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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Lawrence S. on January 21, 2003, at 2:02:32
I'm on wellbutrin 400mg klonopin 2mg, ritalin 15mg, mirapex 1.5mg. I still get social anxiety, lethargy anhedonia, derealization, obsessive thoughts. What do I try next? My Dr. wants me to stop everything cold turkey except the klonopin. Then dry out for 2 weeks and start nardil. Any other suggestions would be appreciated.
Posted by ace on January 21, 2003, at 2:07:59
In reply to Advice needed: cocktail not good enough, posted by Lawrence S. on January 21, 2003, at 2:02:32
> I'm on wellbutrin 400mg klonopin 2mg, ritalin 15mg, mirapex 1.5mg. I still get social anxiety, lethargy anhedonia, derealization, obsessive thoughts. What do I try next? My Dr. wants me to stop everything cold turkey except the klonopin. Then dry out for 2 weeks and start nardil. Any other suggestions would be appreciated.
See my above posts. I think your doc has the best idea. Nardil is brilliant. My problems sound very similiar to yours. Do you also get strong phobic anxiety associated with the deralization?
Mr. Nardil (aka ace)
Posted by ace on January 21, 2003, at 2:08:49
In reply to Advice needed: cocktail not good enough, posted by Lawrence S. on January 21, 2003, at 2:02:32
> I'm on wellbutrin 400mg klonopin 2mg, ritalin 15mg, mirapex 1.5mg. I still get social anxiety, lethargy anhedonia, derealization, obsessive thoughts. What do I try next? My Dr. wants me to stop everything cold turkey except the klonopin. Then dry out for 2 weeks and start nardil. Any other suggestions would be appreciated.
See my above posts. I think your doc has the best idea. Nardil is brilliant. My problems sound very similiar to yours. Do you also get strong phobic anxiety associated with the deralization?
Mr. Nardil (aka ace)
Posted by Ritch on January 21, 2003, at 9:49:14
In reply to Advice needed: cocktail not good enough, posted by Lawrence S. on January 21, 2003, at 2:02:32
> I'm on wellbutrin 400mg klonopin 2mg, ritalin 15mg, mirapex 1.5mg. I still get social anxiety, lethargy anhedonia, derealization, obsessive thoughts. What do I try next? My Dr. wants me to stop everything cold turkey except the klonopin. Then dry out for 2 weeks and start nardil. Any other suggestions would be appreciated.
I would go for what your pdoc is wanting to do. Wellbutrin worsened my SA symptoms, Ritalin didn't really help them much, and Mirapex just made me real drowsy/lethargic and nauseous.
Posted by Lawrence S. on January 21, 2003, at 13:16:44
In reply to Re: Advice needed: cocktail not good enough, posted by ace on January 21, 2003, at 2:07:59
Yes I do get strong phobic anxiety as well as derealization. I was on Nardil for about 4-5 years and it is the best. I had some scary experiences when I had to go into emergency surgery while on it. I still have that fear that someone will give me a plate of food with some really aged cheese in it and not tell me. I guess that's just the price you have to pay if you want results. The other thing is the drying out period. Anyone know of other meds besides AP's that can help me through this?
Posted by JohnL on January 21, 2003, at 17:51:15
In reply to Advice needed: cocktail not good enough, posted by Lawrence S. on January 21, 2003, at 2:02:32
The antipsychotics can really shine in situations like yours. Zyprexa would be my first pick, Risperdal second. The cool thing is that if they are to be of any good to you, they will do so in a week or less. No long waiting. The whole washout Nardil thing will be very nasty. Instead, just put a little Zyprexa in there for a week, Risperdal the second week, and see if either one helps. If one does, then give it a longer trial.
The newer APs offer so much more than most of the other psychiatric meds. They are quickly gaining in popularity and becoming first line treatments for depression, anhedonia, and mania.
I have a lot of faith in the APs generally. More often than not, I hear positive comments from people who try them a lot more than negative comments. Just my opinion, but I think the APs are better for depression than the ADs are. Especially when the depression is the anhedonic type.
And as a sidenote, Wellbutrin doesn't sound like it is doing much for you. In fact, it may even be making some of your symptoms worse. If any med in the cocktail was to go, I would let that one go away first. And as another sidenote, the APs seem to work best with a small bit of an SSRI in there. You might consider replacing the Wellbutrin with a little bit of Prozac. The Prozac turbocharges the AP, and vica versa. I've never seen that happen with Wellbutrin.
But back to where I started, think about doing some quick trials of APs. You might be surprised.
John
Posted by xjs7 on January 21, 2003, at 19:27:47
In reply to Re: Advice needed: cocktail not good enough, posted by JohnL on January 21, 2003, at 17:51:15
Hi JohnL,
I think it is great that you have done so well on Zyprexa and Prozac. I think however that you might have a little too much faith in these medications.
Medications like Zyprexa are very serious drugs which can cause disfiguring and even crippling side effects. Risperdal has been blamed on some very serious cases of tardive dyskinesia and dystonia. There are some people who are crippled because of these drugs.
Tardive dyskinesia is always a risk when taking an antipsychotic agent, regardless of dose and duration of treatment. True, high doses for long periods of time in older people increase the odds of developing this condition. But TD can occur in people treated with low doses only for a couple months. Also the odds of developing TD are higher for people who do not have the diagnosis of schizophrenia. So, if you do not have that diagnosis you are running an even higher risk of developing this condition.
