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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Peter on July 7, 2002, at 16:42:32
Hi all. I'm confused. After 6 years of seeing the same p-doc, I've gone through numerous medication regimes. Also, my doc has shaped my diagnosis over the years as he's gotten to know me better. His final assessment of my condition is that I have mild hypomania with some social phobia, a little experience in the past of panic attacks, and "probable" ADD. He tells me that none of these are "full blown," but it is the varying degrees of combined elements of each disorder that tends to make my life unmanageable at times. The annoying thing about this is that I'm always taking some sort of complex cocktail in order to target these various areas. Right now I'm taking zoloft 62.5mg for depression/SP/anxiety, adderall 12.5 to 15mg (in three divided doses) for attention, motivation, impulse control, klonopin 1.5mg (in 3 divided doses) for SP/anxiety/panic prevention, depakote 500mg for mood stability, and ambien 10mg for sleep. The sheer variety and number of pills I pop each day tends to make me feel like a robot; it seems like I'm taking a drug for every possible symptom. What really bothers me is that my p-doc has many times supported my trying to stop meds altogether because he said my case is not so 'serious!' Where is the line between having 'mild' symptoms of different 'disorders' and just being a human being with a full emotional spectrum?!
Furthermore, Most people I know with multi-sided diagnoses are stable on 1 or 2 meds. It's wierd because part of me wants to simplify my intake but another part of me feels comfortable and 'in control' taking so many pills. Are such complex 'cocktails' necessary? Are they common? I'd appreciate any thoughts or suggestions.
Peter
Posted by jennie on July 7, 2002, at 22:07:59
In reply to Complex Medication Cocktails, posted by Peter on July 7, 2002, at 16:42:32
i think you have to do what is right for you. and try to figure that out if you don't know. trust how you feel. is it possible to try to slowly cut back? i stopped taking zoloft cold turkey and also birth control pills becaue physically i felt terrible. now all of this emotional stuff that has been subdued is coming up. i know its not smart to just stop especially when you have sucicidal tendancies, but im a week off and so far i feel extremely shitty but ok. if that makes sense. i still take dexedrine though. one thing at a time. i just think meds after a while wear you're body down. im only 19 and my body has so much damage to it from meds. at one point i was on 13 different meds for various things. i almost died last year form pneumonia but i have cut back to 4 meds and an inhaler over the past couple monthes. patience and lots of it. and a good punching bag. good luck.
Posted by rainbowlight on July 8, 2002, at 0:03:24
In reply to Complex Medication Cocktails, posted by Peter on July 7, 2002, at 16:42:32
I can totally relate to your post. I have almost the same diagnosis that you have and I take an almost identical regimen. I too feel like I can open up my own pharmacy, lol! In my experience (diagnosed at 19, now I am 34) I have had much better luck in combining meds than in only using just a few. It's been hard to handle the thought of it, but I actually feel much better now that I am on 6 (maybe it's 7) meds than I did on 1 or 2. Don't feel bad, I think there are many people here that are on quite a few meds, in fact I think it's the majority from what I have read. As far as trying to stop all meds, if you do I would suggest only cutting out one at a time. It would be much easier on you mentally and physically and you could gage which were needed and which could be dropped. Good luck.
Posted by oracle on July 8, 2002, at 0:48:05
In reply to Complex Medication Cocktails, posted by Peter on July 7, 2002, at 16:42:32
The right number of meds is the number that works.
The real question is are they working. Are they ?
I've taken 4 meds together of years with no problems.
Posted by Peter on July 8, 2002, at 3:04:30
In reply to Re: Complex Medication Cocktails, posted by oracle on July 8, 2002, at 0:48:05
> Firstly, thank you everyone for your useful and caring input. I think the main problem with my situation is that I've been on so many combos for so long that I really don't no if it's all working or not, or, for that matter, if I need any of it. What further complicates it for me as that my doctor believes that all of these symptoms I have which stem from various disorders are in themselves mild. As I mentioned before, he even supported my two decisions in the last year to taper off of various meds. On both occassions, I tapered slowly, one at a time. The first time I was on adderall, depakote and klonopin. I got off the adderall and depakote gradually, but before I could even start coming off the klonopin, I started experiencing real emotional discomfort-anxiety, restlesness, social phobia, etc..which made me run back to my p-doc for a new med combo. Another thing that further confuses all this is that in the mid 1990's a was a hardcore drug addict (heroin, cocaine, and anything I could get my hands on). It's true that many of my current mental problems were caused or exacerbated by my drug use, but the real catch is that I got off of heroin and cocaine in summer 1997, and since then my pdoc has had me on one drug regime after the next-from all the SSRI's to many different mood stabilizers to klonopin to dopamine agonists, beta-blockers, stimulants, u name it! So, essentially, my system has not been 'chemical free' (whether illicit drugs or pharmaceuticals) since the early 90's! So I can't tell if these meds work! What would I feel without them? I mean, the two times I tried tapering off everything, I freaked out and ran back to my doc, only to be placed on yet another slew of meds. I do recall at one point going to a second pdoc-a very well-known one in NYC, for an evaluation, like a second opinion. He said he doesn't think I have ADD (whereas my normal pdoc says I do!) and this second guy wanted to take me off everything and simplify it all down to lithium once a day. Well, I freaked out reading about the side-effects and the simple fact that anxiety and mild mood swings are more what I go thru than large Bipolar I episodes, which is what lithium seems to target best. So I didn't take it, and just went back to what I knew helped me be more social and less depressed - an SSRI. Yet, since the SSRI's in the past tended to make me crave alcohol because of dopamine-deficiency, I stayed on adderall for impulse control and my 'possible' ADD. Then, since I've been taking klonopin for 4 years, he told me to just continue it indefinitely, even though I feel nothing at all from it-I guess it just wards off panic for me now. And, of course, even though he says I sometimes have mild hypomania, he absolutely insisted that I not take an SSRI without a mood stabilizer, so I opted for depakote since I was used to it from being on it for years. And I'm a jazz pianist and composer, so the whole dulling effect that anticonvulsants can have on creativity is another issue for me, and therefore the pros and cons of if all of these meds are necessary. I'm really sorry for blabbering on and on-I just need to get it off my chest. But if anyone had the patience to trek through my boring self-absorbed essay here, I'd love to know what anyone thinks or advices. Thank you so much...all you guys are really the best.
