![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by EmilyAnn on July 3, 2002, at 16:26:22
Hi. I really need some support. Can someone please help me?
Posted by IsoM on July 3, 2002, at 16:39:20
In reply to Did anyone get my post?, posted by EmilyAnn on July 3, 2002, at 16:26:22
I saw it, Emily but know little about BP. I'm sorry. There's holidays happening both in Canada (July 1)& the States (July 4). You'll probably get answers soon.
Posted by cybercafe on July 3, 2002, at 16:41:18
In reply to Did anyone get my post?, posted by EmilyAnn on July 3, 2002, at 16:26:22
Hi, I read your message, but I don't consider myself qualified to prescribe medication.
It's also really important to have a good idea of someone's full symptomology first.What I can tell you is that there are many, many treatments you have not yet explored.. totally different classes of drugs with totally different mechanisms of action.
.. for example.. when you say that drugs did not work... do you mean that you had a 0% response, or closer to 80%?
Obviously if it's a 0% response, augmentation therapy is not as good an idea as if you had a 80% response...I didn't respond well to SSRIs (agitation) or 100% to Effexor XR (but it still did quite a bit of good...) ...
Now I'm on Parnate with some Gabapentin thrown in to control the anxiety + agitation + insomnia + possible hypomania
But I'm BP II, primarily depressive ....
What was your biggest complaint? Depression?
Did the SSRIs send you into (hypo)mania, or just not work at all?
Posted by Ed O`Flaherty on July 3, 2002, at 17:18:45
In reply to Did anyone get my post?, posted by EmilyAnn on July 3, 2002, at 16:26:22
It may be worth your while trying omega-3 fish oil.Stoll in Harvard started the idea in 1999.Have a look at my site at www.omega3.20megsfree.com
Posted by EmilyAnn on July 3, 2002, at 21:55:45
In reply to Re: Did anyone get my post?, posted by cybercafe on July 3, 2002, at 16:41:18
>
> Hi, I read your message, but I don't consider myself qualified to prescribe medication.
**Thank you for responding. I understand that you (and others) are not able to prescribe medication. However, my experience (and that of others I have spoken to) has shown me that too often Doctors do not take into account the patient's situation. For example, sometimes they deal with every BPII case the same as if out of a textbook rather than looking at the individual. So, I am hoping that I can get advice here...like what has worked for others. That kind of thing.I'm not sure what augmentation therapy is. So, I probably didn't try it! I've been in therapy since I was 14. I found a therapist (finally) that helped me, but I cannot pay for the sessions and my insurance benefits have run out for the year.
As for symptoms. Depression is my main problem. My lows are incredible bad. Effexor XR, I must admit, did help a little. I was able to function a bit better on it; however, it stopped working all together. My mania (hypomania) manifests as severe anxiety and irritability, inability to fall asleep, waking up early in the morning and not being able to fall back to sleep, irresponsible behavior, etc... I am able to control my behaviors a bit more. I think the recovery program I am in for alcoholism helps a great deal with that. But, the depression is the most debilitating aspect of my illness. It's hard to even get out of bed anymore. Even more difficult to leave the house. Often I do not go out as to avoid having a low or an anxiety problem in public, because it is embarrasing to have something wrong with you all the time.
High dose of Effexor and adding Buspar (for anxiety...I was also taking Depakote at the time) drove me into the worst anxiety attach of my life. It was the worst mania too. I'm not sure what casued it...the increased Effexor or the Buspar or both because my old psych. said to make both changes at the same time.
So now, I'm taking Welbutrin SR again. I took it before and it did not help at all (0%). So I just want to know what has worked with others so in case this does not work (again), I can discuss it with my new psych.
Hope that answers your questions. Thank you so much for taking the time to write me.
-Bernadette
> It's also really important to have a good idea of someone's full symptomology first.
>
> What I can tell you is that there are many, many treatments you have not yet explored.. totally different classes of drugs with totally different mechanisms of action.
>
> .. for example.. when you say that drugs did not work... do you mean that you had a 0% response, or closer to 80%?
> Obviously if it's a 0% response, augmentation therapy is not as good an idea as if you had a 80% response...
>
> I didn't respond well to SSRIs (agitation) or 100% to Effexor XR (but it still did quite a bit of good...) ...
>
> Now I'm on Parnate with some Gabapentin thrown in to control the anxiety + agitation + insomnia + possible hypomania
>
> But I'm BP II, primarily depressive ....
>
> What was your biggest complaint? Depression?
> Did the SSRIs send you into (hypo)mania, or just not work at all?
Posted by EmilyAnn on July 3, 2002, at 21:59:05
In reply to Re: Did anyone get my post?, posted by Ed O`Flaherty on July 3, 2002, at 17:18:45
thank you so much for responding. I'll check out that website.
Happy 4th!~
Posted by EmilyAnn on July 3, 2002, at 21:59:59
In reply to Re: Did anyone get my post? » EmilyAnn, posted by IsoM on July 3, 2002, at 16:39:20
Thank you for responding. I didn't think about the holiday, thanks for reminding me. I am just freaking out a little! :)
Posted by Iago Camboa on July 4, 2002, at 3:51:08
In reply to Re: thank you, posted by EmilyAnn on July 3, 2002, at 21:55:45
> High dose of Effexor and adding Buspar (for anxiety...I was also taking Depakote at the time) drove me into the worst anxiety attach of my life. It was the worst mania too. I'm not sure what casued it...the increased Effexor or the Buspar or both because my old psych. said to make both changes at the same time.
