![[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 bp peanut on January 27, 2016, at 21:18:32
First of all, I know I am on many, many meds, so no reason to let me know that. It seems like each drug helps some but not enough, so we've added more (see the list below).. I have no drug interaction issues with the Parnate.
My sleep meds have pooped out, so it takes a crazy amount of meds to make me sleep. They are interfering with my cognitive function and memory, and I hate that (see the list I'm trying below). I am more than happy to go off of benzos and sleep meds it I can find something else that works
I have started struggling with depression more over the last couple months, and the behavioral strategies are only doing so much. I wanted to add Latuda. I'm on Geodon and it controls my mixed and manic states and helps so with the depression so I am not willing to go off of it (or most of my other meds, for that matter). Can you take both Geodon (240mg) and Latuda? Will Latuda help with anxiety, so maybe I can get rid of the clonazepam?
Please help. Neither my psychiatrist nor I know where to go next for the depression, anxiety, and insomnia.
Will Latuda help me sleep? I have no idea where to go with the sleep problem. I'm not excited about benzos because my memory is getting horrible. What would you recommend for sleep?
Meds for mixed/manic states
-Geodon 240mgMeds for bipolar depression
- elavil 200mg
-parnate 90mg
-adderall (30mg xr then 20mg immediate later- does not cause anxiety and have been sleeping fine with this for almost a year until last few weeks)meds for anxiety/sleep until last few weeks:
Ambien CR 12.5
Perphenazine 4mg- does not help with any other symptomWhat I have added just to get to sleep
These I space out an hour at a time and keep going until I finally fall asleep- I also have done behavior modification
-zyprexa zydis (10mg) worked wonderful now almost useless
-Klonipin 1mg
-Lorazepam 2mg
-if still awake, more of the aboveSorry so long, but if you have ideas on any of this, please help!!!
Posted by Lamdage22 on January 28, 2016, at 9:35:20
In reply to med poop out- where to go next (Latuda?), posted by bp peanut on January 27, 2016, at 21:18:32
less uppers in the morning = less downers at night.
I dont think Latuda will help.
I dont know if there is something that would knock you out despite all the uppers.
Posted by Lamdage22 on January 28, 2016, at 9:49:27
In reply to med poop out- where to go next (Latuda?), posted by bp peanut on January 27, 2016, at 21:18:32
maybe horse tranquilizers.
No offense.
Posted by Lamdage22 on January 28, 2016, at 9:54:17
In reply to Re: med poop out- where to go next (Latuda?), posted by Lamdage22 on January 28, 2016, at 9:49:27
latuda is pretty weak
Posted by Christ_empowered on January 28, 2016, at 10:17:01
In reply to Re: med poop out- where to go next (Latuda?), posted by Lamdage22 on January 28, 2016, at 9:35:20
Ummm...I dunno. Lamdage has a point, of course. 50mgs of pharmaceutical grade amphetamines could potentially de-stabilize anybody, especially w/ mood elevators in the mix.
Reduce the adderall? Switch to Ritalin? Try going without Rx stimulants? Parnate can cause insomnia, too.
Latuda is very $$$ and I think its big draw is that it helps Bipolar depression and doesn't cause much weight gain. I seem to recall reading that the EPS profile isn't so great, so that's kind of worrisome.
I'm hardly one to encourage uppers+downers use...its not the 50s, you know. But...if Ambien isn't working, could you try Restoril for a short while? 30mgs Restoril could knock me down even when I'd been on other BZD drugs and Ambien had stopped working. I seem to recall reading that some docs will Rx phenobarbital for night time use. I don't know what that's about, but it does seem like another way to combat insomnia.
What else...well, to me, it seems that all that Geodon should be more than enough neuroleptic. I mean, you only have so many D2 receptors. Maybe neurontin, lyrica...I seem to recall reading that some docs even use phenergan as a sedative. Oh, yeah...hydroxyzine (Vistaril, atarax). I don't much care for it, but some people swear by it...lower doses during the day for tension, higher doses at night as a sedative.
Good luck.
Posted by Lamdage22 on January 28, 2016, at 11:08:26
In reply to Re: med poop out- where to go next (Latuda?), posted by Christ_empowered on January 28, 2016, at 10:17:01
He said that Adderall wouldnt cause the insomnia. I think its the combination though.
