![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by bob on January 10, 2002, at 21:21:09
Well... it's been a long road (11 years w/over 20 psychtropics - many for more 3 months, some for more than a year) and I'm at an important crossroads.
I've never been able to tolerate any of the meds I've been on long term, due to the physical effects I get from them. One of the worst problems is severe sedation - especially in the mornings. Activating drugs give me agitation. I also have anxiety/muscle tension that I could swear is aggravated by higher doses of the meds. I've taken all classes of meds with the exception of the MAOIs. It has now come to the point that I endure significant sedation/bodily discomfort for the sake of some relief from my mental problems. However, I can no longer make it to work -- I feel too lethargic and sick.
HERE'S THE DILEMMA:
My doctor has arrived at the decision that I should slowly taper off of all meds and go it alone with intense psychotherapy! After all these years of hearing the medical community say that these problems have a biological underpinning, that's all going to be downplayed now? The prospect he's suggesting scares the heck out of me. I tried to live without meds 3 times before: Initially I came off of Anafranil and survived for 2 months, after which I spiraled down (about 9 years ago). I came off of Effexor in 95, and nearly died -- laying in my bed all day almost catatonic with SEVERE anxiety. The anxiety I had only waned when I reached therapeutic doses of Depakote. I lived with significant apathy and lethargy however. Then I tried to taper the Depakote in a last ditch effort to see if I could live without it. I never made it, as I degenerated into a sobbing anxious mess.
I don't know how I would survive off of all meds (I'm on Luvox and Klonopin now). Frankly, I fear I would not survive the washout transition to an MAOI. The doctor said he thinks I'm overplaying it, and that although there might be a bad period, I would recover. He said if I got into a crisis, I could always go into the hospital. His current view is that although I receive some measure of mental relief from some of the meds, the cost is at the expense of my physical health. It leaves me unable to work or have much of a life because of the physical limitations. It's a real quandry. I suspect that if I try what he is suggesting, I will spiral down into a dangerous crisis, and end up back on meds (or ECT), and will have to live out the rest of my life in a significantly compromised state. Unfortunately, changing meds and coming of and on them has really taken it's toll on me. I don't know if I can continue to do it any more. The doctor says I could go on forever trying new combos, and that going off might be worth a try.
I just don't know. It scares me. Suicidality/major depression and severe anxiety scare me the most, followed by the inevitable return of my other problems: obsessions/ruminations, anger/irritability, and a phobia about urinating in public. He thinks these things can be addressed through therapy and need to be faced. Maybe the meds have become too much of a crutch for me? The seems to reach right down to the controversy of psychoactive meds, and I never thought I'd hear my doc saying what he's saying.
By the way, he is a pretty capable pschopharmacologist, and I do have respect for his ablilities and knowledge. He has a point; I've suffered greatly from the side-effects of the meds, in addition to the transitions from one to another. Before I took my first pill 11 years ago, I never could have imagined the physical problems some of these meds could cause.
Sorry to ramble.
