Psycho-Babble Medication Thread 511

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Thanks Toby!

Posted by DL on September 3, 1998, at 19:19:29

In reply to Re: Toby, can you help?, posted by Toby on September 3, 1998, at 9:13:22

Yes I am menopausal--54 now. No cycles for 3 years. The SSRI's were tried within the first year after I sought tx (summer 96-summer 97) with symptoms pretty much the same as postpartum. This seemed to be precipitated by the Provera which blocks progesterone receptors as opposed to being taken up by receptors. But when it was stopped in April 96 just before I went for help I did not get better.
At one point about a year ago I pulled out the old Paxil script and tried cutting the 10mg tablets in quarters. I took it for a while but as soon as I went beyond 5 mg the internal racy feeling came back. Since it wasn't helping the depression I stopped.
The central problem seems to be the sleep. What I would give for a deep restful nights sleep! Even when I sleep it is not restorative. Sleep deprivation can cause all sorts of symptoms on its own.
I can also tell you that I grew up with a father who was terrifying to me. He is probably OCD--everything in the house had to be straightened and lined up and I had to follow endless lists of rules all the time. He used to push food down my throat with his fingers to make sure I ate all on the plate and would creep up the stairs to make sure my sister and I were not talking after we were sent to bed. I always jumped at unexpected noises so I would wait stiffly holding on to the bed each night to be ready if he suddenly yelled at me. So you can see that I was set up at an early age to have sleep problems! And, I had a marriage where my husbands drinking built up into physical abuse and mental abuse. I have lived for many years with high levels of stress and now have graduated with a professional degree, have started a new job, and am going to mediation for divorce. Soooooooo......There is a lot going on here. I can't remember when there was peace in my life for long. But except for postpartum, scattered stressful times, and these last 2 years, I have managed to cope. I can even remember back enjoying cooking, gardening and volunteering in my kids schools--perhaps even laughing--even when stressful things were going on.
As part of my present profession I took psychology and mental health classes and did a 3 month affiliation in an acute mental health facility. My impression of Bipolar illness was that the decreased sleep involved there was not a major hindrance to the person. They seemed to feel they just didn't need the sleep and had lots of energy. Whereas I struggled to function during the day and tried everything to sleep. I was so exhausted I had to force myself to keep going all the time. So I didn't think I fit that picture.
Isn't .5 mg klonopin a pretty small dose? I knew of people in the hospital who took 4 or 5 mg a day. I think my system is very sensitive. I have never tried more, assuming the afternoon disconnected/drowsy feeling would get worse. The Dr said this was from my fragmented sleep and not from the klonopin.
The Depakote and Verapamil--what about side effects and toxicity? At one point more than a year ago the Dr talked of lithium but that scared me since I have read a lot about it's side effects.

Yes, I worry in that things will run through my mind and I sometimes can't still the thoughts. But there are a lot of things in my life to worry about. And, I do not have trouble going to the mall or out places, but your description of meeting a friend instead of a stranger does fit. I have no idea why, but sometimes if I see someone I know in the grocery store or out shopping I find myself avoiding them. I think back and wonder why I am doing this--why is this?
I did a lot of reading on Buspar. Some articles really built it up, but when I took the info to the psychiatrist he said it is not effective for people who have been taking benzodiazepines. I did read about continuing the klonopin and starting on Buspar at the same time then tapering off, but he said it would probably not be effective for me after the months on the klonopin. What do you think?
And I also read a lot of articles on Serzone and some on Remeron which was the newest AD when I was on my affil. The Dr. had also said at one point about a year ago that he did not find Serzone to be a very effective AD so I did not try it. Docs at the hospital said Remeron tended to make people gain weight. Do these two cause the hyper feeling in people sometimes too?
I see the Doc in a few weeks for one of those drive by visits. When ever I lower the klonopin dose, within about 24 hours I start to feel the over stimulated stuff again. Is this just withdrawal or unmasking of anxiety?
Do you have suggestions for therapy? I have seen a MSW off and on and it's nice to be supported and validated but I don't feel I am learning new ways to cope. What kinds of therapy or professionals would be helpful to me?
With what I have told you here, do you have any suggestions?
I have been taking Saint John's Wort and sometimes some Kava Kava. Other than that just vitamins. I'm not sure if the SJW is doing anything but am sort of afraid to stop in case I get even worse. It seems to help a lot of people.
Thanks for taking the time to reply. THe doc doesn't seem to have the time even though he is nice.
I wonder if I will ever feel excitement and enjoyment and most of all peace in life again.
Dotty

 

Re: Thanks Toby!

Posted by Toby on September 4, 1998, at 15:29:09

In reply to Thanks Toby!, posted by DL on September 3, 1998, at 19:19:29

> The central problem seems to be the sleep. What I would give for a deep restful nights sleep! Even when I sleep it is not restorative. Sleep deprivation can cause all sorts of symptoms on its own.

Have you had an overnight sleep study? These can document which phases of sleep are disturbed and therefore indicate what treatment is needed. There are cases of insomnia that no cause can be found for, but for which very tiny doses of tricyclic antidepressants are a complete cure. The usual antidepressant dose of, say, Elavil is about 200 mg per day, but insomnia may respond to a dose of 10-25 mg per day without the daytime grogginess. If you are overweight, sleep apnea may be the cause which can be fixed by tonsillectomy or an airway mask that you wear at night. Most insurance will pay for this with a referral.

> I can also tell you that I grew up with a father who was terrifying to me. He is probably OCD--. So you can see that I was set up at an early age to have sleep problems! And, I had a marriage where my husbands drinking built up into physical abuse and mental abuse.

Look into EMDR. See the website www.emdr.org (I think. It may be .com) and see if there are any therapists doing this in your area. It can dramatically lower or completely extinguish your anxiety.

> As part of my present profession I took psychology and mental health classes and did a 3 month affiliation in an acute mental health facility. My impression of Bipolar illness was that the decreased sleep involved there was not a major hindrance to the person. They seemed to feel they just didn't need the sleep and had lots of energy. Whereas I struggled to function during the day and tried everything to sleep. I was so exhausted I had to force myself to keep going all the time. So I didn't think I fit that picture.

You have a good point there. But there are some odd varieties of Bipolar that don't fit DSM criteria but that still seem to respond to medications for Bipolar disorder. Remember that DSM is constantly revised and that we are still finding out new things about all these disorders.

> Isn't .5 mg klonopin a pretty small dose? I knew of people in the hospital who took 4 or 5 mg a day. I think my system is very sensitive. I have never tried more, assuming the afternoon disconnected/drowsy feeling would get worse. The Dr said this was from my fragmented sleep and not from the klonopin.

Yes, it is a small dose and your doc may be right, too. If you have been consistently on this dose and the drowsy feeling has never gone away, I suspect it is because you are tired (since it is occurring in the afternoon) and not from the Klonopin since you are taking it at night, the effects would be gone by the following afternoon. Perhaps trying a small increase during an extended holiday when you aren't going to be really busy would give you an idea of whether it's drowsiness from the Klonopin or from lack of sleep.

> The Depakote and Verapamil--what about side effects and toxicity? At one point more than a year ago the Dr talked of lithium but that scared me since I have read a lot about it's side effects.

Lithium isn't a good antidepressant although it CAN augment other antidepressants (and even that is being called into some question in the scientific literature). As I said, Depakote and Verapamil can be good antianxiety meds as well as good mood stabilizers and they have been shown to be right good antidepressants in folks that waffle in their baseline mood. Since you are sensitive to meds, you would want to start with the lowest possible dose of either. You can read about the side effects elsewhere in this site, but if you "start low and go slow," most of the time you can avoid the side effects.

> Yes, I worry in that things will run through my mind and I sometimes can't still the thoughts. But there are a lot of things in my life to worry about. And, I do not have trouble going to the mall or out places, but your description of meeting a friend instead of a stranger does fit. I have no idea why, but sometimes if I see someone I know in the grocery store or out shopping I find myself avoiding them. I think back and wonder why I am doing this--why is this?