I wouldnt sleep either.
Posted by Lou Pilder on January 28, 2016, at 20:55:23
In reply to med poop out- where to go next (Latuda?), posted by bp peanut on January 27, 2016, at 21:18:32
> First of all, I know I am on many, many meds, so no reason to let me know that. It seems like each drug helps some but not enough, so we've added more (see the list below).. I have no drug interaction issues with the Parnate.
>
> My sleep meds have pooped out, so it takes a crazy amount of meds to make me sleep. They are interfering with my cognitive function and memory, and I hate that (see the list I'm trying below). I am more than happy to go off of benzos and sleep meds it I can find something else that works
>
> I have started struggling with depression more over the last couple months, and the behavioral strategies are only doing so much. I wanted to add Latuda. I'm on Geodon and it controls my mixed and manic states and helps so with the depression so I am not willing to go off of it (or most of my other meds, for that matter). Can you take both Geodon (240mg) and Latuda? Will Latuda help with anxiety, so maybe I can get rid of the clonazepam?
>
> Please help. Neither my psychiatrist nor I know where to go next for the depression, anxiety, and insomnia.
>
> Will Latuda help me sleep? I have no idea where to go with the sleep problem. I'm not excited about benzos because my memory is getting horrible. What would you recommend for sleep?
>
> Meds for mixed/manic states
> -Geodon 240mg
>
> Meds for bipolar depression
> - elavil 200mg
> -parnate 90mg
> -adderall (30mg xr then 20mg immediate later- does not cause anxiety and have been sleeping fine with this for almost a year until last few weeks)
>
> meds for anxiety/sleep until last few weeks:
> Ambien CR 12.5
> Perphenazine 4mg- does not help with any other symptom
>
> What I have added just to get to sleep
> These I space out an hour at a time and keep going until I finally fall asleep- I also have done behavior modification
> -zyprexa zydis (10mg) worked wonderful now almost useless
> -Klonipin 1mg
> -Lorazepam 2mg
> -if still awake, more of the above
>
> Sorry so long, but if you have ideas on any of this, please help!!!
>peanut,
You wrote,[..I am on many, many meds...struggling with depression...Neither my psychiatrist nor I know...please help...].
I can help you but there's no time left for life is very short and there's no time to find a magic combination of drugs in your case. This is all because the combination of those drugs can cause death, and death quickly. You see, when these drugs are combined the effects are increased exponentially. In your case, I have a meter, and I broke a needle and it can't work.
Your doctor doesn't know, but I do. Before my meter broke, it told me a lot. And worse, there is the perfect storm for an all out homicidal episode cause by the drugs or suicide. Thus is compounded because of the sleep issue and the BZDs.
I could have you saved but there are prohibitions to me by Mr. Hsiung that prevent me from leading you out of depression and into a marvelous light. You could have your psychiatrist enter this forum and have dialog with me and I could bring it out through him/her. But after I have dialog with the psychiatrist, he/she could decide to quit what he/she is doing so let him/her know that .
Lou
Posted by rjlockhart37 on January 28, 2016, at 23:09:19
In reply to Lou's response-doctor doesn't know » bp peanut, posted by Lou Pilder on January 28, 2016, at 20:55:23
thank you for stating the intention of your medical emergency
Posted by SLS on January 29, 2016, at 5:46:14
In reply to Re: Lou's response-doctor doesn't know » Lou Pilder, posted by rjlockhart37 on January 28, 2016, at 23:09:19
Posted by Lou Pilder on January 29, 2016, at 7:04:54
In reply to Lou's response-doctor doesn't know » bp peanut, posted by Lou Pilder on January 28, 2016, at 20:55:23
> > First of all, I know I am on many, many meds, so no reason to let me know that. It seems like each drug helps some but not enough, so we've added more (see the list below).. I have no drug interaction issues with the Parnate.
