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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 42. Go back in thread:
Posted by emmanuel98 on July 26, 2011, at 20:07:21
In reply to calling ZYPREXA, posted by B2chica on July 26, 2011, at 14:02:25
I can't answer your question, but I do know that 2mg perphenazine bid is an extraordinarily low dose. When I was in the hospital, they had me on 12mg tid, which I cut to 4mg tid when I got out and developed akathesia. I've never heard of such a low dose. Does it even affect you at all at that dose? If not, why not just stop it?
Posted by Christ_empowered on July 26, 2011, at 20:17:46
In reply to Re: calling ZYPREXA, posted by emmanuel98 on July 26, 2011, at 20:07:21
That is a rather small dose of perphenazine. They tried to put me on a similar dose (in addition to full-dose depakote and full-dose risperdal) in a hospital to control agitation. I said no, but, anyway...maybe you could try ramping up the dose a little bit before you add in another antipsychotic? Or just drop it and replace it with the zyprexa?
Posted by floatingbridge on July 26, 2011, at 20:31:52
In reply to calling ZYPREXA, posted by B2chica on July 26, 2011, at 14:02:25
B2c,
An obvious question for clarification. You have not taken them together before?
Does anyone here see any contraindications?
I just want you to stay safe.
If you were changed over, was that because of zyprexa sides?
Can you call the pp where your doc works? The guy has to have a pager. I know you are a very competent person. Relying on the board for info has it's risks. But I don't know
about AP's.The temporary xanax isn't seeing you through?
Posted by Phillipa on July 26, 2011, at 22:07:35
In reply to Re: calling ZYPREXA » B2chica, posted by floatingbridge on July 26, 2011, at 20:31:52
I did email him. No reply surprised. He might be working. But he takes them both together has for years. I'm sorry he hasn't answered you as he's reliable with stuff like this. Phillipa
Posted by morgan miller on July 26, 2011, at 22:35:39
In reply to calling ZYPREXA, posted by B2chica on July 26, 2011, at 14:02:25
Damn, I'm starting to become another Lou Philder(is that his name?). I'm not crazy about all the polypharmacy I'm seeing. I can't help but wonder if some psychobabblers are not getting the support they need, and are not doing everything possible in terms of lifestyle changes, therapy, and supplements. Just my thoughts, sorry if this offends anyone.
Posted by morgan miller on July 26, 2011, at 22:36:59
In reply to Re: calling ZYPREXA, posted by Christ_empowered on July 26, 2011, at 20:17:46
Pretty sound advice CE. Adjust doses or replace a drug with another, don't add another to the list. Sheesh...
Posted by floatingbridge on July 27, 2011, at 1:18:55
In reply to Re: calling ZYPREXA, posted by morgan miller on July 26, 2011, at 22:35:39
Oh don't Morgan. Then who would be you?
> Damn, I'm starting to become another Lou Philder(is that his name?)
Posted by morgan miller on July 27, 2011, at 5:56:47
In reply to Re: calling ZYPREXA » morgan miller, posted by floatingbridge on July 27, 2011, at 1:18:55
Ha ha, hey FB, I won't. I'm just getting super frustrated with doctors piling up on the medicaition instead of giving things time and finding a integrative approach to healing.