I was curious about possible social phobia which sounds like the above. And if your worrying just goes in circles without allowing you to make any headway in solving the problems and you are "on edge" and get an upset stomach frequently, that could be generalized anxiety which may respond to Buspar. The thought USED to be that patients wouldn't respond to Buspar if they'd been on benzos for a long time. And that is still somewhat true, but usually occurs when the dose is above 3 mg per day for Xanax and Klonopin or 20-30 mg per day for Valium. And even then, it can still work for selected patients if they have been off the benzo for several months. Also, the thought these days is that you can give a tiny dose of benzo such as what you are taking and start the Buspar and then taper off the benzo as you suggested. And besides, even if you find it doesn't work, Buspar is one of the most benign meds we've got, it certainly couldn't hurt to TRY it.

> And I also read a lot of articles on Serzone and some on Remeron which was the newest AD when I was on my affil. The Dr. had also said at one point about a year ago that he did not find Serzone to be a very effective AD so I did not try it. Docs at the hospital said Remeron tended to make people gain weight. Do these two cause the hyper feeling in people sometimes too?

I have seen hyper feelings in 2 patients on Serzone who started it at 100 mg twice daily. When the dose was decreased to 50 mg at bedtime and then slowly increased, the hyper feelings vanished. I also used to think that Serzone didn't work, but then discovered that it was a matter of trying it in the right person (anxious, on edge, jittery, can't sleep, just plain stressed out kind of depression). Since then, I have found that it works as well as anything else. Dr. Stephen Stahl is a pharmacology guru and he recommends it highly and I have found that it works in some resistant depressions that respond to nothing else. In regard to the Remeron, the weight gain occurs in about 25% of patients, but if you are aware of it beforehand, you can just watch out for sweet cravings and avoid it. Also, it works the opposite of other meds: at the lowest doses it makes you the most sleepy and makes you gain the most weight. As the dose increases, the risk of gaining weight decreases and the sedative effect is less (though my patients tell me they still sleep as well, they just aren't groggy during the day). So, with your system being sensitive, Remeron may be right for you because you can increase the dose to an effective range for the anxiety and depression and decrease the side effects at the same time.

> I see the Doc in a few weeks for one of those drive by visits. When ever I lower the klonopin dose, within about 24 hours I start to feel the over stimulated stuff again. Is this just withdrawal or unmasking of anxiety?

Probably unmasking of anxiety since your dose is so low.

> Do you have suggestions for therapy? I have seen a MSW off and on and it's nice to be supported and validated but I don't feel I am learning new ways to cope. What kinds of therapy or professionals would be helpful to me?

Check out EMDR. I cannot praise it enough.


> I have been taking Saint John's Wort and sometimes some Kava Kava. Other than that just vitamins. I'm not sure if the SJW is doing anything but am sort of afraid to stop in case I get even worse. It seems to help a lot of people.

If you try any new antidepressant, you will most likely need to stop the SJW. I'm also concerned about the kava kava since you are taking Klonopin. Even though you are taking a small dose, the kava can interact with it and there has been at least one report of accidental overdose and coma as a result of mixing the two (the guy was trying to taper himself off the benzo and had started kava and in about 1 week had achieved a toxic benzo level because the kava had inhibited his liver from eliminating the benzo from his bloodstream) so just be careful.

 

Much appreciation for your thoughts

Posted by DL on September 6, 1998, at 0:56:23

In reply to Re: Thanks Toby!, posted by Toby on September 4, 1998, at 15:29:09


> Have you had an overnight sleep study? These can document which phases of sleep are disturbed and therefore indicate what treatment is needed. There are cases of insomnia that no cause can be found for, but for which very tiny doses of tricyclic antidepressants are a complete cure.

No, I have not, but I don't think insurance would cover the cost and it is probably expensive. But, I would like to. I live in NH and would probably have to go to Boston. When I took Pamelor for about 2 months at 10, then 25, then 50 mg, my sleep did not improve.

> If you are overweight, sleep apnea may be the cause

Not enough to be a problem here. I am 5'6'' and 145.

> Look into EMDR. See the website www.emdr.org (I think. It may be .com) and see if there are any therapists doing this in your area. It can dramatically lower or completely extinguish your anxiety.

I will check it out. I think I have been there before and might have even written to them. I think a lot of therapists are trained in EMDR. I don't think the one I see is. I thought it was mostly for recent trauma and PTSD?

>. Perhaps trying a small increase during an extended holiday when you aren't going to be really busy would give you an idea of whether it's drowsiness from the Klonopin or from lack of sleep.

Last night I took .75mg of klonopin (1 1/2 tabs) at bedtime to see. I woke up about 6 hrs later with a strange, somewhat uncomfortable feeling--mildly nauseous--that stayed with me for a few hours. Later in the day I noticed a strange symptom I used to have when I first started the klonopin. It has strange effects on my eyes. It will seem like my glasses need cleaning or I need a new prescription, and my eyes don't seem to track as fast as normal. It's almost as if my eye muscles have been relaxed or slowed. This also gives the feeling of drowsiness since it's more work to keep the eyes open--pretty strange but somewhat dangerous when driving!

> As I said, Depakote and Verapamil can be good antianxiety meds as well as good mood stabilizers and they have been shown to be right good antidepressants in folks that waffle in their baseline mood.

What do you mean my waffle? Up and down mood swings?

> > Yes, I worry in that things will run through my mind and I sometimes can't still the thoughts. But there are a lot of things in my life to worry about. And, I do not have trouble going to the mall or out places, but your description of meeting a friend instead of a stranger does fit. I have no idea why, but sometimes if I see someone I know in the grocery store or out shopping I find myself avoiding them. I think back and wonder why I am doing this--why is this?

> I was curious about possible social phobia which sounds like the above. And if your worrying just goes in circles without allowing you to make any headway in solving the problems and you are "on edge" and get an upset stomach frequently, that could be generalized anxiety which may respond to Buspar.

All of the above fit except the upset stomach. That is rarely a problem with me. When I stop the klonopin I go back to having a very hyper startle reflex (even now it is bad!), I tend to hold my breath without even noticing it as I work. Most of the time my neck is tense and I have terrible trouble with my TMJ joint from apparently clenching and grinding my teeth at night

Exactly what do you mean by social phobia? I go out shopping and to do errands without any problem, and even gave presentations at school without much problem. But I do that silly thing of seeing someone I know and avoiding them when shopping. And when I was in the throws of the terrible postpartum depression I ended up isolated in the babies room and wouldn't even see visitors. I can remember way back then like it is right now because it was etched into my memory from the emotional pain.

> I also used to think that Serzone didn't work, but then discovered that it was a matter of trying it in the right person (anxious, on edge, jittery, can't sleep, just plain stressed out kind of depression).

Well, that does describe me.

> In regard to the Remeron, it works the opposite of other meds: at the lowest doses it makes you the most sleepy and makes you gain the most weight. As the dose increases, the risk of gaining weight decreases and the sedative effect is less (though my patients tell me they still sleep as well, they just aren't groggy during the day). So, with your system being sensitive, Remeron may be right for you because you can increase the dose to an effective range for the anxiety and depression and decrease the side effects at the same time.

How long does it take to get used to Remeron? If you have to go through a groggy period that wouldn't be good for work.

> If you try any new antidepressant, you will most likely need to stop the SJW. I'm also concerned about the kava kava since you are taking Klonopin. Even though you are taking a small dose, the kava can interact with it and there has been at least one report of accidental overdose and coma as a result of mixing the two (the guy was trying to taper himself off the benzo and had started kava and in about 1 week had achieved a toxic benzo level because the kava had inhibited his liver from eliminating the benzo from his bloodstream) so just be careful.