Bob
Posted by CalvaryHill on January 11, 2002, at 0:37:20
In reply to WARNING!!! OFF ALL MEDS?!!!, posted by bob on January 10, 2002, at 21:21:09
I believe you can do well with one of two most tolerable MAOIs (which I have taken too with success):
Moclobemide (Aurorix):
I was thinking you could possibly take the MAOI/RIMA moclobemide, ordering it from outside the United States. It can be taken with your current regimen too. Moclobemide is a new MAO inhibitor antidepressant which differs from previous MAO inhibitors in two ways: its action on MAO is reversible and its inhibitory action is relatively selective for MAO-A. The drug is shortacting and increases brain concentrations of both noradrenaline and serotonin. Its interaction with dietary amines causes considerably less increase in blood pressure than occurs with the classical MAO inhibitors. It is an effective antidepressant which is relatively free of adverse effects.****Selegiline (Eldepryl), MAOI-B (mostly):
High-dose selegiline appears to be an effective therapy for treatment-resistant depression in out-patients. The epidemiologic data are clear that depression and suicidal behavior occur at high rates in TRD patients. It is also well documented that many of the side effects associated with traditional tricyclics prohibit their application in this population. Consequently, monoamine oxidase (MAO) inhibitors are often used by clinicians to treat the TRD patient. Sunderland and colleagues in the NIMH intramural program examined the efficacy of high-dose selegiline (formerly known as L-deprenyl) in treatment-resistant depressed patients. Of interest is the robust clinical improvement in depression with a daily dose of 60 mg of selegiline in only a 3-week clinical trial. This is a good response in a relatively short period and suggests an unusually rapid onset of action...Good luck to you, whatever you decide,
CalvaryHill
Posted by sjb on January 11, 2002, at 10:08:43
In reply to WARNING!!! OFF ALL MEDS?!!!, posted by bob on January 10, 2002, at 21:21:09
Bob,
I feel for you and wish you all the best. I, too, want to go off all meds. It's so scary in whatever direction I think of to go for help. Has all the meds just made things worse, and yes, there's so much out there. We can waste more of our lives by experimenting. Yet, when the drugs help, it's wonderful. Unfortunately for me, the start-up side effects that are good do not last.
I don't know where to turn for help or what can help me. The lonliness and despair is indescribable. I look awful/don't want to go out anywhere. My husband and small circle of friens are high-achieving athletic types. I die a thousand deaths to see him go to the gym and come back to tell me all our friends were there, etc. I have no energy from depression and binge eating and don't know what to do.
Posted by mr.scott on January 11, 2002, at 12:02:40
In reply to WARNING!!! OFF ALL MEDS?!!!, posted by bob on January 10, 2002, at 21:21:09
...and will have to live out the rest of my life in a significantly compromised state...
You already are living in a significantly compromised state... Why not give it a go... There is no magic in psychiatric medicine.. Not yet anyways..
Maybe keep the klonopin on board for awhile, and just try that and some therapy.
Scott
Posted by bob on January 11, 2002, at 14:09:21
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » bob, posted by mr.scott on January 11, 2002, at 12:02:40
> ...and will have to live out the rest of my life in a significantly compromised state...
>
> You already are living in a significantly compromised state... Why not give it a go... There is no magic in psychiatric medicine.. Not yet anyways..
The doctor effectively said that the whole thing about the amine theory of depression is just that, a theory. He told me there's no reason to believe I can't change my brain chemistry with psychotherapy. The only thought that comes to mind, though, is people with severe disorders like OCD and Schizophrenia, who are indeed helped by meds. They too have to put up with serious side effects, and many are disabled. I've read a lot of things where people struggle in psychotherapy for years without progress.
>
> Maybe keep the klonopin on board for awhile, and just try that and some therapy.
>That's funny! That is EXACTLY what the doc said. I should taper off of my Luvox and keep the Klonopin for now.
> Scott
Posted by Simcha on January 11, 2002, at 14:14:41
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » mr.scott, posted by bob on January 11, 2002, at 14:09:21
Bob,
I wish you every blessing on your journey. May it work for you.
I did find that after 10 years in psychotherapy, 6 years in 12-step groups, many years of meditation and taking herbs, I did not get well until I tried medication.
I'm still in therapy. I still use 12-step spirituality. I still take herbs. The meds are what stabilized me finally.
I have Major Depressive Disorder and Sexual OCD. My pdoc has warned me yet again that I need to continue my medication because it is no cure and I am not cured. The medication brings me into remission and keeps me there.
I hope that you can avoid any setbacks and that you will never need to shell out any money to any drug company ever again.
G-d Speed!
Simcha
> > ...and will have to live out the rest of my life in a significantly compromised state...
> >
> > You already are living in a significantly compromised state... Why not give it a go... There is no magic in psychiatric medicine.. Not yet anyways..
>
>
> The doctor effectively said that the whole thing about the amine theory of depression is just that, a theory. He told me there's no reason to believe I can't change my brain chemistry with psychotherapy. The only thought that comes to mind, though, is people with severe disorders like OCD and Schizophrenia, who are indeed helped by meds. They too have to put up with serious side effects, and many are disabled. I've read a lot of things where people struggle in psychotherapy for years without progress.
