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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 Simcha on October 4, 2002, at 17:40:24
I just met with a possible new psychiatrist who was concerned that I have gained 30 lbs. in the past 2 years on antidepressants.
I'm on:
40mg Celexa
200mg WellbutrinSR
1mg KlonopinHe was also concerned about treating the bruxism with Klonopin. He has suggested that Klonopin interrupts sleep patterns and that there are some other dangerous side effects to it. (Could this doc just be anti-benzo?)
Well, then he said that Neurontin would be better at treating bruxism. The down side is that Neurontin is usually associated with weight gain.
He then suggested that I study up on Topamax. This is supposed to get the bruxism too. I've seen that Topamax is also indicated for bipolar disorder. He really gave me a quiz about bipolar. It's been suggested before that I might be bipolar.
Topamax is supposed to cause weight loss too.
I have also read that it can cause Glaucoma, sudden death, and kidney stones. These all sound especially unpleasant. (esp. that sudden death thing.)
Then he seemed to freak out that my current choice of a therapist at one time suggested that someday I might not need meds. The pdoc felt he could not work on a team with someone who would say that I could be without meds. My own history and family history suggest that it would be unethical for any doctor to say anything but, "You're on meds for the long haul, kid." All of this according to the new doc.
I called my therapist today for clarification. He said that perhaps I was misunderstanding him. He has referred patients to psychiatrists before to be put on meds. He is not anti-med per se. He trusts the pdoc's judgement where that is concerned. He just thinks that it would be better if one could live without medication and he said that sometimes this is not possible. He said he'd be willing to work with the new pdoc if I chose to work with him.
I would like anyone's opinion about all of this. Is the pdoc giving me good advice about medication, especially the quitting of the Klonopin in favor of Topamax or Neurontin but also about him working with my therapist?
Well, I'll bring this out too. My current therapist is actually a counselor who chose not to be licensed because his work is with a special population. He is a specialist on treating Sexual Compulsion. There are unconventional treatments that he uses that he claims he would not be able to use if he were licensed here in California. I think he's great but will the pdoc flip even further if my counselor is not "licensed?"
Any comments are welcome.
Simcha
Posted by utopizen on October 4, 2002, at 18:13:50
In reply to Treat Bruxism? Topamax, Neurontin, or Klonopin?, posted by Simcha on October 4, 2002, at 17:40:24
I have teeth grinding, and my orthodontist gave me a retainer called a night guard.
I'm not sure why meds are given for it, although the jaws could become a problem... lots have bruxism, and few people seem to lose their jaws or something. Anyway, my orthodontist never mentioned drugs. All I said was someone heard my teeth grinding at night. And how do you know if meds work? I didn't even know I did grind until someone told me they heard me at night.
Klonopin blocks REM sleep. It's given to sleep disorder patients when their REM sleep needs some blockage.
All I know is that it seems to cause me nightmares. I remember one night I woke up and told my roommate in sleep talking that "I hate Klonopin, I'll never take it again" and then I went back to sleep. I felt very frazzled, I remember, like in a sleep terror.
Posted by xjs7 on October 4, 2002, at 18:21:44
In reply to Treat Bruxism? Topamax, Neurontin, or Klonopin?, posted by Simcha on October 4, 2002, at 17:40:24
Hi Simcha,
I have moderate to severe bruxism (according to my dentist) and I also take Celexa (30 mg). Although I can't really help you decide between anti-convulsants and Klonopin, I would be interested in how these drugs work on your bruxism. Have you had success with Klonopin so far? Anyways, please keep the board updated about your problem with bruxism; I am looking for a solution myself and I am sure others are too. I truly hope you find success with one of these drugs.
xjs7
Posted by Simcha on October 4, 2002, at 19:25:24
In reply to Re: Treat Bruxism? Topamax, Neurontin, or Klonopin » Simcha, posted by xjs7 on October 4, 2002, at 18:21:44
Yes, I have had great success with Klonopin. He's just concerned with my sleep, I've been an insomniac, and my weight.
He seems to believe that Klonopin has some very undesireable side effects in my case and that the anticonvulsants might be better meds for me in the long run.
Also, in regards to a bite plate my main problem was jaw pain that was so bad that I could barely open my mouth in the mornings and chew my food.
I guess I could just go off of the Klonopin and not eat! LOL ;-)
Anyway, I have gone back to being a vegetarian for the past three months. I used to be one and I found that I naturally lost and kept off weight on a vegetarian diet. Well, after three months I'm not losing any of the weight.