Hi. Why not try the obvious? Sure maintain the Effexor XR but substitute Buspar by Xanax. I bet your anxiety will vanish and hopefully your 'mania' too... Get prescribed Xanax .5mg by your pdoc and swallow a pill; repeat 6 hours later and then again after 6h. Please tell us how you feel.
Please keep the amount of Xanax at the minimum required to have you anxiety-free all day and night and enjoy summer time! Good luck.Have a nice July 4!
Iago
Posted by cybercafe on July 4, 2002, at 3:56:57
In reply to Re: thank you, posted by EmilyAnn on July 3, 2002, at 21:55:45
> **Thank you for responding. I understand that you (and others) are not able to prescribe medication. However, my experience (and that of others I have spoken to) has shown me that too often Doctors do not take into account the patient's situation. For example, sometimes they
Yeah I know I can do something for others -- as long as they don't expect too much. It's really hard to tell how bad your irritability and irresponsible behaviour is and how it effects your life without seeing you in person. Also... one problem I also find is that besides leaving things out by mistake, all of us are somewhat selective about what symptoms we want others to know about -- i.e. suicidal behaviour, hallucinations, what have you.
Keeping that in mind -- it's great that you listen to what people say online, but you definately need to confirm things with your doctor first. Especially if it involves herbal remedies, ... since so many drugs can be fatal in combination, or have other serious side effects (exacerbate psychosis, cause suicidal agitation, etc etc)....
Anyways enough of a disclaimer from me! :)>deal with every BPII case the same as if out of a textbook rather than looking at the individual. So, I am hoping that I can get advice here...like what has worked for others. That kind of thing.
What would you like to know? I can't tell you what's worked for me 100%, cuz nothing has yet ;)
but I've only tried a few meds.Right now I'm taking Parnate and a little Gabapentin (I'm BP II as well)
The Parnate is good for me cuz I sleep way too much, and the Gabapentin I take so that I can sleep while on Parnate :) and it also works wonders for anxiety and agitation.
I find it less potent than benzos, but I seem to be able to tolerate life without them (both Parnate and Gabapentin offer anti-anxiety effects).> I'm not sure what augmentation therapy is. So, I probably didn't try it! I've been in therapy
augmentation just means you combine one medication with another.... or other times it more specifically means that you combine drugs that interact with one another -- "synergism" would be a better description here
since I was 14. I found a therapist (finally) that helped me, but I cannot pay for the sessions and my insurance benefits have run out for the year.
Yeah I hear ya :) I wonder if that violates the constitution at all?
Or if you could rob a bank, and plead not guilty by reason of necessity
> As for symptoms. Depression is my main problem. My lows are incredible bad. Effexor XR, I must admit, did help a little. I was ableYeah Effexor XR probably helped me improve like 40% or so. But I could sure do a hell of a lot better than that, I'm sure
to function a bit better on it; however, it stopped working all together. My mania (hypomania) manifests as severe anxiety and irritability, inability to fall asleep, waking up early in the morning and not being able to fall back to sleep, irresponsible behavior, etc... I
I get the anxiety and definately lots of irritability and agitation, .. but I always slept way too much
Did the mood stabilizers help with that at all?
If not, what does your doctor intend to put you on instead? Benzos, other mood stabilizers, anti-psychotics?>am able to control my behaviors a bit more. I think the recovery program I am in for alcoholism helps a great deal with that. But, the depression is the most debilitating aspect of my illness. It's hard to even get out of bed
Ahh... so that you can make the informed decision that many people often aren't made aware of -- drinking will really screw you up. And I'm not just talking about depressive effects of alcohol...
Alcohol prevents your liver from metabolizing medication for... I believe 56 hours minimum. That's 2.5 days. So if you are drinking every 2.5 days, or more frequently, you may as well just take no medication
Or to put it more positively -- stop drinking, if at all possible, and you might find yourself getting a lot better. Of course maybe you already have stopped, but I just don't want you to miss out if you havn't.
Your doctor should have a few means at his disposal to help you quit -- again, no offence if you already have :)>anymore. Even more difficult to leave the house. Often I do not go out as to avoid having a low or an anxiety problem in public, because it is embarrasing to have something wrong with you all the time.
Yeah this is something that I wish someone had told me about --- I was experiencing unbearable depression, and it wasn't until I was forced to leave the house that I realized it was in a large part due to sensory depravation :(
Don't worry, anxiety is probably one of the easier symptoms to treat if it is a big problem... if you have substance abuse problems, maybe your doc is reluctant to give you a benzo, but there are other meds available (possibly not as good, but a hell of a lot better than nothing)
> High dose of Effexor and adding Buspar (for anxiety...I was also taking Depakote at the time) drove me into the worst anxiety attach of my life. It was the worst mania too. I'm not sure what casued it...the increased Effexor or the Buspar or both because my old psych. said to make both changes at the same time.What?! ... I don't know the circumstance, but that does sound like a bad idea
> So now, I'm taking Welbutrin SR again. I took it before and it did not help at all (0%). So I just want to know what has worked with others so in case this does not work (again), I can discuss it with my new psych.I have never taken a med that hasn't worked at least 20%, conservatively, so it's not hard to beat that 0% you're getting. Of course I encourage you to give it a decent trial, a fair dose, a fair period of evaluation, possibly even a blood test ...