>
>
> >
> > Maybe keep the klonopin on board for awhile, and just try that and some therapy.
> >
>
> That's funny! That is EXACTLY what the doc said. I should taper off of my Luvox and keep the Klonopin for now.
>
>
> > Scott
Posted by bob on January 11, 2002, at 14:20:39
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » bob, posted by Simcha on January 11, 2002, at 14:14:41
> Bob,
>
> I wish you every blessing on your journey. May it work for you.
>
> I did find that after 10 years in psychotherapy, 6 years in 12-step groups, many years of meditation and taking herbs, I did not get well until I tried medication.
>I have heard many stories like yours. That's why I'm afraid of this route. I thank you for your well wishes. For me, I'm just worried I could land in the hospital.
> I'm still in therapy. I still use 12-step spirituality. I still take herbs. The meds are what stabilized me finally.
>
> I have Major Depressive Disorder and Sexual OCD. My pdoc has warned me yet again that I need to continue my medication because it is no cure and I am not cured. The medication brings me into remission and keeps me there.
>Sounds like we have some similar conditions. I too have "sexual OCD", and major depression/anxiety. I also suffer from significant irrational rumination.
> I hope that you can avoid any setbacks and that you will never need to shell out any money to any drug company ever again.
Thank you!
>
> G-d Speed!
> Simcha
>
>
> > > ...and will have to live out the rest of my life in a significantly compromised state...
> > >
> > > You already are living in a significantly compromised state... Why not give it a go... There is no magic in psychiatric medicine.. Not yet anyways..
> >
> >
> > The doctor effectively said that the whole thing about the amine theory of depression is just that, a theory. He told me there's no reason to believe I can't change my brain chemistry with psychotherapy. The only thought that comes to mind, though, is people with severe disorders like OCD and Schizophrenia, who are indeed helped by meds. They too have to put up with serious side effects, and many are disabled. I've read a lot of things where people struggle in psychotherapy for years without progress.
> >
> >
> > >
> > > Maybe keep the klonopin on board for awhile, and just try that and some therapy.
> > >
> >
> > That's funny! That is EXACTLY what the doc said. I should taper off of my Luvox and keep the Klonopin for now.
> >
> >
> > > Scott
Posted by bob on January 11, 2002, at 14:34:23
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » bob, posted by Simcha on January 11, 2002, at 14:14:41
Simcha:
What have you settled on medication-wise? Have you been able to find a long-term combo (as in years and years), or do you have to adjust and switch every so often?
Bob
Posted by Simcha on January 11, 2002, at 15:04:42
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » Simcha, posted by bob on January 11, 2002, at 14:34:23
Bob,
I've been on Celexa 40mg and WellbutrinSR 200mg for the past 7 months or so. Before that (For about 4 months) I was on 150mg of Effexor.. I've only been at this med thing for almost a year.
My pdoc just added 1mg of Klonopin to be taken at bedtime for restless legs and grinding teeth. These are both anxiety related and med related.
I'm happy to say that the Klonopin is working wonders. I'm am not anxious at all. My restless legs are gone. I don't grind my teeth. I sleep like a baby at night. (I've been an insomniac for years.)
My side effects are minimal. I'm a little tired during the day and that's about it.
So, I do not have a report of the "Magic Bullet" but I do have to say that my pdoc agrees with me that I am finally stable on my current combo. I could take this forever (assuming nothing poops out...which I read that more than likely I'll need to change sometime in the future...)
So my dosing schedule is as follows:
1)40mg Celexa + 100mg WellbutrinSR when I wake in the morning. (I also take 40mg of gingko biloba with this)
1a. After lunch I take 100mg of ginseng, 40mg of gingko biloba, and 1 multivitimin.
