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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by B2chica on June 6, 2011, at 12:21:38
i think im in trouble again.
i am on:
5mg Perphenazine BID
20mg adderall BID or TID (as needed)
50mg Pristiq
300mg Gabapentin in evenings (or as needed for anxiety)
the last month has been the best that i remember since before the year 2000.my cognitive abilities were back
my assurity and self confidence slowly came back
my memory has been working better
my social skills better
weight GREAT****************************
now... last couple weeks i have had about 3 down days, nothing i would consider even depressive...just down.today hit like a meteor. I have severe depressive symptoms, slow movements, dulling of thoughts, cant eat, hard to even drink, tearing up. And am running backwards at the thought of going on another round of 'new drug trial'.
********************************
listing what i'm on. can there be any alterations done with those? rather than trying new medications?
i know i'm low on perphenazine, but that is only D agonist right? that wont necessarily effect mood, just thoughts?i have appt with pdoc in two weeks.
i am Not suicidal and i dont PLAN to be... ahem you hear that depression...i'm NOT going there this time!
anyway.
im in need of advice...
please.
b2c.
Posted by Phillipa on June 6, 2011, at 13:25:19
In reply to to those tx resistant..., posted by B2chica on June 6, 2011, at 12:21:38
B2chica certainly no expert but what about the pristiq to l00mg? Just a thought. Did anything happen that could trigger you? Phillipa
Posted by B2chica on June 6, 2011, at 14:49:08
In reply to Re: to those tx resistant... » B2chica, posted by Phillipa on June 6, 2011, at 13:25:19
my pdoc said they rarely saw any advantage to giving more than 50mg pristiq. (plus a few years ago i tried going up -with other pdoc- and it did nothing).
no, nothing triggered...
least not that i can think of. and its not a psychological emotive. i've learned and gotten pretty good at telling the difference.this one is certainly a biological thing.
thanks though.
Posted by mellow on June 6, 2011, at 15:18:40
In reply to Re: to those tx resistant..., posted by B2chica on June 6, 2011, at 14:49:08
I can feel you. I've been down 3 days in a row now. No thoughts of death or typical depression just lethargic, sad, sense of impending doom, scared, insecure. I slept 15 hours yesterday. One thing that helped was a good run. I went out and just killed it. I ran my hard loop with hills around my neighborhood and sometimes that kind of resets my brain. I would recommend some exercise if you can muster up the energy. You will feel better even if its just for a couple of hours. Also try doing something like cleaning the house, catching up on you laundry and doing anything that is productive.
Sometimes you have to fight back. I never really totally bought into the chemical imbalance theory until i had these spells hit me out of the blue. It like you aren't in control of your emotions. It sux! Try and use your non medication options first. Dose adjustments could take weeks to kick in anyway from my experience.
Good luck!
mellow
Posted by B2chica on June 6, 2011, at 15:33:05
In reply to Re: to those tx resistant... » B2chica, posted by mellow on June 6, 2011, at 15:18:40
great minds. just went out for a fast walk (in 96 weather)
i feel a bit better for now even if its only a few extra endorphins...i'll take it.i'm hoping it was a minor set back and tomorrow i will be better.
but there are two things different since last friday. 1) i've been getting actually more sleep than normal. and
2) i switched mfg in my generic adderall. and i know my adderall is a biggy in helping my morning moods especially.so we'll see.
i should be back on schedule this week sleep wise. and after that i'll see pdoc next week and ill bring up the generic difference and if i have to wait a few more weeks than ill see if pharmacy can order the previous generic that i was taking.thanks mellow.
b2c.
Posted by Christ_empowered on June 6, 2011, at 16:20:16
In reply to to those tx resistant..., posted by B2chica on June 6, 2011, at 12:21:38
At that dosage the perphenazine is (I would think) more of a tranquilizer than a true antipsychotic, which is probably what you need to curb agitation and what not.
I don't mean to sound harsh, but I don't think 3 days of misery=cause to change meds, unless your meds have you down or you have psychosis. Maybe talk therapy, supplements, hobbies, that sort of thing would be more appropriate than shifting the drugs around. Just my opinion, though.
Posted by B2chica on June 7, 2011, at 8:03:13
In reply to Re: to those tx resistant..., posted by Christ_empowered on June 6, 2011, at 16:20:16
actually thats what the perphenazine is for, to stop the severe anxiety that i was having which perpetuated my depression.
And you dont sound harsh at all. i'm not thinking three days of depression. i felt yesterday a huge drop in mood and i've learned that as i get older or at least as time has gone by when my depression hits, it hits harder and faster than previously. So i was majorly..."freakingout" about a downslide and all i could think about was that i could NOT handle another med change. (THUS rampid anxiety)and depressing me more (situational) about previous bouts. i was in the hospital day/outpatient program the month of december and i guess i was partially remembering how bad i was then and comparing that feeling. and How much that hospital put me in debt. and that i have no therapist anymore, and of course how many different meds i've been on in the past and some horrible side effects i've had...etc.So i think i was more reaching out, hoping people could give me some news about the meds i am on now. hoping i could (if needed) do some dosage changes vs some serious med change. as i am NOT up to that...