When Effexor didn't work for me completely (I hesitate to say it didn't work, because when a med works 30 or 40% and you are feeling like total crap you really appreciate that 30 or 40%) .. my doc decided to try an MAOI ... so I'm on Parnate now, and it's definately doing something. It's been about 4 weeks and I'm probably looking at somewhere between a 30 and a 50% response. (these numbers are non-systematic guesses of course).. and the dose can be increased, I'm sure
If you're looking for antidepressants, I can give you a long list of different drugs and strategies you can go over with your doctor
If you can't take an anti-anxiety med and get out and get rid of that depression, .. then perhaps you should try to find a way to predict whether it will work or not...
I don't know how many doctors know how to get a blood level done
I don't know how many doctors know how to use an EEG to predict an early response ...
probably worth looking into yourself, though...How long have you been on Wellbutrin for btw (this time around)?
> Hope that answers your questions. Thank you so much for taking the time to write me.
No problem .... sorry I can't be more help, .. I might just become one of those happy people who goes off and lives their lives and you never hear from them again
Or at least we can hope ;)Really though... I was surprised how much better I feel when I'm interacting with people... but it might just be me I don't know
Posted by cybercafe on July 4, 2002, at 4:05:09
In reply to try Xanax in stead of Buspar » EmilyAnn, posted by Iago Camboa on July 4, 2002, at 3:51:08
> Hi. Why not try the obvious? Sure maintain the Effexor XR but substitute Buspar by Xanax. I bet your anxiety will vanish and hopefully your 'mania' too... Get prescribed Xanax .5mg by your pdoc and swallow a pill; repeat 6 hours later and then again after 6h. Please tell us how you feel.Totally no offense dude.. but I think the doc might be concerned about someone who has a problem with alcohol ... I'm not making the comment that he should be concerned, just that he probably is....
though in truth I don't know anything about Xanax myself... but isn't it like the most addicting benzo (due to euphoric effects?) ...
probably safer to use something like clonazepam, if a benzo is to be used ...
i really don't know the potential for abuse in this situation.. and even worse i have no clue whether or not benzos worsen depression or by how much ... Ug :( :(
so it is so hard to say> Please keep the amount of Xanax at the minimum required to have you anxiety-free all day and night and enjoy summer time! Good luck.
but Xanax sounds so good -- how could anyone *not* abuse it? :) i could sure use some euphoria out here, that's for sure
.. hah.. i also hate those short acting benzos... i feel like i'm on an emotional rollercoaster ride...
plus! .. if you wish to make sure you are taking the absolute lowest dose... you have to keep testing yourself to see if the anxiety is there or not... and then take it if it is...
i hate that .. because i constantly end up having bad anxiety pop up in my day 3 or 4 times
maybe this is totally limited to me ...
but i just love the gabapentin, cuz i take the same dose everyday and i don't wait to see if any anxiety comes around, or worry about addiction, or sedation, or increased depression or memory loss .. :) :) .. it's like a guilt free anxiolytic to me-- this message has been brought to you by Warner-Lambert <GRiN>
Posted by hildi on July 4, 2002, at 13:10:33
In reply to Re: try Xanax in stead of Buspar, posted by cybercafe on July 4, 2002, at 4:05:09
>
> > Hi. Why not try the obvious? Sure maintain the Effexor XR but substitute Buspar by Xanax. I bet your anxiety will vanish and hopefully your 'mania' too... Get prescribed Xanax .5mg by your pdoc and swallow a pill; repeat 6 hours later and then again after 6h. Please tell us how you feel.
>
> Totally no offense dude.. but I think the doc might be concerned about someone who has a problem with alcohol ... I'm not making the comment that he should be concerned, just that he probably is....
>
> though in truth I don't know anything about Xanax myself... but isn't it like the most addicting benzo (due to euphoric effects?) ...
> probably safer to use something like clonazepam, if a benzo is to be used ...
> i really don't know the potential for abuse in this situation.. and even worse i have no clue whether or not benzos worsen depression or by how much ... Ug :( :(
> so it is so hard to say
>
> > Please keep the amount of Xanax at the minimum required to have you anxiety-free all day and night and enjoy summer time! Good luck.
>
> but Xanax sounds so good -- how could anyone *not* abuse it? :) i could sure use some euphoria out here, that's for sure
>
> .. hah.. i also hate those short acting benzos... i feel like i'm on an emotional rollercoaster ride...
>
> plus! .. if you wish to make sure you are taking the absolute lowest dose... you have to keep testing yourself to see if the anxiety is there or not... and then take it if it is...
> i hate that .. because i constantly end up having bad anxiety pop up in my day 3 or 4 times
> maybe this is totally limited to me ...
> but i just love the gabapentin, cuz i take the same dose everyday and i don't wait to see if any anxiety comes around, or worry about addiction, or sedation, or increased depression or memory loss .. :) :) .. it's like a guilt free anxiolytic to me
>
> -- this message has been brought to you by Warner-Lambert <GRiN>Xanax should not be used if someone has any history of alcohol or substance abuse- there is a very strong possibility of abusing this drug. Addicts/alcoholics (like me) very often switch drugs of abuse, so people (like me)who have 'addictive personalities' need to stay away from any benzos, anything that makes us feel too good.
Even if someone is trying to control their drinking problems can still occur. My mom, a known alcoholic to her MD, was precribed xanax for her anxiety. . .Guess what?? She is dead. My mom OD'd at 48 years old from taking her 'normal' dose of perfectly legal, dr. precribed xanax and consuming alcohol.
Xanax is a powerful drug for people like us.Buspar is what I used to take for anxiety. Worked for a while, then I stopped, and now when I try it it doesn't seem to work as well as before.
