![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 86 to 110 of 150. Go back in thread:
Posted by Dima on August 31, 2010, at 13:36:53
In reply to Re: I feel horrible, posted by ed_uk2010 on August 31, 2010, at 12:44:34
I took 100 mg last night and I may be experiencing increased fatigue, but it's hard to tell, since my energy goes up and down on its own anyway. I can deal with fatigue, though, if it means no depression or anxiety.
I'm off the citalopram.
I don't see my regular doctor until the 19th, and she doesn't really listen to me anyway. It's hard to reach her by phone, too. The walk in doctor was much friendlier and was open to suggestions when I saw her last. They work at the same place.
Posted by ed_uk2010 on August 31, 2010, at 14:09:26
In reply to Re: I feel horrible, posted by Dima on August 31, 2010, at 13:36:53
>I took 100mg last night and I may be experiencing increased fatigue, but it's hard to tell, since my energy goes up and down on its own anyway. I can deal with fatigue, though, if it means no depression or anxiety.
In that case, perhaps it would be best to stay on 100mg for a week or so to give your body chance to adjust.
>I'm off the citalopram.
Good. What about your other meds?
>The walk in doctor was much friendlier and was open to suggestions when I saw her last. They work at the same place.
It would be best if you could see the same doctor again. Is that possible?
Posted by Dima on August 31, 2010, at 14:36:24
In reply to Re: I feel horrible, posted by ed_uk2010 on August 31, 2010, at 14:09:26
I believe she is the default walk in doctor, so I think so.
Currently I'm on the Anafranil 100, Lithium 300 twice per day, and Seroquel 50 at night.
I'm hopeful about my low carb diet, too. It's been three weeks and the acne on my arms is disappearing, which is a good sign. The weird thing is that my hunger and cravings are still around, which most people see disappear on low carb. Last time I ate like this in December, the day my hunger disappeared was the day I started to feel alive for the first time in months. Diet was the only thing different both times I felt better last year, so I really hope it happens again.
I really appreciate the fast responses. Thanks ed and everyone else.
Posted by ed_uk2010 on September 1, 2010, at 5:36:48
In reply to Re: I feel horrible, posted by Dima on August 31, 2010, at 14:36:24
>I believe she is the default walk in doctor, so I think so.
Ok. well that's good. There's nothing worse that having to 'tell your story' to a different doctor each time.
>Currently I'm on the Anafranil 100, Lithium 300 twice per day, and Seroquel 50 at night.
As you increase clomipramine, you might find that you feel some tiredness during the day. This is common during the early stages of treatment with tricyclics antidepressants (except desipramine). If you doctor agrees, stopping Seroquel might reduce the daytime drowsiness. You could go to 25mg for a few days before stopping. What do you think? I don't think it's a good idea to be on overly complex med combos! Taking clomipramine as a single dose in the evening might be sufficient to help you sleep.
As far as lithium is concerned, I don't think it's clear just yet whether (or not) you actually need it. 150mg to 300mg twice a day seems to be the norm for unipolar depression. Have you noticed any side effects? Clomipramine is fairly potent on its own so I'm not sure how much benefit lithium adds, except in bipolar disorder. Anyway, I think it's best that you continue lithium until you are feeling more stable - you don't want to make too many changes at once.
>I'm hopeful about my low carb diet, too. It's been three weeks and the acne on my arms is disappearing, which is a good sign. The weird thing is that my hunger and cravings are still around, which most people see disappear on low carb.
Also, if you can stick to a low carb diet, that might prevent the weight gain from your meds. You still need your fruit and veg though!
Are you going to the walk in clinic today? I forgot what you said.
Posted by Dima on September 1, 2010, at 7:08:44
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on September 1, 2010, at 5:36:48
I'm here now waiting to see her. I'll ask about lowering Seroquel.
And I love the weight loss with the low carb. I weigh the most I've ever weighed due to Remeron, but now that I don't eat carbs, I can eat as much as I want and the weight is slowly getting back to normal every day.
Posted by Dima on September 1, 2010, at 9:20:40
In reply to Re: I feel horrible, posted by Dima on September 1, 2010, at 7:08:44
I saw her and she would not raise the dosage. She said I have to wait before raising it further due to side effects and serotonin toxicity. She said ask about raising it when I see my regular pdoc on the 20th, so I guess I'm taking 50 mg again until then.
Posted by ed_uk2010 on September 2, 2010, at 12:15:16
In reply to Re: I feel horrible, posted by Dima on September 1, 2010, at 9:20:40
> I saw her and she would not raise the dosage. She said I have to wait before raising it further due to side effects and serotonin toxicity. She said ask about raising it when I see my regular pdoc on the 20th, so I guess I'm taking 50 mg again until then.
Oh OK, but does she know that you're not taking citalopram anymore? Or perhaps she is concerned about the possibility of an interaction with lithium?
Good new about the weight loss! You do sound a little happier.