Peter
Posted by Rainbowlight on July 8, 2002, at 17:05:20
In reply to Re: Complex Medication Cocktails, posted by Peter on July 8, 2002, at 3:04:30
Hi Peter. I know how frustrating this is for you (for me too, as I hate taking meds too) In my experience the only mood stabilizer I have found that doesn't make you a dull/blunted emotions/couch potato is Lamictal. I have been on just about every other one, and this is the one that everyone is raving about. It has been wonderful. I would have to agree with your doctor, if you are bipolar than taking an AD without a mood stabilizer is a bad idea. I did it and it landed me in the hospital (manic, agitated, insomnia). I am like you as I don't get the manic highs, therefore I am classified as Bipolar II. It sounds like you really want to give "no meds" a try, I would suggest starting with one med at a time, perhaps the one you feel is not giving you any benefit. As far as keeping social phobia at bay the AD's seem to do that the best. Mood stabilizers just seem to balance mood (not too high, not too low). For me anyway the mood stabilizers don't help with my anxiety, Zoloft does. Perhaps if you were on a different AD that better addressed your anxiety you might not need the Klonopin.
Posted by Ritch on July 8, 2002, at 22:00:14
In reply to Re: Complex Medication Cocktails, posted by Peter on July 8, 2002, at 3:04:30
> > Firstly, thank you everyone for your useful and caring input. I think the main problem with my situation is that I've been on so many combos for so long that I really don't no if it's all working or not, or, for that matter, if I need any of it. What further complicates it for me as that my doctor believes that all of these symptoms I have which stem from various disorders are in themselves mild. As I mentioned before, he even supported my two decisions in the last year to taper off of various meds. On both occassions, I tapered slowly, one at a time. The first time I was on adderall, depakote and klonopin. I got off the adderall and depakote gradually, but before I could even start coming off the klonopin, I started experiencing real emotional discomfort-anxiety, restlesness, social phobia, etc..which made me run back to my p-doc for a new med combo. Another thing that further confuses all this is that in the mid 1990's a was a hardcore drug addict (heroin, cocaine, and anything I could get my hands on). It's true that many of my current mental problems were caused or exacerbated by my drug use, but the real catch is that I got off of heroin and cocaine in summer 1997, and since then my pdoc has had me on one drug regime after the next-from all the SSRI's to many different mood stabilizers to klonopin to dopamine agonists, beta-blockers, stimulants, u name it! So, essentially, my system has not been 'chemical free' (whether illicit drugs or pharmaceuticals) since the early 90's! So I can't tell if these meds work! What would I feel without them? I mean, the two times I tried tapering off everything, I freaked out and ran back to my doc, only to be placed on yet another slew of meds. I do recall at one point going to a second pdoc-a very well-known one in NYC, for an evaluation, like a second opinion. He said he doesn't think I have ADD (whereas my normal pdoc says I do!) and this second guy wanted to take me off everything and simplify it all down to lithium once a day. Well, I freaked out reading about the side-effects and the simple fact that anxiety and mild mood swings are more what I go thru than large Bipolar I episodes, which is what lithium seems to target best. So I didn't take it, and just went back to what I knew helped me be more social and less depressed - an SSRI. Yet, since the SSRI's in the past tended to make me crave alcohol because of dopamine-deficiency, I stayed on adderall for impulse control and my 'possible' ADD. Then, since I've been taking klonopin for 4 years, he told me to just continue it indefinitely, even though I feel nothing at all from it-I guess it just wards off panic for me now. And, of course, even though he says I sometimes have mild hypomania, he absolutely insisted that I not take an SSRI without a mood stabilizer, so I opted for depakote since I was used to it from being on it for years. And I'm a jazz pianist and composer, so the whole dulling effect that anticonvulsants can have on creativity is another issue for me, and therefore the pros and cons of if all of these meds are necessary. I'm really sorry for blabbering on and on-I just need to get it off my chest. But if anyone had the patience to trek through my boring self-absorbed essay here, I'd love to know what anyone thinks or advices. Thank you so much...all you guys are really the best.
