![[dr. bob]](/dr-bob-sm.gif)
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 Peter on August 26, 2003, at 19:22:36
Hi all:
wow. I've posted recently, but I wanted to start this new thread instead of burying a post within one of my older ones; I think this way more people would see it and I can get more responses, 'cause I need a lot of advice. Sorry if I should have added it to an older one, Dr. Bob; redirect if necessary(-:
Here's a little background before I pose my question (for those who have already read my posts regarding what I've been struggling with these past 2 weeks, please forgive me and skip to the bottom): my doc had me taking multiple combos of varying doses of the following meds all throughout this past winter, spring, and early summer:Lamictal (50-100mg), prozac (5-10mg), adderall (35-45mg), straterra (10-25mg), klonopin (2-3mg), temazepam (15-30mg), ambien (5-10mg), trazadone (25-50mg).
I was originally diagnosed in 1996 with bipolar disorder; my pdoc has often told me I faLL somewhere within the 'milder' areas of the 'bipolar spectrum.' He said I have a comorbid condition that is difficult to pinpoint or catagorize, as it touches on elements of different disorders - adult ADHD, bipolar, social anxiety, depressive anxiety, general anxiety, etc. Sometimes I'm more symptomatic in some areas than in others, and he has altered my med regimes more times than I can count over the years. He's had me on numerous 'cocktails' since '96, many of which involved AC mood-stabilizers and/or lithium, and some which did not. I've taken SSRI's, 'atypical' AD's, dopamine agonists, beta-blockers, stimulants, benzos, and the list goes on.
The most recent cocktail I mentioned above seemed to keep my symptoms somewhat at bay. However, in June, my various anxieties began to heighten, and doc began to have me taper off each med for means of the process of elimination (to see what med[s] was exacerbating my symptoms).
Well, as it turned out, by the middle of June, he had tapered me off of every med except for klonopin and temazepam!
The last taper was for adderall, and it was swift and painful. In the proceeding weeks, my anxieties - general, obsessional, and social - went through the roof.
In the past, SSRI's, though they've had their downsides for me, have always treated my core anxieties better than any other med class. During this recent time of acute anxiety, I asked my pdoc if I could resume the SSRI I had with me (Prozac). He said no, simply because I was too anxious and the acute SE's of an SSRI can make things even worse for a while before the therapeutic effects take hold. So, instead, he said, we should concentrate on rapidly lowering my overall anxiety levels by doubling my daily klonopin intake. He said if I don't feel 80% better within 4 days of the raised klonopin, or if I feel a bit better but really tired, I should resume the adderall 20mg (10 mg bid)-i.e add it to my raised klonopin. Though he had me taper off of it less than a month beforehand, he said the adderall has a stimulating yet calming effect on me and could help my ADD symptoms while counteracting klonopin-fatigue.
Ok. The higher klonopin dose did lower my OVERALL anxiety levels, but I still felt tired and socially withdrawn, so after agonizing about it in my head (and a lot of people here can testify to that), I resumed the adderall. The adderall helped me during the day as it worked, but, because it's a lower dose and not combined with any other meds, I was more sensitized to the 'crash' and spent the early evenings up until bedtime feeling like a lobotomized zombie.
This stressed me out more and I even called the doc who was covering for my pdoc, as he is away on vacation for a few weeks. This doc said I should keep taking it a few days and the acute withdrawal from the stimulant I go through in the early evening might improve. (I know for a fact that adding a 3rd dose early evening would improve this greatly, but I don't want to start raising adderall doses without doctor's consent).
Ok. It all sounds sensible, right? Well here's the problem. While all this craziness has been happening, I've been on vacation overseas, staying in a nice, isolated, underpopulated area; I haven't even left the confines of this place.
Well I just got some calls from friends around Europe whom I haven't seen in years asking me to visit them in different countries, meet their friends, etc. Hello! Social anxiety time! What I call my 'anticipatory anxiety,' went through the roof. And this kind of anxiety for me is the most debilitating, because it causes me to make one excuse after the next - one 'raincheck' after the next, because I'm too anxious to do anything new or meet new people. I usually say I'll do something and opt out at the last minute out of sheer terror - this has destroyed a multituded of relationships I've been in, not to mention trigger intense depressive episodes in me as I ponder my debilitations.
