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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by noa on April 11, 2003, at 18:09:37
My pdoc and I agreed, as planned, for me to see what happens when I lower my dose of Effexor XR from 262.5 to 225.
We led up to this by increasing my fish oil dose, which has brought continued mood improvement.
I am not planning to discontinue Effexor, just to reduce the dose a bit, and hopefully improve on the s/e situation a bit.
BTW, I also take:
Adderall XR 30 mg
synthroid
Cytomel
chromium picolinate 400 mcg
Folic Acid
Multi vitamin
Serzone 500 mg
ativan .25 mg
Alesse (oral bc for hormones)
Posted by Janelle on April 11, 2003, at 18:13:44
In reply to Lowering my Effexor dose, posted by noa on April 11, 2003, at 18:09:37
Hi noa,
Feel like I *know* you cuz you and I respond to quite a bit of the same posts and to each other sometimes!
Wow - you were able to get up to 262.5 mg of EffexorXR! I could not tolerate 150 mg! Actually, I couldn't tolerate that med at all it turned out.
How much fish oil are you taking? I have heard such good things about it, but have tried it and it repeats on me - I *burp* up fish tasting. Yuck.
What does s/e stand for?
BTW, thanks for listing what you take - it sounds like you take more supplements/natural type remedies than meds!
I am guessing that you have hypothyroid cuz you take Synthroid - what dose do you take? I take .1 whatever of it/day for low thyroid. It has worked; my thyroid now tests in the normal range.
Posted by noa on April 11, 2003, at 19:32:29
In reply to Re: Lowering my Effexor dose » noa, posted by Janelle on April 11, 2003, at 18:13:44
Hi, Janelle,
>> Wow - you were able to get up to 262.5 mg of EffexorXR! I could not tolerate 150 mg! Actually, I couldn't tolerate that med at all it turned out.
I was once up much higher but couldn't tolerate it. But it worked for me as an antidepressant, after trying others, so it is good that lowering it made it more tolerable. Not perfect, but ok.
>>How much fish oil are you taking?Actually kind of a lot, I guess. I started at 1 to 2 grams of EPA per day and that made big improvements, so my pdoc suggested I double or triple that.
I try to take between about 3 and 8 g. per day. I stopped measuring, actually and just take a swig of a certain approximate amount! But sometimes I get 2 doses in and soemtimes 3, and sometimes I only manage one if it was a hectic day, so it does vary from day to day. Over all it seems to be a good amount for me. I probably should measure more carefully, but I got lazy. If I measured more carfully, I might avoid wasting money if I'm taking too much!
>>I have heard such good things about it, but have tried it and it repeats on me - I *burp* up fish tasting. Yuck.
Yep, but I don't get the burps with the liquid version that I take. I got them with the gelcaps, but not with this liquid (Carlson's) which is lemon-flavored. Only problem--not very portable--hence inconsistency in number of doses per day.
>>What does s/e stand for?
Side effects (It would probably be more accurate to say either "undesired effects" or "adverse effects")
> BTW, thanks for listing what you take - it sounds like you take more supplements/natural type remedies than meds!Not really, but the supplements were added recently. Cool pdoc supports them and tells me about research, etc.
> I am guessing that you have hypothyroid cuz you take Synthroid - what dose do you take?
Yup--that is what the synthroid and cytomel are for. I take 12.5 mcg. of cytomel twice a day, and 50 mcg of synthroid once a day. Before my hypothyroidism was really addressed, I was a MESS!! ie, not really responding well to antidepressants, etc. Physically, emotionally, mentally a MESS. Getting that under control probably saved my life.
Posted by Janelle on April 11, 2003, at 19:53:39
In reply to Re: Lowering my Effexor dose, posted by noa on April 11, 2003, at 19:32:29
Hi noa,
Well before I get to the liquid fish oil I gotta ask - you said you were once up "much" higher on EffexorXR - HOW MUCH HIGHER? I've heard that over 300mg/day can give a person high blood pressure. I do know someone at 300 mg/day who's doing great on it.
Okay, so fish oil is available in LIQUID form - wow, and duh on me I had NO IDEA! This is promising news because it was those darn gelcaps that repeated on me and made me stop taking it.
Sounds like you are getting a good/decent, heck more than decent dosage in with those swigs.
Does it have to be REFRIGERATED? Something tells me it does. Just guessing.
I will have to see if Carlson's or any other brand is available where I live - fish oil is good for depression, right?
My pdoc also supports supplements AND as we go through the "streamlining" process (getting me off some of the many meds I'm on) he is going to have me try a NATURAL THYROID SUPPLEMENT a patient of his told him about who has had good results with it!
