![[dr. bob]](/dr-bob-sm.gif)
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 December 28, 2011, at 21:47:19
I started having my thumb(s) twitch yesterday. It's been off and on today. Two days after I see my pdoc and he asks if I have any twitches (no), I finish my starter pack, fill my script, and we pack off for our first month apart.
How immediate is this concern? Could it subside, and what *IF* no new symptoms emerge? Is it possible to skate for a month? Shoot, shoot, shoot.
Posted by sleepygirl2 on December 28, 2011, at 22:04:42
In reply to Thumb twitches on AAP, posted by floatingbridge on December 28, 2011, at 21:47:19
Which med fb?
Posted by floatingbridge on December 28, 2011, at 22:05:34
In reply to Re: Thumb twitches on AAP » floatingbridge, posted by sleepygirl2 on December 28, 2011, at 22:04:42
Saphris.
Posted by sleepygirl2 on December 28, 2011, at 22:12:25
In reply to Re: Thumb twitches on AAP » sleepygirl2, posted by floatingbridge on December 28, 2011, at 22:05:34
Ah, a pretty new one. I'm not so knowledgeable about meds, but I was curious.
I hope some folks here will have some experience with it.
What are you hoping to target with it?
Posted by floatingbridge on December 28, 2011, at 23:04:12
In reply to Re: Thumb twitches on AAP » floatingbridge, posted by sleepygirl2 on December 28, 2011, at 22:12:25
Bipolar depression.
I was reading. I guess I need to call him.
Posted by Phillipa on December 28, 2011, at 23:17:50
In reply to Re: Thumb twitches on AAP » sleepygirl2, posted by floatingbridge on December 28, 2011, at 23:04:12
FB call Bipolar? Aren't you on emsam? Love Phillipa
Posted by Christ_empowered on December 29, 2011, at 0:21:09
In reply to Re: Thumb twitches on AAP » floatingbridge, posted by Phillipa on December 28, 2011, at 23:17:50
That sucks, fb. Have you been able to tolerate any other AAP drugs? All I can think of would be to take 1/2-1 benadryl tablet at bedtime.
Posted by floatingbridge on December 29, 2011, at 5:27:54
In reply to Re: Thumb twitches on AAP, posted by Christ_empowered on December 29, 2011, at 0:21:09
CE, does it suck? Does it mean I need to call?
I have cogentin to take. I just don't know.
Is this an EPS? I don't know what qualifies.
Posted by SLS on December 29, 2011, at 5:43:29
In reply to Re: Thumb twitches on AAP » Christ_empowered, posted by floatingbridge on December 29, 2011, at 5:27:54
I wouldn't add an anticholinergic just yet. It might mask any EPS that you are trying to evaluate.
Keep Latuda, Geodon, and Fanapt in your back pocket. Fanapt might be a good choice. Geodon and Latuda can be unpredictable, but they are still worth trying.
- Scott
Posted by floatingbridge on December 29, 2011, at 5:53:30
In reply to Re: Thumb twitches on AAP » floatingbridge, posted by SLS on December 29, 2011, at 5:43:29
So I know I sound like a broken record, are these thumb twitches and now an eye twitch every few an EPS? I can't tell from reading the insert materials.
Are some of these to be lived with perhaps? I do not understand the perimeters or expectations.
Posted by SLS on December 29, 2011, at 6:32:44
In reply to Re: Thumb twitches on AAP, posted by floatingbridge on December 29, 2011, at 5:53:30
> So I know I sound like a broken record, are these thumb twitches and now an eye twitch every few an EPS? I can't tell from reading the insert materials.
>
> Are some of these to be lived with perhaps? I do not understand the perimeters or expectations.Those are excellent questions. I think the starting point is to acknowledge that muscle twitches can be a EPS and indicative of dystonia.
Do the twitches worsen with increased anxiety or stress?
Also:Are fingers a frequent site of EPS twitching or dystonia?
Do EPS twitches prognosticate the development of tardive dyskinesia (TD)?
Is twitching a startup effect that will dissipate?
I haven't researched this stuff well enough to provide answers to these questions.
- Scott
Posted by SLS on December 29, 2011, at 6:34:48
In reply to Re: Thumb twitches on AAP, posted by floatingbridge on December 29, 2011, at 5:53:30
By the way, what are you doing awake at such early hours of the morning?
Insomnia related to depression or hypomania?
How many hours of sleep do you get?
- Scott
Posted by floatingbridge on December 29, 2011, at 6:49:24
In reply to Re: Thumb twitches on AAP » floatingbridge, posted by SLS on December 29, 2011, at 6:34:48
> By the way, what are you doing awake at such early hours of the morning?
>
> Insomnia related to depression or hypomania?
>
> How many hours of sleep do you get?