He also mentioned that I might want to get a thyroid test in the near future to see if there is something amiss with my thyroid.
All of this med stuff can be so complicated. I'm glad that I'm not studying to be a psychiatrist. I'm studying to be a psychotherapist. I won't, or shouldn't have to, prescribe meds.
I do welcome more comments. I'm still curious as to what others have to say.
Simcha
Posted by BrittPark on October 5, 2002, at 21:01:56
In reply to Re: Treat Bruxism? Topamax, Neurontin, or Klonopin » xjs7, posted by Simcha on October 4, 2002, at 19:25:24
I'm a little puzzled as to what your doctor has against klonopin. It and other benzos are often prescribed as a sleep aid, and are generally effective and considered very safe. Maybe you could ask your doctor to go into a little more detail.
Britt
Posted by Simcha on October 5, 2002, at 21:35:33
In reply to Re: Treat Bruxism? Topamax, Neurontin, or Klonopin, posted by BrittPark on October 5, 2002, at 21:01:56
Britt,
Thanks for writing. He claims that Klonopin interrupts certain cycles of sleep. This means that you do not have a proper sleep profile and you may not get enough of the different kinds of sleep you need in a night's sleep.
He also claims that Klonopin has been shown to be depression causing. Of course I was reading up on the other medicines he suggested and Topamax has that listed as a potential side effect.
There was also something about Klonopin causing more motor disruption than the other medication.
Perhaps he is anti-benzo. He does have some compelling arguments in favor of leaving Klonopin for Topamax or Neurontin.
I think we will more than likely choose Topamax because he is concerned about the 30 lbs. I have gained since starting meds two years ago. I believe that this was also one of his main concerns, my weight. I think that he also wants me to get a thyroid test.
Take Care,
Simcha
> I'm a little puzzled as to what your doctor has against klonopin. It and other benzos are often prescribed as a sleep aid, and are generally effective and considered very safe. Maybe you could ask your doctor to go into a little more detail.
>
> Britt
Posted by Ritch on October 5, 2002, at 22:08:28
In reply to Treat Bruxism? Topamax, Neurontin, or Klonopin?, posted by Simcha on October 4, 2002, at 17:40:24
> I just met with a possible new psychiatrist who was concerned that I have gained 30 lbs. in the past 2 years on antidepressants.
>
> I'm on:
> 40mg Celexa
> 200mg WellbutrinSR
> 1mg Klonopin
>
> He was also concerned about treating the bruxism with Klonopin. He has suggested that Klonopin interrupts sleep patterns and that there are some other dangerous side effects to it. (Could this doc just be anti-benzo?)
>
> Well, then he said that Neurontin would be better at treating bruxism. The down side is that Neurontin is usually associated with weight gain.
>
> He then suggested that I study up on Topamax. This is supposed to get the bruxism too. I've seen that Topamax is also indicated for bipolar disorder. He really gave me a quiz about bipolar. It's been suggested before that I might be bipolar.
>
> Topamax is supposed to cause weight loss too.
>
> I have also read that it can cause Glaucoma, sudden death, and kidney stones. These all sound especially unpleasant. (esp. that sudden death thing.)
>
> Then he seemed to freak out that my current choice of a therapist at one time suggested that someday I might not need meds. The pdoc felt he could not work on a team with someone who would say that I could be without meds. My own history and family history suggest that it would be unethical for any doctor to say anything but, "You're on meds for the long haul, kid." All of this according to the new doc.
>
> I called my therapist today for clarification. He said that perhaps I was misunderstanding him. He has referred patients to psychiatrists before to be put on meds. He is not anti-med per se. He trusts the pdoc's judgement where that is concerned. He just thinks that it would be better if one could live without medication and he said that sometimes this is not possible. He said he'd be willing to work with the new pdoc if I chose to work with him.
>
> I would like anyone's opinion about all of this. Is the pdoc giving me good advice about medication, especially the quitting of the Klonopin in favor of Topamax or Neurontin but also about him working with my therapist?
>
> Well, I'll bring this out too. My current therapist is actually a counselor who chose not to be licensed because his work is with a special population. He is a specialist on treating Sexual Compulsion. There are unconventional treatments that he uses that he claims he would not be able to use if he were licensed here in California. I think he's great but will the pdoc flip even further if my counselor is not "licensed?"
>
> Any comments are welcome.