Have you ever seen someone who has tardive dyskinesia? Probably not--most people who have would not recommend AP's to just about any person who has depression or anhedonia.
AP's are not miracle drugs. They are dangerous and can cause serious damage. This damage might be more common than you think.
xjs7
Posted by JohnL on January 22, 2003, at 5:26:03
In reply to Re: Advice needed: cocktail not good enough » JohnL, posted by xjs7 on January 21, 2003, at 19:27:47
Scientific evidence for the safety of Zyprexa is overwhelmingly positive. Risks such as TD are very small with Zyprexa. Reported cases of TD on Zyprexa generally occur with high doses over long periods of time, and the cases are few. This is in contrast to other APs that have higher incidents and risks.
I've tried just about every psychiatric drug out there over the last 20 years. From my own personal experience, Zyprexa is one of the very best cream of the crop meds and it also has the fewest side effects I've ever experienced.
And with all drugs, no matter what they are, there are risks. Simple Aspirin can cause serious side effects. People have even died from Asppirin. Each patient has to make a risk/benefit decision.
I experience such an improved lifestyle with Zyprexa that I willingly accept the potential risks. It is comforting to know that the risks in scientific trials were very low.
For me, the risks are low but the benefits are high. That's the way it should be.
If one goes through life never accepting a risk to get ahead in life, then one never will get ahead.
John
Posted by Lawrence S. on January 22, 2003, at 13:26:55
In reply to Re: Advice needed: cocktail not good enough, posted by JohnL on January 22, 2003, at 5:26:03
John, What was your main symptom that AP's have treated? I have given them a try and they seem to exacerbate my worst symptoms which are socaial phobia. Growing up I watched my Mother take her Ap's and from what I saw shortly after taking her dose she became docile, spacey and was content with chain smoking and lethargically staring into space. It took away her zest, motovation, personality. This was also true when the pdoc switched her to the "miracle drug" lithium.
Posted by Jack Smith on January 24, 2003, at 11:52:08
In reply to Re: Advice needed: cocktail not good enough, posted by JohnL on January 22, 2003, at 5:26:03
John L,
Just wondering what your diagnosis is? Do you have any psychotic symptoms?? Have you ever tried an MAOI? Just wondering and congratulations on finding a good med combo, How long have you been on Z and Prozac and what doses?
Jack
Posted by cybercafe on January 24, 2003, at 13:22:04
In reply to Re: Advice needed: cocktail not good enough, posted by JohnL on January 22, 2003, at 5:26:03
> Scientific evidence for the safety of Zyprexa is overwhelmingly positive. Risks such as TD are very small with Zyprexa. Reported cases of TD on Zyprexa generally occur with high doses over long periods of time, and the cases are few. This is in contrast to other APs that have higher incidents and risks.
zyprexa is definately my number one choice for an AP... very low incidence of EPS/TD... for schizophrenics, anyways :(
i had EPS but it resolved within 3 weeks... then again, i had EPS on effexor :(
i don't think TD should be a concern at all, since it occurs over years (by definition) ... and by that time there will probably be much better treatments for illnesses and side effects...
what is a real concern is irreversible EPS... people who start to notice numbness in their mouth/head and continue to take the med i think could be in for real trouble..i think if you are vigilant and catch numbness early you would be okay (anyone know?)
worst case scenario.... i would be happy to have a movement disorder and be happy... but be sad to have no movement disorder and be depressed
no one seems to worry about drugs like lithium, but visible tremors and possible kidney failure seems worse than anything zyprexa would give me
> I've tried just about every psychiatric drug out there over the last 20 years. From my own personal experience, Zyprexa is one of the very best cream of the crop meds and it also has the fewest side effects I've ever experienced.yeah... the only thing that bugs me is having to sleep an extra 2 or 3 hours :(
but i've always been a hypersomniac and i do have to admitt that once i'm awake there is no sedation from zyprexai miss zyprexa + parnate :(
> I experience such an improved lifestyle with Zyprexa that I willingly accept the potential risks. It is comforting to know that the risks in scientific trials were very low.yeah, when you're happy you're too busy living your life to worry about these "what-ifs"
Posted by JohnL on January 25, 2003, at 5:37:50
In reply to Re: Zyprexa--John L, posted by Jack Smith on January 24, 2003, at 11:52:08
Jack,
My diagnosis has varied from one doc to the next. They all say something different. But basically I would say bipolar, primarily anhedonic depression. I don't go by diagnosis anymore, because from what I have seen, the meds that end up working best for someone are often unrelated to the diagnosis. Ironically, the meds that docs THINK should work, based on the diagnosis, often don't. I think trying to match a diagnosis to a med is a strategy full of flaws. There are other ways to make med decisions.
I did try MAOIs. They made me profoundly suicidally depressed within hours. A perfect example of the diagnosis, an appropriate med for that diagnosis, and big time failure.
My cocktail for the last two years has been 20mg Prozac, 5mg Zyprexa, and 300mg Adrafinil. All minimum doses. Recently I added the herb Rhodiola Rosea.
> John L,
>
> Just wondering what your diagnosis is? Do you have any psychotic symptoms?? Have you ever tried an MAOI? Just wondering and congratulations on finding a good med combo, How long have you been on Z and Prozac and what doses?
>
> Jack
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