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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 floatingbridge on August 31, 2011, at 21:55:04
This question involves Emsam, Nardil, or nothing, possibly.
I cannot sleep for more than two-three hours at a clip.
Factors: 9mg Emsam?
Now I am told to take it off at night. And take 60mg (yes, holy cow, that equals 3-4mg Xanax) of tenazepam! (I see him next week after vacation.)
Will I have the same quality insomnia (intractable) on any Mao-i? This is the bind. The stimulation of Emsam is kicking in, and it adresses the vegetative symptoms I have (total
lethargy, slow thought, debilitating fatigue). Would Nardil provide relief from vegatative symptoms as well? Parnate I
imagine would be too stimulating regarding insomnia. And anxiety!But there is the famous Nardil insomnia as well.
I just want to sleep at night. I feel like I'm bargaining with god. Can I ask for 5 hours? Seven hours?
Even my doc is not sure that Emsam is right given everything.
I don't have much faith in the Tenazapam.
Will lamictal possibly contribute to sleep once it gets going?
Doc says next stop is AAP's for sleep :-/.
I am thinking the maoi's are a no-go. Which is kinda sad. And I finally made peace with risperidone.
Anyone do Emsam then find more relief w/ Nardil? Would I still have some energy?
What a ramble. I'm still reeling from the tenazepam increase and my cranky afternoon.
Sorry for the toxic dump.
Posted by jono_in_adelaide on August 31, 2011, at 22:01:05
In reply to Big fat impossible advice sought, posted by floatingbridge on August 31, 2011, at 21:55:04
Could you try adding a low dose of Seroquel to the temazepam to give it a boost?
Sorry, I dont know the answers to your questions.... one suggestion might be Nardil + nortriptyline (nardil is great for seretonin and GABA, less so for noradrenalin, nortriptyline fills that gap)
Posted by morgan miller on August 31, 2011, at 23:13:33
In reply to Big fat impossible advice sought, posted by floatingbridge on August 31, 2011, at 21:55:04
So you are taking Emsam along with Lamictal? How do you know Lamictal is not beginning to cause stimulation?
Sounds like a job for Depakote to me. Your going to get sleep disruption with the MAOIs.
Morgan
Posted by Christ_empowered on August 31, 2011, at 23:33:06
In reply to Re: Big fat impossible advice sought, posted by morgan miller on August 31, 2011, at 23:13:33
Do you think taking a very low dose atypical during the day might counter the agitation and make it easier to sleep (with the restoril) at night? I'd be scared to mix a sedating neurolpetic with a high dose of temazepam, especially when you have other benzos on board, but that's just me. Have you tried zyprexa? I've heard it can help sleep. The only downside is typical neuroleptic stuff--dulled out, EPS, potential akathisia--but if you keep the dose low enough it might be just the ticket. I think the EPS is less common than with Risperdal and also its rather sedating. Zyprexa is also commonly used for agitated and psychotic depressions.
So..yeah..zyprexa. You can take metformin with it for the weight gain, if your doc is up for that.
Posted by floatingbridge on September 1, 2011, at 2:48:08
In reply to Big fat impossible advice sought, posted by floatingbridge on August 31, 2011, at 21:55:04
Well, I'm not taking that much tenazepam. And Xanax is down to one mg. CE, there's a problem with benzo's and neuroleptics? Or with the riperidone? My impression is doc is still working this out....
When lamictal is up and running, maybe I could cut out the Emsam? (I don't know what lamictal will do.) Well, that's what i'm wondering.
Depakote had years ago.. I don't think it would be that good for me. Endocrine issues and women. Doc brings up zyprexa, but diabetes runs in my family.
Thanks for the suggestions. Lamictal is stimulating? I didn't know this. Thought it was non-flattening.
What a puzzle. Ugh. New territory for me.
Posted by Christ_empowered on September 1, 2011, at 10:17:41
In reply to Re: Big fat impossible advice sought, posted by floatingbridge on September 1, 2011, at 2:48:08
hey. I wasn't trying to say that your mega-dosing the Restoril or anything, I'm just saying that I'd personally be kind of scared to mix a sedating neuroleptic (especially seroquel) and a relatively high dose of a sleeping pill. If your doc OKs it, then that's cool.
