble and go woops I made a mistake. I will need the drugs at times.
1. So you will now define when we need drugs and when it is acceptable to take them based on your experiences.
2. Wow you just can't stop. You have no right to lecture and assume a leadership role when your own life appears to be in chaos. You just give yourself a pass everytime you can't follow your edicts and redefine the book of Christ Emp.
3. You appear to be the one that needs a leader not vice versa...
4. When you came back into babble and did the woops I made a mistake everyone was so kind and understanding. Maybe you need people holding you responsible for your actions.
I'm outta here again so Dr. Bob can do whatever he wants to do.
But you Mr. Christ need to start looking inside of yourself and when you have attained perfection you can start lecturing. It appears you have learned nothing from your previous mistakes.
Posted by ed_uk2010 on July 18, 2010, at 12:49:59
In reply to When to add stimulant to Anti-Depressant?, posted by vic80 on July 17, 2010, at 18:43:08
Hi Vic80,
There are several issues here which I think you need to consider....
1. I get the impression that Savella is not working well for your depression at all. If this is the case, wouldn't it be better to taper Savella and try something else rather than attempting to 'augment' it? I think it would be a good idea to discuss this with your doctor.
2. Although Provigil gave you brief periods of mood elevation, it also caused severe mood swings. For this reason, Provigil could end up causing you more harm than good. What do you think?
3. Also, since Provigil caused a rapid mood elevation on day 2, is there a risk that you could become dependent on it, leading to worsening of you overall condition?
Personally, I get the impression that 'augmenting' problematic and ineffective treatments happens far too frequently. If a drug doesn't make you feel better but does cause adverse effects, why not switch to something else? IIRC, your last AD was Lexapro - which was not effective. I think it would make sense to try an AD from a different class, rather than another SSRI or SNRI. Have you tried mirtazapine or nortriptyline?
Posted by Christ_empowered on July 18, 2010, at 16:36:25
In reply to Re: When to add stimulant to Anti-Depressant? » Christ_empowered, posted by bulldog2 on July 18, 2010, at 10:18:28
that Ritalin is commonly used (I think) to augment treatments for depression and its cheaper (on insurance, anyway) to get the old school kind that requires dosing a couple times a day.
Obviously, I'm not a doc. I just thought mentioning Ritalin as a possibility seemed appropriate.
Posted by bulldog2 on July 18, 2010, at 18:11:45
In reply to I was just thinking..., posted by Christ_empowered on July 18, 2010, at 16:36:25
> that Ritalin is commonly used (I think) to augment treatments for depression and its cheaper (on insurance, anyway) to get the old school kind that requires dosing a couple times a day.
>
> Obviously, I'm not a doc. I just thought mentioning Ritalin as a possibility seemed appropriate.I apoligize for posting my critical post on the wrong thread. Not sure how I did that one. Anyhow I'm not sure how to delete my post and move it to the correct thread.
Posted by Phillipa on July 19, 2010, at 12:04:42
In reply to Re: I was just thinking... » Christ_empowered, posted by bulldog2 on July 18, 2010, at 18:11:45
Don't think you can move it. Phillipa
This is the end of the thread.
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