Well, all these feelings returned when I got these phone calls. My initial reaction inside was 'man I gotta figure out a way to get out of this!' And then I got all depressed, because I DON'T WANT TO BE LIKE THIS - so socially avoidant, isolating, etc. And, though I haven't given the adderall+klonopin combo a sufficient trial, i know from past experience that only SSRI's can target and treat this kind of anxiety in me - neither klonopin nor adderall, nor a combo of both will do it.
Now, I have prozac 10mg pills with me, and I'm very tempted to drop the stimulant (I have only been on it every other day for a few days), and begin the prozac, like 5mg every other day, titrating slowly, and maintaining my higher-dose klonopin to help alleviate any uncomfortable acute SE's. I don't know what my normal pdoc would say to this, as he's still away and I can't reach him. Even though he said 'no' when I asked him last time, it was because he wanted me first to get on the higher klonopin dose before doing anything else.
But I'm pretty sure the doc covering for him wouldn't give me the green light on a totally new med regime-after all, I'm not his patient and he doesn't know me. I've never 'self-medicated' with an SSRI, but I just have a feeling in my gut that it will help me get through the next few months of travelling/meeting people/socializing, in a way that the adderall+klonopin combo will not.
It's really a dilemma. My pdoc gets back in 1-2 weeks, but I could already by that time be beginning to experience the benefits of the SSRI in time to be able to take on the invites of my friends and travel.
Mind you, various trials have proven that the SSRI is not the 'ideal' solution for me, just as is the case with any other of the many meds I've taken. But I can't start something COMPLETELY new, and at least I'm familiar with SSRI effects. So I have a choice yet again that I can't seem to decide upon - give the adderall+klonopin a few more days like the substitute pdoc said, stay isolated from crowds, and make up more excuses to my aquaintances about my 'not being able to make it this time around.' Or start up the SSRI, even though it holds its own risks, and maybe feel crappy for a few weeks until i start feeling better. Yet another thing I'm concerned with is that prozac has such a long half-life, which is great for minimizing withdrawal, but not so good if you start it up, feel like crap, and want it out of your system immediately.
In terms of going back to taking ONLY the klonopin WITHOUT adderall, I just don't like the extreme feeling of dullness, like I'm under water - it's just unpleasant and I find I'm just as socially avoidant, even though it has pushed my overall anxiety levels down. But these more specific areas of anxiety are not being targeted and treated as an SSRI would do.
Any advice? Sorry again for the length! Man I don't think I'm capable of writing a short post!
thanks,
Peter
Posted by Jasmine Neroli on August 26, 2003, at 22:40:33
In reply to 'anticipatory anxiety' treatment-please help, posted by Peter on August 26, 2003, at 19:22:36
Hey Peter, boring old me again :)...just noticed your post. I can't remember if I told you on your initial thread, but the GAD anticipatory worries and the resulting insomnia were my first symptoms of my anxiety disorder. After resisting my doc for some time, I agreed to go on Celexa, and it worked like a hot damn for that!! I recommend it! Even now, after coming off Celexa 15 months later, I have no return of those kinds of worries. Just the panicky, hit you from nowhere anxieties that Klonipin seems to be addressing. Also, my daughter has recently started taking Celexa for the same reason and has found it be equally successful.
Somehow I doubt that, if you're taking Klonipin, any initial start-up agitation/anxiety from Celexa, would be an issue. I (and my daughter, likewise) found no such symptoms on starting Celexa. I can't comment on Prozac, never taken it. The only 2 people I know that have been on it said they felt like zombies all the time!
However, I'm not sure the Celexa really stopped me from being "withrawn" consistently..I definitely had "down" times whilst on it. Hope you are able to say "yes" and mean it to at least one invite, over there.
Enjoy the rest of your hols!
