![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 53. Go back in thread:
Posted by sukarno on November 27, 2012, at 16:40:23
In reply to Re: Smoking cessation ('cold turkey') » sukarno, posted by ChicagoKat on November 27, 2012, at 16:15:51
The irony of it is my stomach was feeling better for a few days but started acting up again after having green tea.
I have suffered depression since I was a teenager but my first experience with severe, full blown melancholic depression and intractable panic attacks was in 1992 when I quit cold turkey. I voluntarily checked myself into the drug rehabilitation section of the hospital because they didn't have a psychiatric wing at the time. I only stayed there for two days because it cost too much.
I was given Klonopin (clonazepam) and Vistaril (hydroxyzine) and it was okay but made me feel fuzzy headed.
The depression resolved itself without need for antidepressants a few months later.
I did have a few cigarettes but didn't enjoy them and didn't get the "buzz" from them. I guess that means I'm not hooked on them anymore and they won't be useful for depression. I would like to take antidepressants but I can't take SSRIs because of a previous GI bleed when on Prozac.
My pdoc said there is a new antidepressant named Valdoxan (agomelatine) but I'm not sure how good it is. Have you heard of it? I'm very reluctant to try something that hasn't been on the market for very long. We don't know what the long term effects will be and sometimes drug companies suppress bad results from their clinical trials.
The same thing happened in September 2011 when I tried cold turkey. A day or two after the cravings vanished I just felt like an empty shell of a man and no desire to live but not suicidal.
I can't see that it is worth it to be a non-smoker and remain this depressed and empty. It's too heavy of a feeling. But cigarettes look nasty to me now. I don't know...maybe if I only have a few a day until I see my pdoc to find out what he can do medication-wise.
Thanks for your message. I appreciate it a lot.
Posted by ChicagoKat on November 27, 2012, at 18:50:49
In reply to Re: Smoking cessation ('cold turkey') » ChicagoKat, posted by sukarno on November 27, 2012, at 16:40:23
Green tea brought the pain back? That I've never heard of before...wow you really do have a sensitive stomach, and I know it's the worst feeling. For a while Ritalin was making my stomach hurt so bad that I would force myself to throw up to feel better. Then I discovered the *weirdest* solution, Ambien actually took all the pain and nausea away. Now is that not strange?
I feel bad for you, you are so depressed, and now you don't have the 'benefit' of cigarettes so you feel even more depressed. I am sorry, I am so exhausted from not sleeping last night I am too lazy to read all the previous posts to find out, but have you tried a dopaminergic drug like Wellbutrin or Ritalin? I'm sure you have, but if by chance you have not they would def be worth a try. And you're on a PPI aren't you? Again, I'm sure you are. And I saw you mentioned H pylori, that is def worth checking out. Again, sorry, can't think of anything else right now, my brain is running on empty. But I'll think about it and let you know if I think of anything. Hang in there.
Kat
Posted by papillon2 on November 27, 2012, at 19:43:27
In reply to Smoking cessation ('cold turkey'), posted by sukarno on November 22, 2012, at 18:53:27
Hi!
Well done for taking steps to stop smoking.
Have you thought about asking a doctor about the suitability of taking Wellbutrin/Zyban? It is approved for short-term use as a smoking cessation aid and might help get you over this initial stage.
Good luck!
Posted by rjlockhart37 on November 27, 2012, at 20:53:24
In reply to Feel empty inside and depressed, posted by sukarno on November 26, 2012, at 16:17:18
albuterol....the stuff they give people for asthma...i don't have it but my doctor gave it to me during bronicitus and smoking during it too....it will clear up the breathing passages, still until the future the pores in the lungs that have smoke in them is a toughy...i wish could pull my lungs out and wash them, like a cloth that's been used in a tar body shop for cars.
i may look this up and see what they have treatments to clear the pores in the lungs...
hang in there...
r
Posted by sukarno on December 16, 2013, at 19:08:27
In reply to Re: Feel empty inside and depressed » sukarno, posted by rjlockhart37 on November 27, 2012, at 20:53:24
I didn't want to dig up an old thread but thought I'd say I quit smoking on the 19th of April this year. I was forced to as my stomach became so bad I lost my appetite and was too nauseated to eat.
I went to the hospital to see the gastroenterologist and he said to avoid the risk factors/triggers for gastritis such as smoking, coffee, spicy food, etc and I followed all of his advice.
It took 4 or 5 months for my stomach to feel like new again but my lungs definitely feel like new. :-)
I still get nicotine cravings every other day but I tell myself that smoking is not an option as it would hurt my stomach again and all the other diseases that go with tobacco.
I feel more relaxed without cigarettes. My mood was cranky for a few months after quitting but now it is pretty much back to normal.
Now I can smell cigarettes a mile away.