Thanks for the caution. I was taking one capsule of kava and 1/2 tab klonopin (.25mg) to try to get off the klonopin since everywhere I look I see MD's and others downing benzos and talking about addiction and withdrawal.

If the mental and physical tension and anxiety symptoms are always there, but at times of stress and hormonal change I also slip deeper into depression, what of all the above do you think would be a good first try to suggest to MD?

Also, do you think cognitive behavioral and other "relearning" therapies work?

Thanks again for the discussion. No one else has taken the time to have this give and take with me. And none of the mental health proffesionals has seemed to realize how much I have learned on the subjects of depression and anxiety and mental health in general--and respected me as a full partner in my tx.
.

 

Toby, can you explain EMDR a little bit?

Posted by DL on September 7, 1998, at 0:34:45

In reply to Much appreciation for your thoughts, posted by DL on September 6, 1998, at 0:56:23


> > Look into EMDR. See the website www.emdr.org (I think. It may be .com) and see if there are any therapists doing this in your area. It can dramatically lower or completely extinguish your anxiety.

Exactly what does this entail? If I went to someone trained in this, what would they probably do, and what would I be expected to do? Is this something you have done?

 

Re: Much appreciation for your thoughts

Posted by Toby on September 8, 1998, at 10:27:00

In reply to Much appreciation for your thoughts, posted by DL on September 6, 1998, at 0:56:23

Regarding the sleep study: it won't hurt to call the insurance company and find out if they will cover the test and what kind of info is required in the referral in order to get coverage. If it is covered, then check with your doctor to see if he will make the referral.
You said you'd tried Pamelor without much sleep relief; Imipramine in tiny doses has been tried with better results for sleep. Pamelor usually helps sleep in bigger doses which you may not tolerate.
Regarding your experiment with the Klonopin: you are indeed exqusitely sensitive. The body usually becomes tolerant to the sedating effects of Klonopin after about 7-10 days (sometimes faster when the dose is small) so you may still want to try an increase in it when you have a longer holiday (like Christmas or Thanksgiving) when you don't have to drive or work. Was the quality of you sleep any better with the extra Klonopin? And was the eye fatigue different from the usual sleepiness you feel in the evening and could you tell any difference in the sleepy feeling that day? If no difference in sleepiness but the quality of your sleep was better, then the lack of restful sleep at night may not be the main factor in your daytime sleepiness. In which case I still recommend the sleep study if possible.
By "waffle in baseline mood" I mean small, frequent changes in your mood rather than the huge, longlasting changes that characterize full blown mania. Those small changes still greatly affect your ability to function and feel good or normal, and are probably related to bipolar disorder without exactly fitting medical criteria for bipolar. In which case, those medications I mentioned still would be helpful.
Regarding the social phobia: This is not the same as agoraphobia which is anxiety about being in places or situations from which escape might be difficult or in which help may not be available in the event of having a panic attack. People with agoraphobia typically avoid any situation that involves being outside the home alone, being in a crowd or standing in a line, being on a bridge, or traveling in a bus, train, or car. Social phobia, on the other hand is the fear of being in a social or performance situation in which you could be exposed to unfamiliar people or to scrutiny by others and there is the fear that you will act in a way that will be humiliating or embarrassing (such as showing anxiety symptoms of shakiness, sweating, stuttering, or anything else like that). Many people with social phobia can't put that fear into words like the above without pretty close examination, but they know that they just get really nervous in situations like you described before. These folks know that their fear is excessive or unreasonable but can't stop it and so they avoid these kinds of situations or else endure them with intense distress. You asked about cognitive-behavioral therapy and it is very helpful for social phobia. You work on finding those thoughts that start the train of anxiety when you see a friend in the grocery store, and then you work on stopping those thoughts before they can get you revved up. It's very effective. Most courses take 6-10 weeks.
In regard to the EMDR: It is used for recent trauma and also for trauma that is very old, even up to 50 years old in one patient of mine (WWII trauma). It is used for PTSD and also for what they are calling "little trauma" which would be anything that might fail to cause full blown PTSD in a particular person, which could be an abusive husband, a frightening father, a car wreck, death of a loved one who might have left without saying goodbye, sexual harrassment at work, being fired from work unfairly, all of which I have treated successfully in addition to the big traumas of rape, attempted murder, tornados, heavy machinery accidents, sexual abuse. Some people need only 1 session, others need 2-4 sessions and some people use it intermittently during long term therapy to address issues as they come up, and usually that would be in cases of long term abuse or a chronic problem like eating disorders. A session is usually about 2 hours long, just you and the therapist, no drugs or hypnosis involved. The therapist has you think about a particular incident that is distressing to you, along with the negative thought about yourself that that memory causes and the negative physical feeling that occurs in your body (anything from pain to anxiety). Then the therapist moves his fingers in front of your eyes (just so your eyes have something to track on) while you focus on those things listed above. This is related to REM sleep which is involved in memory and learning. By focusing on several distressing aspects of the memory at once and doing the REM movements, the brain is able to rapidly sort out what is important, what is no longer needed for your survival, and is able to let go of the physical sensations that are no longer needed in order to "catalog" the memory. Once the physical feelings are gone, the memory becomes tolerable, and is able to be properly filed away without causing distress anymore. For example, when you lie down at night, if you didn't feel the same feelings of anxiety that your dad caused when you were a kid, you probably wouldn't grip the sheets and be tense and would be able to sleep.
In regard to which medication to try first, I'd think about Buspar first since it is pretty benign and doesn't interact with much else.
In regard to the Remeron, it takes about a week to get used to the daytime sedation, but if you tolerate it, I usually increase it from 15 mg to start with up to 30 mg at bedtime after the first 3 days which takes care of the sedation in most people.

 

Response to Toby

Posted by DL on September 9, 1998, at 22:18:15

In reply to Re: Much appreciation for your thoughts, posted by Toby on September 8, 1998, at 10:27:00


> Regarding the sleep study: it won't hurt to call the insurance company and find out if they will cover the test

I will call and ask. I know they do them in Boston, but a little hospital near by does also. Is there a difference in where you have such a test done? I have heard that a number of such centers have sprung up in local hospitals but that they may not have really qualified personnel to interpret the info and make suggestions--that they are primarily looking for sleep apnea. I read once about studies done in people's homes with a special "hat" fitted to them connected to a recording device. Have you heard of this? Also, I have so much trouble sleeping here that I don't think I would sleep at all at a hospital. Even with the klonopin if stress level is high I sleep very little. And, without it I revert to just staying awake all night and feeling increasingly desperate.

> You said you'd tried Pamelor without much sleep relief; Imipramine in tiny doses has been tried with better results for sleep. Pamelor usually helps sleep in bigger doses which you may not tolerate.

How long does it take for the Imipramine to start to help? Is it the 4-8 wks often quoted when used for depression? And what are the side effects/toxicity?

> Regarding your experiment with the Klonopin: you are indeed exqusitely sensitive. Was the quality of your sleep any better with the extra Klonopin? And was the eye fatigue different from the usual sleepiness you feel in the evening and could you tell any difference in the sleepy feeling that day?

Sleep quality was not different that I remember. Just what I said about waking after a short time sleeping and feeling strange (sort of the way you feel before you get sick) I don't remember differences in the level of fatigue because I was trying to function with that strange "eye muscle/focusing problem" during the day and because I can't remember back to when I have not felt tired and exhausted.

> By "waffle in baseline mood" I mean small, frequent changes in your mood rather than the huge, longlasting changes that characterize full blown mania.

I don't think I fit that. I have been pretty much depressed and anxious for a long time. It is easy for the anxiety level to spike with any new stress because I think I have totally worn out my body's stress system. But, I WISH I could have even a tiny hypomanic minute or two just to see what it is like.

> Social phobia, on the other hand is the fear of being in a social or performance situation in which you could be exposed to unfamiliar people or to scrutiny by others and there is the fear that you will act in a way that will be humiliating or embarrassing (such as showing anxiety symptoms of shakiness, sweating, stuttering, or anything else like that).

