![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 32. This is the beginning of the thread.
Posted by sl on July 17, 2001, at 16:55:20
So, I went today and the doctor (they didn't call her a doctor but her tag said PhD) said Klonopin was too addictive but I had the right idea to add an anti-anxiety med to the Wellbutrin. So she gave me Buspar. I don't know much about it. I know it might make me a little weirder than normal til I'm off the Prozac and Nortrip (5 days and 2 days, respectively).
She stated that it was not habit-forming but would be best if I took it regularly, like at the same time as the Wellbutrin SR. She said since I'm still tapering down on the Nortrip and plan to discontinue both Prozac and Nortriptyline, it would be okay to start the Buspar right away. I was thinking I'd start by taking 5mg at bedtime since it may be sedating mixed with the Prozac and Nortrip.Does this sound safe? Does it ring little warning-bells in anyone's head? Is there anything I should know about Buspar? How fast should I be tapering-up to the 15mg therapeutic dose, and would there be problems if I divide it by 2/day instead of 3/day?
Input always welcomed...!
sl
PS This lady knew her stuff, I liked her. :)
Posted by SalArmy4me on July 17, 2001, at 18:25:47
In reply to Tell me about Buspar?, posted by sl on July 17, 2001, at 16:55:20
http://www.vh.org/Patients/IHB/Psych/Medications/buspiron.html
Posted by AKC on July 18, 2001, at 6:34:33
In reply to Tell me about Buspar?, posted by sl on July 17, 2001, at 16:55:20
Without going into the details, I am one of the ones on this board who had a very negative experience with buspar, I believe (I was on a cocktail at the time, but I believe it was the buspar that was having the negative effects). I would urge you to do a search on this board for buspar - I am not alone with the negative experiences, but I am sure there are some who have had positive - that way you might get a more rounded picture - without me ranting and raving (and you will pick up a couple of my ranting and raving posts in such a search!). Good luck. And pay attention to the any side effects you might be experiencing as you are on this med - report them to you doctor - don't ignore them, because they might not go away and they might get worse.
Posted by Elizabeth on July 18, 2001, at 9:18:16
In reply to Tell me about Buspar?, posted by sl on July 17, 2001, at 16:55:20
BuSpar is sedating for some people but not others, and still others get even more jittery when they first start taking it. I think it's relatively unlikely that it will make you feel tired. It's not a "tranquiliser." It's really more properly classified as an antidepressant, although it's marketed for anxiety and the doses required for depression are much higher (average around 60 mg) than those used for anxiety (average more like 30 mg).
BuSpar is a sort of "hit or miss" drug: an awful lot of people find it does nothing whatsoever for their anxiety, a few say it's very helpful. I guess it's worth a try, but I wouldn't get my hopes up about it if I were you. Also, if it does work, it can take up to eight weeks (the research I've read suggests that BuSpar might take longer to work than most antidepressants).
Now, what is a PhD (psychologist, presumably) doing prescribing medication? That's what I'd like to know. Is this one of those arrangements were the psychologist (who actually meets with
you) tells the doctor what prescriptions to write, and the doctor just writes them? That's really not very ethical on the part of either of the professionals.> So, I went today and the doctor (they didn't call her a doctor but her tag said PhD) said Klonopin was too addictive
Klonopin is fine, and it's particularly unsavory for a PhD (that means probably not an MD -- people who have both degrees will list both on their IDs or will list the MD if they have to choose) to be telling you that this drug or that drug is "too addictive."
If you take Klonopin regularly for too long and then decide to stop, you need to decrease the dose slowly ("taper") and not just stop all at once. Anxiety patients who generally don't abuse drugs are unlikely to abuse benzos, and some former drug abusers or addicts are able to stay off of drugs of abuse (particularly alcohol) with the aid of medications like Klonopin. (These are people who were "self-medicating" their anxiety.)
> She stated that it was not habit-forming but would be best if I took it regularly, like at the same time as the Wellbutrin SR.
That's right. It won't *work* unless you're taking it regularly. (It's better to take it in divided doses because there are fewer peaks and troughs in your serum level that way.)
BTW, 15 mg is a *very* minimal dose, even for augmentation. You should expect that you may need to increase it to at *least* 30 mg.
> How fast should I be tapering-up to the 15mg therapeutic dose, and would there be problems if I divide it by 2/day instead of 3/day?
I think it's better
> PS This lady knew her stuff, I liked her. :)
She may, and I'm glad that you liked her. (I have to say, though: I'm not especially impressed with her unwillingness to let you take the most effective available medication (Klonopin really is right up there) for your anxiety -- one that will almost certainly help now rather than maybe helping many weeks from now -- or with her apparent willingness to "prescribe" drugs without any real involvement of a medical doctor. I may not be getting what's really going on, but that's what it sounded like.)
Best of luck to you.
-elizabeth
Posted by Elizabeth on July 18, 2001, at 9:19:58
In reply to Re: Tell me about Buspar? » sl, posted by AKC on July 18, 2001, at 6:34:33
> Without going into the details, I am one of the ones on this board who had a very negative experience with buspar, I believe (I was on a cocktail at the time, but I believe it was the buspar that was having the negative effects).
It's possible: there is a potential for pharmacokinetic interactions with other drugs (what else were you taking?). I think that really bad reactions to BuSpar are pretty rare; the worst thing that happens is usually just that it doesn't do anything.
-elizabeth
Posted by Mitch on July 18, 2001, at 9:50:09
In reply to Tell me about Buspar?, posted by sl on July 17, 2001, at 16:55:20
Sl, hi,
I had a pretty bad experience with Buspar, but with bipolar and ADHD and a history of paradoxical reactions to anxiolytics/stimulants that is no big surprise. Just be watchful for any irritability/hostility/hypomania developing and tell your doc about it. Elizabeth is right that a lot of people don't get anything out of it, though. I had one pdoc that was really down on it because he thought it was ineffective. However, it can be a highly effective boosting agent (for some folks) with an antidepressant-in your case Wellbutrin.
BTW, I was in the supermarket a few months back getting groceries and overheard a Mom talking about her son's ADHD. They had prescribed Adderall (an amphetamine) and Buspar and she said it ws working wonders for him. Wellbutrin is something of a stimulant as well-maybe it will work really well for you.
good luck,Mitch
> So, I went today and the doctor (they didn't call her a doctor but her tag said PhD) said Klonopin was too addictive but I had the right idea to add an anti-anxiety med to the Wellbutrin. So she gave me Buspar. I don't know much about it. I know it might make me a little weirder than normal til I'm off the Prozac and Nortrip (5 days and 2 days, respectively).
> She stated that it was not habit-forming but would be best if I took it regularly, like at the same time as the Wellbutrin SR. She said since I'm still tapering down on the Nortrip and plan to discontinue both Prozac and Nortriptyline, it would be okay to start the Buspar right away. I was thinking I'd start by taking 5mg at bedtime since it may be sedating mixed with the Prozac and Nortrip.
>
> Does this sound safe? Does it ring little warning-bells in anyone's head? Is there anything I should know about Buspar? How fast should I be tapering-up to the 15mg therapeutic dose, and would there be problems if I divide it by 2/day instead of 3/day?
>
> Input always welcomed...!
>
> sl
>
> PS This lady knew her stuff, I liked her. :)
Posted by sl on July 18, 2001, at 11:03:12
In reply to Re: Tell me about Buspar? » sl, posted by Elizabeth on July 18, 2001, at 9:18:16
>relatively unlikely that it will make you feel tired. It's not a "tranquiliser." It's really more properly classified as an antidepressant, although it's marketed for anxiety and the doses required for depression are much higher (average around 60 mg) than those used for anxiety (average more like 30 mg).
The booklet from the makers said it wouldn't make me tired, and that's wonderful. I just am on so many right now, I've got a few days left so I'm gonna stick it out. But anyway, drugchecker said it might interact with the tricyclics and/or the Prozac to make me more sleepy, at least til I'm off those.