What is Cytomel and how is it different than Synthroid? I forget which one Synthroid is - T3 or T4, so I'm betting that whichever it is, that Cytomel may be the other one?
Glad to hear that getting your thyroid condition under control with two meds that have excellent reputations has helped you so much!
Posted by noa on April 11, 2003, at 22:15:41
In reply to Liquid fish oil !! Ah-ha ... » noa, posted by Janelle on April 11, 2003, at 19:53:39
Cytomel is T3, Synthroid is T4.
I was on 450 mg of effexor xr for a while. Blood pressure was ok, but sleep problems were worse, also had sweating, memory problems, bladder problems were much worse, also had orthostatic hypotension (even fainted once), and muscle jitteriness and myoclonus (muscle jerks).
Yes, liquid fish oil definitely has to be refrigerated. And, take a look at the thread above with me, Ritch and Larry discussing the need to shake up the refrigerated fish oil before taking it because of settling.
Is the natural thyroid supplement going to be Armour Thyroid? It is made of dessicated pig thyroids. I won't take it because I don't eat beef, fowl or pork, etc. But the synthroid and cytomel are fine for me anyway. What people say is good about Armour is that it combines the T3 and T4. Or maybe you are talking about herbs that supposedly enhance thyroid function? I don't know much about those but have heard mention of them. Somehow, I sense that the latter don't have much research to back them up yet.
Good luck.
Posted by Janelle on April 12, 2003, at 0:10:07
In reply to Re: Liquid fish oil !! Ah-ha ..., posted by noa on April 11, 2003, at 22:15:41
Hi,
Thanks for clarifying which of those two was T3 and T4!
HOLY COW - you were on 450 mg of effexorXR for a while. That is the highest dose I've heard of! No wonder you had all those s/e's.
Thanks for the info about liquid fish oil needing to be both refrigerated AND shaken up (yeah, of course it would settle!)
The natural thyroid supplement my pdoc has in mind for me will not be Armour, which I am familiar with and know it is made of dessicated pig thyroids.
Wait till you hear what happened to me with one of those types - it was not Armour, which is the ONLY one regulated by the FDA (I found out a bit too late) -- Almost a year ago, I went to a doctor (not pdoc, just doc who USED to be a pdoc) who specializes in thyroid problems - well, he does blood tests using very different ranges than the usual ones. Very narrow ranges, so virtually all of his patients test out high or low - I tested low (all of my previous tests, done using the regular range, had always come out normal/fine/within the range).
So he puts me on something called "Nature-throid" made from dessicated pigs like Armour. The main difference is that the Nature-Throid is hypoallergenic. A few months later when I wind up in the hospital (due in part to that supplement) they test my thyroid and I can't remember which number it was (T3, T4, T7) it was, but whatever it was read ZERO. My thyroid had stopped working! I was SUPER-HYPO thyroid.
A doctor at the hospital did some research on that natural supplement I'd been downing and found out it's NOT regulated here and therefore the amount of natural pig thyroid varies from bottle to bottle and PILL to PILL! You could be getting waaaaaay more than the 1mg or way less, and never know it. Combined with EffexorXR, that stuff made me bonkers.
They put me on Synthroid right away, and I tested fine a few weeks later. I was also put on Lithium for other obvious reasons, and even though it's a low dose they are keeping me on Synthroid cuz Lithium can cause hypothroid.
You can be sure I will ask LOTS of questions and go all over the Internet when I find out the name of the supposedly natural thyroid supplement my pdoc is considering for me.
Thanks for your info.
Posted by noa on April 12, 2003, at 11:14:00
In reply to Wait till you hear THIS saga re natural thyroid !! » noa, posted by Janelle on April 12, 2003, at 0:10:07
Wow. A cautionary tale for sure!
Re Lithium--as a matter of fact, while I had been diagnosed by my pdoc as "subclinical hypothyroid" a few years earlier, it was only when I went on lithium that the importance of my thyroid disorder in my depression became apparent.