Anyway, about my stomach.. the doctor at the other hospital didn't like Xanax and gave me diazepam instead. He gave me enough to cover for any withdrawal.Diazepam was very sedating and I noticed my stomach felt like "new" again. No gastritis symptoms.. it felt very calm.
Maybe it's more of a "functional gastritis"..related to the mind.
I couldn't stay on diazepam for long as it made me depressed and exhausted so I went back to my pdoc and he put me back on Xanax. He didn't like diazepam and said it was making me worse.
Anyway, I hope anyone out there considering quitting smoking will give it a shot.
I don't think there's a product legally on the market that causes as many diseases as tobacco.
Posted by SLS on December 16, 2013, at 20:32:51
In reply to update, posted by sukarno on December 16, 2013, at 19:08:27
Thanks for posting.
How are you feeling overall?
- Scott
Posted by ed_uk2010 on December 18, 2013, at 13:48:54
In reply to Re: Smoking cessation ('cold turkey') » ChicagoKat, posted by sukarno on November 27, 2012, at 16:40:23
Good to hear you're doing better. Is your stomach still settled now you're back on Xanax?
I'm sure you said before, but why are you on a very high dose of famotidine rather than a proton pump inhibitor?
Posted by sukarno on December 18, 2013, at 14:13:43
In reply to Re: Smoking cessation ('cold turkey') » sukarno, posted by ed_uk2010 on December 18, 2013, at 13:48:54
Hi Scott, Ed.. :-)
I'm feeling a lot better. I never did have gastritis until about 2006. Prior to that it was only GERD but my stomach felt perfectly fine and could handle black coffee, hot peppers, black pepper..anything.
Most people in this country are H. pylori positive and I've read that H. pylori can be contagious. I tested negative for H. pylori in 1996.
The reason why I can't take proton pump inhibitors is because they give me a delayed hypersensitivity reaction which is quite serious. I'll get a high fever along with tachycardia (140-160bpm for 12 hours) and bad bone pain. I tried a few rechallenges and the reaction was more swift and worse.
I am concerned about famotidine at high doses. I recently had an ECG (EKG) and my QTc was 449ms (max is 450ms for a male). I had read that famotidine can prolong QT although some abstracts contradict this. AZCert's website has famotidine on the list of drugs which can prolong the QT interval.
I'm not sure what else I can take. I'm pretty much hooked on famotidine. If I even lower the dose a little I get acid rebound and feel nauseated.
Posted by sukarno on December 18, 2013, at 14:18:17
In reply to Re: Smoking cessation ('cold turkey') » sukarno, posted by ed_uk2010 on December 18, 2013, at 13:48:54
My stomach sure did feel a lot better on diazepam.
I might give diazepam another try.
The odd thing is and maybe you can give me some insight into this:
If my GERD is bad, my stomach feels perfectly fine. When my GERD is under control, my stomach starts to feel like it is burning.
I wonder if I have bile reflux and not acid reflux? It really doesn't make sense but I've noticed it every time.
If I had a lot of heartburn my stomach felt fine. No heartburn, stomach feels messed up.
*confused*
Posted by SLS on December 18, 2013, at 14:45:09
In reply to Re: Smoking cessation ('cold turkey') » sukarno, posted by ed_uk2010 on December 18, 2013, at 13:48:54
Would a beta-blocker be of any use here?
- Scott
Posted by alexandra_k on December 18, 2013, at 15:04:11
In reply to Re: Smoking cessation ('cold turkey') » ed_uk2010, posted by SLS on December 18, 2013, at 14:45:09
damn. i was just about to ask about a beta blocker...
i need to remember to ask my current clinicians about them for me. as an alternative to benzos.
congrats on quitting. i quit... must be nearly 2 years ago now. it is amazing how the sense of smell comes back
Posted by ed_uk2010 on December 20, 2013, at 15:02:09
In reply to Re: Smoking cessation ('cold turkey'), posted by sukarno on December 18, 2013, at 14:13:43
Hello.
>The reason why I can't take proton pump inhibitors is because they give me a delayed hypersensitivity reaction which is quite serious. I'll get a high fever along with tachycardia (140-160bpm for 12 hours) and bad bone pain. I tried a few rechallenges and the reaction was more swift and worse.
Were the rechallenges with the same drug or a different PPI? Which drugs specifically caused this reaction? It sounds very unpleasant.
>I am concerned about famotidine at high doses. I recently had an ECG (EKG) and my QTc was 449ms (max is 450ms for a male).
What constitutes a normal QTc interval is a matter of some debate. 449ms is perhaps borderline abnormal, like you say, but not definitely so. It would be good to know what your QTc interval was without famotidine, for the purpose of comparison. Would you be able to stop famotidine for a few days using antacids/alginates etc?