> BuSpar is a sort of "hit or miss" drug: an awful lot of people find it does nothing whatsoever for their anxiety, a few say it's very helpful. I guess it's worth a try, but I wouldn't get my hopes up about it if I were you. Also, if it does work, it can take up to eight weeks (the research I've read suggests that BuSpar might take longer to work than most antidepressants).Well, I've only got 3 wks before the next dr's appt, and if it's not doing anything for me, we'll try something different. I DO know that last night my nervous headache went away, but I'm not sure which med to attribute that to, since I take 3 at bedtime at this point.
> Now, what is a PhD (psychologist, presumably) doing prescribing medication? That's what I'd like to know. Is this one of those arrangements were the psychologist (who actually meets with
> you) tells the doctor what prescriptions to write, and the doctor just writes them? That's really not very ethical on the part of either of the professionals.No, this is a very special situation. It's a sliding-scale clinic. And there WAS another thing on her tag, I think it might have been RN.
Anyway, a regular situation wouldn't have worked, I couldn't afford the psychiatrist, it was out of the realm of my GP, and I was running out of time (and meds!) so I tried this out. And _I_ REALLY don't care what it said on her tag, since she knew what was what. She was better than the last MD, who didn't know enuf to check interactions before prescribing! I think we had this discussion before: Is it better to have a GP who knows you and checks their plan, or a psychiatrist or other professional who blows you off?
> > So, I went today and the doctor (they didn't call her a doctor but her tag said PhD) said Klonopin was too addictive
> Klonopin is fine, and it's particularly unsavory for a PhD (that means probably not anAgain, it might have a lot to do with the situation. A sliding-scale clinic would probably see a LOT of folks after addictive drugs. And I absolutely respect her opinion. It's not like she dismissed my idea, she just steered me towards a less-addicting anti-anxiety med. Which I'm glad of, I've seen the horror-stories of getting off Klonopin, have you???
>MD -- people who have both degrees will list both on their IDs or will list the MD if they have to choose) to be telling you that this drug or that drug is "too addictive."
Ummm...have you noticed that an awful lot of MD's wont even ask you what you want? They'll TELL you "this is what you're going to take!". Like my last one. I'm just glad this woman took my opinion into account and understood the point (anxiety relief) instead of thinking I just wanted habit-forming benzos.
> once. Anxiety patients who generally don't abuse drugs are unlikely to abuse benzos, and some
Keep in mind, I'd never met this woman before, she didn't have my records, all she had was my word. Wouldn't you give her credit for caution??
>divided doses because there are fewer peaks and troughs in your serum level that way.)
Sounds sensible to me.
> BTW, 15 mg is a *very* minimal dose, even for augmentation. You should expect that you may need to increase it to at *least* 30 mg.Absolutely fine. She gave me ...well, not free reign, but said I could look up the info and decide how I wanted to taper on and how far to go up. She told me how the tabs look, and how to split them to get an even amount. :) And of course, neither of us were sure how I'd respond til the other meds were out of my system. I'll probably stick with just 10mg/day until then (4 more days!).
> >problems if I divide it by 2/day instead of 3/day?
> I think it's betterDefinately easier to remember, since I have to take the Wellbutrin 2/day. :)
> > PS This lady knew her stuff, I liked her. :)
> She may, and I'm glad that you liked her. (I have to say, though: I'm not especially impressed with her unwillingness to let you take the most effective available medication (Klonopin really is right up there) for your anxiety -- one that will almost certainly help now rather than maybe helping many weeks from now -- or with her apparent willingness to "prescribe" drugs without any real involvement of a medical doctor. I may not be getting what's really going on, but that's what it sounded like.)See all of the above. I think you're overly harsh on someone who was doing this for me when nobody else would. AND spent more time talking to me and observing me than the last MD did.
By the way, I am unemployed, and had she actually written a prescription, I couldn't afford to fill it, and she KNEW this and gave me a jar. A jar that would have cost me $100 or more, even just to try out for 3 weeks.
sl
Posted by MB on July 18, 2001, at 11:59:27
In reply to Tell me about Buspar?, posted by sl on July 17, 2001, at 16:55:20
> So, I went today and the doctor (they didn't call her a doctor but her tag said PhD) said Klonopin was too addictive but I had the right idea to add an anti-anxiety med to the Wellbutrin. So she gave me Buspar. I don't know much about it. I know it might make me a little weirder than normal til I'm off the Prozac and Nortrip (5 days and 2 days, respectively).
> She stated that it was not habit-forming but would be best if I took it regularly, like at the same time as the Wellbutrin SR. She said since I'm still tapering down on the Nortrip and plan to discontinue both Prozac and Nortriptyline, it would be okay to start the Buspar right away. I was thinking I'd start by taking 5mg at bedtime since it may be sedating mixed with the Prozac and Nortrip.
>
> Does this sound safe? Does it ring little warning-bells in anyone's head? Is there anything I should know about Buspar? How fast should I be tapering-up to the 15mg therapeutic dose, and would there be problems if I divide it by 2/day instead of 3/day?
>
> Input always welcomed...!
>
> sl
>
> PS This lady knew her stuff, I liked her. :)BuSpar worked really well for my anxiety, and, by the way, I took it with Wellbutrin with no real problems. They say that BuSpar takes a while to alleviate anxiety, but I felt better right away. Unfortunately, I quit because it made me feel really dizzy (not dizzy in an "inner-ear" way, but dizzy in the EXACT same way that SSRI withdrawal makes you dizzy: weird electric shocks of vertigo) and made my hands go numb ant twitch. I was bumbed because it really calmed me down. If things get worse, it would be a med I'd be willing to try again. I think my side effects aren't that common, and I really think BuSpar might work well for you. Good Luck!
Posted by sl on July 18, 2001, at 12:46:51
In reply to Re: Tell me about Buspar? » sl, posted by MB on July 18, 2001, at 11:59:27
Thank you! It's nice to hear from someone who took it and had good effects. :) So far there's no side-effects, but it's only been 12 hours. I can see where those side-effects would be intolerable. I was already getting dizzy-spells from the Nortriptyline, so it'll be next wk before I can weed out what's the BuSpar effects from the other stuff.
thanks for the hope! :)
sl
> BuSpar worked really well for my anxiety, and, by the way, I took it with Wellbutrin with no real problems. They say that BuSpar takes a while to alleviate anxiety, but I felt better right away. Unfortunately, I quit because it made me feel really dizzy (not dizzy in an "inner-ear" way, but dizzy in the EXACT same way that SSRI withdrawal makes you dizzy: weird electric shocks of vertigo) and made my hands go numb ant twitch. I was bumbed because it really calmed me down. If things get worse, it would be a med I'd be willing to try again. I think my side effects aren't that common, and I really think BuSpar might work well for you. Good Luck!
Posted by AKC on July 18, 2001, at 13:14:02
In reply to Re: Tell me about Buspar? » AKC, posted by Elizabeth on July 18, 2001, at 9:19:58
>
> It's possible: there is a potential for pharmacokinetic interactions with other drugs (what else were you taking?). I think that really bad reactions to BuSpar are pretty rare; the worst thing that happens is usually just that it doesn't do anything.
>
> -elizabethThat is a great point! You are absolutely right - unfortunately, I don't quite remember the cocktail I was on at the time (so many cocktails ago!). All I remember is that on my third hospitilization, the first night the doctor removed Buspar from the mix - and the next day the horrible fog and loud noise in my head had gone - I was literally insane and to this day, I blame the buspar - I had never thought it could have been caused by a reaction between the buspar and something else - but the buspar was sure to blame. But, in all fairness, I will have to keep this in mind that I was on a lot of meds at the time I was insane when I rant and rave about buspar.
Thanks.
Posted by MB on July 18, 2001, at 14:53:33
In reply to Re: Tell me about Buspar? » MB, posted by sl on July 18, 2001, at 12:46:51
> Thank you! It's nice to hear from someone who took it and had good effects. :) So far there's no side-effects, but it's only been 12 hours. I can see where those side-effects would be intolerable. I was already getting dizzy-spells from the Nortriptyline, so it'll be next wk before I can weed out what's the BuSpar effects from the other stuff.
>
> thanks for the hope! :)Cool! Let us know how things work out for you.