Posted by morgan miller on July 27, 2011, at 6:12:47
In reply to Re: calling ZYPREXA » morgan miller, posted by floatingbridge on July 27, 2011, at 1:18:55
FB, look at your medication history, where has it gotten you? Didn't you say one time that you wish you had just stuck with the SSRI that worked o.k. for you. I realize this may have been your doing and not the doctor, but I'm just trying to make the point that the medication merri-go-round and this out of control polypharmacy, in the absence of a more integrative approach, seems to be making recovery harder for many people. Maybe it works for some, like Scott, but I don't know of many people doing very well that take some crazy cocktail of meds. I hear more about side effects than benefits. I'm not saying polypharmacy never works, I just believe it is used all too often, and again, in the absence of a more integrative approach-proper exercise, therapy(group is best!), diet(paleo!), supplements(amino acids/fish oil/magnesium/vitamin D3), the right amount of support(actually, most have zero control over this, which is sad), yoga, meditation, and working hard to socialize and find some kind of easy job that is somewhat enjoyable(if the person has not been working for a while and can work). Oh, and time!!! We are often too much in a rush to stack up the drugs in an attempt to feel better. We also often think we need to solve everything with drugs, we start thinking that drugs are the only way to manage symptoms. I always hear about wanting to reach full remission using medication. What ever happened to getting 70 percent relief, then working hard at other things to get the other 30 percent? Or, just dealing with the other 30 percent, because in my opinion, 70 percent is pretty damn good.
Morgan
Posted by Zyprexa on July 27, 2011, at 7:57:48
In reply to calling ZYPREXA, posted by B2chica on July 26, 2011, at 14:02:25
I take 15mg zyprexa and 12mg x3 perphenazine. no weird sideeffects. I think its a great combo. About the only sideeffect I have is sedation. The eaties have gone away. I've lost 27 lbs in the last year. Not sure why, maybe job, or zyprexa/perphenazine mix. But not hungry all the time like I was before on 10mg zyprexa with no perphenazine.
Posted by Zyprexa on July 27, 2011, at 8:06:39
In reply to calling ZYPREXA, posted by B2chica on July 26, 2011, at 14:02:25
I find that the combination of perphenazine with zyprexa, that I don't need as much zyprexa. Still it does not replace zyprexa, just a bit of it. Before the perphenazine I was taking 20-50 mg a day of zyprexa.
I've been stable on the combo for quite some time now. No plans to make any changes.
Posted by B2chica on July 27, 2011, at 8:13:34
In reply to Re: calling ZYPREXA » B2chica, posted by Zyprexa on July 27, 2011, at 7:57:48
thanks so much zyprexa.
i started last night and had the best night sleep in LONG time. granted overslept a bit this morning but only 10min late to work. no problem.pdoc called me last night. i was Very glad to hear from him. he said no prob to add zyprexa but he didnt think i would need to stay on it long time he thinks just slump in meds?
for all the others, i eat very well (except my splurge of a dougnut or roll most mornings) lots of fruits and home grown veggies. low red meat. i exercise daily (if can) do weights, and cardio alternating days. read, watch movies i enjoy. Love spending time with kids.and kids activities.
i am doing all the alternative holistic things as per RX by pdoc in the past.
still headed down.However after discussion last night, when pdoc sees me in two weeks if i still am having this problem, i will stop zyprexa and start deplin.
we'll see how this goes.
i was panicking (surprise) because this episode mirrored an episode i had with last pdoc whom i Never got ahold of during horrible crisis. i was scared that if this doc wasnt around i would end up in hospital or worse.
i should have known. He's available. and he told me that if i get worse or if something else is wrong i can contact him.i feel better knowing someones got my back.
and normally the zyprexa only takes a day or two to kick in so hopefully by tomorrow that really bad visions and depressive state will cease.Thanks for help.
Posted by Zyprexa on July 27, 2011, at 9:28:12
In reply to Re: calling ZYPREXA, posted by B2chica on July 27, 2011, at 8:13:34
I wouldn't waste my time with deplin. You would have better results with B vitamins, folic acid is the same as deplin and much cheaper. The only reason to take deplin is if your body does not process the folic acid into folate, very rare. I've found good sucess with taking B vits. Still do.
Posted by B2chica on July 27, 2011, at 10:56:57
In reply to Re: calling ZYPREXA, posted by Zyprexa on July 27, 2011, at 9:28:12
i know there's different type of B-vitamins..which ones do you take?
b2,b16? etc.thanks!