> PeterHi there,
Your situation sounds a lot like mine. There have been flips in my diagnosis over the last few years, but what seems to stick for sure is bipolarII and panic disorder. I've tried stimulants for my ADHD symptoms and they will fix the attentiveness problems, but worsen the panic ones. Klonopin wards off panic, but too much makes me depressed and worsens attentiveness. Depakote quells my hostility and improves impulse control, but too much of that also worsens my attentiveness. So, I have kept the Depakote and Klonopin minimal (250mg+.5mg at nite), and added Effexor for ADHD and depression in the morning (just 25mg AM). So far, so good. A lot of my attentiveness problems are related to anxiety. If I can reduce anxiety without making me stupid it helps. The low-dose Effexor is having an antipanic effect as well. I get a *little* hypomania later in the day (when my Depakote levels are falling off), but it is manageable, and the Effexor is low enough at bedtime I can sleep OK without sleep help. I guess what I am trying to say is..that complex cocktails are fine IMO if you can tolerate them and they work. If you want to simplify things, you can, but it isn't going to be easy.
Mitch
Posted by oracle on July 9, 2002, at 0:27:46
In reply to Re: Complex Medication Cocktails, posted by Peter on July 8, 2002, at 3:04:30
Hmmmm.....
Would you describe how long you took to get
off each med ? Or just how long from start to finish for all
of them.
Posted by Peter on July 9, 2002, at 3:06:18
In reply to Re: Complex Medication Cocktails, posted by oracle on July 9, 2002, at 0:27:46
> Hmmmm.....
>
> Would you describe how long you took to get
> off each med ? Or just how long from start to finish for all
> of them.
> Well, the two times I opted to go off meds, my doc started with a depakote taper. I think both times I was taking 750mg nightly, and he put me on a really gradual taper-about 125mg off every few weeks. By the time I reached my last 125mg, I had episodes of agitation, restlesness, and anxiety; it wasn't unbearable, but unpleasant enough that I wanted relief with more meds 'cause I didn't know how else to deal with it. Not to mention that the first time I was reducing meds, Sept. 11th happened, and I' m in Manhattan-my internist thought I had anthrax 'cause of these little marks on my skin which turned out to be some allergy! it was pretty awful- biopsies and everything. So all that really precipitated my anxiety/depression. The second time there were also external factors that might have triggered these episodes, thus making it hard to tell if it was a legitimate verification of a chemical imbalance or just natural psychological reactions to dire circumstances. I sure tend to overthink everything-right now I'm doing ok-I feel stable-the zoloft is helping my social phobia and depressive dips, the adderall my motivation, and I'm sure the depakote and klonopin are doing what they're supposed to. Freedom from meds would be nice, but I have alot to be grateful for. Even if I don't need the meds, things seem okay on them-if it ain't broke, don't fix it. I'd love to live by that motto! Easier said than done! (-:
Peter
Posted by cybercafe on July 9, 2002, at 22:29:22
In reply to Re: Complex Medication Cocktails, posted by Rainbowlight on July 8, 2002, at 17:05:20
>emotions/couch potato is Lamictal. I have been on just about every other one, and this is the one that everyone is raving about. It has been wonderful. I would have to agree with your
Hey ... glad it works for you.... mind if I ask what dose you are taking? I tried 125, but didn't notice a benefit...
>doctor, if you are bipolar than taking an AD without a mood stabilizer is a bad idea. I did it and it landed me in the hospital (manic, agitated, insomnia). I am like you as I don't get
.... hmm.... when you say manic do you mean hypomanic or full blown mania (psychosis, or violence or whatever) ........
... and should we go to the hospital for agitation and insomnia? ... i never know what is 'normal'...>social phobia at bay the AD's seem to do that the best. Mood stabilizers just seem to balance mood (not too high, not too low). For me anyway the mood stabilizers don't help with my anxiety, Zoloft does. Perhaps if you were on a different AD that better addressed your anxiety you might not need the Klonopin.
... yeah.... i don't know why gabapentin works.... maybe it relieves agitation and not anxiety? ... who knows...
Posted by jsarirose on July 16, 2002, at 14:38:26
In reply to Re: Complex Medication Cocktails, posted by cybercafe on July 9, 2002, at 22:29:22
Don't know if anyone responded to your Lamictal comment, but sometimes it is necessary to push the dose up pretty high. I tried it once and we went to 400mg then quit. After I quit my doctor consulted with someone else and he recommended pushing it even higher. I have a friend who takes 600mg and I'm back on it as a Parnate supplement (and possible replacement) and will push it as high as 800mg as long as there are no ill effects.
I definitely wouldn't consider 125mg a good trial unless you're getting negative side effects. I know in the beginning it is important to ramp up slowly to avoid possible rash.
You may want to try it again.
-Jessica
This is the end of the thread.
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