Posted by terra miller on July 18, 2001, at 15:54:12
In reply to Re: Tell me about Buspar? » sl, posted by Elizabeth on July 18, 2001, at 9:18:16
Elizabeth (& others),
Opinion wanted:
As an aid to the healing process of PTSD, I am currently stable on 75mg Wellbutrin I.R. 4xday. Can no longer take ambien (too long to explain) for sleep or ativan (getting rebound effects badly) for panic/anxiety. (Currently am not sleeping well at all nor handling the irritability during waking hours well either.) Therefore, being switched to wellbutrin (continue at same dose), 50mg 1xday Trazadone at bedtime, 30mg BuSpar (15mg 2xday... after a week at 7.5mg 2xday) with the understanding from my pdoc that BuSpar works for some on anxiety and not for others/and it can take months for it to "kick in."
This combination seems reasonable to me. Are there adverse reactions from this combination? (I am not aware of any.) Thanks. -Terra
Posted by Elizabeth on July 18, 2001, at 21:11:13
In reply to Re: Tell me about Buspar? » sl, posted by Mitch on July 18, 2001, at 9:50:09
> I had a pretty bad experience with Buspar, but with bipolar and ADHD and a history of paradoxical reactions to anxiolytics/stimulants that is no big surprise.
If you're bipolar, Buspar can trigger mania. It's basically an antidepressant that happens to be approved for generalised anxiety instead of depression (like Luvox is approved for OCD).
> Elizabeth is right that a lot of people don't get anything out of it, though. I had one pdoc that was really down on it because he thought it was ineffective. However, it can be a highly effective boosting agent (for some folks) with an antidepressant-in your case Wellbutrin.
It's used to augment serotonergic ADs; I'm not so sure there's a synergistic effect with Wellbutrin. One thing that might be neat to try would be combining it with pindolol. I've also been impressed with the results when people push the dose to 60 mg or more and give it a long time to work.
> BTW, I was in the supermarket a few months back getting groceries and overheard a Mom talking about her son's ADHD. They had prescribed Adderall (an amphetamine) and Buspar and she said it ws working wonders for him.
Buspar sometimes helps people with aggressive behaviour; it can be used to treat childhood hyperactivity and conduct disorder, and some people have had success with it for aggression related to brain lesions.
-elizabeth
Posted by Elizabeth on July 18, 2001, at 21:33:39
In reply to Re: Tell me about Buspar? » Elizabeth, posted by sl on July 18, 2001, at 11:03:12
> The booklet from the makers said it wouldn't make me tired, and that's wonderful. I just am on so many right now, I've got a few days left so I'm gonna stick it out. But anyway, drugchecker said it might interact with the tricyclics and/or the Prozac to make me more sleepy, at least til I'm off those.
I wouldn't listen to drugchecker, FWIW. < g > If it made you sleepy, my guess is that the mechanism would be decreasing the rate of metabolism of the tricyclic.
> Well, I've only got 3 wks before the next dr's appt, and if it's not doing anything for me, we'll try something different.
3 weeks might not be long enough.
> I DO know that last night my nervous headache went away, but I'm not sure which med to attribute that to, since I take 3 at bedtime at this point.
Jeez. I had headaches as a teenager that were eliminated by Prozac, FWIW. I'd guess that the relief of your headaches is due either to the Buspar or to *reducing* the dose of one of the other ones.
> No, this is a very special situation. It's a sliding-scale clinic. And there WAS another thing on her tag, I think it might have been RN.
If you think to check next time, I'd like to know. (She might be a nurse practitioner, a "mid-level" clinician who can prescribe under some circumstances). Sliding-scale clinics aren't a "special case" in the sense of not having to practise ethically! I don't fault you for taking medication from whomever will give it to you, but they shouldn't be operating like that.
> And _I_ REALLY don't care what it said on her tag, since she knew what was what.
I dunno, if she thinks Klonopin is "too addictive" to be used for anxiety, I'm not convinced that she knows so much. (Don't tell her I said that. :-) )
> I think we had this discussion before: Is it better to have a GP who knows you and checks their plan, or a psychiatrist or other professional who blows you off?
A GP is different from a nurse or a psychologist. A GP is a doctor.
> Again, it might have a lot to do with the situation. A sliding-scale clinic would probably see a LOT of folks after addictive drugs.
Maybe, but that sort of prejudice doesn't justify mistreating their patients (IMHO).
> And I absolutely respect her opinion. It's not like she dismissed my idea, she just steered me towards a less-addicting anti-anxiety med. Which I'm glad of, I've seen the horror-stories of getting off Klonopin, have you???
Withdrawal symptoms aren't the same as drug addiction. But anyway, if you taper off really slowly (it can take 6 months or more), it's perfectly possible to stop taking benzodiazepines after long-term use. Assuming you no longer need them, of course.
> Ummm...have you noticed that an awful lot of MD's wont even ask you what you want? They'll TELL you "this is what you're going to take!".
That's why I try to talk to them on the phone before making an appointment: to get a feel for whether they're worth my time (and money). Anyway, I've met psychologists, social workers, and nurses who were just as arrogant and inconsiderate as any doctor! < g >
> Like my last one. I'm just glad this woman took my opinion into account and understood the point (anxiety relief) instead of thinking I just wanted habit-forming benzos.
I understand. I just think you should be able to expect that from any competent clinician.
> Keep in mind, I'd never met this woman before, she didn't have my records, all she had was my word. Wouldn't you give her credit for caution??
Actually, I didn't know she didn't have your records. Usually when I've moved and needed to find a new doctor, s/he's wanted me to release my medical records from previous doctors. I do think that caution is reasonable, but my impression from what you related was that she just dismissed the idea of benzos, rather than setting it aside as something to try if the Buspar doesn't work.
> Absolutely fine. She gave me ...well, not free reign, but said I could look up the info and decide how I wanted to taper on and how far to go up.
That's cool. (I think you should read about the use of higher doses for depression and severe anxiety, of course. :-) )
> She told me how the tabs look, and how to split them to get an even amount. :)
They look like little white coffins, don't they?
> And of course, neither of us were sure how I'd respond til the other meds were out of my system. I'll probably stick with just 10mg/day until then (4 more days!).
That's a sensible idea, assuming you can afford to take the time.
> I think you're overly harsh on someone who was doing this for me when nobody else would. AND spent more time talking to me and observing me
than the last MD did.You're probably right; I've had problems in the past with doctors who didn't want to prescribe benzodiazepines on the grounds that they were "addictive." They didn't seem to understand that I don't get any kicks out of Xanax or Klonopin and that I've been taking them as needed for years without ever having problems. (Taking more Klonopin than is needed just makes me more likely to fall asleep).
> By the way, I am unemployed, and had she actually written a prescription, I couldn't afford to fill it, and she KNEW this and gave me a jar. A jar that would have cost me $100 or more, even just to try out for 3 weeks.
Let's hear it for samples! (I got my month's worth of Remeron that way, too.)
Say, isn't there generic buspirone now?
-elizabeth
Posted by Elizabeth on July 18, 2001, at 21:35:47
In reply to Re: Tell me about Buspar? » MB, posted by sl on July 18, 2001, at 12:46:51
> Thank you! It's nice to hear from someone who took it and had good effects. :)
They're out there, you just have to look really hard. (That's what Squibb did in order to get it approved, right?) < g >
> So far there's no side-effects, but it's only been 12 hours.
I think that's enough time. It sounds like you will be able to tolerate it long enough to give it a fair trial. G'luck!
-elizabeth
Posted by Elizabeth on July 18, 2001, at 21:37:13
In reply to Re: Tell me about Buspar? » Elizabeth, posted by AKC on July 18, 2001, at 13:14:02
> in all fairness, I will have to keep this in mind that I was on a lot of meds at the time I was insane when I rant and rave about buspar.
The moral of the story: know your cytochromes. :-)
-elizabeth
Posted by sl on July 18, 2001, at 21:48:04
In reply to Re: Tell me about Buspar? » AKC, posted by Elizabeth on July 18, 2001, at 21:37:13
I don't know my cytochromes. I don't even know what a cytochrome is. *hee*
sl
> The moral of the story: know your cytochromes. :-)
>
> -elizabeth
Posted by Elizabeth on July 18, 2001, at 21:48:27
In reply to BuSpar/Wellbutrin/Trazadone: Elizabeth, posted by terra miller on July 18, 2001, at 15:54:12
> As an aid to the healing process of PTSD, I am currently stable on 75mg Wellbutrin I.R. 4xday.