I was having more and more recurring episodes of depression and they were worse and worse. Right before lithium, I had gotten so depressed so my pdoc and I went back to reconfiguring my cocktail. That is when he suggested Lithium because he was then hypothesizing that I had a cycling type of depression in the BP family. And, in any event, he said lithium was shown to help poteniate ADs in depression. So I went on lithium, and after about 2 weeks started to feel better. This continued for about 6 weeks and them I started to feel worse and worse. The physical symptoms also got worse. So I started looking into the thyroid factor. My pdoc had my thyroid tests done again, and sure enough, my TSH had gone from 2.5 (as it turns out, this was too high for me anyway) to 3.8 during that 8 weeks on lithium. So I decided the thyroid must be a key factor for me, not just a side factor. I went looking for info and as it happens that months, Mary Shomon's book, "Living Well with Hypothyroidism" was published! And I also discovered Ridha Arem's "The Thyroid Solution" somewhere around that time, too. I read Shomon's book in one sitting and her description of the brain fog was uncannily like what I had been experiencing. I had told my therapist for months that I felt like I had cotton in my head! I couldn't think straight, couldn't figure out how to sort through papers at work, or start a task, or make small decisions like whether to put my skirt on over my head or step into it. Also, the physical symptoms of hypothyroidism matched what I had been experiencing (fatigue, muscle weakness, edema, pain in legs, etc.) Anyway, that prompted me to see an endocrinologist (found on Shomon's doc recommendation page, btw), who diagnosed primary hypothyroidism and had me raise my med doses gradually using symptom improvement (not lab results) as a guide, and stopping at the last level where symptoms had improved. For me, this left me at a TSH of less than 1.
It was then that I started seeing improvement over a period of about a year. I felt like I was responding to the antidepressants for the first time.
Posted by Janelle on April 12, 2003, at 12:18:20
In reply to Re: Wait till you hear THIS saga re natural thyroid !!, posted by noa on April 12, 2003, at 11:14:00
Well first of all, it sounds like the Lithium, in your case, did seem to induce/cause/aggravate hypothryoidism - I forget the statistics but it's a high percentage of women (for some reason it strikes women; lucky us!) who will develop hypothroidism when they are on Lithium (I think it might be dose-related to some degree; I'm on a sub-therapeutic dose so I'm hoping that MAYBE if the pdoc stops the Synthroid my thyroid will be back to within the *normal* range again like it always was before that disasterous experience.)
Ah, thank you for inadvertently mentioning TSH - that is what went to ZERO on me after being on that unregulated natural supplement for several months! And I think it was the T4 that was high because it was overcompensating for there being NO TSH secreted. What a mess that was.
Your symptoms that you had sound EXACTLY like mine and I can't tell you how *relieved* I am to hear that someone has gone through something similar. When I describe what I was feeling like (but in my case I don't think it was thyroid, but rather a-d related; I have Serotonin issues) I have yet to find someone who can *really* relate, having felt the same way. And I've talked and shared with a lot of people in similar boats!
I was also cycling like never before (until the low dose of Depakote was added to augment the low dose of Lithium; this is known to be an effective combo - what's interesting is I'd had two BAD experiences with Depakote, but higher doses and combined with other meds. However, I decided to remain OPEN-MINDED and try it again because I really trust my current pdoc so when he told me it was basically my only choice for mood stabilzer - can't tolerate Lamictal, allergic to Tegretol (and therefore probably Trileptal), I went along with him.
Thanks for the links to those thyroid books - right now I'm still having trouble concentrating on reading, but I do plan to check them out when I'm able to.
I was feeling EXACTLY what you described - it is UNCANNY the similarity and when I describe it to others, fellow *sufferers* I have yet to find someone (till you!) who knows what I'm talking about and has "been there, felt that!"
I also felt like I had cotton in my head! I couldn't think straight, couldn't figure out how to sort through papers (at home; I don't work right now) or start a task, or make small decisions, heck any kind of decision (the latter is a symptom of depression).
However, I did NOT have muscle weakness, edema, pain in legs, etc.)
How interesting that you are OKAY with a TSH of less than 1. I could not function on that.
Which a-d did you say you were on - sorry, but the Lithium, even at low dose, has messed up my memory. Have you found this to be the case for you at all?
Also, just curious - what kind of work do you do? You are lucky to be able to work; I can't just yet.
Again, thanks for continuing to share. It sounds like we have been down parallel roads! :-)
Posted by jane d on April 13, 2003, at 0:15:24
In reply to Re: Wait till you hear THIS saga re natural thyroid !!, posted by noa on April 12, 2003, at 11:14:00
Posted by noa on April 13, 2003, at 11:42:48
In reply to Re: Does time of day matter for thyroid supps? (nm), posted by jane d on April 13, 2003, at 0:15:24
NOt that I know of.
But these factors are important:
Take on an empty stomach--at least 3 hours after eating, and 1 hour before eating. Food limits its absorption.
It is good to be fairly consistent on time of day. Especially so with T3 (cytomel) which has shorter action.
My endo recommended I split my T3 into 2 doses per day rather than taking all at once.
This is the end of the thread.
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