Cybercafe, you sound pretty happy with the neurontin (did I spell that right?). Do you think it is as effective as a benzo? Could this be a non-addicing alternative to benzo's? I have read other good posts on this med and I am very curious to try it myself.
Hildi
Posted by cybercafe on July 4, 2002, at 14:15:33
In reply to Xanax bad idea if possibility of alcohol abuse, posted by hildi on July 4, 2002, at 13:10:33
> Buspar is what I used to take for anxiety. Worked for a while, then I stopped, and now when I try it it doesn't seem to work as well as before.
Hmmm.. Buspar never worked for me, but then I think I only took about 5 mg. I guess many family doctor's just have no clue what the therapeutic range is ....
> Cybercafe, you sound pretty happy with the neurontin (did I spell that right?). Do you think it is as effective as a benzo? Could this be a non-addicing alternative to benzo's? I have read other good posts on this med and I am very curious to try it myself.
Yes I am very happy with the neurontin ....
No I didn't find it as effective as a benzo... but personally I find I need high dosages and so I probably havn't given it a "fair trial" just yet...
Ummmm... the good and the bad is that with benzos if I am totally going nuts and trapped somewhere (say 8 hour car ride) I can increase the dose and sooner or later I will fall asleep ....
the reason I'm taking gabapentin is precisely that
a. i am afraid benzos are going to make me go through life half asleep
b. i am afraid use of benzos is going to make me more depressedIn fact in a sense I'd say nothing is as powerful as benzos... because you can always take more and more until you fall asleep... but that really isn't much of a lifestyle...
plus I am afraid of getting "addicted" or of developing a "physical dependence".....so for me antidepressants are no guilt, no cost (i.e. falling asleep at work, possible depression etc etc) methods of relieving anxiety
gabapentin seems to be a low guilt, low cost method of relieving anxiety
and benzos seem to be high guilt, high cost methods of relieving anxiety...
Like when I took benzos (very low dosages btw) I still felt anxiety somewhat but people around me would ask what the hell is wrong with me.... (i was somewhat sleepy or non-talkative)
(i used to take about .5 mg of clonazepam)...on gabapentin i cut out the most intense anxiety situations (like sitting still in a 8 hour car ride, Ug) .... but... i have 2 or 3 groups of friends who have never met .. that comment they are so glad i am off medication, Haha...
so i dunno.. i mean i don't think anyone knows for sure how gabapentin works .. so maybe in a few years i'll be growing a third eyeball... but
as someone who is a perfectionist when it comes to academia... i appreciate the cognitive-enhancing abilities... and as someone who wants to be in awesome shape... i appreciate the fact that i am more awakeso if you don't have the same problems with benzos that i do, hey maybe they are the right choice for you... but for me, I think based on my experiences I made the right choice....
at least until i can find an antidepressant that makes me happy (non depressed) and go-lucky (non-anxious)good luck :)
Posted by EmilyAnn on July 4, 2002, at 15:12:18
In reply to try Xanax in stead of Buspar » EmilyAnn, posted by Iago Camboa on July 4, 2002, at 3:51:08
Iago,
Thanks for the advice. I've never tried Xanax before. I'll research it and talk to my Dr. about it. The effexor xr is done. It doesnt work anymore. Maybe the welbutirn + Xanax will help.Thanks again. Have a nice holiday!
-
Posted by EmilyAnn on July 4, 2002, at 15:51:21
In reply to Re: thank you, posted by cybercafe on July 4, 2002, at 3:56:57
> Yeah I know I can do something for others -- as long as they don't expect too much. It's really hard to tell how bad your irritability and irresponsible behaviour is and how it effects your life without seeing you in person. Also... one problem I also find is that besides leaving things out by mistake, all of us are somewhat selective about what symptoms we want others to know about -- i.e. suicidal behaviour, hallucinations, what have you.
> Keeping that in mind -- it's great that you listen to what people say online, but you definately need to confirm things with your doctor first. Especially if it involves herbal remedies, ... since so many drugs can be fatal in combination, or have other serious side effects (exacerbate psychosis, cause suicidal agitation, etc etc)....
> Anyways enough of a disclaimer from me! :)
> ***:) the disclaimer is all good. I understand hon! You do seem very well educated on this subject. I think that's very important. We need to know about our illness and the treatments. I do value the opinions and experience of others and I try to research the meds as well.> What would you like to know? I can't tell you what's worked for me 100%, cuz nothing has yet ;)
> but I've only tried a few meds.
> **Is that common? That not med works 100%...I guess it is because therapy is an important component too.> Right now I'm taking Parnate and a little Gabapentin (I'm BP II as well)
> The Parnate is good for me cuz I sleep way too much, and the Gabapentin I take so that I can sleep while on Parnate :) and it also works wonders for anxiety and agitation.
> I find it less potent than benzos, but I seem to be able to tolerate life without them (both Parnate and Gabapentin offer anti-anxiety effects).
>***The Gapapentin is Neurotin. I was on that for about a month and a half. Still on it, but tapering off...in about a week I'll be off. It seems strange the my new psych would not have me on a mood stabilizer. What I've read on BPII shows that a mood stabilizer is crucial and that you have to watch how much of an anti-depressant you take b/c it can induce mania. But, he said that there are many mood stabilizers I haven't tried and if I need it, we'll try them. It just sucks that I have to try all these meds just to be functional! It's a bit frustrating, as all of you proably know. I'll research Parnate and see what's up with it. I just want to know what's out there so I can work with my psych. in finding the best meds for me (in case the new tx doesn't work).