Posted by ed_uk2010 on December 20, 2013, at 15:12:30
In reply to Re: Smoking cessation ('cold turkey'), posted by sukarno on December 18, 2013, at 14:18:17
>I might give diazepam another try.
Bear in mind, the dose of diazepam needed to block alprazolam withdrawal symptoms may be high, and substantially more than you would otherwise need. It is therefore unsurprising that you felt tired.
What happens when you take say 5mg of diazepam while continuing alprazolam? Anything? If it helps, you could reduce alprazolam somewhat and continue with a small dose of diazepam, initially in divided doses then in 1-2 daily doses after a few weeks. Combining benzos is this way is unconventional... but might it help? I don't know, but you can easily find out.
>I wonder if I have bile reflux and not acid reflux? It really doesn't make sense but I've noticed it every time.
Interesting. Have you ever tried a prokinetic such as metoclopramide? (Metoclopramide is generally only suitable for short-term use). Domperidone should be avoided due to your borderline QTc.
Posted by ed_uk2010 on December 20, 2013, at 15:18:14
In reply to Re: Smoking cessation ('cold turkey') » ed_uk2010, posted by SLS on December 18, 2013, at 14:45:09
>Would a beta-blocker be of any use here?
To be honest, I suspect not. Beta blockers do not reduce reflux, nor is there evidence that they reduce the gastro-intestinal symptoms of anxiety. The somatic symptoms best relived by propranolol are cardiac symptoms (racing heart, palpitations etc) and tremor (but not muscle tension). Cardioselective beta blockers such as metoprolol and atenolol may relieve cardiac symptoms but not tremor.
Posted by sukarno on December 30, 2013, at 13:09:52
In reply to Re: Smoking cessation ('cold turkey') » sukarno, posted by ed_uk2010 on December 20, 2013, at 15:02:09
Hi Ed! :-)
I tried lansoprazole first (30mg) and 10 days later had the fever, tachycardia and bone pain for about 12 hours. I tried a rechallenge with it later and the reaction occurred 3 days later. Next time it happened nearly the same day if I remember correctly.
I tried omeprazole 3 years later in small amounts by emptying out a capsule and taking small pieces every hour or so. I started getting sharp pains that would be felt randomly in different parts of the body (in the bones.. ribs, arms, legs.. everywhere there was a bone).
Interestingly, I had the same reaction with diet soda that contained cyclamate and saccharin. Fever, bone pain and tachycardia for about 12 hours.
I found that these drugs are all sulphonamides or sulfur compounds when metabolised.
Maybe I have some sort of hypersensitivity to sulphonamides or substituted benzimidazoles (PPIs), although PPIs also break down into sulfur-like compounds when they reach the stomach.
Posted by sukarno on December 30, 2013, at 13:17:55
In reply to PPIs, posted by sukarno on December 30, 2013, at 13:09:52
I quit Xanax 5 days ago (1mg 4 times daily) and substituted it with diazepam 15mg 4x/day for the first two days, then 10mg 4x/day for a day, 10mg 3x/day for a day and only 10mg twice a day today.
I can feel the effects of diazepam increasing despite the dose reduction, which is probably because of the long half-life of diazepam.
I had no withdrawal symptoms during the transition except for a few "adrenaline rushes" which led to mild panic attacks on two occasions.
My stomach feels so much better that I forgot to take my famotidine. Usually my stomach is so sour and like there's a lit match inside it that I have to take famotidine around the clock. Failure to do that can result in nausea and a lot of gastritis.
Anyway, wow.. my stomach feels so "calm" and settled despite only two famotidine tablets taken today.
I did read an old medical abstract that claimed diazepam reduces gastric acid production, but I find that difficult to believe.
I suppose diazepam reduces stress or relaxes muscles near the stomach so there's less acid being produced.
Maybe it's functional dyspepsia which means it is psychological or psychogenic.
I guess I should have an endoscopy one of these days.
Posted by ed_uk2010 on December 30, 2013, at 13:23:29
In reply to Valium settles the stomach, posted by sukarno on December 30, 2013, at 13:17:55
Hi!
That's great news. I don't think you'll necessarily find diazepam so sedating this time. Sedation might simply mean that the dose is too high. The pharmacokinetics of diazepam are complex and may necessitate successive dosage adjustments over the next few weeks.
Let us know how you do.
Posted by sukarno on December 30, 2013, at 13:42:38
In reply to Re: Valium settles the stomach » sukarno, posted by ed_uk2010 on December 30, 2013, at 13:23:29
I don't really know why, but diazepam consistently (no matter how long I take it) produces a good subjective sense of sedation in me along with a lot of muscle relaxation whereas alprazolam did neither appreciably.
Being on alprazolam was like being emotionally numb and apathetic with very little sense of sedation.
Right now I feel "buzzed" pretty deeply on diazepam. One dose lasts at least 12 hours and the whole time I feel doped.