As a child everything I did was scrutinized and criticized. Nothing I did was ever good enough for my dad. We learned to "act perfect" in front of other people and not to talk about anything that would lead others to think things were not perfect in our family. I guess I continued that early structure all through my life and lived with some pretty horrendous things while people around me thought things were "perfect" with me! It's only in the last few years I have started to learn that normal people are not perfect and it's OK. Perhaps when I met people and felt uncomfortable it was because I was fearing they would find out something that was not perfect about me...I feel comfortable with the friends I have made in the last few years--people I have opened up to and told about the pain in my life. But for years and years I dreaded parties and tried to find ways out of gatherings at my place.

>You asked about cognitive-behavioral therapy and it is very helpful for social phobia.

How does one go about finding the right person for cog. beh. therapy? There are a number of people who supposedly do it, but I don't have the money to experiment. Would the same person likely do EMDR also?

> In regard to the EMDR: The therapist has you think about a particular incident that is distressing to you, along with the negative thought about yourself that that memory causes and the negative physical feeling that occurs in your body (anything from pain to anxiety).

What if the feelings that come up are so deep and distressing that I become tied up in wrenching tears and feelings of loss/desertion? Because that's what happens. Right now as I am fighting off some memories there are tears running down my face. How would I be able to participate in the EMDR session?

> Then the therapist moves his fingers in front of your eyes (just so your eyes have something to track on) while you focus on those things listed above. This is related to REM sleep which is involved in memory and learning. By focusing on several distressing aspects of the memory at once and doing the REM movements, the brain is able to rapidly sort out what is important, what is no longer needed for your survival, and is able to let go of the physical sensations that are no longer needed in order to "catalog" the memory.

This is really interesting to me. The REM sleep part. I have trouble getting to sleep and waking up early, but during the night I frequently wake up every 90 min or so--especially if I am taking nothing to help me sleep. It's like I break through whenever I am coming into REM sleep. I seem not to dream. I can only remember dreaming once or twice in the last few years. But when I used to dream a common theme was that I had done some terrible thing like kill someone and I was trying to hide it from everyone. Some of my decreased concentration and memory is probably releated to no renewing REM sleep.

> In regard to which medication to try first, I'd think about Buspar first since it is pretty benign and doesn't interact with much else.

Would you suggest I take it with the klonopin
for a while? How long should I give it before I decide if it is helpful? Does it help with depression? Have you known it to be effective in people similar to me? Does it have side effects I should look out for? And does it help with sleep? Any guidelines on dose in case I get the psychiatrist to prescribe it? If he does not want to prescribe it with the klonopin, what else would you suggest for sleep for a while?

> In regard to the Remeron, it takes about a week to get used to the daytime sedation, but if you tolerate it, I usually increase it from 15 mg to start with up to 30 mg at bedtime after the first 3 days which takes care of the sedation in most people.

Remember that I had drastic reactions to tiny doses of a number of other AD's. If the MD does not want to prescribe Buspar, what would your next suggestion be? You mentioned Serzone, Remeron, and Elavil or Imipramine. Or should i just search out Cog Beh Therapy?

Can you tell I am lost and pretty desperate? I feel like the mental health system has walked past me with hardly a turn of the head. Where can i find someone like you? (You can e-mail me directly if you want).

Thanks again for listening and keeping me going when I was ready to give up!


 

Re: Response to Toby

Posted by Toby on September 10, 1998, at 16:14:21

In reply to Response to Toby, posted by DL on September 9, 1998, at 22:18:15

You want to be sure the doctor reading the sleep study is Board Certified in Sleep Medicine and will interview you both before and after the study so that you can discuss your problems and then the recommendations. The study in the home is primarily for sleep apnea if I am not mistaken and is usually for people who are homebound and also to follow up every year on people with sleep apnea to make sure their treatment machines are working right. If you do have a test in the hospital or clinic, it's OK if you don't sleep well all night. That's what you are there for: the EEG will still be able to pick up many clues as to why you don't sleep. Also, if you get less than a certain amount of sleep, the lab will recommend a second night to negate that "first night effect."
Should imipramine become a choice for you, the sleep effects should be fairly quick acting (like a week) and the doctor may give you leeway in adjusting your dose yourself up to a certain amount so you can judge what the benefits and side effects are at different doses without having to labor through a long period on one particular dose, then returning to see the doctor for another dose change.
It does sound as though social phobia is high on the diagnostic list. To find a good therapist (never foolproof but narrows the chances of finding a good one) for cog-beh therapy, you should be able to call and get a brief telephone consult. Things to ask: how many years experience do they have (somewhere between 2 and 10 is the best because you can be better assured that they are pretty much up to date on new techniques, etc), were they TRAINED in school in cog-beh therapy and what is their degree (anything with a bachelors or higher is best, you don't want a "certificate in therapy" only), about how many patients have they treated with social phobia and depression and (probable) PTSD (the more the better), do they use groups plus individual (better if they do but not an absolute requirement), what is the length of the usual course of treatment and how often are the sessions (less frequently than every 2 weeks is generally useless and once weekly for individual therapy and every 2 weeks for group is generally the best option).
For the EMDR (which I'm recommending to you before searching out a cog-beh therapist) I found 4 therapists listed in Mass but my list is a little old so there may be more now (one in Boston/Cape Cod/Nantucket, one in Cambridge, one in Needham/Newton/Winchester and one in Gardner who is my personal favorite). The worry about getting "tied up in tears and loss/esertion" is valid, but the EMDR will prevent you from getting "tied up" in that. Many people do cry and experience some powerful emotions but, whereas ordinarily those feelings would be overwhelming and you would want to escape them quickly by squelching them, the EMDR allows these emotions to occur but to become quickly tolerable and lose their "power" over you. It is highly difficult to explain on paper in a few sentences, but so far I have not had a single person be unable to continue with the procedure. It's as though suddenly the event "dries up" and it doesn't make sense anymore that it should have a place in your life. Most people describe something along the lines that the pictures get smaller, more distant, less distinct and usually they have trouble even getting the image anymore, at which point the emotions just evaporate. All that in less than 2 hours.
Regarding the Buspar, there's no reason why you shouldn't be able to start the Buspar while you are still taking the Klonopin and the usual starting dose is 7.5 mg twice daily for 1 week then up to 15 mg twice daily. Usually that is continued for 2-3 weeks and if symptoms aren't gone, increase to 22.5 mg twice daily for a few weeks then max out at 30 mg twice daily. Even if you must remain on the Klonopin for sleep, your functioning during the day should improve with the Buspar. I've found Buspar to be more effective than I originally thought it was when it was introduced about 6 years ago. It can be effective by itself and certainly is a good augmenting agent for antidepressants. Regarding the Remeron, remember you get paradoxically FEWER side effects as you increase the dose, so if you try it and you are too sleepy at 15 mg each night, INcreasing it should reverse the sleepiness. Other sleep meds to consider in place of Klonopin are doxepin and trazodone although they may give you a hangover because you are sensitive and you can't get it in really small doses, imipramine, or Serzone (the only problem there is possible nausea but you can get it now in very small doses).

Let me be clear though since we have discussed so many different options. Look into the EMDR first because it has the greatest chance of quickly clearing up many of your symptoms without meds (there are some insurance companies that will pay for it now because it is so quick). Then try cog-beh therapy. If EMDR isn't an option and you are trying cog-beh therapy, then proceed with Buspar, then Remeron, then Serzone along with the cog-beh stuff. Keep Depakote in mind if the antidepressants poop out as it is a pretty good antianxiety medication (125 mg per day to start and slowly increase up to as high as you can tolerate). You can look into the sleep study as a sideline while you are doing these other things; the sleep study may not be as profitable to you as the EMDR and/or cog-beh therapy now that I have more info about you, because it sounds as though the sleep problems are rooted in your depression and anxiety (which doesn't mean you are hysterical, just traumatized and trained to not sleep) and a sleep study would probably just confirm that via the EEG results of your brain waves being hyperaroused and simultaneously clinically depressed.
Just because I'm suggesting these meds doesn't mean you need to fight with your doctor if he feels there is another, better option. Just keep these things in mind to continue to look into. After all, unfortunately there's no test to see which med will definitely do the trick and even the ones I mentioned have the potential to fail in any particular person. As always, good luck.

