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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Noa on April 29, 2000, at 13:13:04
Hi, all.
Today is the second of two days feeling a lot better. I have been on vacation for two weeks (just stay at home, no travelling) and that has certainly helped a lot. Not every day has been great--some days, I have been lazing around the house and feeling unmotivated and bored and somewhat depressed, but nothing like the despondent, overwhelmed moods I was in a couple of weeks ago.
Besides the R&R, here's the med situation that *might* be helping: 1)I have been on this dose of cytomel and synthroid for 6 weeks now, and the hypothryoid symptoms of the depression have abated significantly--energy, stamina, "brain fog", etc. And, 2)about a week ago, I decided to see what would happen if I lowered my Effexor XR from 375 to 300, and simultaneously raise my Serzone from 225 to 300. The reason for this is I was having terrible restless legs--both delaying sleep onset, and I was waking up with my feet doing a flutter kick at ultra rapid speed. Also, I am curious as to whether my bladder control problem will be better with a lower dose of Effexor. I also wanted to see if this would help my anxiety, which is always there when the depression isn't dominating all the airtime.
I am happy to be off the lithium. I know it is a good drug, and it even helped my mood initially, but the thirst and urination problems, along with the hypothyroid thing just made it not such a good one for me.
Yesterday I saw an endocrinologist. Omigod. Get this: A doctor's office that is actually NOT chaotic. Where the staff are helpful and seem to be good at their jobs. Where the doctor himself greets you in the waiting room, takes a careful and unrushed history in his office, then does the exam all himself, rather than having someone else do the vitals, etc. Where the doc then brings you back into the office and has an unrushed, attentive discussion with you about his recommendations, taking the time to explain things and answer questions!!!!!!! What more can I say? (But I will, of course) This was so refreshing, as both my internist and my pdoc are part of huge managed care practices.
Endocrine upshot: The doc ok'd my current thryoid doses, and ok'd being at a very low TSH, which I know will not make my internist happy. He gave me guidelines for tweaking the dose if needed, such as splitting the cytomel dose in two, as it has a short half-life, which is totally new info to me. He offered to speak to my internist, gynocologist, and pdoc as needed. He also told me he suspects I might have another endocrine disorder beside the thyroid problem, and wants me worked up for insulin resistance syndrome, Cushings, and congenital adrenal hyperplasia. He also wants to review my workup results from 7 years ago for polycystic ovary syndrome.
PDoc update: I have decided to stick with the guy I have been seeing because, well I don't know, I guess I do feel very comfortable with him, he does know his stuff, we have a good rapport in terms of the back and forth discussions about strategies. As for the accessibility problem, I did confront him about this last time (two weeks ago) and he told me the best times to page him, and said he would allow me to make longer appointments if I want, even though the insurance guidelines call for a 15 min. med maintenance session. And he is humble: today he said the job of the psychopharmocologist is one for masochists, because you have to deal with being wrong so much, because each patient is so different.
Plan: stick with my current cocktail for another few weeks and see how it goes: 300 effexor xr, am; 300 serzone, pm; 20 mg ritalin sr, 2x/day; cytomel 12.5 mcg 2x/day; 50 mcg synthroid, am. Next possible steps: a trial of adderall instead of the ritalin (thanks to JohnL and others!), or adding a morning dose of 75-150 serzone, possibly lowering the effexor more if need be.
Finally, about my mood: Yesterday I felt more ok than I had in a long time. I had coffee with a friend who is at home part time with her infant. I had that good doc appointment in the afternoon. And I had a great time last night, just going to dinner and a movie with a good friend. I laughed and talked more than I have in a long time. I was getting a bit self-conscious about whether I was talking too much or too fast, or being too bubbly or having too many flights of ideas, as conversations tend to have with pals. But I asked my friend and she said she didn't see that at all. She did see me seeming to feel good, and she said she would describe it as euthymic. See, I don't know what normal is. The possible bipolar III (bp depression) dx has me so vigilant for anything that might smack of hypomania, that simply having a good time makes me worried. I did feel more reassured by my friend's words, though. I cried, though, out of sadness for myself and joy, for realizing how sweet and wonderful it is to have one good day, finally, just one good day, and to laugh and be silly, and engage in that energetic girltalk that can be silly and can flit from tangent to tangent, and doesn't have to be a red flag for more pathology.