2)100mg WellbutrinSR at about 3pm (actually it's now time for that one...) :-)
2b. After dinner I take 40mg of Gingko biloba
3)1mg Klonopin (as generic Clonazepam) just before going to bed. (I also take 40mg of gingko biloba at bedtime too.)
Basically the gingko and the ginseng are supposed to help keep my sex life going in a healthy way. The multivitimin is to make sure that I get proper nutrition which seems to be very important for all of us, yet even more so for those of us who suffer from any illness.
That is what I'm doing chemically for my health now.
I'm also going to hypnotherapy 1x a week.
I workout at lease 2 times a week (I shoot for 3x a week)
I meditate, I pray, and I write.
My pdoc has told me that medication alone is not enough. He suggested that I keep up with all of my spiritual practices and physical self-care. The combination helps me to stay stable. I believe it also helps me to have higher self-esteem. If I'm doing all of this to take care of myself then I must be worth something.
> Simcha:
>
> What have you settled on medication-wise? Have you been able to find a long-term combo (as in years and years), or do you have to adjust and switch every so often?
>
> Bob
Posted by bob on January 11, 2002, at 15:11:30
In reply to Re: WARNING!!! OFF ALL MEDS?!!!, posted by Simcha on January 11, 2002, at 15:04:42
I'm quite glad that you've found a combo you can take indefinitely, and I hope dearly that it stays that way for you.
A few final questions:
Why did you quit Effexor?
Why do you take the Welbutrin? Is it to help you from sleeping too much, or because it helps with your depression?
I appreciate your informative and quick response, by the way.
Bob
Posted by mr.scott on January 11, 2002, at 16:38:34
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » mr.scott, posted by bob on January 11, 2002, at 14:09:21
I don't think anyones really knows all that much about this stuff, you gotta do what works and is tolerable. If you cure your OCD, but gain 50 lbs, and lose the ability to have sex, then I'd almost say your better off with OCD.
Just be open minded I guess I'm saying. And believe in yourself that things can and will change with or without this drug or that drug.
Rarely is anything either or, certainty is a myth, and nothing in life is guaranteed.
Posted by bob on January 11, 2002, at 17:03:09
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » bob, posted by mr.scott on January 11, 2002, at 16:38:34
Thanks for the advice Scott, you seem rather insightful. I guess I will be giving what the doctor suggests a go, but I definitely have serious reservations. I see MANY posts on here about people who tried years of psychotherapy to no avail. I also tried to get off of medecines twice before "on my own", with no success. The thing I'm most afraid of in the short run though, is serious, intractable anxiety and depression, that would land me in the hospital. It's hard to predict how far you can push yourself.
Oh well, I guess I'll give it an honest try.
BTW, 50lb weight gains with no sex drive... been there and done that.
Posted by jay on January 11, 2002, at 17:26:36
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » bob, posted by mr.scott on January 11, 2002, at 16:38:34
>
>
> I don't think anyones really knows all that much about this stuff, you gotta do what works and is tolerable. If you cure your OCD, but gain 50 lbs, and lose the ability to have sex, then I'd almost say your better off with OCD.
>
> Just be open minded I guess I'm saying. And believe in yourself that things can and will change with or without this drug or that drug.
>
> Rarely is anything either or, certainty is a myth, and nothing in life is guaranteed.So true..thank you!! I notice once on meds for
awhile, I really understood this. The meds affect
some very basic symptoms, but things like *majorly*
reducing stress...regulating sleep..and having
someone to talk to, someone who cares, is of
*dire* importance. Medication helps, but it is
really less important in the *big* picture.Imho...
Jay
Posted by Dinah on January 11, 2002, at 18:13:31
In reply to WARNING!!! OFF ALL MEDS?!!!, posted by bob on January 10, 2002, at 21:21:09
Bob,
I've been following this thread with interest. I decided 12/00 to go completely off meds. At the time I was on Luvox, Klonopin, and Depakote. A few months later I was back on Klonopin. A few months after that I was back on Depakote. In the meantime I had a most interesting couple of months of withdrawal, complete with bizarre perceptual changes, false "ah-hah" experiences, and unbelievable overstimulation. I hope your experience is less interesting than mine.