Why four times a day? And why not use Wellbutrin SR? Wellbutrin is awfully activating, and while I can see how you could take it four times a day with the last time not being too late (I took Parnate six times a day), it would be tricky.
> Can no longer take ambien (too long to explain) for sleep or ativan (getting rebound effects badly) for panic/anxiety.
SSRIs, some tricyclics, and MAOIs are all good for anxiety and panic, and the tricyclics I'm thinking of (imipramine, clomipramine) would probably help you sleep, too.
> Therefore, being switched to wellbutrin (continue at same dose), 50mg 1xday Trazadone at bedtime, 30mg BuSpar (15mg 2xday... after a week at 7.5mg 2xday) with the understanding from my pdoc that BuSpar works for some on anxiety and not for others/and it can take months for it to "kick in."
I'd give it 8 weeks and try higher doses if low ones aren't helping, yeah.
> This combination seems reasonable to me. Are there adverse reactions from this combination? (I am not aware of any.) Thanks. -Terra
There's a possible interaction between Buspar and trazodone where the levels of Buspar would be raised -- you'll know by how well you tolerate it, I think.
-elizabeth
Posted by sl on July 18, 2001, at 23:52:54
In reply to Re: Tell me about Buspar? » sl, posted by Elizabeth on July 18, 2001, at 21:33:39
>said it might interact with the tricyclics and/or the Prozac to make me more sleepy, at least til I'm off those.
>
> I wouldn't listen to drugchecker, FWIW. < g > If it made you sleepy, my guess is that the mechanism would be decreasing the rate of metabolism of the tricyclic.Not necessarily...cuz the Prozac INCREASED the metabolism of the tricyclic. I could tell cuz I was dopey all the time and when I backed off the dosage I felt better. BUT you're right about BuSpar not making me sleepy, even with Prozac and Nortrip. I DO feel less nervous, but I had a really good day too. ;)
> > Well, I've only got 3 wks before the next dr's appt, and if it's not doing anything for me, we'll try something different.
> 3 weeks might not be long enough.Right. But a drug that takes 6 months or even 2 months wouldn't be right for me. Not if I have any choices left. I'm going back to college in 6wks and I need to get this ironed out if I want to be successful. So we need to find an anti-anxiety med that works for me, in the next 6-8 wks.
> > I DO know that last night my nervous headache went away, but I'm not sure which med to > Jeez. I had headaches as a teenager that were eliminated by Prozac, FWIW. I'd guess that the relief of your headaches is due either to the Buspar or to *reducing* the dose of one of the other ones.
I think I see what you mean..I was reducing, so I got headache, but when I put more in my system I felt better, right? I think it's the first idea, tho. But I really WANT Buspar to work, so I'm already biased. I'm _trying_ not to placebo. ;)
> > thing on her tag, I think it might have been RN.
>
> If you think to check next time, I'd like to know. (She might be a nurse practitioner, a "mid-level" clinician who can prescribe under some circumstances).I'm almost positive it was RN. And can't Registered Nurses prescribe? I had one before, but I don't know if she checked with the doctor behind the scenes or not.
> Sliding-scale clinics aren't a "special case" in the sense of not having to practise ethically! I don't fault you for taking medication from whomever will give it to you, but they shouldn't be operating like that.
They might be allowed because of the scarcity of doctors with volunteer tendencys. We [poor people] don't stop needing meds just cuz some doctor would rather play golf, and I'd hope the rule-makers would realize that and allow for it.
> > And _I_ REALLY don't care what it said on her tag, since she knew what was what.
>
> I dunno, if she thinks Klonopin is "too addictive" to be used for anxiety, I'm not convinced that she knows so much. (Don't tell her I said that. :-) )*laugh* I won't. And she didn't say that it was too addictive to be used, or too addictive to be used for anxiety, just that she would be uncomfortable prescribing it to someone she'd just met, in the absence of any history besides my intake paperwork. I suspect that once she's gotten to know me a little and perhaps called for my records, she'll be much more comfortable (since I don't have _any_ history of substance abuse).
> > I think we had this discussion before: Is it better to have a GP who knows you and checks their plan, or a psychiatrist or other professional who blows you off?
>
> A GP is different from a nurse or a psychologist. A GP is a doctor.I know. And I phrased that badly but I couldn't think of a better way to say it. I could have stuck with a MD who didn't know their stuff. But I'd rather have someone "lesser" who was more knowledgeable and open to trying different combos.
(we even discussed the use of Zyprexa for my ruminations...when I suggested that to the MD before she looked like I'd suggested beheading chickens by moonlight!!)> > Again, it might have a lot to do with the situation. A sliding-scale clinic would probably see a LOT of folks after addictive drugs.
> Maybe, but that sort of prejudice doesn't justify mistreating their patients (IMHO).Like I said, she didn't really mistreat me or dismiss the idea of Klonopin altogether, just used her judgement and knowledge to gently nudge me towards a less-addicting drug, at least until such time as she feels comfortable giving me something like that.
> > Which I'm glad of, I've seen the horror-stories of getting off Klonopin, have you???
> Withdrawal symptoms aren't the same as drug addiction.Funny you should say that. I'll have to do some research of my own, cuz you seem fairly knowledgeable and so does the lady I saw. But one of you thinks it's addictive (yes, REALLY, requiring more and more to get same effect!) and one thinks it's not.
> > TELL you "this is what you're going to take!".
> That's why I try to talk to them on the phone before making an appointment: to get a feel for whether they're worth my time (and money).WOW, how do you get a doctor to speak personally on the phone?? Do you pretend to be their mother or something?? I've never spoken to my doctor directly on the phone, I always talked to her nurse. I honestly can't imagine talking to her on the phone, or her even having time for that.
>Anyway, I've met psychologists, social workers, and nurses who were just as arrogant and inconsiderate as any doctor! < g >
True, there's jerks in every profession.
> > Like my last one. I'm just glad this woman took my opinion into account and understood
> I understand. I just think you should be able to expect that from any competent clinician.*chuckle* If you take the point of view that attitude and consideration are as important to competence as knowledge, then there's a LOT of incompetent folks practicing!! Unfortunately, I don't think they test for people-skills in med-school. :P
> > Keep in mind, I'd never met this woman before, she didn't have my records, all she had was my word. Wouldn't you give her credit for caution??
>
> Actually, I didn't know she didn't have your records. Usually when I've moved and needed to find a new doctor, s/he's wanted me to release my medical records from previous doctors.Oh, I think (but don't remember) that form was in the intake paperwork somewhere, cuz I know they need a signature for that. So anyway, she WILL have my records I hope, but I didn't fill out intake papers til I got there, so she couldn't have it for first appt.
>I do think that caution is reasonable, but my impression from what you related was that she just dismissed the idea of benzos, rather than setting it aside as something to try if the Buspar doesn't work.
Of course I can't be in her head, but I think that if nothing else worked and I had no more options left, she wouldn't just say "deal with the anxiety and ruminations" and ditch me. :P
If I go to her and say I'm still having these horrible things stuck in my head for days on end, she'll do what it takes. That was the impression I got. And that's what I need.> > (re: dosages and researching them myself)
> That's cool. (I think you should read about the use of higher doses for depression and severe anxiety, of course. :-) )Yes. Will do some more research on that tomorrow. :) I've decided that I'll go up to 30mg/day eventually and see how I feel then. I think I know myself well enuf to tell if it's doing anything at all and plan accordingly.
> > She told me how the tabs look, and how to split them to get an even amount. :)
> They look like little white coffins, don't they?Umm...not to me. They're strips divided by 5mgs, scored into thirds, but then there's a side-score for breaking them in halves.
> > And of course, neither of us were sure how I'd respond til the other meds were out of my system. I'll probably stick with just 10mg/day until then (4 more days!).
> That's a sensible idea, assuming you can afford to take the time.Well, the other meds will be done then, and it's 3 wks til the next appointment. So I'll have two weeks to figure out about BuSpar and if it has _any_ effect then I can stay on it and up-dosage.