Posted by morgan miller on July 27, 2011, at 11:05:56
In reply to Re: calling ZYPREXA, posted by B2chica on July 27, 2011, at 8:13:34
It sounds like things are pretty bad, sorry B2chica. I guess in your case maybe a short stint on Zyprexa would be helpful.
I admittedly don't know much about studies on the efficacy of therapy in helping to treat psychotic disorders in the long run, but I do wonder if certain therapies, with the right therapist of course, can eventually be helpful if they are stuck with long enough.
I would suggest a fairly strick paleo/primal diet, where you would almost eliminate added sugar and grains. The daily donut or roll in the morning would not be good for mental and physical energy. Your brain and body will eventually work much better utilizing fat as an energy source. This diet may be helpful at calming excitatory neurotransmitters. If you want to go all the way and do everything you can for yourself, you would give a more primal diet a try. Don't believe the last 40 year scare over saturated fat. As long as you are'nt eating processed or fried foods, and cooking with the right oils(coconut oil is best), the saturated fats that naturally occur in foods(nut, animal meat, dairy), should not be avoided. What we should be avoiding are grains, especially wheat.
Hope you feel better soon!
Morgan
Posted by morgan miller on July 27, 2011, at 11:08:03
In reply to Re: calling ZYPREXA, posted by Zyprexa on July 27, 2011, at 9:28:12
If you take folate, take Solgar's l-methylfolate. Some of your meds may be depleting nutrients like folate, something your doctors don't talk about, so you should probably be taking it anyway.
Posted by morgan miller on July 27, 2011, at 11:13:22
In reply to calling ZYPREXA, posted by B2chica on July 26, 2011, at 14:02:25
The problem I have with this polypharmacy is that you are taking a powerful stimulant like adderall, which might be making it necessary for you to take some of the other medications. Or, your condition is less stable and some of the meds are not as effective because of the adderall. I bet with time, you could find a way to function well and feel better, more stable, without something like adderally in your regimen. Adderall cannot be good for anyone with a disorder that involves mood swings or psychosis.
I'm sure you have tried lithium and depakote. How did you do on these? Did you take time to try to find a dose that was still somewhat effective without unbearable side effects? Did you know you have to take L-carnitine and folate when you are on Depakote? And folate and maybe inositol when you are on a reasonable dose of Lithium? You see, doctors neglect to talk about these things. Another reason why I'm totally disappointed in the field of psychiatry.
Morgan
Posted by Christ_empowered on July 27, 2011, at 11:20:21
In reply to Re: calling ZYPREXA, posted by morgan miller on July 27, 2011, at 11:13:22
Hey. I take a B-100 capsule 2x daily. I take lots of other stuff, too (niacinamide, taurine, green tea extract, vitamin c, vitamin e+selenium, zinc, etc.), but the B-100 really does help a lot. Take it with food.
Posted by B2chica on July 27, 2011, at 12:37:19
In reply to Re: calling ZYPREXA » B2chica, posted by morgan miller on July 27, 2011, at 11:05:56
thanks mm.
i have pretty much cut out most processed foods. at home we cook almost all dinners from scratch. including my bread with flax seed (which sounds very good right now) though i make it less in the summer due to it heating up the house.
and i know i really need to stop or limit my doughnut in the morning. i think i work great from toast with (real)butter and tahini. its a great start for morning.
just been lazy lately and in a rush.
we don't fry very much but we only use olive oil. one of my daughters has a very severe pn/tn allergy so we need to watch what is in our house. her specialist did say to avoid coconut till she gets a bit older and retested. otherwise id give it a try.as for grains. i don't think i eat a whole lot of those except oatmeal and i use granola (hard to find with no pn/tn) with my plain yogurt.
if you have any favorites, im always looking for fresh ideas.
btw i LOVE tabour salad, put that in a tortilla with spinach-from garden;) and UM!