> >
> > My sleep meds have pooped out, so it takes a crazy amount of meds to make me sleep. They are interfering with my cognitive function and memory, and I hate that (see the list I'm trying below). I am more than happy to go off of benzos and sleep meds it I can find something else that works
> >
> > I have started struggling with depression more over the last couple months, and the behavioral strategies are only doing so much. I wanted to add Latuda. I'm on Geodon and it controls my mixed and manic states and helps so with the depression so I am not willing to go off of it (or most of my other meds, for that matter). Can you take both Geodon (240mg) and Latuda? Will Latuda help with anxiety, so maybe I can get rid of the clonazepam?
> >
> > Please help. Neither my psychiatrist nor I know where to go next for the depression, anxiety, and insomnia.
> >
> > Will Latuda help me sleep? I have no idea where to go with the sleep problem. I'm not excited about benzos because my memory is getting horrible. What would you recommend for sleep?
> >
> > Meds for mixed/manic states
> > -Geodon 240mg
> >
> > Meds for bipolar depression
> > - elavil 200mg
> > -parnate 90mg
> > -adderall (30mg xr then 20mg immediate later- does not cause anxiety and have been sleeping fine with this for almost a year until last few weeks)
> >
> > meds for anxiety/sleep until last few weeks:
> > Ambien CR 12.5
> > Perphenazine 4mg- does not help with any other symptom
> >
> > What I have added just to get to sleep
> > These I space out an hour at a time and keep going until I finally fall asleep- I also have done behavior modification
> > -zyprexa zydis (10mg) worked wonderful now almost useless
> > -Klonipin 1mg
> > -Lorazepam 2mg
> > -if still awake, more of the above
> >
> > Sorry so long, but if you have ideas on any of this, please help!!!
> >
>
> peanut,
> You wrote,[..I am on many, many meds...struggling with depression...Neither my psychiatrist nor I know...please help...].
> I can help you but there's no time left for life is very short and there's no time to find a magic combination of drugs in your case. This is all because the combination of those drugs can cause death, and death quickly. You see, when these drugs are combined the effects are increased exponentially. In your case, I have a meter, and I broke a needle and it can't work.
> Your doctor doesn't know, but I do. Before my meter broke, it told me a lot. And worse, there is the perfect storm for an all out homicidal episode cause by the drugs or suicide. Thus is compounded because of the sleep issue and the BZDs.
> I could have you saved but there are prohibitions to me by Mr. Hsiung that prevent me from leading you out of depression and into a marvelous light. You could have your psychiatrist enter this forum and have dialog with me and I could bring it out through him/her. But after I have dialog with the psychiatrist, he/she could decide to quit what he/she is doing so let him/her know that .
> Lou
>
peanut,
I fixed my meter and again used it in your case and it broke a needle and could not show. When this happens, the meter shows extreme danger of death by the drugs.
The causes are shown before the needle broke as being killed by the drugs through heart failure, extreme seizures, serotonin syndrome and stroke. Non of these can be prevented by adding other drugs for they could also increase exponentially your chances of being killed by these drugs.
So if anyone here tells you to take more drugs, I would consider them to be reckless and not being in your best interest to be staying alive. This is compounded by that the doctor that chairs this site states that being supportive takes precedence and here he has not interceded to help you stay alive so that readers could think that taking all of these drugs is being supportive when they could kill you.
The drugs in question have chemical constituents used in the commission of mass-murder and used in killing insects and rats and parasites. What is happening to you is that the chemicals have attacked your brain functions so that thinking rationally will be very difficult so that you could be killed by confusion and lost reasoning power so that you do not know what to do and end up killing yourself by ignorance. This could happen with alcohol as that their thinking becomes impaired and do not know right from wrong. It is worse in your case due to the sheer volume of different chemicals that you take. And when I used my meter before the needle broke, it flashed a sever warning. And when it does that, it make s a noise like Quack Quack Quack.
If you ever needed help, you need it now. The tragedy here is that I am prevented from posting what I think could save your life due to the prohibitions posted to me here by Mr. Hsiung. Your blood will not be upon me from being killed by the drugs and suffer a horrible death by them.
Lou
Posted by SLS on January 29, 2016, at 11:26:12
In reply to med poop out- where to go next (Latuda?), posted by bp peanut on January 27, 2016, at 21:18:32
I don't know if you need all of the drugs that you are taking, but let us assume that you do. Despite your difficulties with sleep, are you in full remission with respect to your mental illness? Are there any residual symptoms at all?