> > I think you're overly harsh on < snip >
> You're probably right; I've had problems in the past with doctors who didn't want to prescribe benzodiazepines on the grounds that they were "addictive." They didn't seem to understand that I don't get any kicks out of Xanax or Klonopin and that I've been taking them as needed for years without ever having problems. (Taking more Klonopin than is needed just makes me more likely to fall asleep).*laugh* that's what I wanted Klonopin for. But I do know that I can take herbal sleeping pills and sleep okay most of the time, too.
And if I was already on them and they worked for me, she might have been more apt to keep it going. I can't imagine a doctor refusing to refill a scrip for something you're already on...that's terrible. If there's anything I've learned in my time on this board and dealing with psychiatric meds, it's that if you've got a good thing, go with it!
> >a jar. A jar that would have cost me $100 or more, even just to try out for 3 weeks.
> Let's hear it for samples! (I got my month's worth of Remeron that way, too.)*grin* yeah, I was pretty happy. She could only give me 3 wks of Wellbutrin, cuz samples are smaller packages, but the jar of BuSpar is enough to take it at 30mg/day for a month. :) So I hope it works, it'd be such a waste to throw that out.
> Say, isn't there generic buspirone now?Yup. But the savings isn't extreme. It's $120 for brand-name and $96 for generic. (www.drugstore.com usually has pretty average prices, good for a general idea)
I'm tired out. G'night. :)
sl
Posted by AKC on July 19, 2001, at 6:34:37
In reply to Re: Tell me about Buspar? » AKC, posted by Elizabeth on July 18, 2001, at 21:37:13
cytochromes. :-)
>What are cytochromes??? (it's not in my regular old fashion dictionary, and I'm too lazy to look it up on the net. :) !)
Posted by Elizabeth on July 19, 2001, at 13:05:13
In reply to Re: Tell me about Buspar?, posted by sl on July 18, 2001, at 21:48:04
> I don't know my cytochromes. I don't even know what a cytochrome is. *hee*
They're enzymes that, among other things, catalyse the metabolism of drugs.
-elizabeth
Posted by Elizabeth on July 19, 2001, at 17:29:57
In reply to Re: Tell me about Buspar?, posted by sl on July 18, 2001, at 23:52:54
> > If it made you sleepy, my guess is that the mechanism would be decreasing the rate of metabolism of the tricyclic.
>
> Not necessarily...cuz the Prozac INCREASED the metabolism of the tricyclic.Nope. Prozac inhibits the metabolism and clearance of tricyclics. That's (probably) why you were getting more side effects: because the nortriptyline wasn't being transformed into inactive metabolites.
> Right. But a drug that takes 6 months or even 2 months wouldn't be right for me. Not if I have any choices left. I'm going back to college in 6wks and I need to get this ironed out if I want to be successful. So we need to find an anti-anxiety med that works for me, in the next 6-8 wks.
I hope so. I tried living in the fast track for a while, never taking breaks; it ended up not working out.
> I'm almost positive it was RN. And can't Registered Nurses prescribe?
No. Nurse practitioners can, though.
> I had one before, but I don't know if she checked with the doctor behind the scenes or not.
She did.
> They might be allowed because of the scarcity of doctors with volunteer tendencys. We [poor people] don't stop needing meds just cuz some doctor would rather play golf, and I'd hope the rule-makers would realize that and allow for it.
That's what Medicaid is supposed to be for. HMOs try to use nurses and physicians' assistants to cut costs too; that doesn't make it right.
> *laugh* I won't. And she didn't say that it was too addictive to be used, or too addictive to be used for anxiety, just that she would be uncomfortable prescribing it to someone she'd just met, in the absence of any history besides my intake paperwork.
Ahh. You just said that she'd said it was "too addictive." That made her sound pretty benzophobic. :-)
> I suspect that once she's gotten to know me a little and perhaps called for my records, she'll be much more comfortable (since I don't have _any_ history of substance abuse).
Yeah, being open and honest, letting them see your records and talk to past docs, etc. really helps them feel like they can trust you.
> I know. And I phrased that badly but I couldn't think of a better way to say it. I could have stuck with a MD who didn't know their stuff. But I'd rather have someone "lesser" who was more knowledgeable and open to trying different combos.
And to be sure, some non-physicians probably do know enough that they can prescribe safely. But it's sort of sleazy for them to do something that's really outside the scope of their practise. Also, the doctor who's signing off on these prescriptions could get in serious trouble if anything bad happened.
> (we even discussed the use of Zyprexa for my ruminations...when I suggested that to the MD before she looked like I'd suggested beheading chickens by moonlight!!)
Zyprexa is *awfully* sedating.
> Like I said, she didn't really mistreat me or dismiss the idea of Klonopin altogether, just used her judgement and knowledge to gently nudge me towards a less-addicting drug, at least until such time as she feels comfortable giving me something like that.
And like I said, that makes more sense.
> > Withdrawal symptoms aren't the same as drug addiction.
>
> Funny you should say that. I'll have to do some research of my own, cuz you seem fairly knowledgeable and so does the lady I saw.I'm sure she is.
> But one of you thinks it's addictive (yes, REALLY, requiring more and more to get same effect!) and one thinks it's not.
Tolerance isn't the same as addiction, either. (The definition I'm using is the one in DSM-IV, "substance dependence.") Anyway, I wouldn't say that Klonopin is not addictive at all, but I think the risk is minimal. I *don't* think you should have to wait several weeks for Buspar to kick in (or some other antidepressant that could make your anxiety worse before it made it better).
> WOW, how do you get a doctor to speak personally on the phone?? Do you pretend to be their mother or something??
< g > No, I just leave a message saying I'm looking for a psychiatrist and would like to speak to them to find out if we'd be a good match.
> I've never spoken to my doctor directly on the phone, I always talked to her nurse.
I see a psychiatrist who's in private practise. If I leave a message he either calls me back or gives his receptionist a message to give to me and she calls me back.
> *chuckle* If you take the point of view that attitude and consideration are as important to competence as knowledge, then there's a LOT of incompetent folks practicing!!
There sure are!
> Unfortunately, I don't think they test for people-skills in med-school. :P
Not that I know of, nope.
[re medical records:]
> Oh, I think (but don't remember) that form was in the intake paperwork somewhere, cuz I know they need a signature for that. So anyway, she WILL have my records I hope, but I didn't fill out intake papers til I got there, so she couldn't have it for first appt.Ahh, that makes sense. Hopefully your records aren't full of glaring errors, so they will actually give her a good idea of what your story is rather than a distorted one!
> Of course I can't be in her head, but I think that if nothing else worked and I had no more options left, she wouldn't just say "deal with the anxiety and ruminations" and ditch me. :P
> If I go to her and say I'm still having these horrible things stuck in my head for days on end, she'll do what it takes. That was the impression I got. And that's what I need.That's what we all need. :-)
> > That's cool. (I think you should read about the use of higher doses for depression and severe anxiety, of course. :-) )
>
> Yes. Will do some more research on that tomorrow. :) I've decided that I'll go up to 30mg/day eventually and see how I feel then.30 mg is enough for some people. I'm worried that it will take too long to work (especially if you're increasing the dose slowly) and you'll get impatient and want to give up on it, and then you'll be back to square 1.
> > They look like little white coffins, don't they?
>
> Umm...not to me. They're strips divided by 5mgs, scored into thirds, but then there's a side-score for breaking them in halves.Those are the 15 mg ones, then? I was thinking of the 5's and 10's.
> > > I'll probably stick with just 10mg/day until then (4 more days!).
>
> > That's a sensible idea, assuming you can afford to take the time.
>
> Well, the other meds will be done then, and it's 3 wks til the next appointment.Wow. If you only have six weeks to lick this thing, you're cutting it close.
> So I'll have two weeks to figure out about BuSpar and if it has _any_ effect then I can stay on it and up-dosage.
The problem with that is that 15 mg isn't really all that likely to do anything. So if you base your decision on whether 15 mg helps, you're most likely just going to give up on it.
> > (Taking more Klonopin than is needed just makes me more likely to fall asleep).