Risperidone can be helpful. My only concern with Risperdal is that, of all the atypicals, its probably the roughest in terms of EPS. However, it causes less weight gain that Zyprexa and its not as mind-numbingly sedating as Seroquel, so I imagine that in low doses its a good option. If you're still over stimulated, I guess the trick would be getting the Risperdal up to a dose that you can tolerate but that is also effective as a tranquilizer.
It sounds like you have a good doctor.
As for you Lamictal being stimulating...I have no idea. I'm only on 50 and I don't feel terribly stimulated. I mean, my thoughts are clearer and I don't feel as slowed down, but its not like taking an Adderall or anything. But that's just me. I'm taking mine with a relatively high dose (30) of Abilify, so its entirely possible that I'm just not noticing much stimulation. With a stimulating MAOI on board, it might be causing synergistic stimulation, kind of like 1+1=3, if that makes sense (I don't know how else to explain it).
Good luck to you!
Posted by floatingbridge on September 1, 2011, at 10:34:04
In reply to Re: Big fat impossible advice sought, posted by Christ_empowered on September 1, 2011, at 10:17:41
>
> It sounds like you have a good doctor.Well, so far. I think he listens, rewinds quickly but not too hastily . Plus he's gay. After my last guy doc, that big bonus points. But that's neither here m
Nor there.Hey I only thought you were poning out a contraindication
between the benzos and the AAP. I'm the one not pleased with boat loads of>
> As for you Lamictal being stimulating...I have no idea. I'm
only on 50 and I don't feel terribly stimulated. I mean, my thoughts are clearer and I don't feel as slowed down, but its not like taking an Adderall or anything. But that's just me. I'm taking mine with a relatively high dose (30) of Abilify, so its entirely possible that I'm just not noticing much stimulation. With a stimulating MAOI on board, it might be causing
synergistic stimulation, kind of like 1+1=3, if that makes sense (I don't know how else to explain it).
>
good point.I'll go for 1+1=3,
What's EPS?
> Good luck to you!
Thanks! How you doing at 50 mg today?
Posted by Phillipa on September 1, 2011, at 10:55:03
In reply to Re: Big fat impossible advice sought » Christ_empowered, posted by floatingbridge on September 1, 2011, at 10:34:04
FB hope you slept last night. EPS is extraparamydal Symptoms spelling wrong. I do think it's the Emsam as known to be stimulating. I don't know what to suggest. Phillipa
Posted by Christ_empowered on September 1, 2011, at 10:57:57
In reply to Re: Big fat impossible advice sought » Christ_empowered, posted by floatingbridge on September 1, 2011, at 10:34:04
hey. EPS is short for Extra Pyramidal Symptoms. It just means that the D2 blockade from antipsychotics (old and new) can sometimes cause things like muscle twitches and, more rarely, full blown Parkinson's like symptoms. Usually it refers to tremor and dystonia.
Yeah, male psychiatrists have a tendency to piss me off, which is weird since I'm male. You'd think it'd be preferable to get help from someone of your own sex, but I really prefer female psychiatrists. The only gay psychiatrist I've encountered (that I know of...) was a resident at the last place I was hospitalized. He thought I was cute and kind of followed me around and stared at me a lot. I had mixed feelings about it, but he seemed like a nice guy.
Posted by floatingbridge on September 1, 2011, at 11:21:41
In reply to Re: Big fat impossible advice sought, posted by Christ_empowered on September 1, 2011, at 10:57:57
CE would not care for that too much on a hospital myself. My last pddoc was a man, about 20+ years to him, and I think I looked a bit good to him; you know, youth (relative) plus I could make him laugh and I suspect he began to count on it. I learned a lot about my habit of being a pleaser from interacting with him.
Now this young doctor may be gay (there is OUT magazine in the community waiting room and ARTVOICE), but it's his manner. He always calles me Miss_____. In a respectful tone. Plus he takes what I say seriously instead of saying things like that's ridiculous or that's just part of your pathology to say those things about yourself :-/
Posted by morgan miller on September 2, 2011, at 8:33:52
In reply to Re: Big fat impossible advice sought, posted by floatingbridge on September 1, 2011, at 2:48:08
Hey FB,
What happened with Depakote years ago? Certain supplementations would be in order with Depakote, like l-carnitine and l-methylfolate. Also, Depakote's side effects are likely dose dependent. So, if you could get relief from a 500 or 750 mg dose, do the supplementation, and not have any side effects, it might be worth considering. I'm just not sure it is in your best interest to eliminate certain treatments based on the possibility of things like endocrine issues. There's a potential drawback to every medication, as you know.