>
> augmentation just means you combine one medication with another.... or other times it more specifically means that you combine drugs that interact with one another -- "synergism" would be a better description here
> ***oh, I get it. :) Yeah, I've been on multiple meds for about two years now.> Yeah I hear ya :) I wonder if that violates the constitution at all?
> Or if you could rob a bank, and plead not guilty by reason of necessity
> ***LOL!! yeah really! I took a human services course and we discussed the issue of HMO benefits a great deal. The ethical problems for the counselor...because the patient may not be better and you have to let them go because they can't pay. It's a shame. \
>
> Yeah Effexor XR probably helped me improve like 40% or so. But I could sure do a hell of a lot better than that, I'm sure
> **I hear ya!> I get the anxiety and definately lots of irritability and agitation, .. but I always slept way too much
> ***it's weird. I sleep too much too at times. Esp. when I am depressed. but other times I just can't sleep at all. I guess that's when i'm cycling. Wouldn't it be better to have the 'fun' mania? LOL. Just kidding. But sometimes feeling grandious seems better than being so dang irritalbe and agitated. But all of it is difficult.> Did the mood stabilizers help with that at all?
> If not, what does your doctor intend to put you on instead? Benzos, other mood stabilizers, anti-psychotics?
>***the mood stabilizers I've tried (depakote and neurotin) have not worked with respect to the cycling. It seems that all meds work for me maybe at 40% and I am able to function a bit better, then they just stop working. I don't think I need an anti-psycotic b/c I 've never experienced those type of symptoms (thank God, my friend who has BP w/ psychotic features, says it bites but his meds are working fine for him now). Do the anti-psychotic meds have any other benefits rather than stopping psychosis?
>
> Ahh... so that you can make the informed decision that many people often aren't made aware of -- drinking will really screw you up. And I'm not just talking about depressive effects of alcohol...
> Alcohol prevents your liver from metabolizing medication for... I believe 56 hours minimum. That's 2.5 days. So if you are drinking every 2.5 days, or more frequently, you may as well just take no medication
***Dang, I didn't know that! Hmm, no wonder it was worse when I was drinking alot!> Or to put it more positively -- stop drinking, if at all possible, and you might find yourself getting a lot better. Of course maybe you already have stopped, but I just don't want you to miss out if you havn't.
***I've been sober for 5 months (b/c of the program I am in and w/ God's help). It's partly more difficult now b/c I have nothing to 'self-medicate' when I get anxious or depressed. Does that make sense? But when I was drinking, my moods were all messed up too...but I didn't care b/c I was drunk
!
> Your doctor should have a few means at his disposal to help you quit -- again, no offence if you already have :)
>***no offense taken hon! You are so helpful and very sensitive to others. Great qualities. Are you in a helping profession?
> Yeah this is something that I wish someone had told me about --- I was experiencing unbearable depression, and it wasn't until I was forced to leave the house that I realized it was in a large part due to sensory depravation :(
***hmm, that's a good point.> Don't worry, anxiety is probably one of the easier symptoms to treat if it is a big problem... if you have substance abuse problems, maybe your doc is reluctant to give you a benzo, but there are other meds available (possibly not as good, but a hell of a lot better than nothing)
> ***thank you :0) the benzodiapines addictive? I had better steer clear of those then!
>
>
> What?! ... I don't know the circumstance, but that does sound like a bad idea
> ***Hell yeah! I think I need to be more assertive w/ my doctors. I tried explaing things to her, but I think I get caught up in the fact that she is a doctor and knows more than me. But, I know myself and what is and is not working...so darn it, I should stick up for myself, huh? Hopefully I will be able to w/ my new Doc.
>
> I have never taken a med that hasn't worked at least 20%, conservatively, so it's not hard to beat that 0% you're getting. Of course I encourage you to give it a decent trial, a fair dose, a fair period of evaluation, possibly even a blood test ...
> ***I agree. :) And yeah, anything is better than 0% effective! I am just so fearful that soemthing else won't work or even worse make me sicker.> When Effexor didn't work for me completely (I hesitate to say it didn't work, because when a med works 30 or 40% and you are feeling like total crap you really appreciate that 30 or 40%) .. my doc decided to try an MAOI ... so I'm on Parnate now, and it's definately doing something. It's been about 4 weeks and I'm probably looking at somewhere between a 30 and a 50% response. (these numbers are non-systematic guesses of course).. and the dose can be increased, I'm sure
*** MAOI's are a bit tricky aren't they? I mean don't you have to watch your diet with those? Well I guess that's a fair trade off for being able to function. I'm happy for you that the Parnate seems to be working for ya. :)> If you're looking for antidepressants, I can give you a long list of different drugs and strategies you can go over with your doctor
> **thank you :)> If you can't take an anti-anxiety med and get out and get rid of that depression, .. then perhaps you should try to find a way to predict whether it will work or not...
> I don't know how many doctors know how to get a blood level done
> I don't know how many doctors know how to use an EEG to predict an early response ...
> probably worth looking into yourself, though...
> ***thanks for that information. Dang, you're like an encyclopedia!! :) I'll look into it.> How long have you been on Wellbutrin for btw (this time around)?
