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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Renee N on February 22, 2000, at 23:16:23
I had a long weekend(President;s Day) and just slept it away. I would crawl back to bed after being up only an hour or two. I was yawning in the shower right after getting up from seven or more hours of sleep. I could barely stay awake at work today. I take 225mg Effexor XR(recently went up in two baby steps from 150. I had read that sometimes you need a higher dose to get to the energizing effect!? It doesn't make a whole lot of sense to me, but I have read it more than once. I also take 150mg Wellbutrin Sr, and 10 mg of ADDerall three times a day. At one time I took 30 mg of ADDerall twice a day, or was it three times? Anyway my pdoc had me lower the ADDerall due to BP problems. I'm now on BP medicine, and my BP is back in the normal range. I feel like getting off all my meds, because nothing helps my *@#! memory and pooor attention to detail anyway! Maybe I should go back to just coping with the ADD the best I can, and learning to accept what I can't change. I had big plans about all the housework I could get done with the extra day off. What a joke!I feel like an incompetent loser.
It sure didn't help that today I had to go pay $20 to get my speeding conviction back to court. I paid the fine the day I got it, but didn't send the request for court supervision in in time, so I was convicted. Now I also will lose a day's pay at work. Subs don't get paid when they don't work.
I realize that others here have some much more serious problems than I do, but I needed to tell someone how I'm feeling. My husband certainly doesn't want to hear it. My pdoc told me to come in every 3 weeks for awhile, until we can find the right meds, or figure out if ADD, or depression, or both are the cause of my problems. Well, that was right before Christmas! The receptionist said she would call when they figured out his new schedule of having med checks on Saturdays now. A couple of weeks ago I called, and she said that their computer was down for 5 days, so it wasn't a good time to ask about schedules. Yesterday I wnet in to pick up a scrip, and finally got an appointment for the middle of March. Should I change pdocs? Are they all like this? Are the only ones who take hmo patients a bunch of losers desperate for patients? If I do change, what do I do? Do I tell the old one why I'm changing, or just do it and ask him to send my records?
Posted by medlib on February 23, 2000, at 2:11:29
In reply to Too sleepy on Effexor, posted by Renee N on February 22, 2000, at 23:16:23
Renee-
I'm relatively new to Effexor, too (late November). Each time I increased the dosage, the initial side effects would return--for me, excess sleepiness and nausea--and each time they went away eventually. My sleep is still messed up, but it's difficult to tell whether that's due to the remaining depression, the fact that I have always been a night owl, or from the lack of external structure (no job right now). I sleep in 2-5 hour chunks.
So, your sleepiness, too, may be due to the recent E. increase. At higher doses Effexor is supposed to affect the NE receptors in addition to the seratonin ones. More time at this higher dose may decrease the sleep side effect and increase energy (NE effect). BTW, Effexor raises BP in some people.
Also, many BP drugs can cause sleepiness (especially the Vasotec I'm on and betablockers).And did your pdoc ever explain why Adderall? I'm under the impression that Ritalin is more effective for ADD--maybe Cam can tell us for sure.
Few things in life are as frustrating as tweaking drug cocktails--it takes so much time and there seem to be an infinite number of permutations and combinations. For me, the stress and uncertainty this causes tends to make each minor setback seem like a last straw! That's why this board is so helpful; no reasonably normal person can possibly understand this. (I'm on the 3rd week of a BuSpar augmentation trial; so far it has done nothing--except reliably generate migraine headaches.)
Don't beat yourself up over small "failures." We each have to play the hand we were dealt; mine didn't include "perfection," or even "normal." So far, wishing, and occasionally striving for those has left me unable to see, much less enjoy, what I do have.
Re your pdoc: Unless you really like him, why put up with that kind of treatment? If you feel confrontational, you could call, insist on talking with him "about the course of your treatment" and tell him you're dissatisfied with the behavior of his front office staff and have been unable to get an appointment per his request.
If you don't like him enough to bother with that, pick out another pdoc and go with a list of questions (including his policy on stimulants).