>
>
> - ScottOh, sleep issues. Last I fell asleep before taking the saphris so awoke early which my typical pattern w/o saphris. I need sleep but cannot get it w/o help.
I need and usually get eight if I plan ahead.
Depression related?
Posted by SLS on December 29, 2011, at 6:58:31
In reply to Re: Thumb twitches on AAP » SLS, posted by floatingbridge on December 29, 2011, at 6:49:24
> > By the way, what are you doing awake at such early hours of the morning?
> >
> > Insomnia related to depression or hypomania?
> >
> > How many hours of sleep do you get?> Oh, sleep issues. Last I fell asleep before taking the saphris so awoke early which my typical pattern w/o saphris. I need sleep but cannot get it w/o help.
>
> I need and usually get eight if I plan ahead.
>
> Depression related?Not necessarily. What does your baseline sleep pattern look like?
- Scott
Posted by floatingbridge on December 29, 2011, at 7:03:02
In reply to Re: Thumb twitches on AAP » floatingbridge, posted by SLS on December 29, 2011, at 6:32:44
> > So I know I sound like a broken record, are these thumb twitches and now an eye twitch every few an EPS? I can't tell from reading the insert materials.
> >
> > Are some of these to be lived with perhaps? I do not understand the perimeters or expectations.
>
> Those are excellent questions. I think the starting point is to acknowledge that muscle twitches can be a EPS and indicative of dystonia
>
> Do the twitches worsen with increased anxiety or stress?
>
>
> Also:
>
> Are fingers a frequent site of EPS twitching or dystonia?
>
> Do EPS twitches prognosticate the development of tardive dyskinesia (TD)?
>
> Is twitching a startup effect that will dissipate?
>
>
> I haven't researched this stuff well enough to provide answers to these questions.
>
>
> - Scott
Well, I imagine at this point, I will be calling the
pdoc rather than wait a month. I like the way you've framed the questions, so I'll ask him on the phone and see what he says. There is just too much that I do not know here.Thanks Scott & everyone.
fb
Posted by floatingbridge on December 29, 2011, at 7:06:13
In reply to Re: Thumb twitches on AAP » floatingbridge, posted by SLS on December 29, 2011, at 6:58:31
Kinda like this. Fall asleep early. Awaken around 3:00 a.m. Unless I take various sleep aides.
Posted by SLS on December 29, 2011, at 7:48:57
In reply to Re: Thumb twitches on AAP » SLS, posted by floatingbridge on December 29, 2011, at 7:06:13
> Kinda like this. Fall asleep early. Awaken around 3:00 a.m. Unless I take various sleep aides.
If the insomnia were related to MDD, early morning awakenings and morning worsenings of depression are usually associated with melancholic endogenous depression. TCA is often effective for treating this subtype. The best schedule to keep is 11:00pm to 7:00am. Maintaining a healthy circadian rhythm can be important to achieving mood stability. You could wait for your 3:00am awakening to take a short-acting hypnotic. Sonata (zaleplon) might be a good choice. I read recently that having a 1 - 2 hour break in sleep midway through the night is normal for some people, and is not necessarily unhealthy.
How do you treat your insomnia currently?
I wonder if doxepin or trimipramine taken at night might help with depression and insomnia.
- Scott
Posted by floatingbridge on December 29, 2011, at 7:59:59
In reply to Re: Thumb twitches on AAP » floatingbridge, posted by SLS on December 29, 2011, at 7:48:57
With Saphris, I usually sleep from 10 or 11 until 6:30 or 7:30.
Before Saphris, I had gabapentin with the occasional help of tenazapam to keep those hours.
Those are the best hours, agreed.
Every so often there is the off night to be weathered....
Posted by Phillipa on December 29, 2011, at 18:39:47
In reply to Re: Thumb twitches on AAP » SLS, posted by floatingbridge on December 29, 2011, at 7:59:59
FB what did the doc say? Phillipa
Posted by floatingbridge on December 30, 2011, at 10:17:43
In reply to Re: Thumb twitches on AAP » floatingbridge, posted by Phillipa on December 29, 2011, at 18:39:47
I have a call out to him.
Thanks for asking, Philipa.
Posted by Phillipa on December 30, 2011, at 18:48:49
In reply to Re: Thumb twitches on AAP » Phillipa, posted by floatingbridge on December 30, 2011, at 10:17:43
FB any call back as of yet? Phillipa
Posted by sigismund on December 31, 2011, at 16:57:32
In reply to Re: Thumb twitches on AAP » floatingbridge, posted by SLS on December 29, 2011, at 7:48:57
>I wonder if doxepin or trimipramine taken at night might help with depression and insomnia.
I didn't really like doxepin. It didn't deepen sleep like mirtazpine or cyproheptadine. Both of those were awful on awakening though.
I am interested in trying trimiprimine.
A prescription for mirtazepine and Dexedrine for the day after would do me.
This is the end of the 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.