***I just started the Welbutirn (this time) yesterday (wed).
>>
> No problem .... sorry I can't be more help, .. I might just become one of those happy people who goes off and lives their lives and you never hear from them again
> Or at least we can hope ;)
> ***you HAVE been of help. and I truly appreciated it.> Really though... I was surprised how much better I feel when I'm interacting with people... but it might just be me I don't know
***I understand. When I can force myself to leave the house, it's usually a good thing that I'm around friends. But it's hard...most of my friends are in the alcoholism recovery program taht I'm in and they are totally great and I love them all, but some do not understand my mental illness and that's difficult.Thank you again. God bless you.
-Bernadette (my real name...I couldn't use it as a screen name, it was already taken!)
Posted by EmilyAnn on July 4, 2002, at 15:53:40
In reply to Re: try Xanax in stead of Buspar, posted by cybercafe on July 4, 2002, at 4:05:09
yeah, if Xanax is addicting, that wouldnt' be a good idea for an alcoholic and addict like me! Although the eurphoria is tempting!
Posted by EmilyAnn on July 4, 2002, at 15:58:02
In reply to Xanax bad idea if possibility of alcohol abuse, posted by hildi on July 4, 2002, at 13:10:33
Hildi,
I'm so sorry to hear about your mother. Why would her doc give her Xanax if it's known to have reprocussions? That's a shame. I don't know if you believe in God or not...but I'm sure your mom is with Him now and she is no longer in pain.
Thank you for giving your input to the benzos...I too am an alcoholic and addict. Addictive personality sums it up very well.
Take care.
-Bernadette
Posted by cybercafe on July 5, 2002, at 5:25:29
In reply to Re: thank you, posted by EmilyAnn on July 4, 2002, at 15:51:21
> > ***:) the disclaimer is all good. I understand hon! You do seem very well educated on this subject. I think that's very important. We need to know about our illness and the treatments. I do value the opinions and
Yeah it's easy to become well educated when you have so much time on your hands -- and you're motivated to get better :)
> > What would you like to know? I can't tell you what's worked for me 100%, cuz nothing has yet ;)
> > **Is that common? That not med works 100%...I guess it is because therapy is an important component too.I dunno! That's something I'd like to know....
I do think 60 - 70% of people do well enough on their first med to not feel like they need to try another... that sounds promising
> >***The Gapapentin is Neurotin. I was on that for about a month and a half. Still on it, but tapering off...in about a week I'll be off. It seems strange the my new psych would not have me on a mood stabilizer. What I've read on BPIIHow did gabapentin work for you? Make you feel better at all? What type of dose were you taking?
>>shows that a mood stabilizer is crucial and that you have to watch how much of an anti-depressant you take b/c it can induce mania.
Yeah especially for BP type I. If type II just means you get hypomania, it doesn't seem as dangerous. I'm sure it must vary on a person to person basis (and how quickly you can see your doc if you have a problem)
>>But, he said that there are many mood stabilizers I haven't tried and if I need it, we'll try them. It just sucks that I have to try all these meds just to be functional! It's a bit
... well who knows... i'm just happy they're learning more about the meds out there, and inventing better ones too...
plus i expect genome discoveries will allow for much more powerful drugs with much fewer side effects..>>frustrating, as all of you proably know. I'll research Parnate and see what's up with it. I just want to know what's out there so I can work with my psych. in finding the best meds for me (in case the new tx doesn't work).
.... yeah it would be nice to have a systematic method of deciding which drugs to take in which order....
> > ***it's weird. I sleep too much too at times. Esp. when I am depressed. but other times I just can't sleep at all. I guess that's when i'm cycling. Wouldn't it be better to have the 'fun' mania? LOL. Just kidding. But sometimes feeling grandious seems better than being so dang irritalbe and agitated. But all of it is difficult.hey it would definately be better to have the fun mania... as long as you don't go completely nuts .... though i guess it might make it harder to come down... Ug... never is ever simple :(
> >***the mood stabilizers I've tried (depakote and neurotin) have not worked with respect to the cycling. It seems that all meds work for me maybe at 40% and I am able to function a bit better, then they just stop working. I don't
how long do they work for? ... i often wonder if the effets i am getting are just placebo :(
>>think I need an anti-psycotic b/c I 've never experienced those type of symptoms (thank God, my friend who has BP w/ psychotic features, says it bites but his meds are working fine for him now). Do the anti-psychotic meds have any other benefits rather than stopping psychosis?
...yes... zyprexa, for example, is anti-depressant, anti-manic, anti-anxiety, mood-stabilizing ... and anti-psychotic...
some use it alone, some use it with ADs for anti-depressant effect...
> > Alcohol prevents your liver from metabolizing medication for... I believe 56 hours minimum. That's 2.5 days. So if you are drinking every 2.5 days, or more frequently, you may as well just take no medication
> ***Dang, I didn't know that! Hmm, no wonder it was worse when I was drinking alot!.. it's bad stuff man... i definately wouldn't want to risk compromising the effectiveness of my meds...
> ***I've been sober for 5 months (b/c of the program I am in and w/ God's help). It's partly more difficult now b/c I have nothing to 'self-medicate' when I get anxious or depressed. Does that make sense? But when I was drinking, my moods were all messed up too...but I didn't care b/c I was drunk
...it's good you're not drinking anymore...
... i never found i could drink alone, .. but yeah it did help me when i was socializing...> >***no offense taken hon! You are so helpful and very sensitive to others. Great qualities. Are you in a helping profession?
.. i'm flattered that you think so :) ...
...i'd go to med school, but i am way too squeemish :) ...
.. who knows, maybe pharmacy + psychology...