So far, today has been good, too. On Monday, I go back to work, which I am dreading. We'll see if my mood can hold up under pressure. I was a basket case right before the vacation, as some of you might remember from my post about my meltdown at work. One other benefit of this vacation is that I have had time to reflect about my job, and I realize that I don't like it. I like many things about it, but I don't think it is the right job for me. I even clipped out some job ads, which is amazing, just that there were things I was interested in (interest, how we take it for granted!!). I don't have a lot of confidence now about my competence in general or my ability to conduct a job search. I might not actually make the applications just yet, but I think the exploration is useful in itself. At the moment, I am thinking maybe I will stay at this job for another school year, but begin looking around more seriously at what I want to do next. I might even go see a career counselor, who knows.
Posted by Noa on April 29, 2000, at 13:22:24
In reply to Serzone, Effexor, Thyroid: an update(LONG), posted by Noa on April 29, 2000, at 13:13:04
Another good thing I have noticed that is either due to better thyroid status or to lower effexor dose: my vocabulary is coming back! I am finding myself using more words when talking, words that are in my repetoire but have been inaccessible to me in spontaneous conversation because of word retreival problems. I hadn't thought of my word retrieval problems as being so bad, with the xr version of effexor, compared to the regular version of effexor, which made me feel incredibly inarticulate, but the difference now is very distinct. I think this is from the lowered effexor dose, but it could also be a function of a clearer head, from not being hypothyroid.
Posted by KarenB on April 29, 2000, at 13:51:54
In reply to Serzone, Effexor, Thyroid: an update(LONG), posted by Noa on April 29, 2000, at 13:13:04
Hi Noa,
So good to hear you are feeling better and that the vacation helped. On a day like today (see my migraine post) I needed to hear about someone for whom medication is making a significant difference. I am glad it is for you!
From your post, I gather that you are looking for a job more suited to your interests/aptitudes. I highly recommend the Johnson O'Conner Research Foundation for testing. My husband's grandfather (a scientist, inventor and super brain) suggested it to my husband for years. So, when we returned from the Philippines last year, Kevin thought it would be a great time to take it, to help guide him in the right direction for re-entering the job market. It was awesome and the results right on. It takes a day and 1/2 to take and costs just under $500 but is totally worth it. You will do three dimensional puzzles, vocabulary testing and they check for tonal aptitude and rhythym, etc. They leave no stone unturned and at the end, the evaluate your scores with you and give recommendations. You can get info at: www.members.aol.com/jocrf19/
Best Wishes - hope the good stuff continues.
Karen
Posted by KarenB on April 29, 2000, at 14:34:42
In reply to Re: Noa...and maybe Harry too?, posted by KarenB on April 29, 2000, at 13:51:54
Sorry about that guys - it's what appeared on my computer but when I tried to get there, no go. Here's the correct one:
www.jocrf.org
Karen
Posted by bob on April 29, 2000, at 21:12:40
In reply to Re: Noa...Harry too - URL correction, posted by KarenB on April 29, 2000, at 14:34:42
Noa, that is such wonderful news!!! You've deserved better than a break for so long, and it looks like things are turning in your favor. And about time, I say!
I know exactly how you feel about not knowing how to know how much good is good. I'm glad you had the opportunity and sense to check it out with someone else. Me? I just make my own unilateral decisions, and it's gotten me into trouble, ruining a good thing when I've had it. Anyway, if it feels good AND it feels unfamiliar, then it probably means that it's how you're SUPPOSED to be feeling. ;^)
cheers,
bob
Posted by bob on April 29, 2000, at 21:30:41
In reply to Hot dang!, posted by bob on April 29, 2000, at 21:12:40
Since I've been thinking about a career shift myself (well, Noa just said job shift ...) I just had to check that place out.
One of the most interesting pages, for me, was one that drew a distinction between asking yourself "What should I *be*?" and "What should I *do*?" For me, the first question ALWAYS distracts me from answering the second.
(psst! Noa -- take a look at it ... maybe the summer would be a good time to give greater consideration to that "finding a new job" thing!)
cheers,
bob
Posted by Janice on April 30, 2000, at 0:22:21
In reply to Cool URL, KarenB!, posted by bob on April 29, 2000, at 21:30:41
For some reason, I especially like what your endoctrist (?spelling?) wants to check.