The first thing I thought of for sleep was to switch from perphenazine to low-dose Seroquel (50-100 mg h.s.).
If all else fails, I would consider combining Halcion (triazolam) with Ativan (lorazepam). Halcion is the most potent benzodiazepine (BZD) for sleep, but it has a very short half life, and often allows for rebound awakening. However, if you are also taking another BZD with a longer half-life like Ativan or Restoril (temazepam), sleep can be maintained through the night.
- Scott
Posted by Lamdage22 on January 29, 2016, at 11:42:14
In reply to Lou's response-suffer a horrible death by them, posted by Lou Pilder on January 29, 2016, at 7:04:54
My vote is for Neurontin and/or maybe less Parnate.
Benzos are addictive.
Posted by SLS on January 29, 2016, at 11:54:59
In reply to med poop out- where to go next (Latuda?), posted by bp peanut on January 27, 2016, at 21:18:32
One of the more common side effects of Geodon (ziprasidone) is insomnia. This might be amplified when added to Parnate, since Geodon is a reuptake inhibitor of serotonin. As you were titrating Geodon, how did you come to such a high dosage? I read that 320 mg/day was no more effective in schizophrenia and schizoaffective disorder than 160 mg/day after enough time passed for blood levels to settle - 8 weeks.
http://www.ncbi.nlm.nih.gov/pubmed/23775057
Have you ever tried valproate or Trileptal for mood stabilization mixed/states? You might be able to drop the Geodon in favor of one of these two drugs, thus reducing insomnia. I have even seen Topamax 100-200 mg/day work well for hypomanic mixed-states. Cognitive side effects can be minimized by using a very gradual titration.
Another idea is to get rid of the Geodon in favor of Saphris (asenapine). Saphris is not known for causing insomnia, and can exert an antidepressant effect along with antipsychotic effects.
- Scott
Posted by SLS on January 29, 2016, at 12:16:08
In reply to Re: Lou's response-suffer a horrible death by them, posted by Lamdage22 on January 29, 2016, at 11:42:14
> My vote is for Neurontin and/or maybe less Parnate.
>
> Benzos are addictive.Was your post meant for Lou Pilder?
I am confused based upon your not having reset the subject line back to what it was previous to Lou Pilder's post.
"med poop out- where to go next (Latuda?)"
If you don't mind seeing Lou's name in every subject line all over the board, then you can reject the idea of rewriting your subject lines to reflect the issues expressed by the poster who began the thread. I am not a big fan of graffiti.
- Scott
Posted by SLS on January 29, 2016, at 14:30:53
In reply to Re: » Lamdage22, posted by SLS on January 29, 2016, at 12:16:08
I was too snarky in my last post to you. I apologize.
- Scott
Posted by SLS on January 29, 2016, at 14:35:16
In reply to Re: Lou's response-suffer a horrible death by them, posted by Lamdage22 on January 29, 2016, at 11:42:14
Sorry, Lamdage.
My previous post was too snarky. I apologize.
I feel strongly about the importance of taking the time to rewrite the subject line when it is hijacked.
- Scott
Posted by SLS on January 29, 2016, at 14:55:08
In reply to med poop out- where to go next (Latuda?), posted by bp peanut on January 27, 2016, at 21:18:32
Hi BP Peanut.
How are you doing?
Have you found any of the feedback from others helpful?
I tried Latuda (lurasidone) in combination with Parnate and nortriptyline. It exacerbated my bipolar depression, but I think I understand why. One of its actions is to block NE alpha-2a receptors - much like Remeron (mirtazapine). I always react badly to drugs that do this. Remeron itself is used quite often for sleep with great success. Still, I would be reluctant to recommend Remeron because I don't know how the NE alpha-2a blockade would interact with a MAOI. It might be too noradrenergic. The combination is contraindicated by the manufacturer.
- Scott
Posted by Lamdage22 on January 30, 2016, at 6:04:13
In reply to Re: med poop out- where to go next (Latuda?) » bp peanut, posted by SLS on January 29, 2016, at 14:55:08
No offense taken, Scott!