>
> *laugh* that's what I wanted Klonopin for. But I do know that I can take herbal sleeping pills and sleep okay most of the time, too.I never got anything out of "herbal remedies" -- other than morphine, of course. Which one(s) do you use?
> And if I was already on them and they worked for me, she might have been more apt to keep it going. I can't imagine a doctor refusing to refill a scrip for something you're already on...that's terrible.
I moved recently and I had a hard time finding a pdoc in the area who would consider prescribing buprenorphine, which I really need.
> If there's anything I've learned in my time on this board and dealing with psychiatric meds, it's that if you've got a good thing, go with it!
I'll drink to that! (err)
> > Let's hear it for samples! (I got my month's worth of Remeron that way, too.)
>
> *grin* yeah, I was pretty happy. She could only give me 3 wks of Wellbutrin, cuz samples are smaller packages, but the jar of BuSpar is enough to take it at 30mg/day for a month. :) So I hope it works, it'd be such a waste to throw that out.Yeah, I don't know what you can do that's legal if you have pharmaceuticals that you don't want to waste but for which you have no use. (If "legal" isn't of concern to you, you could give them to someone else who needs them, of course.)
> > Say, isn't there generic buspirone now?
>
> Yup. But the savings isn't extreme. It's $120 for brand-name and $96 for generic.I think it's like that when drugs first go generic: the generic is almost as much as the name brand. Once there's more competition -- once more companies are marketing buspirone -- the prices of generics will go down.
Desipramine is cool because it's *cheap*.
> I'm tired out. G'night. :)
And g'day to you!
-elizabeth
Posted by sl on July 19, 2001, at 21:57:37
In reply to Re: Tell me about Buspar? » sl, posted by Elizabeth on July 19, 2001, at 17:29:57
> > Not necessarily...cuz the Prozac INCREASED the metabolism of the tricyclic.
> Nope. Prozac inhibits the metabolism and clearance of tricyclics. That's (probably) why you were getting more side effects: because the nortriptyline wasn't being transformed into inactive metabolites.Ooooohh....I just went back and re-read the interaction info. If you don't know what cytochromes are, it sounds like it's INCREASED, but since you said that's the break-down stuff, then I understand.
In a nutshell: If it's in the plasma that means it's not being broke-down/used, right?
> >anti-anxiety med that works for me, in the next 6-8 wks.
> I hope so. I tried living in the fast track for a while, never taking breaks; it ended up not working out.Yeah, I've tried that too. That's why I'm only planning on 12 credits. That's the minimum required to be full-time.
> > I'm almost positive it was RN. And can't Registered Nurses prescribe?
> No. Nurse practitioners can, though.Hrm. She must have done more than I thought when she left the room. Cuz I suspect it's a government-funded type thing and couldn't afford to mess around. (might lose funding!)
> > [poor people] don't stop needing meds just cuz some doctor would rather play golf, and I'd hope the rule-makers would realize that and allow for it.
> That's what Medicaid is supposed to be for. HMOs try to use nurses and physicians' assistants to cut costs too; that doesn't make it right.*mock laughter* oh, you're funny.
You don't even want to get me started.
Since I wasn't dumb enuf to have babies [I wouldn't be able to care for], I don't get public assistance. You gotta be disabled (on SSI, I don't qualify) or have kids to qualify for almost anything. Can you belive that my lousy $888/month disqualifies me from food stamps? Even tho my rent is more than HALF that!?The public systems are a joke. They take care of people being stupid and promiscuous and leave those of us who do our best to stay independent out in the cold.
> Ahh. You just said that she'd said it was "too addictive." That made her sound pretty benzophobic. :-)
Well, I got the feeling she is, but mostly through the kind of people in there. She never even smiled or made a face except once ...it was like she'd seen eVERYTHING and nothing _I_ could say would phase her. On the one hand, she looked me in the eyes and was paying attention, but on the other hand she seemed distant. But she'd have to be, in that position.
> > I suspect that once she's gotten to know me a little and perhaps called for my records, > Yeah, being open and honest, letting them see your records and talk to past docs, etc. really helps them feel like they can trust you.I hope she does call. My doc and her nurse know me pretty well, they know my financial situation is precarious at best, and they know I'm intelligent enuf to know when something's wrong.
And by the way, there ARE side-effects to this Buspar. I'm going to ask you about them later on....
> > stuff. But I'd rather have someone "lesser" who was more knowledgeable and open to trying different combos.
> And to be sure, some non-physicians probably do know enough that they can prescribe safely. But it's sort of sleazy for them to do something that's really outside the scope of their practise. Also, the doctor who's signing off on these prescriptions could get in serious trouble if anything bad happened.I could argue that if they DO do it all the time then they probably know the drugs better than most MDs, but I won't start that again. I know they have only certain drugs available, so maybe that plays a part in the way it's run too. Actually, maybe she didn't HAVE klonopin, it's a schedule something-drug right? More controlled?
> > (we even discussed the use of Zyprexa for my ruminations...when I suggested that to the MD before she looked like I'd suggested beheading chickens by moonlight!!)
> Zyprexa is *awfully* sedating.*heh* But she didn't say that. She just turned and gave me this wide-eyed stare like I'd pulled a dead rat out of my shirt or something. But she was lousy anyway. :P
> > But one of you thinks it's addictive (yes, REALLY, requiring more and more to get same effect!) and one thinks it's not.
> Tolerance isn't the same as addiction, either. (The definition I'm using is the one in DSM-IV, "substance dependence.") Anyway, I wouldn't say that Klonopin is not addictive at all, but I think the risk is minimal. I *don't* think youOkay, I see. So it could be used with extra care. I mentioned it to my friend and he said "my gf has a bottle laying around from last summer, they gave it to her to sleep and it knocked her out for 14 hours!". I thought about asking him to send it, but ...well, I'd really rather go legal, y'know??
> should have to wait several weeks for Buspar to kick in (or some other antidepressant that could make your anxiety worse before it made it better).
*heh* That might also be part of the reason. She knows that I'm already on Wellbutrin and it works for me, so the depression isn't there, just the nagging worry and ruminations. (I avoid thinking about certain things so the things that DO get stuck are fairly benign, but it'd be nice to let my mind wander!)
> > their mother or something??
> < g > No, I just leave a message saying I'm looking for a psychiatrist and would like to speak to them to find out if we'd be a good match.Hrm. I saw one lady once, I said we didn't click, and they tried to insist I see her again to make sure. Bleh.
I never get the opportunity to choose, anyway, so I guess it doesn't matter how I'd go about it. I'm jobless and probably will be right til school starts and then I'll be a student. :/
> > I've never spoken to my doctor directly on the phone, I always talked to her nurse.
> I see a psychiatrist who's in private practise. If I leave a message he either calls me back or gives his receptionist a message to give to me and she calls me back.That's nice of him. I remember once I had a psychiatrist who had an office downtown, and I'd just drop in and pick up sample meds, but eventually it came time for anotehr appointment and I couldn't afford it. :(
> [re medical records:]
> Ahh, that makes sense. Hopefully your records aren't full of glaring errors, so they will actually give her a good idea of what your story is rather than a distorted one!*heh* I'm afraid the file is rather thick.
Allergies and chronic depression (dysthymia?) do that and there used to be big stomach problems that I now control with diet. :P I hope she skims the most recent parts tho.> > > That's cool. (I think you should read about the use of higher doses for depression and severe anxiety, of course. :-) )
> > Yes. Will do some more research on that tomorrow. :) I've decided that I'll go up to 30mg/day eventually and see how I feel then.I didn't see much specifically about treating depression with BuSpar. I did see that I could take up to 60mgs.
> 30 mg is enough for some people. I'm worried that it will take too long to work (especially if you're increasing the dose slowly) and you'll get impatient and want to give up on it, and then you'll be back to square 1.I'm increasing the dose about every other day, since the side-effects are ...well, different.
And we still won't be at square one, we'll have ruled out ONE option.
> > Umm...not to me. They're strips divided by 5mgs, scored into thirds, but then there's a side-score for breaking them in halves.