... or i could go into law, and help people sue for mental health services.. that would be cool.. er.. rewarding.. :)problem... if you have substance abuse problems, maybe your doc is reluctant to give you a benzo, but there are other meds available (possibly not as good, but a hell of a lot better than nothing)
> > ***thank you :0) the benzodiapines addictive? I had better steer clear of those then!.... i guess you can always ask your doc what they think...... up here in canada worse case scenario i could get a doc to start out by giving me only 5 days supply... but i suppose you don't have free doctors in the states?? ... how does medicaid work anyways?? ...
> > ***Hell yeah! I think I need to be more assertive w/ my doctors. I tried explaing things to her, but I think I get caught up in the fact that she is a doctor and knows more than me. But, I know myself and what is and is not working...so darn it, I should stick up for myself, huh? Hopefully I will be able to w/ my new Doc.
... i dunno.... i mean you have to deal with this stuff 24/7 and your doc just can't always be there.... so it seems really important that they let you know where you're heading.. and what to expect... i'm sure all doctors would find that reasonable...
> > ***I agree. :) And yeah, anything is better than 0% effective! I am just so fearful that soemthing else won't work or even worse make me sicker.... yeah i hear you.... sometimes i wonder if it might not be better to try something more dangerous under the close supervision of a doctor just to convince myself that drugs do in fact work.... then after a number of weeks go onto something safer...
> *** MAOI's are a bit tricky aren't they? I mean don't you have to watch your diet with those? Well I guess that's a fair trade off for being able to function. I'm happy for you that the Parnate seems to be working for ya. :)
... i havn't really cut anything out of my diet except for marmite .... and i watch out for aged cheese ... which i havn't really come across yet :)
but individual results may vary of course...
> > If you're looking for antidepressants, I can give you a long list of different drugs and strategies you can go over with your doctor
> > **thank you :)Disclaimer: I'm not sure how effective each med or med combo is, so I just guessed :)
Systematic Approach for Choosing an Antidepressant
Consider contributing medical conditions that may contribute to or cause the depressed state.
Use treatment appropriate to the subtype of depression (e.g., nortriptyline in melancholia). (i.e. different symptoms correlate with different neuroreceptor types)
Ensure adequate antidepressant dosage (or if available serum levels) and duration of treatment (at least equal to 4 weeks and 6 preferred).
If a patient had a partial response to an antidepressant and doesn't have significant side effects than increase the dose.
If a patient had no response to an antidepressant than the drug should be discontinued and an antidepressant from another class tried.
If nonresponsive at this point, then a trial with a different class of antidepressant might be attempted or augmentation with lithium or thyroid might be attempted.
Electroconvulsive treatment can be considered after any of these steps.
Lower potential meds:
Stimulant / ADD meds
Anti-Parkinson meds
Anti-cortisol (high urine free cortisol depressives)
Nefazodone
Steroids (only for steroid-induced depression?)
rTMS (repetitive trans-cranial stimulation) (short term relief only?)
Fair response:
Bupropion
Lamictal
Antipsychotic
Lithium
Quite good:
MAOI
Lithium Augmentation
Antipsychotic Augmentation
Lamictal Augmentation
Other Mood stabilizers (Carbamazepine? Keppra?)
Thyroid T3 or T4 Augmentation (increases norepenephrine receptor sensitivity?)
ECT
Opiods (buprenorphine?)Possibly Dangerous:
MAOI + TCAHigh Doses Lethal:
MAOI + TCA + stimulant
MAOI + stimulant
MAOI + stimulant + thyroid hormoneReally Last Resort:
SSRI + Stimulants
SSRI + MAOI
Unknown:
VNS (Vagus Nerve Stimulation)
MST (Magnetic Stimulation Therapy)
> ***I just started the Welbutirn (this time) yesterday (wed).Oh... yeah it's still a little early :)
> > ***you HAVE been of help. and I truly appreciated it.
Thanks :)
> ***I understand. When I can force myself to leave the house, it's usually a good thing that I'm around friends. But it's hard...most of my friends are in the alcoholism recovery program taht I'm in and they are totally great and I love them all, but some do not understand my mental illness and that's difficult.
Hmmm... I don't expect people to understand my illness... I just expect them to be able to have a decent sense of humour :)
Posted by Iago Camboa on July 6, 2002, at 3:42:15
In reply to Re: try Xanax in stead of Buspar, posted by cybercafe on July 4, 2002, at 4:05:09
'American benzophobic disorder' (ABD for short) would be a good name for the characterization of people who seem to believe that 'benzos' are addictive & dangerous drugs (Xanax worst of all, an authentic creation by the devil himself... due to its "euphoric effects") .
[Let it be said here between brackets that I've been taking the Xanax 7 months since as an anxiolytic & have never experienced any *euphoric effects* whatsoever (nor any *dysphoric effects* for that matter)...].
The said 'disorder' goes to the point of making its victims believe that benzos in general and the Xanax in particular aggravate depression instead of helping depressed people out of it!
[Let it be said again between brackets that Xanax is indicated & used for the treatment of depression in several European countries (e.g. Switzerland, France & Germany) and a physician friend of mine tells me he finds it better than Prozac, IHHO]
It seems to be further 'accepted' by some 'benzophobics' (totally no offense dude...) that **Xanax sounds so good -- how could anyone *not* abuse it? :)** (sic). Fortunately enough this 'tragicomic' disorder is only common in N. America and is rarer in the rest of the civilized world where Xanax is considered as a trivial anxiolytic which only has the uncommon property of acting as an anti-depressant as well. Truly fascinating this 'ABD'!... Even children in a few kindergartens are now more scared with the 'benzoman' and his comrade the 'xanaxman' than with the bogyman and his cousin the most cruel hobgoblin... May the Almighty give to all 'benzophobics' a long life free of any of those dreadful "euphoric effects".
