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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 Janelle on May 13, 2003, at 22:48:20
I was on Buspar and got down to 15 mg/night. The ultimate goal was to go off it, which I did and almost immediately my anxiety rose and I began having more difficulty falling asleep at night.
It has been LESS than a week since I stopped it, and I got my pdoc to re-instate the 15 mg/night.
I have read on here that if you stop a med, then start it again, it may not work the second time around, so I'm worried. Perhaps this means if you stop it for a long time (like months) then re-introduce it? I only stopped it a few days.
Do you think it will continue to work for me, based on this short time frame?
Thanks.
Posted by Janelle on May 15, 2003, at 18:40:37
This is strange - my original post about second trial of meds disappeared from here and it did not archive - the ones right before and after it are still here. Anyway, question - I've read on here that if you stop a med, then start up on it later on (I'm guessing like months) it may not work the second time around. What about a few DAYS? I went off Buspar (pdoc and my experiment) and my anxiety rose and I had trouble falling asleep so he put me back on it. I was off it less than a week? Would this make a difference in its efficacy? Is this really a *second* time around or more like a few missed doses? Thanks to whoever can help.
Posted by Janelle on May 15, 2003, at 22:02:03
I've posted this question twice now because it keeps mysteriously disappearing and I don't know why - it is certainly MEDICINE related and belongs here on PB!
I just want to know if going off a med (in this case Buspar) for a few days, then going back on would be considered skipped doses or an actual second trial (because I read on here that second trials of the same med often don't work)? Any info greatly appreciated.
Posted by ace on May 16, 2003, at 0:38:12
In reply to trying 3rd time - re med second trial:, posted by Janelle on May 15, 2003, at 22:02:03
I read on here that second trials of the same med often don't work)? Any info greatly appreciated.
I would say skipped doses. It is absolute rubbish 2nd trials of the same drug don't work. I have never seen ANY anecdotal, clinical evidence of this. Maybe it happens to 1 in so many thousands but don't worry about that.Good luck to you friend, any further qstns welcome!
BTW, this is on the subject, I just re-started NARDIL around 3 hours ago - I can literally FEEL it in my body again, and the great response which is on the way!
Ace.
Posted by zeugma on May 16, 2003, at 9:46:47
In reply to Re: trying 3rd time - re med second trial: » Janelle, posted by ace on May 16, 2003, at 0:38:12
> I read on here that second trials of the same med often don't work)? Any info greatly appreciated.
>
>
> I would say skipped doses. It is absolute rubbish 2nd trials of the same drug don't work. I have never seen ANY anecdotal, clinical evidence of this. Maybe it happens to 1 in so many thousands but don't worry about that.
>
> Good luck to you friend, any further qstns welcome!
>
> BTW, this is on the subject, I just re-started NARDIL around 3 hours ago - I can literally FEEL it in my body again, and the great response which is on the way!
>
>
> Ace.
>
I agree with Ace about both things (that it's a skipped dose, and second trials can work). On my second trial with nortriptyline, beginning last summer, the drug has put me into a state of complete remission in terms of depression- which is what it had done the first time, about 13 years ago. And Buspar, in particular, is a benign drug as far as skipped doses go- I've been skipping doses of it lately because of a decrease in anxiety and because the drug is _inconvenient_ to take- 3x/day with meals- I'm always carrying around a little bottle of pills- and I've noticed no ill effects, either from the missed dose itself, or from the dose I take later.
Posted by SLS on May 16, 2003, at 10:07:44
In reply to trying 3rd time - re med second trial:, posted by Janelle on May 15, 2003, at 22:02:03
Hi Janelle.
> I just want to know if going off a med (in this case Buspar) for a few days, then going back on would be considered skipped doses or an actual second trial (because I read on here that second trials of the same med often don't work)? Any info greatly appreciated.
I agree with the others that missing a few days of dosing of a psychotropic would not endanger your response to it. However, I would have to disagree with them regarding your question about a reduced efficacy of previously successful trials of the same drug. It does happen, and it happens often enough to want to take the phenomenon into consideration when deciding whether or not to discontinue medication. This seems to apply most to the SSRI antidepressants. It can also happen with lithium. I can't comment on the frequency with which this happens. I don't know. It happens often enough to have landed me on Psycho-Babble. 13 years ago, a doctor had me discontinue a very successful treatment of Parnate 60mg + desipramine 150mg. After I relapsed two months later, he decided to give the newly-approved Prozac a try. I guess it was a new toy. It didn't work. Neither did the next few things he decided to try. Now, the previously successful combination no longer works, even when dosages were doubled.
- Scott
Posted by Ritch on May 16, 2003, at 10:24:51
In reply to Post disappeared! Re second trial of meds:, posted by Janelle on May 15, 2003, at 18:40:37
> This is strange - my original post about second trial of meds disappeared from here and it did not archive - the ones right before and after it are still here. Anyway, question - I've read on here that if you stop a med, then start up on it later on (I'm guessing like months) it may not work the second time around. What about a few DAYS? I went off Buspar (pdoc and my experiment) and my anxiety rose and I had trouble falling asleep so he put me back on it. I was off it less than a week? Would this make a difference in its efficacy? Is this really a *second* time around or more like a few missed doses? Thanks to whoever can help.