> Those are the 15 mg ones, then? I was thinking of the 5's and 10's.Yeah, I read the pamphlet, I've got the Dividose ones. The jar is 60 15mg strips, so that meant to me that they think I should take 30mg/day too. ;)
> > Well, the other meds will be done then, and it's 3 wks til the next appointment.
> Wow. If you only have six weeks to lick this thing, you're cutting it close.*sigh* Well, I can try. If it's not gone...well, we'll keep working on it. But as long as the depression is treated successfully, it should be okay to let the anxiety slide a little.
> The problem with that is that 15 mg isn't really all that likely to do anything. So if you base your decision on whether 15 mg helps, you're most likely just going to give up on it.
No...I'm going up to 30mg. Depending on what you say about the side-effects....which're weird. I read the pamphlet, set it aside so I wouldn't lose it, and I don't remember where I put it, so I can't check the incidence of this in the study, but I think it was 1%.
I remember looking at "Urinary Hesitancy" and thinking "gee, that's what that problem was called when I had it on Effexor." But that was mild and now it's...bad. It takes me like 30 seconds and CONCENTRATION to pee, even if I need to badly!
I drink a lot of water to combat the dry mouth from Wellbutrin, and well...I pee a lot! Especially when it's god-awful hot like it's been here lately.Now to make this embarassing revelation relevant:
Does that seem like a side-effect that'd fade away after longer use? Should I be waiting til that gets better before I up the dosage, like I would with more standard side-effects? Will it get worse if I don't wait?The other thing seems to be that I'm hungry all the time, and it takes a LOT of food to fill me up. I ate a big pb&j for dinner 3 hours ago, and an hour later I could've eaten again. I'm not a big person, I don't take that much food to maintain, so I gotta wonder if I'll gain mega-weight on this stuff....some of it is the Wellbutrin, that I know, but it was never this bad before. It was bad enuf earlier today that I was glad I threw out my leftover Effexor, or I would have been tempted to take a little for the appetite-suppressant effect!
> > *laugh* that's what I wanted Klonopin for. But I do know that I can take herbal sleeping pills and sleep okay most of the time, too.
> I never got anything out of "herbal remedies" -- other than morphine, of course. Which one(s) do you use?I used a blend called "Nighttime herbs" from NOW. It had valerian and I think hops and some other stuff. But I ran out, and I can't afford the $7 to get a new jar. *heh* I've had that dilemma before...OTC stuff that I have to pay for, or heavier prescription-stuff that I can get free. :/
> I moved recently and I had a hard time finding a pdoc in the area who would consider prescribing
buprenorphine, which I really need.I don't know what that is, but that just means some docs would rule it out straight-off cuz THEY wouldn't know what it was either. :P
But any doc worth his degree should know that you don't stop psychiatric meds cold turkey anyway, and give you at least enuf to taper off safely!
> > If there's anything I've learned in my time on this board and dealing with psychiatric meds, it's that if you've got a good thing, go with it!
> I'll drink to that! (err)*giggle* I'll have one for you. ;)
That's a nice thing about Wellbutrin. I can drink socially. :)> > it works, it'd be such a waste to throw that out.
> Yeah, I don't know what you can do that's legal if you have pharmaceuticals that you don't want to waste but for which you have no use. (If "legal" isn't of concern to you, you could give them to someone else who needs them, of course.)*heh* I thought of sending it to someone who was already taking it, cuz then it'd just be the crime of sending drugs thru the mail instead of the crime of dispensing without a license. :P
> >name brand. Once there's more competition -- once more companies are marketing buspirone -- the prices of generics will go down.
Hope so. Everything is so expensive.
> Desipramine is cool because it's *cheap*.
*heh* That was on my list when I was looking for something to replace wellbutrin (before I realized it had helped MORE symptoms than it'd missed). But Nortrip made me so damn stupid, I'm almost afraid to try another tricyclic. But the good news is I finished the Nortrip last night and I finish the Prozac Saturday night. *dance*
sl
PS even if you don't have time to respond to the whole post right away, please respond to the side-effects questions ASAP so I know if I should still be titrating or stalled.... THANKS!
Posted by Elizabeth on July 20, 2001, at 0:17:41
In reply to Re: Tell me about Buspar?, posted by sl on July 19, 2001, at 21:57:37
> In a nutshell: If it's in the plasma that means it's not being broke-down/used, right?
Something like that, yeah. It is confusing.
> Yeah, I've tried that too. That's why I'm only planning on 12 credits. That's the minimum required to be full-time.
1 class = 4 credits? (My school had a different system; the average class was 12 credits.)
> > > I'm almost positive it was RN. And can't Registered Nurses prescribe?
> > No. Nurse practitioners can, though.
>
> Hrm. She must have done more than I thought when she left the room. Cuz I suspect it's a government-funded type thing and couldn't afford to mess around. (might lose funding!)I think the government probably sanctions these cost-cutting measures.
> Since I wasn't dumb enuf to have babies [I wouldn't be able to care for], I don't get public assistance.
Really. What state are you in?
> You gotta be disabled (on SSI, I don't qualify)
Oof. Which one is SSI?
> Can you belive that my lousy $888/month disqualifies me from food stamps? Even tho my rent is more than HALF that!?
I can believe it. Public assistance is pretty worthless in the US, for the most part. (Some states do have pretty good Medicaid programs, though.)
> I hope she does call. My doc and her nurse know me pretty well, they know my financial situation is precarious at best, and they know I'm intelligent enuf to know when something's wrong.
That's good -- you have allies. < g >
> And by the way, there ARE side-effects to this Buspar. I'm going to ask you about them later on....
I'm sorry to hear that. I hope they're not too problematic.
> I know they have only certain drugs available, so maybe that plays a part in the way it's run too. Actually, maybe she didn't HAVE klonopin, it's a schedule something-drug right? More controlled?
It's Schedule IV. Buspar isn't a controlled substance, although you do need a prescription for it.
> > Tolerance isn't the same as addiction, either. (The definition I'm using is the one in DSM-IV, "substance dependence.") Anyway, I wouldn't say that Klonopin is not addictive at all, but I think the risk is minimal.
>
> Okay, I see. So it could be used with extra care.Sure. I think that Klonopin is probably less addicting than Xanax or Valium because it takes longer to work and I don't think I've known anyone who found it pleasurable in a recreational sense. But even Xanax and Valium can be used safely. You know best (in your heart of hearts) whether you are in danger of becoming addicted. Just be honest with yourself, and you'll be fine.
> I mentioned it to my friend and he said "my gf has a bottle laying around from last summer, they gave it to her to sleep and it knocked her out for 14 hours!". I thought about asking him to send it, but ...well, I'd really rather go legal, y'know??
Sure. I feel the same way (but I don't try to push my opinion on other people who don't feel the same way).
> She knows that I'm already on Wellbutrin and it works for me, so the depression isn't there, just the nagging worry and ruminations. (I avoid thinking about certain things so the things that DO get stuck are fairly benign, but it'd be nice to let my mind wander!)
I do that too, but I'm confused as to how that would affect her choice of anxiolytic.
> > No, I just leave a message saying I'm looking for a psychiatrist and would like to speak to them to find out if we'd be a good match.
>
> Hrm. I saw one lady once, I said we didn't click, and they tried to insist I see her again to make sure. Bleh.Nope. They're working for you; they don't get to tell you that you can't fire them. I think that's pretty straightforward.
> I never get the opportunity to choose, anyway, so I guess it doesn't matter how I'd go about it. I'm jobless and probably will be right til school starts and then I'll be a student. :/
Which is even worse in some ways (you're actively spending money on school, or going into debt from loans).
> That's nice of him. I remember once I had a psychiatrist who had an office downtown, and I'd just drop in and pick up sample meds, but eventually it came time for anotehr appointment and I couldn't afford it. :(
It sounds like it wasn't worth it anyway if you just went in to get samples.
> > Hopefully your records aren't full of glaring errors, so they will actually give her a good idea of what your story is rather than a distorted one!
>
> *heh* I'm afraid the file is rather thick.It's probably thick with flat-out mistakes, too.
> Allergies and chronic depression (dysthymia?) do that and there used to be big stomach problems that I now control with diet. :P I hope she skims the most recent parts tho.