Thank you for your comments. they are always welcomed!
b2c.
> At that dosage the perphenazine is (I would think) more of a tranquilizer than a true antipsychotic, which is probably what you need to curb agitation and what not.
>
> I don't mean to sound harsh, but I don't think 3 days of misery=cause to change meds, unless your meds have you down or you have psychosis. Maybe talk therapy, supplements, hobbies, that sort of thing would be more appropriate than shifting the drugs around. Just my opinion, though.
Posted by Christ_empowered on June 7, 2011, at 13:03:01
In reply to Re: to those tx resistant... » Christ_empowered, posted by B2chica on June 7, 2011, at 8:03:13
hey! I think I completely misunderstood your post. Doesn't it suck how much hospitalization costs? I hate to whine, but its really unfortunate, especially when the treatment isn't even completely voluntary.
Anyway, sorry you're going through a rough patch. I really don't have any advice on changes to meds you could make yourself...a small bump in the perphenazine, maybe? Just temporarily? I mean, its cheap, its not a controlled substance, its kind of tranquilizing...if you temporarily increase it you might be less bothered by anxiety and what not. Or not...your call, really. Also, it would be unfortunate if you accidentally bumped it too high and started getting EPS and/or dysphoria.
Good luck!
Posted by B2chica on June 7, 2011, at 13:52:08
In reply to Re: to those tx resistant..., posted by Christ_empowered on June 7, 2011, at 13:03:01
thanks and no prob.
im going to add to your "whine" about hosp $$.
i think what is bad is when you have to shell out $600 or so per day...for basically a day-time babysitter.
the only really good thing was that i was able to be monitored daily by both hosp pdoc and T.
which was very helpful to me. able to get meds adjusted.but of course "hosp" costs DONT include Rx OR pdoc bills!! seriously? why must it all be separate?
anyway the only good thing was that it was at the end of the year and i had all my deductible paid so insurance actually helped me out.
Still cant afford it, but i never would have gone would it have been this time of the year...i was thinkin about bumping slightly my perphenazine. but ya i am afraid of the EPS stuff too.
anyway.
today is slightly better than yesterday.
i'm wondering if it was somekind of body adjustment to the change in mfg of adderall?anyway. thanks
b2c.
Posted by Lepus on June 7, 2011, at 15:29:18
In reply to Re: to those tx resistant..., posted by B2chica on June 7, 2011, at 13:52:08
How are you guys getting hospitalized? I can't het a bed around here for med stabilization. I have to be suicidal or homicidal!
Posted by B2chica on June 7, 2011, at 16:06:23
In reply to Re: to those tx resistant..., posted by Lepus on June 7, 2011, at 15:29:18
i didnt do inpatient this time...but in the past if i walked in i may not have gotten a bed and may have gone to 'county' center which is HORRIBLE and scary.but mostly my pdoc would call the hosp and arrange me to come in so that they would have a space for me.
This time i did outpatient hospitalization which is actually a day program that lasts from 8:30 to 3:30. and it is all in one room with anywhere from 10 - 20 others.
T pulls you out 3x week, and pdoc sees you everyday to manage meds. there are nurses there to take BP and such if needed to monitor with new meds. and there were classes. which this time around it was actually more than a babysitter (i mis-spoke earlier) and it was pretty helpful. as they did a psychotherapy (group) for almost 2 hours in the morning.
and they did other 'classes' as well, rec therapy, art therapy, relaxation...etc.but check out around your town and see if there are any outpatient programs like that. i do know that our hospital about 5 years ago got funding for a new wing specifically for psych patients, and they also revamped the outpatient program so i know that ours is a pretty good setup here.
hope you can find something where you're at.
b2c.
Posted by alchemy on June 7, 2011, at 17:51:55
In reply to to those tx resistant..., posted by B2chica on June 6, 2011, at 12:21:38
> i think im in trouble again.
> i am on:
> 5mg Perphenazine BID
> 20mg adderall BID or TID (as needed)
> 50mg Pristiq
> 300mg Gabapentin in evenings (or as needed for anxiety)
>
>
> the last month has been the best that i remember since before the year 2000.
> now... last couple weeks i have had about 3 down days, nothing i would consider even depressive...just down.
>
> today hit like a meteor. I have severe depressive symptoms, slow movements, dulling of thoughts, cant eat, hard to even drink, tearing up. And am running backwards at the thought of going on another round of 'new drug trial'.
>hello fellow tx resistant sufferer,
I don't know what your dx or drug history is, but just as an fyi from my experience- when I took Adderall without a stabilizer I was all over the place.
Posted by jono_in_adelaide on June 8, 2011, at 3:18:04
In reply to Re: to those tx resistant..., posted by B2chica on June 6, 2011, at 14:49:08
Change the pristiq ti an SSRI (sertraline, 50-100mg each morning) and an NARI (bupropion 300mg each morning, or nortriptyline 100mg at night)
It hits the noradrenalin side of the equasion harder than pristiq, can realy help.