Posted by Lou Pilder on January 30, 2016, at 12:46:21
In reply to Re: med poop out- where to go next (Latuda?) » bp peanut, posted by SLS on January 29, 2016, at 11:26:12
> I don't know if you need all of the drugs that you are taking, but let us assume that you do. Despite your difficulties with sleep, are you in full remission with respect to your mental illness? Are there any residual symptoms at all?
>
> The first thing I thought of for sleep was to switch from perphenazine to low-dose Seroquel (50-100 mg h.s.).
>
> If all else fails, I would consider combining Halcion (triazolam) with Ativan (lorazepam). Halcion is the most potent benzodiazepine (BZD) for sleep, but it has a very short half life, and often allows for rebound awakening. However, if you are also taking another BZD with a longer half-life like Ativan or Restoril (temazepam), sleep can be maintained through the night.
>
>
> - ScottFriends,
Be not deceived. Scott wrote here that in his thinking switching from one drug to Seroquel would be "for sleep".
This is allowed here by Mr. Hsiung even though if the poster does get Seroquel he/she could be killed by doing that as Seroquel could exacerbate exponentially the chances of being killed by heart failure by the drugs taken already.
And this is because Scott says it is for sleep. But at what price? You see, Scott does not post the adverse consequences that could befall the poster as the FDA requires when one advocates or promotes a drug on the internet as I understand their rules. If Mr. Hsiung and/or Scott and the others here that promote these drugs are exempt from the FDA rules, I do not know why. For by Mr. Hsiung not interceding, readers could think that what s promoted is supportive. But is death supportive?
And look at all the deaths here. And look at all the names gone. Are they dead also? Did they get a life-ruining condition from these drugs as advocated here and left this forum because they now think that they were deceived into thinking that these drugs were safer than they really are? Or did they become addicted as I have warned here and left the forum feeling cheated as they got an addiction and their lives are worse from reading here? And how many deaths will it take before those are allowed to hear from me?
And just as the Devil beguiled Adam and Eve in The Garden, that Great Deception is still going on today as death upon death by The Prince of Death, the devil, is in the morning papers and on the radio as 1000s of people are killed by these drugs every month including innocent children that are drugged by their parent in collaboration with a psychiatrist thinking that these drugs are "medicines".
And look at the members here telling you to not read what I post or ignore me. And look at that Mr. Hsiung condones such as he also advocates to ignore me. But the Devil told Adam and Eve to ignore what God had said to them. And that God said that if they eat of the fruit from the tree of the knowledge of good and evil that they would die. The devil said when they told him that, "Yea has God said?" He wanted them to ignore that God. But they died just as that God said. The Devil lied. The Prince of Death lied.
Lou
Posted by Lou Pilder on January 30, 2016, at 13:23:01
In reply to Lou's urgent warning-the Devil lied » SLS, posted by Lou Pilder on January 30, 2016, at 12:46:21
> > I don't know if you need all of the drugs that you are taking, but let us assume that you do. Despite your difficulties with sleep, are you in full remission with respect to your mental illness? Are there any residual symptoms at all?
> >
> > The first thing I thought of for sleep was to switch from perphenazine to low-dose Seroquel (50-100 mg h.s.).
> >
> > If all else fails, I would consider combining Halcion (triazolam) with Ativan (lorazepam). Halcion is the most potent benzodiazepine (BZD) for sleep, but it has a very short half life, and often allows for rebound awakening. However, if you are also taking another BZD with a longer half-life like Ativan or Restoril (temazepam), sleep can be maintained through the night.
> >
> >
> > - Scott
>
> Friends,
> Be not deceived. Scott wrote here that in his thinking switching from one drug to Seroquel would be "for sleep".
> This is allowed here by Mr. Hsiung even though if the poster does get Seroquel he/she could be killed by doing that as Seroquel could exacerbate exponentially the chances of being killed by heart failure by the drugs taken already.
> And this is because Scott says it is for sleep. But at what price? You see, Scott does not post the adverse consequences that could befall the poster as the FDA requires when one advocates or promotes a drug on the internet as I understand their rules. If Mr. Hsiung and/or Scott and the others here that promote these drugs are exempt from the FDA rules, I do not know why. For by Mr. Hsiung not interceding, readers could think that what s promoted is supportive. But is death supportive?