Jas
Posted by Budgie on August 27, 2003, at 2:18:59
In reply to 'anticipatory anxiety' treatment-please help, posted by Peter on August 26, 2003, at 19:22:36
Hi Peter,
I can commisterate with a lot that you're going through. SA's caused me to ruin an awful lot of friendships over the years, and the depression that goes with it is agonizing. SSRIs never helped me one bit, in fact they only made everything worse, I think. Then my doc added Zyprexa (first to Zoloft, then to Effexor), and the tension and worrying vanished overnight; I enjoyed my first holiday get-together in years. Just something to think about for the future, although many people here might advise against Z. for anxiety. It helped me, although I eventually had to move on and try something else.
Why not just take the SSRI? At least you'll have made a decision, and you'll also prob. get at least a placebo effect!
Best of luck, keep us posted if you still need help. :)
Budgie
Posted by Peter on August 27, 2003, at 5:29:09
In reply to Re: 'anticipatory anxiety' treatment-please help » Peter , posted by Jasmine Neroli on August 26, 2003, at 22:40:33
> Hey Peter, boring old me again :)...
>>hey-that's the klonopin fatigue talking! You're not boring, you're fun and terrific! And you've helped me out on this board more than any pdoc I know!
>just noticed your post. I can't remember if I told you on your initial thread, but the GAD anticipatory worries and the resulting insomnia were my first symptoms of my anxiety disorder. After resisting my doc for some time, I agreed to go on Celexa, and it worked like a hot damn for that!! I recommend it! Even now, after coming off Celexa 15 months later, I have no return of those kinds of worries. Just the panicky, hit you from nowhere anxieties that Klonipin seems to be addressing. Also, my daughter has recently started taking Celexa for the same reason and has found it be equally successful.
>>I have taken Celexa before (as well as zoloft, paxil, prozac, luvox, ....)o:
The celexa definitely helped me in many respects, and if that were the SSRI I had with me here, I'd definitely want to take it. But the only one I have is prozac, which I've only tried at low doses in combination with the other meds in my last cocktail, but I think it would, at least theoretically, be just as good for me in terms of its ant-anxiety (SAD and GAD) effects.
> Somehow I doubt that, if you're taking Klonipin, any initial start-up agitation/anxiety from Celexa, would be an issue. I (and my daughter, likewise) found no such symptoms on starting Celexa. I can't comment on Prozac, never taken it. The only 2 people I know that have been on it said they felt like zombies all the time!
>>Yeah, I hope the prozac doesn't have many start-up symptoms. I didn't notice them when I took it last, but again I was taking 7 different other meds simultaneously. I think that Paxil and luvox were the ones that really gave me this annoying akasthisia-like restlesness and insomnia for a week, even though I took klonopin along with them.
> However, I'm not sure the Celexa really stopped me from being "withrawn" consistently..I definitely had "down" times whilst on it. Hope you are able to say "yes" and mean it to at least one invite, over there.
>>Well, basically what I'm doing now is waiting to see if the doc covering for my pdoc gives me the green light (I left a message on his answering machine last night). I'm a little wary still about starting it up without doctors' consent. Also, if I had a choice restarting an SSRI, I'd probably choose celexa or lexapro (never tried the latter). I doubt, though, that the 'covering' pdoc would prescribe me something unless he deemed it an 'emergency.' He'd probably just say it's either 'wise' or 'unwise' to drop the stimulant and begin the prozac. Then the choice is up to me. But, hey, beggars can't be choosers(-:
>>It might be worth it for me to wait until September 2nd. That's the day my pdoc returns, even though I'm not actually booked for an appt. with him until the following week. But I can at least call his private office line and bug him to get a direct answer out of him regarding my starting up an SSRI, and if Prozac would be the right choice this time around; it's got such a long half-life that I'm pretty much stuck with it once I take that first dose! So I wouldn't mind making sure my regular pdoc says it's ok.
>>Also, true that SSRI's have helped my GAD/SAD for months at a time, but they ALL seemed to do something undesirable as well: after a few months, I would start craving alcohol and go on binges. The reasons for this are unclear; my pdoc has hypothesized three reasons: 1) The SSRI's render me emotionally NUMB, causing me to seek excessive stimulation after a time; 2) The SSRI's create a dopamine-deficiency in me after a time (sort of like a 'see-saw' effect; the seratonin levels increase, while the dopamine levels decrease). This is one of the reasons why he began putting me on SSRI's WITH a stimulant after a while, and, alas, the stimulant did seem to curb my cravings for alcohol and make me feel more alive and less numb. But his third hypothesis is that the SSRI switches my mood into a subtle hypomania after a while, and I just want to go a bit crazy. Different pdocs have said different things about this bipolar element of my disorder; some have said I DO NOT HAVE bipolar disorder, and others have said I have BP 'otherwise unspecified.' I don't recall if I've taken an SSRI without a mood stabilizer before. Docs usually don't put bipolar patients on an SSRI unless they're stabilized on a mood stabilizer.