Transferring medical records is no problem; you just sign a release form at your new docs, give them the name and address of your old doc and they will request your records.This certainly isn't my most coherent post; hope some of it helps. Good luck.
medlib
> I had a long weekend(President;s Day) and just slept it away. I would crawl back to bed after being up only an hour or two. I was yawning in the shower right after getting up from seven or more hours of sleep. I could barely stay awake at work today. I take 225mg Effexor XR(recently went up in two baby steps from 150. I had read that sometimes you need a higher dose to get to the energizing effect!? It doesn't make a whole lot of sense to me, but I have read it more than once. I also take 150mg Wellbutrin Sr, and 10 mg of ADDerall three times a day. At one time I took 30 mg of ADDerall twice a day, or was it three times? Anyway my pdoc had me lower the ADDerall due to BP problems. I'm now on BP medicine, and my BP is back in the normal range. I feel like getting off all my meds, because nothing helps my *@#! memory and pooor attention to detail anyway! Maybe I should go back to just coping with the ADD the best I can, and learning to accept what I can't change. I had big plans about all the housework I could get done with the extra day off. What a joke!I feel like an incompetent loser.
> It sure didn't help that today I had to go pay $20 to get my speeding conviction back to court. I paid the fine the day I got it, but didn't send the request for court supervision in in time, so I was convicted. Now I also will lose a day's pay at work. Subs don't get paid when they don't work.
> I realize that others here have some much more serious problems than I do, but I needed to tell someone how I'm feeling. My husband certainly doesn't want to hear it. My pdoc told me to come in every 3 weeks for awhile, until we can find the right meds, or figure out if ADD, or depression, or both are the cause of my problems. Well, that was right before Christmas! The receptionist said she would call when they figured out his new schedule of having med checks on Saturdays now. A couple of weeks ago I called, and she said that their computer was down for 5 days, so it wasn't a good time to ask about schedules. Yesterday I wnet in to pick up a scrip, and finally got an appointment for the middle of March. Should I change pdocs? Are they all like this? Are the only ones who take hmo patients a bunch of losers desperate for patients? If I do change, what do I do? Do I tell the old one why I'm changing, or just do it and ask him to send my records?
Posted by S. Suggs on February 23, 2000, at 4:54:37
In reply to Too sleepy on Effexor, posted by Renee N on February 22, 2000, at 23:16:23
Hello Renee: First, Effexor made me sleepy when I took it in the past (200 mg day for 6 mo.). A drug change here may be in order. As a suggestion, I've read a lot about Vivactal (protriptyline) a tca with a little more of a energizing effect than the other tca's.
Secondly, changing docs is a pain, but you owe him no reason, just move your records. Only if you have a good working relationship would I give any indication as to why. I wanted to change docs a year or so ago. But now, I have a relationship with mine that is great. He knows that I know more than the average patient about meds and will listen to me. If my case is logical and sound (do your homework) I can usually get him to write what I think I need. He is a great guy. Also, I've found (11 years in medical sales and calling on dr offices) you can go out of your way to be extra nice to everyone, even when you don't feel like it. It makes you stand out from the rest of the patients. Remember their names and use them. Sorry to ramble. Best wishes and blessings,
S. Suggs
Posted by S. Suggs on February 23, 2000, at 4:57:22
In reply to Re: Too sleepy on Effexor, posted by medlib on February 23, 2000, at 2:11:29
Found out when I took effexor that It made me sleepy during the day and at night while I thought I was sleeping I was only getting around 15 min of rem sleeep!!?? That was the reason for dropping effexor. blessings,
S. Suggs
Posted by Noa on February 23, 2000, at 4:58:39
In reply to Re: Too sleepy on Effexor, posted by medlib on February 23, 2000, at 2:11:29
> Renee-
I have had similar frustrations with my pdoc. His office is chaotic, the staff aren't the most professional, they are hard to reach, he is hard to reach. A couple of years ago I finally confronted him and said I couldn't work with him anymore if I can't reach him or get an appointment, etc. That is when he gave me his pager number and told me to page him to reach him. I said I was uncomfortable if I interrupted him at work, he said it was ok. I don't especially like the idea that he answers pages during sessions, but I have come to accept it. If I page him and he is with someone, he lets me know and then calls back later. Now I have figured out to page him right before his first appointment of the day, or right after his last (in fact I am going to page him this morning about my lab results). I have considered changing docs, but he is good at what he does, despite his awkward social skills, and poorly run operation. When I looked into changing, I found there were other docs who don't accept insurance, and their fees were way out of my affordability range.I think confronting your doc about this might be worth considering. Then, his response can be your final criterion about whether to continue working with him. If he gets defensive, or doesn't listen to your grievances, you'll know it is time to move on. Or, maybe he will respond appropriately and you'll get some changes.