Also, changing from the perphenazine to an atypical could certainly have some benifits
Posted by B2chica on June 8, 2011, at 8:36:36
In reply to Re: to those tx resistant..., posted by Lepus on June 7, 2011, at 15:29:18
ps. the time i've been IN the hospital i was suicidal.
and the two times i've been in partial i was also suicidal.
HOWEVER, i know that in outpatient (partial hospitalization) you dont need to be suicidal. Usually doc referral though.Good Luck.
B2c.
Posted by B2chica on June 8, 2011, at 8:41:37
In reply to Re: to those tx resistant..., posted by alchemy on June 7, 2011, at 17:51:55
Hi Alchemy! thanks for chiming in.
My dx bounces from psychotic depression to bipolar-Mixed.
i dont have "highs" but i have the 'aggitated and psychosis' with my severe depressive bouts. otherwise, i have standard depression the rest of the time. i think i've been dx with just about everything thats out there at one time or another! lol. The only one that's stayed the same is PTSD, and some sort of severe depression.
the one thing i love about this site is there are so many others that 'get' the med-go-round and how exhausting it can get. (though that's not really good, good. but you know what i mean)
my drug hx is very long and quite frankly i cant even remember them all without my list...the one smart thing i've done is keep track of all my med trials/dosage changes since the beginning...2003.
i think its up to about three pages long...lolim just not sure what caused that really really bad day. but i haven't been that down since. (think it was monday). i'm a little low, but nothing comparing.
could be several things but i'm not really worrying about it for now.i need to keep my anxiety in check though.
i can't seem to take mood stabilizers. have never done well on those, it seems to make me be on a bit of a roller-coaster every three days or so. up down etc.
I've always done well on stimulant ritalin or adderall. adderall best, i actually feel less of a crash with it...not sure why, everyone else i hear has more of one on it...ah well. i guess that's also why i've had such a hard time finding good meds.i do believe AP is totally the way for me. zyprexa has ALways been my saving grace. But it really only works well at 10mg and with that i was up to 184lbs. (after baby weight too).
Risperdal, did nothing for me, Abilify made me nasty angry and aggitated, geodon made me psychotic. and although at totally low dose, perphenazine is really helping with things.
not sure in my combo what's helping what, but its working well, and i'm down to 143lbs.
(my normal weight-before kids- was 135-140) so i'm almost there.
Posted by B2chica on June 8, 2011, at 8:43:39
In reply to Re: to those tx resistant..., posted by Christ_empowered on June 7, 2011, at 13:03:01
CE
im going to mention to pdoc about any increase in perphenazine.
although my 'low' from monday is better, my anxiety is still around (more so lately).Thanks for advice.
b2c.
Posted by hyperfocus on June 8, 2011, at 22:23:38
In reply to to those tx resistant..., posted by B2chica on June 6, 2011, at 12:21:38
Best thing to do might be to wait 1 or 2 weeks...a lot of the time recovery isn't a linear process. You're going to go through periods where you feel worse, for a lot of different reasons. I wouldn't change or adjust the dosage of your meds just yet. If you've been feeling better then keep doing exactly as you're doing until you're absolutely sure that the response is plateauing or declining. I'd also look at any supplements or herbal stuff or non-psychiatric meds you started in-between the time you were feeling better and the time you started to decline - they can have a significant adverse impact.
Posted by Phillipa on June 8, 2011, at 22:35:33
In reply to Re: to those tx resistant..., posted by B2chica on June 8, 2011, at 8:41:37
Congrats on the weight loss self=esteem is very important to me. Ever check into hormones? Phillipa
Posted by B2chica on June 10, 2011, at 8:55:08
In reply to Re: to those tx resistant... » B2chica, posted by Phillipa on June 8, 2011, at 22:35:33
thanks phillipa. i am really struggling with my feelings of the weight loss lately.
on the one hand i am very pleased to be back in my normal range of weight.
HOWEVER, i know that i've lost substantial weight and i know that in the past i've lost too much weight and my pdoc is concerned about that today. so that i am getting anxious about this constant loss of weight. if i continue i'm afraid he may take me off one of my meds or switch around and quite frankly i dont want to do any more switching. i dont want to go off the best combo i've been on.
granted its not been 100%.
but its still by far, better than any other combo i've been on in terms of side effects.i guess i'm just never able to be happy. i let things get to me to much.
thanks
b2c.
Posted by Phillipa on June 10, 2011, at 20:42:44
In reply to Re: to those tx resistant..., posted by B2chica on June 10, 2011, at 8:55:08
In weight range for height? Phillipa
Posted by B2chica on June 15, 2011, at 9:54:01
In reply to Re: to those tx resistant... » B2chica, posted by Phillipa on June 10, 2011, at 20:42:44
i am now.
but in the past i went from 160 (zoloft and zyprexa) to 112.
-not eating properly mostly due to some psychotic thinking.
-over exercising due to anxiety.now i'm exercising but not to same degree. only because i dont have time with two little ones.
and i'm doing my best to eat, even when i'm not hungry.today is bad.
Posted by Phillipa on June 15, 2011, at 21:00:06
In reply to Re: to those tx resistant..., posted by B2chica on June 15, 2011, at 9:54:01
I'm so sorry you do so much with two little ones, working demanding job. What does your doc suggest now? Phillipa
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