(ok, there's my other grain)
Posted by B2chica on July 27, 2011, at 12:49:39
In reply to Re: calling ZYPREXA, posted by morgan miller on July 27, 2011, at 11:13:22
actually there was one point where i was ONLY on adderall. i am taking it mostly for mood, some for focus and energy due to lethargy.
you would have to fight me tooth and nail to convince me to have that taken away :)
i know its strong, but i also don't have the same SE some have due to its strength, so i think my body does need it.
the perphenazine i'm on for anxiety but i have that whether i'm on adderall or not and to a similar severe degree, so i have chosen to stay on it.i have not tried lithium or depakote. vie been on three other mood stabilizers and do very poorly on them, they actually create mood swings in me. I haven't tried lithium only because i've said no in the past.
my 'previous' best friend was on that when she past away. i know we are all different, but i equate lithium with her suicide. i just cant go there. MOAI's and Lithium are on my 'last ditch effort' list.and yes. i know you are disappointed with psychiatry as a field.
i agree to an extent. i believe that psychiatrists in general are not allowed the same research funds as other fields. the research is all on the meds not on practice.and i would be fully disappointed if not for my current pdoc. He is so different from any others i've had.
1. he spends at least a half hour with me each visit.
2. he is Very holistic
3. he differentiates psychological issues from biological ones
4. is well versed in psychopharmacology
5. he's cute
ooops i didn't need to put that in there :)
5b. he is very intelligent and has been at several big hospitals
6. and is up on latest research.but that is my personal opinion and BELIEVE ME! i have had some DOOOSIES
in the past. people who probably Barely graduated medical school.
and if that was what i'd base it on, id tell EVERYONE to be their own doc!but alas. it is not. i account this one very caring and intelligent doctor.
i feel blessed to such a competent doctor.
Posted by B2chica on July 27, 2011, at 12:50:18
In reply to B-100, posted by Christ_empowered on July 27, 2011, at 11:20:21
Posted by morgan miller on July 27, 2011, at 13:23:45
In reply to Re: calling ZYPREXA » morgan miller, posted by B2chica on July 27, 2011, at 12:49:39
Sorry about your friend. I do not believe that lithium had anything to do with her suicide though. Unless maybe, she was mistreated with it, and given too high a dose, which made her feel worse and worsened her physical health.
Lithium and depakote get a bad rap, if used properly with the right supplementation, many people can do well on these medications and live very healthy lives. You just never know until you try something.
What SSRIs have you tried?
Morgan
Posted by B2chica on July 27, 2011, at 13:41:49
In reply to Re: calling ZYPREXA » B2chica, posted by morgan miller on July 27, 2011, at 13:23:45
Logically i know it wasn't the drug that did it. but i still link the fact of it not working for her. i think if my current pdoc strongly suggested it i would take it.
anyway. thank you.
and here is a link from last month that i listed (i think) everything i've tried. i think i forgot ativan and maybe one AD, not for sure...there've been so many.but i'm going to keep my hopes up for now that deplin will work. maybe...just maybe its right for me.
but if not. i will try again. i have nothing to lose.
thanks
b2c.
Posted by floatingbridge on July 27, 2011, at 14:34:16
In reply to Re: calling ZYPREXA » floatingbridge, posted by morgan miller on July 27, 2011, at 6:12:47
Morgan, I do look at my treatment history. Dexidrine was amazing. I suspect it wrecked my health (which was already diving due to chronic PTSD and depression) but it flipped the lights on. However, I will also never take it again.
Since recovery and rerecovery is a process of continual re-evaluation, I have currently decided that no ssri nor snri has served me. Notice the use of I statements here. This is not prescriptive. Those two agents created a deep instability in my mood. So let me update you about my current thoughts
on my initial ssri. That and they drained the joy out of my own personal life. No deep laughter, no orgasm, pointless crying for no reason. At least now, when I cry, I have a reason.Polypharmacy for myself is completely out of the question.