IMHO, I would be as worried about someone saying that significant psychiatric illness can be treated by intense psychotherapy alone would worry me as much as as them saying that medication alone will cure all ills. If you don't mind my asking, what type of psychotherapy is he suggesting? Psycho-analysis? Cognitive behavior therapy?
As long as you regard it as an interesting experiment and not a prohibition against returning to medications as needed, it might indeed be worthwhile. But if your doctor refuses to consider medications again, I think I'd get a second opinion.
I don't mean to be discouraging. And I really do wish you all the best in your quest.
Dinah
Posted by Simcha on January 11, 2002, at 18:24:48
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » Simcha, posted by bob on January 11, 2002, at 15:11:30
Bob,
I quit the Effexor because I was totally numb from the waist down.
I take the WellbutrinSR to give me enough sexual energy to stay in my relationship. It is supposed to help tone down the sexual side-effects of the Celexa. Also it increases norepinephrine, they think, so it kind of replaces the Effexor....
I'm not sure I understand all of it. I know that the docs don't either. I'm just glad that it works for now.
> I'm quite glad that you've found a combo you can take indefinitely, and I hope dearly that it stays that way for you.
>
> A few final questions:
>
> Why did you quit Effexor?
>
> Why do you take the Welbutrin? Is it to help you from sleeping too much, or because it helps with your depression?
>
> I appreciate your informative and quick response, by the way.
>
> Bob
Posted by bob on January 12, 2002, at 1:44:36
In reply to Re: WARNING!!! OFF ALL MEDS?!!!, posted by Simcha on January 11, 2002, at 18:24:48
Simcha:
If you don't mind me asking... are you a guy or a gal?
Bob
Posted by bob on January 12, 2002, at 1:47:32
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » bob, posted by Dinah on January 11, 2002, at 18:13:31
Dinah:
I wouldn't see the doc anymore if I didn't have that safety valve of going back on meds. I've tried going off meds before with little success. I can completely relate to your experience. I guess I'll give it another try, because the meds seem to be causing so many physical problems now.
Bob
Posted by Simcha on January 12, 2002, at 12:33:16
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » Simcha, posted by bob on January 12, 2002, at 1:44:36
> Simcha:
>
> If you don't mind me asking... are you a guy or a gal?
>
> BobBob,
I'm a guy. My name is Hebrew for "Joy."
Simcha is a masculine name in Hebrew....
Thanks for asking. Many people assume I'm a woman with such a name.. ;-)
Posted by bob on January 12, 2002, at 14:19:49
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » bob, posted by Simcha on January 12, 2002, at 12:33:16
Yes, the name struck me as being for a woman at first, but then when you started describing your sexual OCD and the fact that some of the medecines made you "numb from the waist down" I had to wonder. Those things seem much more common with us guys.
Posted by babyface on January 12, 2002, at 14:21:53
In reply to Re: WARNING!!! OFF ALL MEDS?!!! » bob, posted by Simcha on January 12, 2002, at 12:33:16
Hi Bob,
I am wishing you luck with quitting all your meds and like people suggested maybe keeping the clonopin for a while sounds like a good idea.
I have been on and off on meds for at least ten years with many frustrating side effects and hopeful first couple of good feeling months only to fizzle out afterwards.
I have had periods of a year here and there of tolerable moods and then going off the meds mostly to get pregnant and have another child and hopeful that I could be off it forever.
But after three hospitalizations and severe depressions with months and months of frustrating finding the right combos and finding that the same drug that worked before suddenly did not do a thing this time around I decided to stick with it for life.
I have been in therapy off and on since age 18 and I must say it has helped me lots. I am 41 now!
I wish I did not have to be on meds but am scared to death(literally)of another major depression so I rather suffer some minor side effects.
This might not be to helpful a letter to you Bob, since you're considering of quitting the meds, sorry. But it is worth a try anyhow, since you are suffering physically so much.
Good luck to you!,
Rachel
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.