> And look at all the deaths here. And look at all the names gone. Are they dead also? Did they get a life-ruining condition from these drugs as advocated here and left this forum because they now think that they were deceived into thinking that these drugs were safer than they really are? Or did they become addicted as I have warned here and left the forum feeling cheated as they got an addiction and their lives are worse from reading here? And how many deaths will it take before those are allowed to hear from me?
> And just as the Devil beguiled Adam and Eve in The Garden, that Great Deception is still going on today as death upon death by The Prince of Death, the devil, is in the morning papers and on the radio as 1000s of people are killed by these drugs every month including innocent children that are drugged by their parent in collaboration with a psychiatrist thinking that these drugs are "medicines".
> And look at the members here telling you to not read what I post or ignore me. And look at that Mr. Hsiung condones such as he also advocates to ignore me. But the Devil told Adam and Eve to ignore what God had said to them. And that God said that if they eat of the fruit from the tree of the knowledge of good and evil that they would die. The devil said when they told him that, "Yea has God said?" He wanted them to ignore that God. But they died just as that God said. The Devil lied. The Prince of Death lied.
> LouFriends,
Be not deceived. It has been revealed to me in these last days of your lives that you are marching to a drummer and marching to a song by a piper that could lead you to your deaths and life-ruining conditions and addictions. But the revelation that I have can lead you to be unshackled from addiction, have your lives restored and sing a new song. And you will be clothed in new garments, bright and shining marching to a new drummer strutting in joy and gladness, free at last. And you will able to overcome a deaf-tone spirit that has caused you to ignore the Spirit of Life.
And you will be led with the others that have also been resurrected from the multitudes that follow death into a parade of gladness being renewed to a joy forevermore. There will be rows and rows thundering their new song with the change that they are given so that they have a new life and a new spirit.
Lou
http://www.youtube.com/watch?v=eBQWsBiM5YY
Posted by bp peanut on January 30, 2016, at 19:03:15
In reply to Re: med poop out- where to go next (Latuda?) (nm) » rjlockhart37, posted by SLS on January 29, 2016, at 5:46:14
Thank you everyone for your replies. I'm overwhelmed to be honest with you. I have dropped all of the sleep/anxiety meds (except maybe .5mg of Klonipin if I have extreme anxiety and switched to Belsomra only. I don't like benzos at all as I think they're killing my memory. I also heard amitriptyline can cause cognitive problems too. Anyway, something is making me stupid.
I'm giving the sleep correction some time to see if it resolves my mild/moderate residual depression. If it doesn't, I'll have to address that somehow, so I may be asking about that in a new thread.
Posted by bp peanut on January 30, 2016, at 19:36:03
In reply to Re: med poop out- where to go next (Latuda?) » bp peanut, posted by SLS on January 29, 2016, at 14:55:08
SLS- I'm glad you're still here (as were others but you really seem to know your stuff). You were such a help to me before. I find your brief explanation of the possible issues with Latuda and Remeron interesting. They were the 2 meds I was thinking about trying next. I certainly wouldn't want to make my symptoms worse. My depression is much better than it was when I was here previously and I've really switched from relying totally on meds and am doing alot of behavioral interventions/treatment as well. Still, I want to believe that this anhedonia and lack of motivation isn't something I'm stuck with forever. I just dropped ambien, perphenazine, zyprexa, and ativan, so I feel better about that. We're cutting down from the 20mg adderall to just 10mg, so I feel good about that too. I just worry about stopping antidepressents and antipsychotics because it seems like if I go off of them, they don't work when I go back on them. One problem with being on so many meds is that I don't know which one has pooped out (or indeed if the meds still work fine but environmental factors have changed. Anyway, I don't know where to go next. I have tried almost every drug I can think of that's not a total contraindication with Parnate (seroquel, risperdal, kind of saphris (for about 1 minute- due to horrible taste), abilify, wellbutrin, ritalin, mirapex, trileptal, depakote, tons of SSRIs, topamax, thyroxine, provigil, nortriptyline, and who knows how many others I don't remember. I feel like I'm just out of options. If I can learn to tolerate the taste of saphris, does it have the same contraindications as latuda and remeron? Sorry so long. Feel free to be as "complicated" in your explanation as you want. I've studies receptors and such (it's been a while), but I think I can decipher your points.
This is the end of the thread.
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