 

You will never know how helpful you have been...

Posted by DL on September 10, 1998, at 23:52:15

In reply to Re: Response to Toby, posted by Toby on September 10, 1998, at 16:14:21

Maybe you can guess how much this correspondence has meant to me--but I don't think so. I don't know what drives you to come to this site and volunteer your time and patient expertise--but it has helped to keep me going.. I sense that at sometime in your life you have been some of the painful places I have been or you would not have the understanding you so freely give. If you were within driving distance I would find a way to you.

I think I did write for the EMDR list for NH at some point but I can't seem to find it. I live in seacoast NH and the drive to the MA border is about 30 min. I will write for the list again, but it will take a while to come. If you have names to suggest I will call them. I would like to try it soon. Your descrption has helped me a lot. Beyond the father who came home from WWII and terrorized me, and the physically abusive husband, there have been many other traumas that I have pushed below the surface. I feel like I am trapped by these things and can't find my way out. Just typing this has the tears running slowly down my face.

Thank you for prioritizing the suggestions. It really helped a lot. I have an appt with the psychiatrist on the 21st and then won't see him for another 2 mos probably. I would like to find someone for EMDR soon so I can see if it will help and then know what to say to the MD. Since you suggest not trying any meds till EMDR, I'm not quite sure what to say to him on the 21st. Do psychiatrists do,or know about EMDR? Should I discuss Buspar or Remeron at this time if I haven't found someone for EMDR yet? I always feel that those quick visits are a waste of insurance money. And is everyone equally qualified to do EMDR, or are there diff levels of training?

At one point you mentioned EMDR was not hypnosis. In your experience does hypnosis help people with problems like mine? When I was in the throws of PPdepression 19 years ago the GYN tried to teach me self-hypnosis in a 20 min office visit. I hadn't slept in weeks and I went home more desperate than ever. When I called the next day at the end of my rope, his suggestion was to relax and go have sex with my husband! I will NEVER forget that. I will always remember being ready to really give up and trying to get help--but it was like screaming into an empty world--no one was willing to listen.
Once again, you are a godsend. Reading your messages has helped to crystalize some of the things in me where I might be able to find help.

It is now 1AM and I get up at 6AM. Maybe I can sleep....


 

Re: NH EMDR therapists

Posted by Toby on September 11, 1998, at 7:57:53

In reply to You will never know how helpful you have been..., posted by DL on September 10, 1998, at 23:52:15

Since you will be seeing your doctor so soon, it would seem reasonable to talk to him about trying the Buspar. You want to keep the Klonopin on board until the Buspar has a chance to work. You can mention the EMDR to him if you want, but if he rolls his eyes, just drop it. Psychiatrists do EMDR, but it has been primarily in the domain of psychology for most of its existence, so many psychiatrists are either unaware of it or don't believe it's possible for a treatment to work so fast (I'm quite a skeptical person and I thought it was just a scam until I started seeing actual and permanent results from it through one of my supervisors in residency). Now, however, there is scientific research using PET scans and SPECT scans (these are like MRI's except that they show activity of the brain rather than just structure) that is showing that real changes are occuring in the brain during and after EMDR. Anyway, if the doctor agrees to the trial of Buspar and it will be a couple of months before you see him, you may just want to get the prescription and try the EMDR before starting the Buspar. There are 2 therapists is New Hampshire (I looked again at this list and these are instructors so they are highly trained and have been doing it for years; there are sure to be others as well in case these two aren't near you), Debbie Korn, Psy.D. in Nashua (800) 866-9006 ext1806 and Roger Poire, Psy.D. in Gilford and Dover (603) 528-4405 or (603) 749-2729. Hope these numbers are current.

 

Re: NH EMDR therapists

Posted by DL on September 12, 1998, at 12:24:37

In reply to Re: NH EMDR therapists, posted by Toby on September 11, 1998, at 7:57:53


> There are 2 therapists in New Hampshire (I looked again at this list and these are instructors so they are highly trained and have been doing it for years), Debbie Korn, Psy.D. in Nashua (800) 866-9006 ext1806 and Roger Poire, Psy.D. in Gilford and Dover (603) 528-4405 or (603) 749-2729. Hope these numbers are current.>

I found my list from EMDR Institute. No one was listed as a facilitator or instructor. There were 9 listed as "level II" in training. Eric Niler PhD (Dover), Edie McCaddin MSW (Durham), Bruce Altman PsyD, Pamela Henry, Mark Moses PhD, Mary Satterthwaite, Judy Albertson MS, Kathryn Driscoll LSW (all Portsmouth) and David Diamond PhD (Rochester). All these places are close, but I am confused about the people with no credentials listed. What does that mean? The person you listed in Dover is listed in my white pages with the same # but is not on the EMDR list sent to me a few months ago. Perhaps if you ask for the list as a professional you get a different list. I saw my therapist today and she said she is going to an EMDR conference at Columbia Portsmouth Hosp (30 min away) next week. I won't see her again until the 26th. I am thinking she may get some helpful info for me but I would like to see someone soon.

I am really stressed now. Tension at home is terrible (going through divorce mediation with an angry, controlling husband) and new job has a director who is controlling and manipulative (most of previous staff have left because of this). It is difficult for me to react to her without lots of internal anxiety. This puts me in a hyperalert state all day. The new career was planned to help me get away from this long term stressful relationship at home but positions in my field are very limited for new grads due to managed care and new Medicare guidelines.--So I felt I had to take this job--full time with benefits. So right now I am pretty desperate. Taking the .5 klonopin and one tablet of kava every night with calming herb tea and calcium. Can't increase the klonopin or before mentioned problems interfere with work. Feeling on the edge all the time.

Thanks for your help.

 

Side effectts of Buspar

Posted by DL on September 13, 1998, at 23:27:08

In reply to Re: NH EMDR therapists, posted by DL on September 12, 1998, at 12:24:37

Toby, My PDR family guide lists the following side effects for Buspar: "more common"--dizziness, dry mouth, UNUSUAL EXCITEMENT, NERVOUSNESS, headache, lightheadedness, nausea. (The caps are mine). In your experience does Buspar usually cause nervousness? That is certainly not anything I need.

 

Check the RX page on this site

Posted by DL on September 13, 1998, at 23:41:27

In reply to Side effectts of Buspar, posted by DL on September 13, 1998, at 23:27:08


> Toby, Have you read the current question on this site's RX page? What are your comments? It is on social phobia and meds.

 

Re: Side effects of Buspar

Posted by Toby on September 14, 1998, at 12:34:09

In reply to Side effectts of Buspar, posted by DL on September 13, 1998, at 23:27:08

Buspar generally does not cause nervousness but everyone reacts differently to every different medication. If you start it at a low enough dose and eat a little with it when first starting out, most people tolerate it well and cannot tell they are even taking anything until a couple of weeks later they start to really feel better.
I don't know if the conference your therapist is going to is a training conference or not, but I didn't see Columbia listed as an upcoming training session, so I would assume not. In which case, she won't want to use EMDR until she is actually trained (a couple of lectures just doesn't get it). Regarding the therapists you found that don't have initials after their name, I couldn't tell you what their credentials would be, but you can only get the EMDR training if you are a real therapist and have a licensing board for whatever your training is. Call a few of them and, if several have openings fairly soon, choose based on any feel of good rapport you may get, or if you don't get to talk directly to them, Level II training is better. Don't worry too much about the initials they have after their name.
Regarding the meds for social phobia: I don't have any personal experience with prescribing MAOI's for social phobia. I've used cog-beh therapy, Inderal for performance anxiety, Paxil several times for pervasive anxiety, and EMDR for situational panic attacks. Never had to resort to the MAOI's.