By the way, it took me a LONG time to muster up the courage to confront my doc about this. I am not great at confrontation. But I am glad I did it.
Good luck.
Posted by Cam W. on February 23, 2000, at 7:23:12
In reply to Re: Too sleepy on Effexor, posted by Noa on February 23, 2000, at 4:58:39
> > Renee-
> I have had similar frustrations with my pdoc. His office is chaotic, the staff aren't the most professional, they are hard to reach, he is hard to reach. A couple of years ago I finally confronted him and said I couldn't work with him anymore if I can't reach him or get an appointment, etc. That is when he gave me his pager number and told me to page him to reach him. I said I was uncomfortable if I interrupted him at work, he said it was ok. I don't especially like the idea that he answers pages during sessions, but I have come to accept it. If I page him and he is with someone, he lets me know and then calls back later. Now I have figured out to page him right before his first appointment of the day, or right after his last (in fact I am going to page him this morning about my lab results). I have considered changing docs, but he is good at what he does, despite his awkward social skills, and poorly run operation. When I looked into changing, I found there were other docs who don't accept insurance, and their fees were way out of my affordability range.
>
> I think confronting your doc about this might be worth considering. Then, his response can be your final criterion about whether to continue working with him. If he gets defensive, or doesn't listen to your grievances, you'll know it is time to move on. Or, maybe he will respond appropriately and you'll get some changes.
>
> By the way, it took me a LONG time to muster up the courage to confront my doc about this. I am not great at confrontation. But I am glad I did it.
>
> Good luck.Renee - Effexor is a different antidepressant. At low doses (75-150mg) it acts like an SRI (eg Paxil) blocking serotonin reuptake ; at higher doses 225-375mg) it acts like the TCA Desipramine, blocking both serotonin and norepinephrine reuptake; and at still higher doses (600-700mg - very unlikely to be used clinically) it also starts blocking dopamine reuptake. Medlib is right. With each increase in dosage the side effects usually reappear for a week or so. Hang in there and see if your body will adjust to the higher dose (perhaps your doctor has been avoiding you because he has seen the sedation on dosage increases of Effexor and expects the drowsiness, etc. to go away. But he should tell you this). As for ADDerall; sorry, we don't have this drug in Canada, so I am not very familar with it clinically. I do know that the combination of Effexor and a drug like ADDerall can, in some people, increase blood pressure. Give it a few more days and see what happens. Keep us informed. Good luck - Cam W.
Posted by peter on February 23, 2000, at 23:02:34
In reply to Too sleepy on Effexor, posted by Renee N on February 22, 2000, at 23:16:23
Renee
I can think of six things than may be associated with your president's weekend, maybe just looking at these may help you.
1) Are you (still) depressed? Maybe the effexor really isn't working like you really want.
2) Effexor does take a while to kick-in and some sleepyness may be a side effect that will go away in time (were you sleepy when you first started effexor?). If you recently upped the dose, this may be the culprit.
3) I couldn't sleep well on wellbutrin so I don't think that's the problem -- rem. I'm only one case.
4) Could the BP meds be making you tired?
5) Maybe what you really wanted was for your husband to either listen better or help clean the @#%@#ing house himself.
6) If you don't remember the benefits of adderall for your ADD/ADHD symptoms, it wasn't working. Try ritalin or dexedrine with a good pdoc or psychologist.Finally, no amount of medication in any combination is going to fix your doctor's (and his office's) problems. Fire this guy! You should call and explain why you're leaving ONLY if that will make YOU feel good, otherwise start shopping for a new doc who fits your HMO. If its at all possible start with local reference (e.g. chadd chapters in most major cities). Don't assume that just because a referred doc isn't on the HMO list you can't work things out. Call the Doc. Call the HMO.
Its standard for doctors to get records from previous ones if they have your permission.Good luck, you'll be doing better soon. Heck, its hard and time consuming enough moving through drug regimens to find one that works without having to also find a pdoc that works.