However, I do remember about a month ago, before tapering off the last meds of my cocktail - the strattera and the adderall- but AFTER I had already tapered off the mood stabilizer (lamictal) - my pdoc said I should resume 5mg prozac in response to my rising SA levels. Then my anxiety rapidly and exponentially increased and he decided to have me taper off the adderall and strattera instead, and then, later, as u know, double the klonopin. But my point is that he seemed willing to have me take the prozac AFTER I had already come off the lamictal, so it would have been without any Mood stabilizer.
>>See but these are the only doubts I have about resuming the prozac. My bipolar disorder, if I have it, is neither evident to me nor to any of my family or friends, but if I DO have it and the SSRI will switch me into an 'episode,' I won't be able to come off of prozac rapidly - even if I stop it 'cold turkey,' it's effects will continue for some time.
>>Jas-did you ever see that hilarious movie "What About Bob?' with Bill Murray. I can't stop feeling that I am Bill Murray in that movie! I'm like on pdoc-withdrawal! It's hilarious!
>>Anyway, there's my long-winded dissertation(-:
For now I'm continuing the stim+klonopin combo until I hear the covering pdoc's opinion, and, if he says it's 'unwise,' I might just stay on these 2 until my beloved pdoc returns (since he knows my brain better than this other guy), and he might very well place me on an SSRI that's better for me - celexa or lexapro. Or he might give me good reason as to why something like wellbutrin or another trial of strattera would be better. I do trust him. Who knows? Maybe we will just decide once and for all to have me avoid the French cheese for a few days and get me on an irreversible MAOI, like Nardil or Parnate. Those, I hear, are the wonder meds for all this SAD/GAD/ADHD, etc. Except for the catch-22 risk of tyramine-induced hypertension; we considered an irreversible MAOI in the past (I've been on a RIMA - moclobemide - but it wasn't very effective for me), but my general anxieties made it virtually impossible for me to start one up! That's why I'm curious about this selegeline patch, which I think makes the tyramine risk less of an issue.
>>There go my tangients. Sorry.
>>Another dilemma regarding the resumption of Prozac is that I usually feel fairly even-mooded and ok while on the adderall+klonopin, but only during the DAY. If I could add another adderall dose early evening, I wouldn't turn into such a zombie at 6p.m and be totally debilitated during the evening hours, which is usuall when I'd do most of my composing. So that's another thing I could do out of my own accord, but then we're talking raising the dose of an amphetamine without doc consent, and that might not be the best of moves?
>>But it's when the adderall wears off that I also get a return of my GAD/SAD anxiety - like when I posted last night about my need to return to SSRI's. Whereas when I'm feeling the effects of the adderall, my mind is focused and doesn't tend to drift off into all this GAD stuff; in a way the stim decreases my GAD while it works and increases it when it ceases to work, all in the same day!
> You're the best,
Peter
p.s->>See your other thread for my opinions about your klonopin journey.
Posted by Peter on August 27, 2003, at 5:41:09
In reply to Re: 'anticipatory anxiety' treatment-please help, posted by Budgie on August 27, 2003, at 2:18:59
> Hi Peter,
>
> I can commisterate with a lot that you're going through. SA's caused me to ruin an awful lot of friendships over the years, and the depression that goes with it is agonizing. SSRIs never helped me one bit, in fact they only made everything worse, I think. Then my doc added Zyprexa (first to Zoloft, then to Effexor), and the tension and worrying vanished overnight; I enjoyed my first holiday get-together in years. Just something to think about for the future, although many people here might advise against Z. for anxiety. It helped me, although I eventually had to move on and try something else.
>>I'll inquire to my pdoc again about Z. Last time I asked he said I wouldn't tolerate the side-effects.