 

Re: Buspar

Posted by DL on September 14, 1998, at 20:41:23

In reply to Re: Side effects of Buspar, posted by Toby on September 14, 1998, at 12:34:09

> I don't know if the conference your therapist is going to is a training conference or not, but I didn't see Columbia listed as an upcoming training session, so I would assume not. In which case, she won't want to use EMDR until she is actually trained (a couple of lectures just doesn't get it).

I realize this. I called and it is a one day "conference". I think it is just informational. They will send me a pamphlet. I just thought she might become familiar with the local people who are practiced in it so she could recommend someone. To me it is scary to choose someone from a list and suddenly allow them inside my pain.. I feel safer when I have a recommendation from someone who knows the person. I imagine I won't get to talk to the professionals themselves--perhaps a secretary--that seems to be the way it is now.
.
> You can only get the EMDR training if you are a real therapist and have a licensing board for whatever your training is.

That is good to know, thanks.

> Regarding the meds for social phobia:

I wan't really thinking of the other meds. Only the comment that Buspar is of no use--which was emphasized. Buspar seems to be viewed by one group as totally useless and by another group as a drug that is underused and has great potential. Why such a division of opinions?

I have 2 more therapy sessions authorized and then could try to get authorization for a diff therapist. I will call insurance co and see if any of those people are on the list of providers before I call them. Would it be likely that someone trained in cog beh would also be EMDR cert?

Thanks for hanging on with me.

 

Re: Buspar

Posted by Toby on September 15, 1998, at 8:36:57

In reply to Re: Buspar, posted by DL on September 14, 1998, at 20:41:23

There are more than 20,000 therapists trained in EMDR now and so it is highly likely that one or more will be on your insurance company's provider list. It's hard to say whether someone trained in cog-beh therapy would be likely to be trained in EMDR, but the reverse is almost sure to be true.

In regard to the Buspar, there are generally two camps of thought on it, as you have seen. Those who tried it early on when it was first released and found that it didn't work because they were using it in patients actively abusing substances or were using it in patients who didn't have the disorder that it is indicated for, which is generalized anxiety (to which I think social phobia is closely related). If they gave up on it at that point and didn't try it again or didn't mend their prescribing ways, they are going to think that Buspar doesn't work at all. Once a doctor gets comfortable with it in generalized anxiety disorder, he can begin to branch out a little in prescribing it for certain other patients for whom other medications don't do much and sometimes the chmistry works just right. These doctors have more confidence in Buspar because they've learned how to channel the medication toward the right patient. And that's more the art of medicine than the science.

 

Reply

Posted by DL on September 15, 1998, at 22:42:49

In reply to Re: Buspar, posted by Toby on September 15, 1998, at 8:36:57


> There are more than 20,000 therapists trained in EMDR now and so it is highly likely that one or more will be on your insurance company's provider list. It's hard to say whether someone trained in cog-beh therapy would be likely to be trained in EMDR, but the reverse is almost sure to be true.

Thanks for the info. The "professional symposium" at the Portsmouth Hosp. is an overview or EMDR 9 only 3 hrs. It is taught by Roger Solomon PhD a member of the EMDR Institute. Objectives are : to understand the model, the research, and how it fits in to a total rx plan. I have the national exam for my profession this Sat for 4 hrs in Boston. Pretty stressful getting ready for it. But I will be checking out EMDR practicioners soon. Thanks agian

 

Help!

Posted by DL on September 21, 1998, at 19:23:16

In reply to Reply, posted by DL on September 15, 1998, at 22:42:49

Toby,
I saw the psychiatrist today. It has been a long time since I saw him. I spoke to him about Buspar and your other recommendations of Remeron and Serzone. I am so glad I had some information to take with me since the visits are so short and he always seems to have to rush somewhere.

As you suggested, he brushed past the EMDR. my impression was that he didn't even know what it was.

After I brought it up he talked about Buspar and asked if I had tried it before (I would think he might know since he's the only MD I have seen for mental health). I reminded him he had told me over a year ago that it probably wouldn't help me. He said his opinion was that it was a very mild anxiolytic.

He then took the time to actually ask me what was going on in my life. I told him divorce mediation, atmosphere at home, and work were making me feel like I was only loosely held together with spider web and that I felt constantly at risk of coming apart. I have been routinely crying most of the time while I drive and even wtih other people will hold my breath or swallow or change the subject from me in order not to cry. He suggested I should try Remeron. He knows how terrible the SSRI's were for me more than a year ago but said Remeron should help me sleep and that some people are now using it for that in the same way Trazadone is used.

He gave me a prescription for the 15 mg tabs and said to cut them in half and take it at bed time. He said I could also keep taking the klonopin but to only take a half. Trying to work, mediate and with my sleep deprivation I am really leery of trying it and would like your comment. I asked if he would want me to increase the dose and he said no, to just stay at the 1/2 tab and come back in 6 wks! He always says to call if any problems but he is never available.

Before I knew it the visit was up and I was on my way out! On the way home I realized there was no discussion of Saint John's Wort. I have been taking 4 tablets a day for 3 months. Recently I ran out and only took 2 one day and noticed increased anxiety/racy feeling in the afternoon and evening. Not sure if it was directly related, but the next day I took the 4 agian and felt better. So I wonder if I can taper off while taking Remeron, or still take it also (a number of people take AD's and SJW and do fine (see hypericum.com). Or do I have to suddenly stop? And should I also stop the one tab of kava? He did not address any of these.

I will wait to hear from you or if not I will try to leave a message for him before starting the Remeron. It is a prescription for 15 tabs (30 doses) with 2 refils.

Not sure what to do. Will taking this interfere with EMDR if I find someone? Because I do want to try it? Help. I am not sure what to do here. And I don't want to be any more affected at work than I already am. You can answer to my e-mail if you want. Dotty

 

Re: Help!

Posted by Toby on September 23, 1998, at 13:55:41

In reply to Help!, posted by DL on September 21, 1998, at 19:23:16

Since he gave you a total of 45 pills and you will see him in 6 weeks (about 42 days), and you will be breaking the pills in half (a total of 90 days worth of medication), then there is certainly room to increase to the full 15 mg dose if 7.5 mg is too sedating. The 7.5 mg is not enough to help depression, but getting good rest is a good start. Since he did give you that many pills, my guess is that you could start with the 7.5 mg for about one week to 10 days and if you are being too sedated during the day, call his office and request to increase to the 15 mg dose. You will still have enough medication to last until you see him in six weeks and increasing the dose will relieve the daytime sedation.
The SJW will probably be OK to continue with the Remeron for now since the dose will be so low, but when you see your doctor again, be sure to tell him you are taking the SJW because there can be interactions between it and any other antidepressant (the interaction can be severe and cause high temperatures, seizures and death). We talked about the kava before and I think at the present dose of klonopin it should be OK to continue it as well for now. The only problem I have with herbals is that the dose is not regulated and you never know from dose to dose what milligrams you are getting and how that dose will interact with your other medications.
None of the medications you are taking, nor about to take, will interfere with the EMDR. The only way it won't work is if you go into it while intoxicated. When you go for the session, don't try to "make" anything happen, don't try to "figure things out," because your brain will do all the work automatically and really too quickly for you to ponder over them during the session. Just let things come to mind and leave again on their own. Concentrate on the physical feelings that come up and do what the therapist tells you to do. Be honest with the therapist and yourself. Other than that, your brain will make the connections and adjustments it has been trying to, but has been too overwhelmed to.