What about a moderate dose of seroquel for now? Say 200 mg? A low dose of Zyprexa might not be a bad idea as you try to figure things out and get stabilized.
I really believe a low to moderate dose of both Depakote and Lithium might be helpful here. I would try this before going the antipsychotic route.
Morgan
Posted by floatingbridge on September 2, 2011, at 10:30:18
In reply to Re: Big fat impossible advice sought, posted by morgan miller on September 2, 2011, at 8:33:52
Hi Morgan. There's a reaction specific to women and depakote. Think, if I recall correctly, it displaces estrogen. One side effect is abdominal fat deposits in women. Not that I avoid it out of vanity alone. Besides, didn't seem to help years ago. I think it was 75mg 3x per day? Didn't have sides except, well, dullness.
I am on small amount of risperdone right now and am finally appreciating it. Not that it keeps me asleep. But would up that first before jumping. Next would be zyprexathough doc wants to hold off because of weight gain and diabetes. Yay! Seroquel gave me the worst reaction once. Dyskenisia (? Sp.). That horrible inner agitation wild animal under the skin feeling.
Low lithium is still possible.
I just really wonder about the long term on Emsam and sleep. Then I wonder if I would have that same intense insomnia on any maoi. Maybe it will abate. That would be nice. Because Emsam is finally kicking in, and it is so easy to take. Though not the biggest anxiety helper.....
Not too psyched about the AAP route myself....
So why do you say lamictal is invasive? Always curiuos about your observations. Have you tried it? I am having trouble finding information out about it, besides the standard issue warnings.
Later, gator.
fb
Posted by morgan miller on September 2, 2011, at 11:09:23
In reply to Re: Big fat impossible advice sought, posted by floatingbridge on September 2, 2011, at 10:30:18
You must have been doing 750 3 times a day. Depakote along usually is not good enough-it needs to be used in conjunction with something else to really recieve benefits. I understand why you wouldn't want to try it.
I risperdal is working and continues to work, that is great.
Lamictal impairs cognition in many people. It caused real functional impairment for me in several ways, including cognition. I was very slowed and could not focus while on Lamictal. My brain felt like it was a car trying to make it's way down a cobblestone street. It sucked for me. I also experienced this weird lack of wanting to or being able to speak properly early in treatment. Drugs that do these things simply freak me out. Lamictal works for many, but it's potentially very invasive IMO.
Glad to here your finding relief with risperdal. My psychiatrist says it's a good one. She also does not believe there is much evidence for neurodegeneration with AP's. She's going to introduce me to an unbiased peer reviewed journal that she believes is a great resource for finding the truth about psychiatric drugs. I wish I had asked her what her thoughts on Lamictal were.
Morgan
Posted by floatingbridge on September 2, 2011, at 11:25:55
In reply to Re: Big fat impossible advice sought, posted by morgan miller on September 2, 2011, at 11:09:23
I've heard that about lamictal and cognition. What was your highest dose?
(Now I am spooked by drugs beginning with 'L'. Lyrica was scare-ee. But here goes my magical thinking again... :-/ )
I have read that AAP's are not really nuerodenerative as first posited. But they can sculpt the brain in ways I don't understand. My biggest concern, again, is the endocrine changes that accompany most of them. But I have a wonky
endocrine system. So I need to watch that aspect.Let me know what that journal is, will you? She sounds like a good doc.
Most docs and therapists are very rah-rah about lamictal. I am wary of trends, but that doesn't necessarily discount lamictal. My concern is that, since it's mode of efficacy is 'not fully understood' as they say, it will be more fully understood in a few more years.....
Oh well. I balance all this by saying that depression and ups and downs are very proven to damage the brain, so even the unknowns could be worth a risk. A calculated risk.
(I can't imagine I took that much depakote. 150 3x per day maybe?)