Maybe it would be good to leave a message telling her that the recent parts are the most important, then.
> I didn't see much specifically about treating depression with BuSpar. I did see that I could take up to 60mgs.
There's not a lot, but Buspar definitely is an antidepressant at higher doses (the effective range is around 45-90 mg).
> I'm increasing the dose about every other day, since the side-effects are ...well, different.
I'm curious.
> And we still won't be at square one, we'll have ruled out ONE option.
Not really. If you don't take it long enough to know whether it works for you, you haven't learned anything from that trial.
> Yeah, I read the pamphlet, I've got the Dividose ones. The jar is 60 15mg strips, so that meant to me that they think I should take 30mg/day too. ;)
At least. I would bet that people with severe anxiety need higher doses just like people with depression do.
> > Wow. If you only have six weeks to lick this thing, you're cutting it close.
>
> *sigh* Well, I can try. If it's not gone...well, we'll keep working on it. But as long as the depression is treated successfully, it should be okay to let the anxiety slide a little.I hope so. For me, residual anxiety has been a major source of trouble.
> I'm going up to 30mg. Depending on what you say about the side-effects....which're weird.
I really want to hear this. < g >
> I remember looking at "Urinary Hesitancy" and thinking "gee, that's what that problem was called when I had it on Effexor." But that was mild and now it's...bad. It takes me like 30 seconds and CONCENTRATION to pee, even if I need to badly!
That's pretty weird, yeah. Opioids (like the buprenorphine that I take) cause that sort of thing, but I can't think of a reason why Buspar would. There's a drug called bethanechol (Urecholine) that could help. It also alleviates dry mouth.
> Does that seem like a side-effect that'd fade away after longer use? Should I be waiting til that gets better before I up the dosage, like I would with more standard side-effects? Will it get worse if I don't wait?
I think increasing the dose slowly would be warranted; I don't know if it will go away but it should get at least somewhat better. It really does stink that you can't have even a small amount of Klonopin to get you through the *long* wait until the Buspar works (if it works).
> The other thing seems to be that I'm hungry all the time, and it takes a LOT of food to fill me up.
That's something that can happen with a lot of antidepressants, although I've never heard of it being caused by Buspar. I'm sort of getting a bad feeling from your description of the side effects of this drug -- it sounds like it might not be worth it to try and stick it out with the Buspar.
> I ate a big pb&j for dinner 3 hours ago, and an hour later I could've eaten again.
How big could a pb&j be???
> I used a blend called "Nighttime herbs" from NOW. It had valerian and I think hops and some other stuff.
I've tried valerian and kava as well as a couple of mixtures that included valerian and some other stuff. It doesn't seem to do anything.
> But I ran out, and I can't afford the $7 to get a new jar. *heh* I've had that dilemma before...OTC stuff that I have to pay for, or heavier prescription-stuff that I can get free. :/
Go for the prescription stuff. < g >
> > I moved recently and I had a hard time finding a pdoc in the area who would consider prescribing
> buprenorphine, which I really need.
>
> I don't know what that is, but that just means some docs would rule it out straight-off cuz THEY wouldn't know what it was either. :PIt's a partial agonist at mu opioid receptors. It has a lot of side effects, and although it is only a Schedule V controlled substance (less controlled than, for example, Klonopin), it's hard to get because it's an opioid and because it only comes in an injectible formulation in the US.
> But any doc worth his degree should know that you don't stop psychiatric meds cold turkey anyway, and give you at least enuf to taper off safely!
Seriously. Some of them don't seem to understand that they aren't supposed to just make you fend for yourself in the way of medication!
> > > If there's anything I've learned in my time on this board and dealing with psychiatric meds, it's that if you've got a good thing, go with it!
> > I'll drink to that! (err)
>
> *giggle* I'll have one for you. ;)Good, 'cause after an unpleasant experience with Fioricet a little while ago, I'm scared to drink on desipramine. (So make mine a Snapple.)
> That's a nice thing about Wellbutrin. I can drink socially. :)
That's true on most ADs, although there are some people who become very sensitive to alcohol when they're taking ADs. I think the tricyclics are the riskiest.
> *heh* I thought of sending it to someone who was already taking it, cuz then it'd just be the crime of sending drugs thru the mail instead of the crime of dispensing without a license. :P
Uhh...I'm not sure that distinction would be made!
> > Desipramine is cool because it's *cheap*.
>
> *heh* That was on my list when I was looking for something to replace wellbutrin (before I realized it had helped MORE symptoms than it'd missed).Wellbutrin is a good drug, even if you have to take other stuff with it. It can be combined with pretty much anything else safely, too (yes, even MAOIs). And of course, it alleviates some of the side effects that other ADs can cause.
> But Nortrip made me so damn stupid, I'm almost afraid to try another tricyclic.
I'm not finding desipramine at all sedating or impairing (I'm up to 200 mg/day, with a target dose of 300). But obviously we have different responses to drugs.
> But the good news is I finished the Nortrip last night and I finish the Prozac Saturday night. *dance*
Congratulations :)
> PS even if you don't have time to respond to the whole post right away, please respond to the side-effects questions ASAP so I know if I should still be titrating or stalled.... THANKS!
I'm afraid I probably couldn't give you a satisfactory answer; I just don't know for sure. Can you call the clinic and tell them you're having trouble with a medication?
-elizabeth
Posted by terra miller on July 20, 2001, at 0:35:00
In reply to Re: BuSpar/Wellbutrin/Trazadone » terra miller, posted by Elizabeth on July 18, 2001, at 21:48:27
Hi and thanks for your reply. To answer the questions you posed:
> > As an aid to the healing process of PTSD, I am currently stable on 75mg Wellbutrin I.R. 4xday.
>
> Why four times a day? And why not use Wellbutrin SR? Wellbutrin is awfully activating, and while I can see how you could take it four times a day with the last time not being too late (I took Parnate six times a day), it would be tricky.You know, I've just gotten used to the routine. It actually makes me sleepy at night believe it or not. I churn wellbutrin up fast no matter if it's I.R. or S.R. After 4-5 hours I know I need more. When I tried the S.R. version I would be hurting by the 5th hour and have to wait to take the other pill. I also developed pretty uncomfortable hypothermia on the S.R. version (which actually is a side-effect listed with the I.R. and not the S.R. version; go figure). So, I switched over to the I.R. version so I could spread the pills out over four dosages a day and taking smaller amounts at a time (75mg) seems to help my body not dive to such extreme and painful temperature lows. I cannot increase over the 75mg pills because anymore at once makes my temperature dive and I get all brain fuzzy. So, 75mg 4x/day it is. I've just settled into the routine. (and I bought a really terrifically helpful pill counter so I know when I've taken what.)
> SSRIs, some tricyclics, and MAOIs are all good for anxiety and panic, and the tricyclics I'm thinking of (imipramine, clomipramine) would probably help you sleep, too.
I'm scared to death of tricyclics, but I have no rational reason for that feeling at all. I know nothing about them. Maybe it's just the ignorance breeding fear thing.
Can't take SSRI's because they make me suicidal. In fact, drugs that primarily effect serotonin levels make me swell up all over and get depressed. I don't get why. I just suspect that serotonin isn't the neurotransmitter I need to mess with in my body. Anyway, it's made finding the right med moderately frustrating.
Do people have serotonin issues because really what they need is help with different neurotransmitters than serotonin?>
> > Therefore, being switched to wellbutrin (continue at same dose), 50mg 1xday Trazadone at bedtime, 30mg BuSpar (15mg 2xday... after a week at 7.5mg 2xday) with the understanding from my pdoc that BuSpar works for some on anxiety and not for others/and it can take months for it to "kick in."
>
> I'd give it 8 weeks and try higher doses if low ones aren't helping, yeah.I'm going to give it a good shot. Pdoc told me to give it that much time as well and to expect the possibility that the buspar does nothing for me. But given that it helps some people, you have to put your nose out there to see if you are one of them.
> There's a possible interaction between Buspar and trazodone where the levels of Buspar would be raised -- you'll know by how well you tolerate it, I think.
What's the issue on this, that is, what action is interacting?
>
> -elizabethThanks for your help. -Terra
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