 

Remeron

Posted by DL on September 23, 1998, at 22:20:10

In reply to Re: Help!, posted by Toby on September 23, 1998, at 13:55:41


THANKS FOR RESPONDING! Where do I find a doctor like you? I'll bet you don't run out the door and hop in your car as soon as your patients leave...The psychiatrist I see is a nice person, but I always feel he just really does not have time for me, and sticks pretty much to what he has always done--not much innovation or individual attention. Perhaps if I see someone for EMDR he/she can suggest another MD if I am still on any kind of med? I will see my therapist this Sat, right after a long mediation session. She will have been to the lecture on EMDR by then and may have suggestions of a person. locally.
> The 7.5 mg is not enough to help depression, but getting good rest is a good start. Since he did give you that many pills, my guess is that you could start with the 7.5 mg for about one week to 10 days and if you are being too sedated during the day, call his office and request to increase to the 15 mg dose.

I think he prescribed the small dose because of my reactions to tiny doses of other AD's in the past. I was surprised he did not suggest increasing the amount at some point though. Would the 15 mg be enough to affect depression or would I probably need more if I could tolerate it?

> The SJW will probably be OK to continue with the Remeron for now since the dose will be so low. We talked about the kava before and I think at the present dose of klonopin it should be OK to continue it as well for now.

When I could not get the MD by phone--and did not want to talk to one I did not know, I did check one other place. My sister is a nurse and knows a very knowledgeable Pharm D at the Veterans Hospital in Manchester NH. When I talked to her by phone this week (and I was at a breaking point...........) she suggested I e-mail him and ask about the SJW and Kava. He did reply and suggested I taper off the SJW over a few days then start the Remeron. So I took only 3 on Tue and only 2 this morning. So perhaps I should be courageous and take the Remeron tonight......He also suggested I not stop the klonopin till I found out if the Remeron helps me. And he agreed with you that the one tab of kava would be OK.

But he did suggest I have baseline WBC and LFT tests and again after 2-4 weeks since a small percentage of people have problems with Remeron. I don't know what LFT is, but I do know that in past blood tests ( 1 1/2 yrs ago and 3 yrs ago) I was told my WBC was slightly below the span of normal each time. Any comments on the above? What is LFT? And should I request these tests? THe psychiatrist never had blood tests done except once when I took Pamelor 2 yrs ago only to check its level. This person also commented I should watch what I eat since a significant # of people have weight gain on Remeron.

QUESTION: Do AD's really work for some people? I mean do they say, wow I really feel better? Because I just seem to hear about the ones who have all the side effects and problems...

The only problem I have with herbals is that the dose is not regulated and you never know from dose to dose what milligrams you are getting and how that dose will interact with your other medications.

The SJW I was taking was the KIRA brand that comes from Germany and was used in the published studies. The Kava had a standardized amount of kavalactones which are supposed to be the active ingredient
.
> None of the medications you are taking, nor about to take, will interfere with the EMDR. The only way it won't work is if you go into it while intoxicated. When you go for the session, don't try to "make" anything happen, don't try to "figure things out," because your brain will do all the work automatically and really too quickly for you to ponder over them during the session. Just let things come to mind and leave again on their own. Concentrate on the physical feelings that come up and do what the therapist tells you to do. Be honest with the therapist and yourself. Other than that, your brain will make the connections and adjustments it has been trying to, but has been too overwhelmed to.

Thank you for the very humanistic explanation. It helps to put me at ease about EMDR. Even if I have to find the money without insurance coverage I will see someone. I used to dirink a glass of wine occasionally but it has been a few years since I have been able to. Even though sometimes it would relax me for a few hours, I would have a backlash after that similar to coffee and SSRI's--I would wake up and feel racy and stay awake. THe last time I tried a glass of wine I started to feel that way within 30 min. I hope the therapist is good at disconnecting me from the defenses I have used for years. I have become very good at canceling pictures and thoughts from my past.--because when I allow myself to think into myself the tears well up and I feel so fragile..

QUESTION: I have been taking a low dose of natural hormones (estradiol and micronized progesterone) to see if that will help. When I had a recent test done through Madison Womens Pharmacy, the nurse there called and said my estradiol level had shot way up to high levels even though I was only taking a tiny dose. She said this frequently happens when there are thyroid problems. She is going to call my GYN to suggest I have a thyroid antibody test done. A few times in the past diff Drs during regular check ups have had TSH done since my thyroid area seems somewhat enlarged. But I was told each time it came out within the normal range. Is this something that can affect depression or anxiety? I know that thyroid problems are fairly common after birth in women but when I had problems years ago I don't think it was checked.

Thanks again for hanging on for me. After the last few years it's nice to know there are a few MD's out there who care.
Dotty

 

Re: Meds

Posted by Toby on September 24, 1998, at 10:27:52

In reply to Remeron, posted by DL on September 23, 1998, at 22:20:10

15 mg of Remeron does work in some people and I have several patients who have gotten relief with 15 mg alone, but many people need to go on up to 45 or 60 mg per day. Weight gain can be a problem at the low doses, not so much at doses above 30 mg, and it is mostly because of some increased craving for sweets and carbohydrates, so watch those. LFT's are "Liver Function Tests." In the clinical studies, 2% of patients had elevations in one of the enzymes that the liver makes; in most of these patients, the enzyme returned to normal and the patients did not have any symptoms of liver trouble. You probably don't need blood work done specifically for starting Remeron. Every patient should have baseline blood work done at the very beginning of treatment for depression or anxiety so that medical causes of depression can be ruled out. If that was done for you when you first started seeking treatment, you probably don't need to repeat most of it. However, the thyroid situation is interesting (if you'll pardon that word). Even if the blood work shows normal or borderline normal levels of thyroid hormone, if you clinically show evidence of hypothyroidism, a small dose of Cytomel (NOT Synthroid) may be very helpful in treating your depression. As far as the CBC goes, stress can cause drops in the white count but it is also a normal finding in about 20% of the population. If there was nothing else suspicious in your CBC, it is probably normal for you. Bottom line, unless it has been several years since you have had any routine blood work done for general health reasons, the only test I would recommend that you really should get for now would be the TSH and the thyroid antibody test.
During the EMDR, you want to try really hard to bring up that painful physical feeling you get in your throat and chest. Think about whatever you have to to keep that feeling going. That will help you to keep from blocking out the pictures. And it doesn't really even matter if the pictures are present before your eyes (with the eye movements, most people can't "see" the pictures well anyway), as long as you "just think about the event" and keep that physical feeling going, your brain will be processing things. And suddenly, that feeling will decrease in intensity, and the event won't hold as much power anymore. From there, it gets progressively easier and easier. And what you process during the session, stays processed; in other words, you don't just get temporary relief, it's permanent. You can try, but the feeling will not be able to get back to the same intensity as it was before, in which case your brain will view that event as "not very important anymore." That's the part that's hard to understand until you experience it because of course those terrible experiences are important and they do matter, but they are stuck in the kind of feeling that "it's still happening, I can't get away" and that causes them to be important in a destructive way and not allow you to grow past them. When your brain experiences them as "not important anymore" the events become important as a learning experience and possibly as a way to galvanize you into age-appropriate action to take care of yourself, but no longer "important" in an overwhelming, frozen-in-time kind of way. You just have to experience it to really get it, but you probably already know that that's kind of the way you want it to be, you just can't get there. Well, good luck on Sat.

 

Started Remeron

Posted by DL on September 24, 1998, at 16:33:23

In reply to Re: Meds, posted by Toby on September 24, 1998, at 10:27:52


> 15 mg of Remeron does work in some people and I have several patients who have gotten relief with 15 mg alone, but many people need to go on up to 45 or 60 mg per day.

Last night I took the half tablet of Remeron (7.5), a half tablet of klonopin (.25mg) and one tablet of kava. I did sleep differently--seemed to be deeper. My alarm woke me and it was very difficult to get up. I would have liked to stay in bed and sleep longer. This is strange for me because I always wake before the alarm and this is ususally about 5 hrs after I go to bed. But I had to go to work.