I'm sure that will go away in a few days but I remember years ago when I was on 5mg 4x/day as maintenance for panic attacks, I always felt a "buzz" in the morning when I'd take that first 5mg tablet before breakfast.
Diazepam always felt stronger than alprazolam but alprazolam prevented almost all panic attacks.
On a few occasions, despite subjective sedation, I experienced panic attacks on a long term maintenance dose of diazepam but never (or very rarely) on alprazolam.
Either way I'm not a big fan of alprazolam because of the withdrawal symptoms should I lose my pills. Scary.. what a nightmare (or medical emergency) that would be.
I think diazepam is much easier to taper off but I've been on BZDs for 23 years now so I suppose I should allow 2 years of tapering at the very minimum to avoid withdrawal symptoms.
I definitely don't like being on BZDs. Life just seems to float by.. time passes by very fast on these drugs. Don't get me wrong though, they are very useful and the downsides may be a lot better than having a full blown panic attack.
Panic attacks are the scariest thing I have ever experienced in my life.
Posted by SLS on December 30, 2013, at 16:12:48
In reply to Re: Valium settles the stomach, posted by sukarno on December 30, 2013, at 13:42:38
Thyroid stuff?
Have you ever tried amitriptyline?
Shots in the dark.
- Scott
Posted by Phillipa on December 30, 2013, at 21:03:21
In reply to Re: Valium settles the stomach, posted by sukarno on December 30, 2013, at 13:42:38
I so agree with you on the panic attacks. You also have been on benzos a long time as have I. I don't think will ever be off them. Phillipa
Posted by sukarno on December 30, 2013, at 23:45:38
In reply to Re: Valium settles the stomach » sukarno, posted by SLS on December 30, 2013, at 16:12:48
My aunt has hyperthyroidism and grandfather has hypothyroidism. I should have a blood test to get it checked again.. haven't checked it in almost 10 years. I remember my TSH or one of those values was near the borderline (if it was below that it would have been hyperthyroidism).
I don't think I can take TCAs anymore. I had tried imipramine but my heart began to beat too fast and irregularly one night about a month into treatment. My pdoc then switched me to nortriptyline which had less side effects (apart from elevated blood pressure).
I remember the pdoc took my BP after being on nortriptyline for a while and said my BP was up so I should get exercise. I ended up exercising regularly and felt great with a resting pulse of 58. Before I took up exercise I used to have tachycardia of 90 or so on the nortriptyline.
I'm not sure if it was the nortriptyline which helped me so much or the regular, brisk 5 mile walks 3 to 4 times a week (or a combination of the two).That was the best I had ever felt in my life.
Posted by sukarno on December 30, 2013, at 23:48:56
In reply to Re: Valium settles the stomach » sukarno, posted by Phillipa on December 30, 2013, at 21:03:21
> I so agree with you on the panic attacks. You also have been on benzos a long time as have I. I don't think will ever be off them. Phillipa
Hi Phillipa. :-)
Yeah, I somehow think I'll never be off them. It's just been too long. The best I can do is to be on the minimum dose that will keep the anxiety at bay.
Posted by sukarno on December 31, 2013, at 0:46:07
In reply to Re: Valium settles the stomach, posted by sukarno on December 30, 2013, at 23:48:56
I'm not sure if it is good to quit it cold turkey but I woke up this morning (12 to 24 hours after last taking famotidine) and my stomach felt fine.. no acidic feeling.
Is it okay to stop just like that?
Thanks in advance.
I've been on famotidine for almost 9 years.
Posted by SLS on December 31, 2013, at 2:12:37
In reply to Re: Valium settles the stomach, posted by sukarno on December 30, 2013, at 23:45:38
> I used to have tachycardia of 90 or so on the nortriptyline.
Did anyone think to tell you that this is a normal reaction to nortriptyline, and that 90 bpm is by no means tachycardia? Your doctor should have known this. I believe the current standard for diagnosing tachycardia is having a resting heart rate of 130 bpm.
Perhaps you should revisit nortriptyline.
- Scott
Posted by sukarno on December 31, 2013, at 2:17:36
In reply to Re: Valium settles the stomach » sukarno, posted by SLS on December 31, 2013, at 2:12:37
Oh, if that's normal then I'm all for it. Sometimes it caused some "skipped beats" along with a palpitation after that but nothing serious.
I was on a low dose of 10 to 25mg/night.
I got 4.0 grades in high school on nortriptyline.
I remember feeling interested and highly motivated in all subjects.
Imagine the total opposite of the benzodiazepine experience along with no panic attacks.
My pdoc said they don't have nortriptyline here.
Maybe I can import it and take it under his approval/supervision in a very low dose and have an EKG done before it and during treatment along with BP tests.
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.