>
> Why not just take the SSRI? At least you'll have made a decision, and you'll also prob. get at least a placebo effect!
> Well, unfortunately, my difficulty sticking with decisions is all part of my disorder. I explain a lot of it in my other post responding to Jasmine.
>Prozac is the only SSRI I have with me, and it's got such a long half-life that I'm pretty much stuck with it once I begin. Then there's the fact that I wish my regular pdoc (who knows my brain a lot better than the doc covering for him) were available, so he could put me on a perhaps more effective med for me, since there's a chance the prozac might not be a good choice NOW.
>The terribly annoying thing about my current adderall+klonopin combo is that it does seem to help my anxiety while keeping me alert - BUT ONLY DURING A FEW HOURS EACH DAY. When my second adderall dose wears off around 6p.m, I become a zombie and my GAD/SAD returns - that's the state I was in last night when I posted about my desperation to get myself back on an SSRI - ANY SSRI.
> But maybe it would be better to stay on these 2 meds, or even add a 3rd dose of adderall early evening, just to hold me over until my regular pdoc returns from vacation on Sept. 2. Then I can ask for an emergency 5 minute phone session and get a solid answer from him.
> Best of luck, keep us posted if you still need help. :)
> Thanks a lot Budgie.
Peter
Posted by Jasmine Neroli on August 28, 2003, at 2:55:21
In reply to Re: 'anticipatory anxiety' treatment-please help » Jasmine Neroli, posted by Peter on August 27, 2003, at 5:29:09
Peter, you're a real gem. Your post perked me up no end :) Ha, Yep, I did see Bill Murray in "What About Bob?"...very, very funny and SOOO appropriate right now, LOL!
I just wanted to share with you something I came accross where GAD and Bipolar 11 are compared to show very overlapping symptomology:
Cognitive:GAD-worry, difficulty concentrating.
BP2-free-floating anxiety, difficulty
concentrating.
Energy: GAD-keyed up, on edge.
Restlessness/tension.
Easily fatigued.
Difficulty falling/staying asleep.
BP2-motor agitation.
restlessness
extreme fatigue
profound insomniaMood: GAD- irritability
BP2- dysphoria/irritabilityThe article suggests that those diagnosed GAD who don't respond to AD's alone and the addition of mood stablizers improve the condition, must surely have a version of BP11. Apparently GAD's with the inability to concentrate + insomnia problems are the ones most likely to be improved by adding mood stabilizers.
Does that help you determine whether or not you fit the bipolar 11 criteria? It's hard to sort out, because you have to try and remember yourself in an unmedicated state. I mean, maybe your ADHD sympoms (focus/concentration problems, restlessness/agitation) are actually accounted for by GAD/Bipolar 2??? Then that would also explain your pdoc's 3rd hypothesis -SSRI induced hypomania.(I'm beginning to think I might be BP2 too!!! Really - it's true.The Internet is a dangerous place!). The one thing I do know is, that there are always more questions than answers.
Let us know what your substitute doc thinks about Prozac/SSRI, but Sept. 2 is drawing closer...and it might be worth waiting to talk to your own doc.
Good luck as always.
Jas
Posted by Peter on August 28, 2003, at 8:07:30
In reply to Re: 'anticipatory anxiety' treatment-please help » Peter , posted by Jasmine Neroli on August 28, 2003, at 2:55:21
> Peter, you're a real gem. Your post perked me up no end :) Ha, Yep, I did see Bill Murray in "What About Bob?"...very, very funny and SOOO appropriate right now, LOL!
>>I loved that movie(o:
> I just wanted to share with you something I came accross where GAD and Bipolar 11 are compared to show very overlapping symptomology:
> Cognitive:GAD-worry, difficulty concentrating.
> BP2-free-floating anxiety, difficulty
> concentrating.
> Energy: GAD-keyed up, on edge.
> Restlessness/tension.
> Easily fatigued.
> Difficulty falling/staying asleep.
> BP2-motor agitation.