My new (thank god good) shrink suggested an augment if
things don't speed up, and I said no. Flatly no. And you know what he said? He actually agreed. He was just trying to his job, but when I said I am done having my meds stacked like jets over JFK airport, he was very cool about it.
And kinda' sad and sober. To his credit, he's just doing the best he can with his science, and he very clearly sees the limits. No drug reps. No piles of samples. He went straight
to the mildest maoi because I said snri's make me worse. Clearly he reads and is aware that snri's are *theoretically* implicated in complicated mood issues.And just so you know that I hear you and respect your advice, I told my old pdoc to f*ck off with his %100 remission
rate. I even say forget %70 in my case. I'll settle for %50 as
long as I can find a way to live that is worthwhile. I am open to being surprised, though. %70 would be happily accepted
here.How many times do I need to remind you, yes to:
Yoga
Therapy
Exercise
Breathing
Dbt skills
Socialization
Fish oil
Whole foodsI have a child. Do you know that the greatest taboo in the United States is to be a mother with chronic depression? Yeah. I break taboos every f*ck*ng day of my life. What else is taboo in this country? Depression (unless it's called feeling blue). Anxiety is well, *just* anxiety. How many times per day can someone feel the fear and do it anyway? Guess that varies from person to person. Being afraid and being
vulnerable is taboo. Having PTSD. No matter what press PTSD gets, everyone is haunted by the 'why me' thing? And if some people know how frightened a person is, well it makes them angry or
worse. Some people will say *it's only PTSD. You don't need any medication. In fact, I'm gonna take away every medication you have because all addicts have PTSD, and if you have PTSD, then you are an addict at heart, too.*That's my recovery to date. So yes I hear you. Yes, I look at my treatment history. Please stop asking me to do that, okay? I can hear you just fine. In fact, I now take lemon balm with my GABA--because of you.
You have and continue to be an important voice for me on babble. Thank you for being Morgan.
fb
> FB, look at your medication history, where has it gotten you? Didn't you say one time that you wish you had just stuck with the SSRI that worked o.k. for you. I realize this may have been your doing and not the doctor, but I'm just trying to make the point that the medication merri-go-round and this out of control polypharmacy, in the absence of a more integrative approach, seems to be making recovery harder for many people. Maybe it works for some, like Scott, but I don't know of many people doing very well that take some crazy cocktail of meds. I hear more about side effects than benefits. I'm not saying polypharmacy never works, I just believe it is used all too often, and again, in the absence of a more integrative approach-proper exercise, therapy(group is best!), diet(paleo!), supplements(amino acids/fish oil/magnesium/vitamin D3), the right amount of support(actually, most have zero control over this, which is sad), yoga, meditation, and working hard to socialize and find some kind of easy job that is somewhat enjoyable(if the person has not been working for a while and can work). Oh, and time!!! We are often too much in a rush to stack up the drugs in an attempt to feel better. We also often think we need to solve everything with drugs, we start thinking that drugs are the only way to manage symptoms. I always hear about wanting to reach full remission using medication. What ever happened to getting 70 percent relief, then working hard at other things to get the other 30 percent? Or, just dealing with the other 30 percent, because in my opinion, 70 percent is pretty damn good.
>
> Morgan
Posted by emmanuel98 on July 27, 2011, at 18:46:36
In reply to Re: calling ZYPREXA » morgan miller, posted by B2chica on July 27, 2011, at 12:49:39
Not all p-docs are terrible. Mine has done therapy with me for 6-1/2 years. He insisted I try to find a DBT therapist and group, since these would be more effective for me than medical interventions. He has actually gone to meet with my DBT therapist and speaks with her on the phone nearly every week. A couple of times, he has had me on multiple meds, but immediately begins to try to cut them back -- cutting out one at a time, seeing what effect it has. Maybe it helps that he is older, trained in therapy, ran a clinic where he worked with SWs and PsyDs and has his BA in psychology.
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