Posted by morgan miller on September 2, 2011, at 16:05:56
In reply to Re: Big fat impossible advice sought » morgan miller, posted by floatingbridge on September 2, 2011, at 11:25:55
Hey FB,
If it was 150 3X a day of Depakote, that was a pretty small dose, and would not be effective for sleep or mood stabilization. You would also need something to go along with it for depression, which would also help keep depakote from numbing too much. I totally understand your position, forgot about the endocrine issues you have.
You kinda gotta give Lamictal a shot right? I was at 125 at the highest. I experienced the weird speech stuff starting at 100. I think it's worth a shot for you, I'm just one person. You may do very well. You may also be able to lower the Emsam dose. I suspect MAOIs of any sort will be too stimulating for you.
I would be curious to see what the addition of 300 mg lithium would do after you hit the target dose for Lamictal. Who knows, maybe Lamictal is the monotherapy you've been looking for. Still, a low dose of lithium has so much potential to do good for the brain, it might still be worth considering-maybe even just 150 mg at bedtime.
Posted by floatingbridge on September 2, 2011, at 17:03:54
In reply to Re: Big fat impossible advice sought, posted by morgan miller on September 2, 2011, at 16:05:56
You might be right about maoi's. At least I am beginning to wonder that myself. I think about dropping back to the 6mg patch, but I know that I mess with meds too much, and have agreed to work with this doc. He says 9mg for another week. He's not sure about it either given my anxiety. Maybe lamictal would be enough AD. I have thought about that too. But that's weeks down the road. Thankfully, I like this doc so far and don't feel alone or without sane counsel.
I wonder if depakote works better for men, given my limited
knowledge. (That was a sweeping, transitory generalization.)Is lithium part of your plan right now?
My pdoc likes lithium, though finally settled on lamictal given
my depressive symptoms and mood lability. If I survive this start up.BTW, did I mention I am liking 5-Loxin?
Posted by morgan miller on September 2, 2011, at 18:31:43
In reply to Re: Big fat impossible advice sought » morgan miller, posted by floatingbridge on September 2, 2011, at 17:03:54
I think depokote works well for men and women, but may be more likely to cause issues with the endocrine system in women.
Well, in a few months, if you feel you could use more relief, the addition of a low dose of lithium may be a good idea.
That's great you are noticing something positive from 5 Loxin! Is it inflammation and pain relief you are experiencing?
Posted by floatingbridge on September 2, 2011, at 18:45:41
In reply to Re: Big fat impossible advice sought, posted by morgan miller on September 2, 2011, at 18:31:43
Re: 5-Loxin, pain relief is what I notice. With that, either increased range of motion or just the desire/ability by being pain-free. I imagine though, it has anti-inflammatory action, but I wouldn't know.
I did not expect such fast improvement. Not cured, but maybe 40% less pain. Considering I take nothing else but Emsam (AD). Not even motrin.
I thank sigi for mentioning it on the alt board. It's not that expensive at the dose I take. I forget, but have easily dropped more at my local market for less effective concoctions.
Posted by sigismund on September 3, 2011, at 2:10:33
In reply to Re: Big fat impossible advice sought » morgan miller, posted by floatingbridge on September 2, 2011, at 18:45:41
> Not cured, but maybe 40% less pain.
Well that is a testimonial for boswellia and only on one capsule a day.
I know it works for arthritis, and I wonder if it has beneficial effects on inflammation generally.
Posted by morgan miller on September 3, 2011, at 9:11:42
In reply to Re: Big fat impossible advice sought » floatingbridge, posted by sigismund on September 3, 2011, at 2:10:33
It's called 5 Loxin because it inhibits the 5 Lox inflammatory pathway, so yes, it is a potent anti-inflammatory.
Great to hear you're getting 40% relief FB. I wonder what would happen with 2 a day.
Posted by floatingbridge on September 3, 2011, at 15:44:19
In reply to Re: Big fat impossible advice sought, posted by morgan miller on September 3, 2011, at 9:11:42
Morgan and sigi, I wasn't clear. I am taking 2x 75mg caps per day. With or without food. Doesn't get much easier.
:-)
Posted by sigismund on September 3, 2011, at 21:33:54
In reply to Re: Big fat impossible advice sought » morgan miller, posted by floatingbridge on September 3, 2011, at 15:44:19
It's good, isn't it?
If I was allowed just one thing for OA, this would be it.
Frankincense. That must be why they gave it to Jesus in the story of the three wise men.
This is the end of the thread.
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