Posted by Dima on September 2, 2010, at 15:41:29
In reply to Re: I feel horrible, posted by ed_uk2010 on September 2, 2010, at 12:15:16
I did not tell her I stopped taking Celexa. I was too scared of her reaction to me not following her exact orders. My mind goes blank and I could barely tell her why I wanted to increase the dose.
Posted by ed_uk2010 on September 2, 2010, at 16:45:05
In reply to Re: I feel horrible, posted by Dima on September 2, 2010, at 15:41:29
> I did not tell her I stopped taking Celexa. I was too scared of her reaction to me not following her exact orders. My mind goes blank and I could barely tell her why I wanted to increase the dose.
I understand. The thing is, she's bound to be concerned about increasing your clomipramine dose when as far as she knows, you're still taking a full dose of another serotonergic antidepressant.
I think you will have to be 100% honest with your doc when you see him (her?) later in the month. You'll just have to say that you stopped citalopram because it wasn't helping....and also due to the risk of serotonergic side effects when combining with clomipramine.
In the mean time, let's hope that 50mg of clomipramine will start to provide some benefit over the next few weeks. The 50mg dose may not be optimal but it's certainly likely to help you up to a point.
So, you'll taper the Seroquel?
Posted by Dima on September 2, 2010, at 18:57:49
In reply to Re: I feel horrible, posted by ed_uk2010 on September 2, 2010, at 16:45:05
Even now, at 50 mg Seroquel, it takes a while to fall asleep and I wake up at 6 am and keep dozing off for a couple hours and waking up in the morning. Is it important to not take Seroquel?
Also, I just tried riding my bike, and it's terrible. A minute into it, my calves are in pain and my chest is burning as if I just biked for miles and miles. How am I so physically tired? Back when I still had energy in December, I ran three miles, now I can't run more than a tenth of a mile. Depression does this??
Posted by Phillipa on September 2, 2010, at 20:21:17
In reply to Re: I feel horrible, posted by Dima on September 2, 2010, at 18:57:49
Dima if you haven't excercised since December you're out of shape and it's natural to have to start all over again. Phillipa
Posted by floatingbridge on September 2, 2010, at 22:18:33
In reply to Re: I feel horrible » Dima, posted by Phillipa on September 2, 2010, at 20:21:17
Depression intensifies it. Did for me. It's a real illness.
Good news is that feeling like absolute sh*t will lift pretty quickly if you exercise a little every day and don't worry. You'll regain physical levels really soon.
Glad you're feeling better.
Posted by Dima on September 3, 2010, at 9:38:24
In reply to Re: I feel horrible » Phillipa, posted by floatingbridge on September 2, 2010, at 22:18:33
I'm not feeling better yet. It takes an enormous effort to motivate myself to exercise. And I'm not very hopeful about exercise making me feel better because I was already working out every other day when the depression hit and knocked me off my feet.
Posted by ed_uk2010 on September 3, 2010, at 10:14:49
In reply to Re: I feel horrible, posted by Dima on September 2, 2010, at 18:57:49
>Is it important to not take Seroquel?
No no, I just thought it might be contributing to your daytime tiredness. If you still need it for sleep, keep taking it for now.
How has lithium affected your energy?
Posted by morgan miller on September 3, 2010, at 10:37:32
In reply to Re: I feel horrible, posted by Dima on September 3, 2010, at 9:38:24
> I'm not feeling better yet. It takes an enormous effort to motivate myself to exercise. And I'm not very hopeful about exercise making me feel better because I was already working out every other day when the depression hit and knocked me off my feet.
Yeah, exercise won't help you until your mind is functioning better.
I know I've brought up the use of supplements before, but I really think some supplements along with medications could possibly help you feel better. Things like Cordyceps, Schisandra, and Fish Oil, can all help your mind and body function better and give you more energy. I think we should all be taking fish oil since it can improve brain function and help medications work better. What do you think about this?
Morgan
Posted by floatingbridge on September 3, 2010, at 11:57:07
In reply to Re: I feel horrible, posted by Dima on September 3, 2010, at 9:38:24
> I'm not feeling better yet. It takes an enormous effort to motivate myself to exercise. And I'm not very hopeful about exercise making me feel better because I was already working out every other day when the depression hit and knocked me off my feet.
I wasn't planning your recovery party yet, but you do sound a bit improved. That's
what I meant.Exercise assists recovery; it doesn't cure depression. It's part of self-care for
depression, an activity to continue when
you're in remission. Some speak of
exercise as a cure-all or prophylactic for depression, and this is untrue, and furthermore, unhelpful. Some people may feel they aren't exercising hard enough or in 'right' way. That can lead to
frustration, self-blame, guilt, etc.Dealing with depression is multifaceted. That's why there is so much advice. Find what works for you. You will. You are.
Best to you. You're a fighter.