Posted by Brad H on February 24, 2000, at 17:55:22
In reply to Re: Too sleepy on Effexor, posted by medlib on February 23, 2000, at 2:11:29
I've had the very same effect on Effexor. I believe when I finally went off of it, I was at the maximum dose of 375mg. I spent my whole days sleeping and eating like mad. I was on Effexor for close to a year and half. I did enjoy that it was the first medicine to calm my anxiety. I was taking mine for depression, so may have a different effect for ADD. I thought that it was just my residual depression that was making me sleep so much, but when I finally changed meds I could not believe the change that occured. I was a lot more lively. So there may be a strong chance that the Effexor is causing the sleepiness. Usually Wellbutrin is a more energizing drug, and the usually dose for depresion is 300mg and can increased all the way to 400-450mg with sustained release. So you may want to look at that avenue.
Posted by Renee N on February 26, 2000, at 2:32:08
In reply to Too sleepy on Effexor, posted by Renee N on February 22, 2000, at 23:16:23
all for your responses. I truly appreciate your ideas, suggestions, questions, experience, and last , but certainly not least, your caring support.
Last night I made a post to thank you. By the time I realized it never showed up, I was too exhausted to repost. I was so dissapointed because I had been oh so clever, funny, etc. Kind of like the fish that got away...
I have tried the other stimulants. While ADDerall doesn't do all I wish it would, I think it helps me to stick with boring tasks and listen a little better.
I have tried Wellbutrin SR up to 450 mg a day with stimulants. It made me less upset about the ADD, but did not improve it. Wellbutrin made me become more easily agitated by my kids, and more loving to my husband. It gave me horrible mouth sores. In fact, I believe my gums became agitated to the point of needing gum surgery(had it a few years ago, also) from the Wellbutrin. 150 mg doesn't seem to cause any adverse reactions for me. I think my pdoc left it in my mix to help my libido. My lack of desire has been a problem throughout my marriage. After I was on Wellbutrin for a short time, I developed an insatiable appetite for sex. Unfortunately for my husband and I, it went back to nearly nonexistant after a couple of very happy, long to be remembered months. (Can you hear me sighing?) Now I can understand men's strong urges. I'm glad my husband knows now that the problem is not him or my feelings for him, but something physical with me.
Speaking of my husband...he was was on a trip the weekend I was talking about in my last post. When he is home, he usually vacuums every weekend. I wish I could say that I also usually get the dusting done and the bathrooms clean, but I am honest to a fault(except when it comes to chocolate. I will steal chocolate with no guilt feelings at all! Once my husband walked into the room just as I was biting off the head of his chocolate Easter bunny. Another time my college roomate's chocolate fudge kept becoming mysteriously smaller everytime she quit doing drugs at her boyfriend's long enough to stumble in for more clothes or something. My kids and I have come to an agreement that I may take candy from them without asking, since when I replace it, I always give them more than I took!)Okay, so I got off subject there, so sue me! I'll just get my lawyer to plead not guilty due to ADD!
Actually my husband is much neater and harder working than I am. My daughter takes after him. My son and I on the other hand...well, let it suffice to say our socks are not all folded in the drawers in neat little rows, and we have never even considered the idea that underpants can be folded. I mean what's the point?! I guess I should be thankful that everyone in the family can relate to someone else in the family.
I suppose that my gut has been telling me for quite a while that I should change pdocs. I'm afraid that I'm slow to make changes sometimes. Besides the common ADD symptoms of procrastination and disorignization, I also have to overcome the paralyzing effect of having both fear of failure and fear of success. I already have the name of another pdoc from my primary care guy. I hope your suppport will be the catalyst needed to set me in motion. I also have problems telling "authority figures" that I don't feel they are good enough for me. I know I have got to get over this, so I can get and do what's best for myself, my family, and the students I work with at my job.
I love Psycho-Babble and it's Babblers, but I am going to try to cut back a bit. I need to focus more energy on building on my positives, rather than dwelling on my negatives. I also will probably feel much better if I start going to bed at a decent hour on worknights.
Again, thank you all for your support. This is very theraputic to babble to others who can relate. Love you guys, Renee N
This is the end of the thread.
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