••••worked up for insulin resistance syndrome, Cushings, and congenital adrenal hyperplasia. He also wants to review my workup results from 7 years ago for polycystic ovary syndrome.••••
I don't know what these things are, but I like the fact you are looking at different, non-psychiatric disorders that could be contributing or causing your depression.
By the way, you sound pretty damn good. Hope going back to work doesn't bring you down.
Janice
Posted by Janice on April 30, 2000, at 0:30:58
In reply to Cool URL, KarenB!, posted by bob on April 29, 2000, at 21:30:41
hi Noa,
did you ever solve the problem of trying to get some sleep without having to get up to go to the washroom in the middle of the night?
hoping you did, Janice
Posted by Racer on April 30, 2000, at 2:09:46
In reply to Re: Serzone, Effexor, Thyroid: PS, posted by Noa on April 29, 2000, at 13:22:24
Um... Sorry, that word wouldn't come... (Effexor XR does that to me, too! I find myself in the middle of a sentence with no idea how to express a concept like "small furry mammal infesting my living room sofa", and just point at the cats!)
Seriously, I just reduced my Effexor dosage, because of difficulty sleeping and dry mouth, and still feel really good. I'm not quite as totally blissful as I was, but lots has changed in my life (moving in with a fellow. Ulp!), but the AD effect hasn't gone away because of the reduction. {smile}
Good luck to you, darling Noa! Join me in smiling upon the world at least twice a week! {{{{}}}}
Posted by Renee N on April 30, 2000, at 4:55:36
In reply to Serzone, Effexor, Thyroid: an update(LONG), posted by Noa on April 29, 2000, at 13:13:04
> 2)about a week ago, I decided to see what would happen if I lowered my Effexor XR from 375 to 300, and simultaneously raise my Serzone from 225 to 300... I also wanted to see if this would help my anxiety, which is always there when the depression isn't dominating all the airtime.
at work.Noa,
If you are lowering one med while increasing another, how will you know which one is really causing lower anxiety(or not helping)? Maybe it's best to try it for a few weeks one at a time. Did you decide the change in doses on your own, or with your pdoc's advice or at least consent?> I even clipped out some job ads, which is amazing, just that there were things I was interested in (interest, how we take it for granted!!). I don't have a lot of confidence now about my competence in general or my ability to conduct a job search. I might not actually make the applications just yet, but I think the exploration is useful in itself.
Noa, I agree that this is a positve first step! Why are you thinking of waiting another school year? What is your reasoning?
Even if you never send them, maybe composing some cover letters in response to the ads along with an updated resume would help boost your confidence in yourself. Sometimes seeing your accomplishments in black and white can help you see them more clearly than just thinking about them through a mind that's often muddled with self doubt and negative self-talk.
I am glad you found at least one doctor who has the time and desire to talk to you and give your care his full attention!!! I know how refreshing that is. I have the most wonderful dentist and gyneocologist. My internist is great, too. Although he appears slightly more rushed, while he is with you he really listens and considers what you have to say. All three of these have called me at home personally, not just through their nurses or office staff. This makes me feel that they care and are dedicated to helping the person, not just treating a medical problem.It was so good to hear of your fun with friends. 8^) Laughter is the best medicine. I also understand how when experimenting with psychotropic drugs, we tend to analyze every little action and feeling we have. It's sad that we have to worry about feeling "too" good...
Best wishes for continued non-manic laughter and good times. Keep focusing on the things you do like about your job when you go back. Also look for small ways you can improve the negatives(or avoid them, if possible without neglecting responsibilities). Renee N
Posted by Deb R on April 30, 2000, at 13:21:03
In reply to Serzone, Effexor, Thyroid: an update(LONG), posted by Noa on April 29, 2000, at 13:13:04
Noa,
I was so pleased to read your post - to hear that you are feeling better gives me a great lift.
Best wishes
Deb
Posted by Noa on April 30, 2000, at 16:53:29
In reply to hey Noa!, posted by Deb R on April 30, 2000, at 13:21:03
Thanks, all for all the encouragement.
Renee---you're right about the 2 changes at once, but I was worried about the effects of 75 fewer mgs of effexor, so I thought doing the additional serzone at the same time would help. It was a bit impulsive, I admit. I did make the change first and told my pdoc afterward, 4 days later. Not the best thing to do, but he approved it, anyway.