> restlessness
> extreme fatigue
> profound insomnia
>
> Mood: GAD- irritability
> BP2- dysphoria/irritability
>
> The article suggests that those diagnosed GAD who don't respond to AD's alone and the addition of mood stablizers improve the condition, must surely have a version of BP11. Apparently GAD's with the inability to concentrate + insomnia problems are the ones most likely to be improved by adding mood stabilizers.
>>Well, my doc thought from the beginning of treatment that I have a type of BP disorder combined with a lot of other stuff. He made the analogy of my 'mild Bipolar' segment of the disorder as being the 'engine' that drives all the other elements that are indicative of other disorders. So, for instance, he said when my general and social anxieties are prominent, it is most likely because my depression or hypomania stemming from my central' bipolar condition has precipitated these other symptoms. That's the tough thing about BPII and all it's subtypes: the hypomania can be so subtle as to be imperceptible by either the person experiencing it or those around him/her.(this is quite different from BPI, in which full-blown mania is much more evident and sometimes accompanied by psychotic symptoms). What makes it all even more complex is that a field of psychiatry now believes in a 'bipolar spectrum' which can go anywhere from an extremely subtle condition to a very severe condition. In the more subtle cases, it's sometimes difficult to differentiate between hypomania and a 'norma'l mood state. Hypomania often does not interfere with daily functioning, and someone experiencing it could just feel (and seem to others) like you're are in a naturally good, ebullient mood. That brings up the larger issue - how does ANYONE know for sure if they have a subtle bipolar condition or if they are just experiencing the natural ebbs and flows of human emotion?
>>So, in this sense, subtler bipolar disorders can overlap with many other conditions. Not only does BPII overlap in many ways with GAD as you showed, but it also overlaps with many ADHD symptoms. Some pdocs resort to just treating both simultaneously in cases that are hard to figure out what's what. This is what my pdoc has been doing for years.
>>He used to always have me on a mood stabilizer, no matter what AD or anti-anxiety agents he added to it. The mood stabilizers always made me feel dulled and down - I have NO IDEA if they were helping in some way in the background. Furthermore, I'd end up craving alcohol and getting more impulsive even if I was ALSO on a high dose of a mood stabilizer. And I read an article once that said many people who take SSRI's experience heightened impulsivity and lowered dopamine and tend to thus crave alcohol more - and these people are not diagnosed with BP. The pdoc I went to for a second-opinion verified this common SSRI effect, and she said it in no way proves my having bipolar disorder (and in the end, she said, in stark opposition to my pdoc, that I do not have BP disorder, just 'depressive-anxiety' - talk about frustrating!
Stangely enough, my regular pdoc now seems a lot less intent on my taking a mood stabilizer even though he claimed to diagree with the '2nd opinion doc.'
> Does that help you determine whether or not you fit the bipolar 11 criteria? It's hard to sort out, because you have to try and remember yourself in an unmedicated state. I mean, maybe your ADHD sympoms (focus/concentration problems, restlessness/agitation) are actually accounted for by GAD/Bipolar 2??? Then that would also explain your pdoc's 3rd hypothesis -SSRI induced hypomania.
>>Well, you know I've gotten to a point where I don't even bother to ask him what my diagnosis is, since it seems so complex - touching upon so many different areas - that I'm just trying to concentrate with him now on treatment that is aimed at whatever my most prominent symptoms are that are causing me the most distress. If I'm taking adderall in an 'off-label' manner to help my drive and motivation, the lack thereof possibly caused by high-dose klonopin, I try not to get all worked up about it anymore ('But what if I'm not an ADD'er! I shouldn't be taking adderall!, ETC.). Also, you're right that re-assesing my condition would require me to really remember how I was drug-free, and this is hard in my case. I've been on one substance or another since my mid teens, when I used to smoke pot all the time (unconsciously self-medicating to assuage an underlying condition? who knows). Then, in College, I got into heavier drugs (cocaine, even heroin). In '97, when I first saw my pdoc and he put me on depakote, which would be the first of hundreds of meds over the the proceeding years, I was just BEGINNING to recover from heroin addiction. I've often thought of coming off all meds for a time to get a more accurate diagnosis, etc., but everytime I've tried, I found that the ensuing anxiety symptoms were not worth my tolerating! At least now I'm on a minimal amount of meds, and I trust that my pdoc has kept my drug-infused past in mind through his judgement of my diagnosis. I find that always trying to understand everything (black&white thinking, 'all-or-nothing-at-all', perfectionism->that's all me) can be just more anxiety provoking than tolerating the ambiguity of not knowing.