>
> SimchaSimcha, I have found that Neurontin or Topamax gives me a better "quality" of sleep than Klonopin. My pdoc has mentioned recently that Klonopin (and other BZD's) tend to reduce the amount of "deep-restful" sleep that you get. The *kicker* (pun intended!), is whether or not those two meds could help with bruxism (or restless legs) better than Klonopin. I get restless while I sleep while on Wellbutrin (I tend to toss and turn a lot and not sleep soundly). Klonopin helps, but I can add just 100-200mg of Neurontin at bedtime and sleep without tossing. Topamax is a little long-acting and I tended to sleep *too* soundly and take too long to wake up in the morning, though. Zoloft gave me restless legs really badly while I slept. I would have sheets, pillow, covers, all twisted around on the floor when I woke up and I would feel tired all day. Reducing SSRI would help the bruxism, but I would be tempted to keep everything the same and just add on 300mg of Neurontin at bedtime.-Mitch
Posted by utopizen on October 5, 2002, at 22:47:34
In reply to Re: Treat Bruxism? Topamax, Neurontin, or Klonopin? » Simcha, posted by Ritch on October 5, 2002, at 22:08:28
"safe" does not ensure perfect 5th wave sleep.
Klonopin blocks REM portions, which is good, and which is why people who need their REM blocked get Klono prescribed.
But it also disrupts 5th wave sleep, the final phase in sleeping. That's the part the makes you feel refereshed when you wake. And for me, it causes nightmares I wake up to sometimes... So, um, no one said it's going to kill you, but no one said you're guaranteed to sleep perfectly on it, either. It's still not available next to Blistex on aisle 5, geesh.
Posted by MJC on October 6, 2002, at 7:03:02
In reply to um, klonopin's safe, but... um..., posted by utopizen on October 5, 2002, at 22:47:34
I sleep like a Rock on Klonopin. I take .5mg before bed with 50mg of Trazadone, close my eyes, adn the next thing I know it's 8 hours later and I'm totally refreshed.However, I do stress, don't take it if you don't need to take it. If you don't have a problem then you can and probably should do without it.
Posted by Simcha on October 6, 2002, at 10:16:09
In reply to Re: Treat Bruxism? Topamax, Neurontin, or Klonopin? » Simcha, posted by Ritch on October 5, 2002, at 22:08:28
>Simcha, I have found that Neurontin or Topamax gives me a better "quality" of sleep than Klonopin. My pdoc has mentioned recently that Klonopin (and other BZD's) tend to reduce the amount of "deep-restful" sleep that you get. The *kicker* (pun intended!), is whether or not those two meds could help with bruxism (or restless legs) better than Klonopin. I get restless while I sleep while on Wellbutrin (I tend to toss and turn a lot and not sleep soundly). Klonopin helps, but I can add just 100-200mg of Neurontin at bedtime and sleep without tossing. Topamax is a little long-acting and I tended to sleep *too* soundly and take too long to wake up in the morning, though. Zoloft gave me restless legs really badly while I slept. I would have sheets, pillow, covers, all twisted around on the floor when I woke up and I would feel tired all day. Reducing SSRI would help the bruxism, but I would be tempted to keep everything the same and just add on 300mg of Neurontin at bedtime.-Mitch
Mitch,
Thanks for the response! :)
I cannot afford to reduce the SSRI. I need it for various reasons. Adding Neurontin makes sense. I do have a question about its weight-adding potential. I've already added 30lbs. on meds...
Thanks,
Simcha
Posted by Simcha on October 6, 2002, at 10:19:07
In reply to um, klonopin's safe, but... um..., posted by utopizen on October 5, 2002, at 22:47:34
> "safe" does not ensure perfect 5th wave sleep.
>
> Klonopin blocks REM portions, which is good, and which is why people who need their REM blocked get Klono prescribed.
>
> But it also disrupts 5th wave sleep, the final phase in sleeping. That's the part the makes you feel refereshed when you wake. And for me, it causes nightmares I wake up to sometimes... So, um, no one said it's going to kill you, but no one said you're guaranteed to sleep perfectly on it, either. It's still not available next to Blistex on aisle 5, geesh.
>
>Utopizen,
Thanks for the great response. :)
I'm glad to hear confirmation of the disruption of sleep cycles concerning the use of Klonopin. I think this is one of the pdocs gripes against it. I'm using it to combat Bruxism so I really need something else. I'm just trying to research other options.
Thanks,
Simcha
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