Janice---about the washroom thing (I admire the more delicate use of language that you demonstrate, vs. my more banal and vulgar way of putting it)--When I was on the lithium, I did not manage to find a solution to the night time trips to the washroom. They continued until I was no longer taking it.
Posted by harry b. on April 30, 2000, at 21:24:06
In reply to Serzone, Effexor, Thyroid: an update(LONG), posted by Noa on April 29, 2000, at 13:13:04
Hi Noa,
Glad to hear you are feeling better and I hope it
lasts. Keep us informed.
Posted by dove on May 1, 2000, at 13:00:32
In reply to Re: Serzone, Effexor, Thyroid: an update(LONG), posted by harry b. on April 30, 2000, at 21:24:06
I am thrilled to hear that life is treating you with a little more respect Noa :-) I sincerely hope this reprieve of sorts lingers for a spell, or at least gives you a chance to soak in some much needed sunshine on your spirit.
In regards to some of your other thoughts on meds, I have been wondering if you've made any decisions yet? When you tried Wellbutrin as an augmenter in your med-cocktail, what kind of dosages were you able to handle? I was reading a bit on it and it seems that the real work begins at fairly high doses, which I could not take and thus haven't experienced.
Serzone, this med has really helped me, though in a mildly strange manner. Serzone enables me to fight my suicidal tendencies/ideations. I can talk myself into waiting, or resting for a couple of minutes. It allows me to let the lethal thoughts and impulses slide off me, rather than attacking either myself or the thoughts. I have had my dosage lowered slightly to 400 mgs, and I take that amount spaced out over the day, with the last dose of 100 mgs taken before bed with 100 mgs of Amitriptyline.
Well, I am so happy to see some good vibes washing over you Noa, and I hope going back to work doesn't deter those vibes on their journey. My fondest wishes to you.
dove
Posted by Noa on May 1, 2000, at 13:07:11
In reply to Re: Noa's Update, posted by dove on May 1, 2000, at 13:00:32
Thanks, Dove.
I am back at work and having a tough time getting stuff done, but letting myself just get used to being here. Just trying to clear my desk off and file some stuff and get a bit more organized.
I don't remember how much wellbutrin I got up to, probably not too high. I developed bad tinnitus and had to stop.
Posted by JudithC on May 1, 2000, at 14:04:20
In reply to Re: Noa's Update, posted by Noa on May 1, 2000, at 13:07:11
> Thanks, Dove.
>
> I am back at work and having a tough time getting stuff done, but letting myself just get used to being here. Just trying to clear my desk off and file some stuff and get a bit more organized.
>
> I don't remember how much wellbutrin I got up to, probably not too high. I developed bad tinnitus and had to stop.Noa,thank you for all of the information you have shared on this board;and I hope that this work week proves to be a very productive one for you.
JudithC
Posted by lburas on July 5, 2001, at 15:44:32
In reply to Re: Serzone, Effexor, Thyroid: PS, posted by Racer on April 30, 2000, at 2:09:46
Hello everyone. I was wondering if anyone else has experienced this. I increased my dose of Serzone from 250 to 300 mg. at my doctor's instruction and after a few days my hypothyroid symptoms started coming back (very cold hands, tired, etc.) I am wondering if the Serzone is somehow canceling out the thyroid medicine's effects.
By the way, I don't take Synthroid anymore; I take Armour, which is the natural thyroid and had been feeling a lot better on it. My morning temperature had been running around 96 degrees, and it rose to 97.9 a few days after beginning the Armour. I also started having a lot more energy and feeling better psychologically.
L
Posted by Noa on July 5, 2001, at 18:35:54
In reply to Re: Serzone and Thyroid, posted by lburas on July 5, 2001, at 15:44:32
I didn't notice any increase in hypothyroid symptoms with serzone, but who knows?
Armour has both T4 and T3 in it, so it seems you needed both, not just the T4. I take Synthroid and Cytomel to get the T3 and T4 (I don't feel comfortable taking Armour for personal dietary reasons but I have read that lots of people are happy with it).
Did you ask your endocrinologist about the serzone/hypothyroid thing?
This is the end of the thread.
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