Posted by Dima on September 3, 2010, at 13:20:35
In reply to Re: I feel horrible, posted by floatingbridge on September 3, 2010, at 11:57:07
I don't think the Lithium has affected my energy.
I did take fish oil for at least six months, in the middle of which I became more depressed. And I spent tons of money on supplements back when I felt better. I don't have the money to keep buying them.
I literally do almost nothing every day. One simple phone call might be all I do for a day, and I always put everything off. My motivation and energy are virtually nonexistant. I've tried to occupy my time with something other than TV, and it all just stresses me out and makes me really want to go back to doing nothing. Help!
Posted by ed_uk2010 on September 3, 2010, at 15:04:07
In reply to Re: I feel horrible, posted by Dima on September 3, 2010, at 13:20:35
> I don't think the Lithium has affected my energy.
That's good. It's just that some experimentation is often needed to find the best dose. Did you ever try 150mg twice a day?
>I did take fish oil for at least six months, in the middle of which I became more depressed.
OK, well you don't *need* to take fish oil as a supplement. Intead, you can benefit from a diet with regular portions of oily fish.
>I literally do almost nothing every day.
I've been like that at times. It's really hard to get out of. The best way is probably to arrange to do something where you have to be in a certain place at a certain time eg. a temporary job, voluntary work etc.
Try to look on the bright side about having to stay on 50mg clomipramine for the next three weeks. For starters, it might be helpful for your depression in spite of the low dose - it's quite a potent med. Secondly, staying on a low dose for a few weeks allows your body to adapt to the drug. This means that you shouldn't experience many side effects if/when you do have to increase up to a high dose.
Posted by Phillipa on September 3, 2010, at 19:52:29
In reply to Re: I feel horrible, posted by ed_uk2010 on September 3, 2010, at 15:04:07
Dima what about walking a bit more daily? Phillipa
Posted by Dima on September 4, 2010, at 14:13:40
In reply to Re: I feel horrible, posted by Phillipa on September 3, 2010, at 19:52:29
Last night I had a really bad headache and nausea, and I don't usually have either of those, so maybe it was side effects of Anafranil. I've also had dry mouth in the morning.
Posted by ed_uk2010 on September 4, 2010, at 14:35:20
In reply to Re: I feel horrible, posted by Dima on September 4, 2010, at 14:13:40
> Last night I had a really bad headache and nausea, and I don't usually have either of those, so maybe it was side effects of Anafranil. I've also had dry mouth in the morning.
Ok, well perhaps it's best that you're staying at 50mg for now. Take some Tylenol for your headache.
Posted by floatingbridge on September 4, 2010, at 15:19:49
In reply to Re: I feel horrible, posted by ed_uk2010 on September 4, 2010, at 14:35:20
>
> Ok, well perhaps it's best that you're staying at 50mg for now. Take some Tylenol for your headache.
>Not on an empty stomach...? But, yes, tylenol might help with general discomfort, too.
Dima, what did you like to do before this episode? Maybe some (or one activity?) you can gently resume. You may feel awful or maybe just disconnected from the activity, but over time you'll recover more connection. Nothing too
challenging or difficult. Go for comfort
because you need to be kind and gentle to yourself. Life will makes it own demands.For example, my first and very worst episode: nothing. I couldn't watch t.v., movies, listen to music, write, craft, read, exercise. My husband had to 'walk' me around the block because I could barely stand. I could, however, go into my backyard (which was treed and green), lie on my back or sit and watch the leaves move and listen to the birds. I'd feel the breeze, the sun-- all non-threatening and soothing. I was also able to take baths and float around the warm bay (when my husband walked me to the beach).
So I started small. I had to.
I hope the above example was somewhat helpful. You probably find different activities work for you.My dbt coach would have me do things
like walk barefoot in sand or run my hands through the sand--stuff to experience nano-seconds of awareness. Anything for a timeout from misery. Then slowly the nano-seconds dilate.(DBT is dialectic behavioral therapy. Some good coping skills.)
Do you have a therapist or someone?
Posted by ed_uk2010 on September 4, 2010, at 16:53:06
In reply to Re: I feel horrible » ed_uk2010, posted by floatingbridge on September 4, 2010, at 15:19:49
>Not on an empty stomach...? But, yes, tylenol might help with general discomfort, too.
You can take acetaminophen on an empty stomach or a full stomach. It should not cause gastric distress or irritation. 650mg every four hours can be useful for headaches. I'm sure the headache will pass soon.
Posted by Dima on September 4, 2010, at 16:59:55
In reply to Re: I feel horrible, posted by ed_uk2010 on September 4, 2010, at 14:35:20
When will I feel better? This is unbearable. Time is taking forever, it's torture. How long does Anafranil take to work?
Posted by floatingbridge on September 4, 2010, at 23:14:59
In reply to Re: I feel horrible, posted by ed_uk2010 on September 4, 2010, at 16:53:06
Ed, I might be thinking of motrin-type stuff.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.