>Totally no offense dude.. but I think the doc might be concerned about someone who has a problem with alcohol ... I'm not making the comment that he should be concerned, just that he probably is....
>
> though in truth I don't know anything about Xanax myself... but isn't it like the most addicting benzo (due to euphoric effects?) ...
> probably safer to use something like clonazepam, if a benzo is to be used ...
> i really don't know the potential for abuse in this situation.. and even worse i have no clue whether or not benzos worsen depression or by how much ... Ug :( :(
> so it is so hard to say
>
> but Xanax sounds so good -- how could anyone *not* abuse it? :) i could sure use some euphoria out here, that's for sure
>
> .. hah.. i also hate those short acting benzos... i feel like i'm on an emotional rollercoaster ride...
>
> plus! .. if you wish to make sure you are taking the absolute lowest dose... you have to keep testing yourself to see if the anxiety is there or not... and then take it if it is...
> i hate that .. because i constantly end up having bad anxiety pop up in my day 3 or 4 times
> maybe this is totally limited to me ...
> but i just love the gabapentin, cuz i take the same dose everyday and i don't wait to see if any anxiety comes around, or worry about addiction, or sedation, or increased depression or memory loss .. :) :) .. it's like a guilt free anxiolytic to me
>
> -- this message has been brought to you by Warner-Lambert <GRiN>
>
Posted by cybercafe on July 6, 2002, at 6:50:28
In reply to the benzoman the xanaxman, posted by Iago Camboa on July 6, 2002, at 3:42:15
> [Let it be said here between brackets that I've been taking the Xanax 7 months since as an anxiolytic & have never experienced any *euphoric effects* whatsoever (nor any *dysphoric effects* for that matter)...]..... i am glad you have found something that works for you....
..... i have met people who have done fine on benzos and others who have done horrible....
i'm not saying that shouldn't be taken, .. i just think people deserve a warning... and care should be taken...
... as for xanax not having euphoric properties.... the reason i said that is i remember people on alt.support.anxiety-panic who would save up their xanax so they could take a large dose at once for the euphoric effects....cheers :)
Posted by EmilyAnn on July 6, 2002, at 20:06:49
In reply to the benzoman the xanaxman, posted by Iago Camboa on July 6, 2002, at 3:42:15
Iago...thanks for you input. My old professor (abnormal psych) told us that benzos are addictive and from what I've read they are. I just assume be more safe than sorry, ya know? I know myself and my ability to get addicted to things.
But thanks for your opinion hon!
-B
Posted by Alan on July 6, 2002, at 22:10:49
In reply to Re: the benzoman the xanaxman, posted by EmilyAnn on July 6, 2002, at 20:06:49
http://panicdisorder.about.com/library/weekly/aa031997.htm
Alan
Posted by EmilyAnn on July 7, 2002, at 0:57:35
In reply to Re: the benzoman the xanaxman, posted by Alan on July 6, 2002, at 22:10:49
Allan...thanks, I'll check the site out now! :)
Posted by d miller on July 7, 2002, at 13:00:50
In reply to Re: Xanax bad idea if possibility of alcohol abuse, posted by cybercafe on July 4, 2002, at 14:15:33
I too have a fear of the benzo's. My pdoc has prescibed clonazpam .5mg and at a later date xanax .5mg.
I tried clonazpam 1/2 of a pill would knock me out for the day. I couldn't get of the couch, my head felt so cloudly. I couldn't understand all the praise for banzo's because of that sedated stupor feeling and I still would have a low level of anxiety. The only thing I do like is on bad nights when I can't sleep, I'll take one and I'll fall asleep and wake up in the same postion I fell asleep in, total knock out.
Xanax gives me the same sensation. My pdoc says to keep taking it, that thats a side effect that will go away. I don't know about that!
I'm very confused on the information thats out for benzo's.
D. Miller
Posted by cybercafe on July 8, 2002, at 2:45:10
In reply to Re: Xanax bad idea if possibility of alcohol abuse, posted by d miller on July 7, 2002, at 13:00:50
Hi d miller :)> I tried clonazpam 1/2 of a pill would knock me out for the day. I couldn't get of the couch, my head felt so cloudly. I couldn't understand all the praise for banzo's because of that sedated stupor feeling and I still would have a low level of anxiety. The only thing I do like is on bad nights when I can't sleep, I'll take one and I'll fall asleep and wake up in the same postion I fell asleep in, total knock out.
>
> Xanax gives me the same sensation. My pdoc says to keep taking it, that thats a side effect that will go away. I don't know about that!oh.. have you been taking the benzos for long?
I hope you begin to feel better on them... or find a medication that is right for you ...
> I'm very confused on the information thats out for benzo's.Yep... I'm pretty much confused about everything.
Posted by joy on July 8, 2002, at 11:20:38
In reply to Re: the benzoman the xanaxman, posted by cybercafe on July 6, 2002, at 6:50:28
No offense, but a large dose of Xanax is more likely to put you asleep. I'm on Xanax as needed; usually for sleeping only .5 a day, and have skipped days. I used to take it .5 2 times a day or even .75 when I could not sleep. I have no problems with this med. It's cheap, it works great, and just wanted to give my humble opinion. No medication is good for alcoholics probably.
Joy
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