You would probably have to give it a couple of weeks at least to be sure. I've never experienced that sort of problem with stops/starts of meds. With some time they always seemed to do the things they had done previously. Also, *worrying* about whether it will work again probably is reinforcing itself some :) (been there done that). Why did you and your pdoc decide to experiment with stopping-did you feel that it wasn't do anything for you?
Posted by Jack Smith on May 16, 2003, at 16:55:06
In reply to Re: trying 3rd time - re med second trial:, posted by SLS on May 16, 2003, at 10:07:44
There is plenty of anecdotal evidence to suggest second trials don't always work as good first. Take a look through the archives. It cannot be easily explained scientifically but none of this stuff can. As far as mental health goes, we are still at the bleeding and leeches stage.
JACK
Posted by ace on May 19, 2003, at 3:10:02
In reply to Scott's 100% right, posted by Jack Smith on May 16, 2003, at 16:55:06
> There is plenty of anecdotal evidence to suggest second trials don't always work as good first.
Ummm....those anecdotes mean little. Biochemically, a fifth trial works as good as a first trial. This whole business is like the nonsense about poop-out. It's a phenomenological problem that is going on - the drug is working just as well as before, but the person is expecting too much, over-analysing.
Actually my Dr disagrees with me, like a lot of you probably will. He seem s to think the enzymes may become overwhelmed. Others think receptor death, blah, blah, blah.
I disagree and think that these drugs are not toxic enough (unlike ones used in cancer treatment) to render such damage to the extent that therapeutic results cease while the drug is acting in the body.
But the above refers to every other AD except SSRIs. I have reservations about these.
Anyhow, just my opinion...guess what? I could be wrong!Doubt it though.
As far as mental health goes, we are still at the bleeding and leeches stage.
We are making great progress actually. This is statement is hyperbolical.
Ace.
Posted by SLS on May 19, 2003, at 7:52:52
In reply to Re: Scott's 100% right » Jack Smith, posted by ace on May 19, 2003, at 3:10:02
I don't know about 100%!
> ...those anecdotes mean little. Biochemically, a fifth trial works as good as a first trial.
The drug might be doing exactly the same thing, but the body reacts differently, sort of like the immune system reacts to an antigen.
Here's my poorly-described proposed example:
During the first exposure to a drug, a series of events in the postsynaptic neuron, ie. a cascade of second messenger events, turn on genes within the nucleus to change the expression of enzymes and surface receptors. At some point, however, this machinery reaches a new equilibrium. A new dynamic balance is reached between drug effects and biological reactions to them. When the drug is discontinued, the cellular machinery and enzyme systems remain changed relative to that which existed previous to its first exposure to the drug. In other words, the system is no longer "naive" to the actions of the drug. The next time these neurons are subject to the drug, the response travels along a somewhat altered biological path, whether it be chemical or temporal. The equilibrium is therefore reached at a different position relative to the first one.
- Scott
Posted by Jack Smith on May 19, 2003, at 14:34:40
In reply to Re: Scott's 100% right » Jack Smith, posted by ace on May 19, 2003, at 3:10:02
> > There is plenty of anecdotal evidence to suggest second trials don't always work as good first.
>
> Ummm....those anecdotes mean little.They mean a whole lot to me. If I was just interested in clinical studies, I wouldn't be here. The point of this board for me is to get anecdotal stories, beyond just the official stuff.
>it's a phenomenological problem that is going on - the drug is working just as well as before, but the person is expecting too much, over-analysing.
>Poopout is a real phenomenon. It is documented. I hope you never experience it but I know I have. I do not know if there is an adequate scientific explanation for it but there are plenty of things that science has yet to explain, especially in the realm of mental illness.
>
> As far as mental health goes, we are still at the bleeding and leeches stage.
> We are making great progress actually. This is statement is hyperbolical.
>It was meant to be hyperbole. But, really, the theory that mental illness is just a simple imbalance of a couple of neurotransmitters just doesn't work. There are so many factors at play in our brain chemistry that we are really just at the beginning of understanding.
Good luck Ace and I hope the Nardil begins its work for you soon.
JACK
Posted by ace on May 19, 2003, at 20:15:03
In reply to Re: Scott's 100% right » ace, posted by Jack Smith on May 19, 2003, at 14:34:40
Sorry man if i appeared agressive...I could have been a little more respectful with my rebuttal.
I just was annoyed once with you after I posted some comments about Nardil. I basically said that things were great and I intended no psychotherapy...I know you like that stuff, and that's cool. But anyhow, you replied with 'Nardil could poop-out'. I felt a little annoyed and thought 'great, thanks for the support...'But that's OK man...I know you have a good heart, and wouldn't have meant ANY malice by it.
Take care.Ace.
This is the end of the thread.
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