However, the feeling hung on all day. I couldn't shake it. Even eating some chocolate didn't cause the hyper feeling it usually does. I think I could have fallen asleep at my desk--which is VERY different for me. Right now I am home between work and an evening meeting. I am wondering how I will stay awake at the meeting. Should I try to stop the klonopin and also stop the kava? Perhaps they are increasing the effect of the Remeron? Or is this normal for Remeron? Or is this my overreactive system again? I am a little worried about driving more tonight due to this. Perhaps going to bed earlier will help. I usually don't because then I wake up so early in the morning.

Is there anything I can do to cope with this feeling? although it is nice that the racy feeling is not there, it is not so great to be so sedated either. It also helps me to see that I was not sabotaging my own tx. I was told at one time that the AD's caused these symptons because I didn't really want to get better!

> Weight gain can be a problem at the low doses, not so much at doses above 30 mg

With my sensitive system and all this drowsiness, do you think I could take more, and how quickly should I titrate up? I can call the MD and ask him about this if you think it would help the drowsiness. Actually it I didn't have to go to work and look for a place to live I would just sleep for days and no one would appreciate it more! Sleep has been elusive for me for years.


However, the thyroid situation is interesting (if you'll pardon that word). Even if the blood work shows normal or borderline normal levels of thyroid hormone, if you clinically show evidence of hypothyroidism, a small dose of Cytomel (NOT Synthroid) may be very helpful in treating your depression.

MD's office has not called me so I will have to check with them about the tests. They did a "hyperthyroid screen" almost a year ago and told me results were within normal spans but I did not see the results. Before that TSH had been tested by PCP and then GYN at various times.

I thought HYPOthyroid meant too much sleep and slowing down, not anxiety symptoms and lack of sleep?

> During the EMDR, you want to try really hard to bring up that painful physical feeling you get in your throat and chest.

Thanks again for the GREAT explanations. I will find a way to try this out.

This feeling from the Remeron just won't leave. I wish I could just go to sleep now. And I actually think I could!!! It has been years since I could sleep during the day....But, sleeping all day is not too functional either.

Well, good luck on Sat.

THANKS! There haven't been a lot of supportive comments in my marriage in years. I guess I have made it the "status quo" and accepted it. I look forward to being able to talk to you. I wish the MD's were more available. I feel so much more supported when I can get my questions answered.

Sincerely, Dotty

 

Re: Started Remeron

Posted by DL on September 24, 1998, at 22:51:06

In reply to Started Remeron, posted by DL on September 24, 1998, at 16:33:23

I am now home from the meeting. I had to stop and get coffee. I never drink coffee. Within the last few years it has sent me into orbit. But I didn't know what else to do to counter the sedated feeling for my meeting. The coffee did not wire me. Rather it just evened out the sedation. I made it through the meeting OK and drove home. Actually felt OK.. Could have just been that the Remeron wore off by then though (18 hrs). Now I have taken the second dose of a half tablet but NO klonopin or kava. Hopefully I will still sleep but not be as sedated tomorrow. Not feeling as small and fragile and lost as I was. Perhaps just having someone respect my knowledge and experience and situation is having an effect? Dotty

 

Re: Started Remeron

Posted by Toby on September 25, 1998, at 8:43:28

In reply to Re: Started Remeron, posted by DL on September 24, 1998, at 22:51:06

I would definitely say to increase the Remeron to 15 mg since 7.5 mg made you so sedated and it hung on throughout the next day. You may still feel some sedation during the day at 15 mg because your body will need to get used to it, but since the weekend is here that will buy some time. If you still feel sedated during the day by Tuesday at 15 mg, call the doc and get permission to increase to 30 mg. That will mean you will run out of medication early, so he may need to call in a new prescription (or give yousamples to tide you over if he has any) if your insurance company won't pay for a refill in the same month. Stopping the kava and klonopin is fine. Give your body these next few days to adjust to all the changes.

 

Second day on Remeron

Posted by DL on September 25, 1998, at 18:16:46

In reply to Re: Started Remeron, posted by Toby on September 25, 1998, at 8:43:28


> I would definitely say to increase the Remeron to 15 mg since 7.5 mg made you so sedated and it hung on throughout the next day.

Today I was still very sedated. Had another cup of real coffee on way to work since I was so out of it. That helped some but by afternoon I was back in the same place again. I again felt un safe on the road. Perhaps the klonopin still needs to wash out of my system some. I will try the 15mg tonight but am afraid with the mediation session at 9 AM tomorrow morning that I won't be able to attend and take part fully.

> If you still feel sedated during the day by Tuesday at 15 mg, call the doc and get permission to increase to 30 mg.

I will keep this in mind if I can make it through the weekend. I may have to make some important decisions about my life in mediation and with real estate this weekend so I hope I can think straight.

My GYN doctor called in an order for thyroid tests to the lab. For TSH and Thyroid antibodies I think. I will have them done before mediation tomorrow morning. I hope the Remeron does not affect that test. I will ask for a copy of the results from this and previous test from the MD.

What should I say to the psychiatrist if I call in for increase in prescription? Should I just tell him what you said about decreased sedation?
'
How long will it take before I should expect results from the Remeron other than sedation, and what should I notice?

Thank you for checking in.....Dotty

 

Foggy and confused

Posted by DL on September 27, 1998, at 19:29:33

In reply to Second day on Remeron, posted by DL on September 25, 1998, at 18:16:46

Yesterday, after taking the 15 mg (I didn't call and ask the Doc since there is only emergency on call nights and weekends) and no klonopin I was a little less sedated but still shouldn't have been driving. More foggy/slow thinking compared to the heavy sedation of the previous 2 days. BUT, my sleep at night returned to the "just under" light sleep I usually have--in fact worse than usual. Now I wish I could have taken those first 2 days off from work when I was so drowsy and just slept. It would have been such a treat for me --you can't even imagine!

I made it through the mediation session Sat. but later at my counseling session the therapist said she was worried about me because of the sedation. After the session I sat in my car in the parking lot for about 2 hours--in and out of a very light sleep. I was off and on aware of the clock and noises, but was startled when the therapist woke me on her way home. She was worried about me driving and stayed with me for about 10 min until I got her to believe I was OK.

I again took the 15 mg last night but was in need of sleep so I took 1/2 the klonopin tablet also. But I still had that same "just under" non dreaming sleep. I remember seeing the clock many times during the night. Is it the Remeron that is causing this? And will I continue to have this kind of sleep? I am pretty confused and don't know whether to take the klonopin or not at this point. Should I continue to take the Remeron? What should I expect if I continue to take it? What should I be looking for to know if it is helping me or not?

Sat. I felt some of the physical tension and hyper feelings I used to have--but under the blanket of sedation. That, and sleep changes prompted me to take the small dose of klonopin. Perhaps tonight I will take the .5 klonpin and see if I sleep better. Any suggestions? You were right that the sedation decreased some, with a larger dose but the sleep did not get better. I may be going to a 2 day conference on Fri and Sat and hope by then to be alert but rested. [Yes know this is probably asking too much considering how my system reacts to drugs]

Do you think changing Docs would be a good idea? The therapist said I should consider that as an option if I feel the one I have is not helpful to me. I am just so tired of the work of life---I just want some peace--

The therapist said she thinks my problems stem more from anxiety than depression and that the depression is probably related to the anger I have pushed back inside related to physical/mental abuse from my husband--and to the stress I have at work and home daily. With the divorce almost all set and the house almost sold I will be out on my own soon--scary after 20 years, but perhaps I will find some peace somewhere--

Do you still think the Buspar is something to try? In case I do switch Docs? I need some guidance on how long to try the Remeron and what I should expect to see if it is working.

As always thank you. I wish my MD here could be available and knowledgeable enough to discuss this with me as you have done. I feel pretty low on his list of priorities. And pretty lost also. Dotty


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