(I'm beginning to think I might be BP2 too!!! Really - it's true.The Internet is a dangerous place!). The one thing I do know is, that there are always more questions than answers.
>>LOL. That's for sure. I've pretty much disgnosed myself with every condition known to man!! The web is awesome, but yes, dangerous as well(-:
> Let us know what your substitute doc thinks about Prozac/SSRI, but Sept. 2 is drawing closer...and it might be worth waiting to talk to your own doc.
>>Yes, you're right. The sub doc said what I had expected-that it's really not up to him to gimme a red/green light on a new med regime like that and that I should bring it up with my pdoc when he returns. I do find that he was right about sticking with the klonopin/adderall for a few days; the moodiness and anxiety has decreased, and, with the help of daily exercise and avoiding caffeine, my mood is smoother and the adderall 'crash' less bothersome.
> Good luck as always.
>>You too! hey how's that headache? Are you taking anything other than klonopin that could be causing it
? Does tylenol help? Splitting up the klonopin dose like you said you're doing might help in terms of minimizing acute fatigue from each dose, but you know, klonopin is so long-acting that the efects of the doses tend to overlap because each one lasts so long. That's good, in a way, 'cause it's smoother and makes sure you're 'covered' all day. Good luck talking to your pdoc about possibilities to help the lethargy.
>>Bill Murray
Posted by Jasmine Neroli on August 29, 2003, at 20:28:46
In reply to Re: 'anticipatory anxiety' treatment-please help » Jasmine Neroli, posted by Peter on August 28, 2003, at 8:07:30
Howdy Bill!
Hmmmmmm, you certainly have a complex drug/symptom history..I'm tempted to throw the DSM-iv (rev.) up in the air and see which page it opens on...that's your diagnosis!!! Either that, or say to your doc "all of the above"! haha.
I agree whole-heartedly with you, though, about treating whatever the most bothersome symptoms are first, and then worry about "what you've got" second! Especially, as you note, the newer descriptions of disorders, particularly Bipolar, are changing and evolving all the time.Your mention of your "self-medicating" days tore at me a little, cuz my job is with at-risk adolescents (in the school system) many of whom have undiagnosed mental health issues and use pot or other stuff in an unconscious effort to feel even or functioning. It can be a destructive path, I've watched with much sadness and stress. But, (and I'd never tell my school Administrator this!) Pot can sometimes really help some kids, in little doses, judiciously used. Helps 'em sleep, helps with anxieties and fears. Of course some react just the opposite and I'd NEVER recommend it, but I have observed this many times.
I was sad to read that, in another of your posts, you were'nt able to follow through on your trip arrangement. I used to do that ALL the time in my teenage years ( and felt like a real jerk!) as well as a few times in the past 2-3 years again. It's such a WEIRD feeling...yet on other days, life and soul of the party, up for anything????As to my headache, it has subsided (pretty much gone really) but lasted a full 4 days and included jaw/eye and ear pain. Dunno what that was about..have had what I used to call my "3 day headaches" before, but not for a year or so. I had started B complex and fish oils that same week as Klonipin, so I dropped them, just in case. Will add, one at a time, to see if they are the culprit.
Splitting the Klonipin into 3 has made a slight difference to my energy in general and I've tried Ames' advice on the Ginseng, for the past 2 days. It seemed to activate me for a short while (about 2 hours only), so maybe I need to take more of that!! Still feel kinda low tho', not sad or despairing, just "without joy", little ups, then down again. However, NO anxiety..yeay!
I go see my doc on Sept. 2. School starts for me then too, so maybe, I'll be less concerned with myself, when I have all my kids to worry about LOL!
BTW, what kind of music do you compose? That is such a talent.
Take care
Jasmine..Destroyer of Diagnostic Manuals!!
Posted by Peter on September 2, 2003, at 18:00:56
In reply to Re: 'anticipatory anxiety' treatment-please help » Peter , posted by Jasmine Neroli on August 29, 2003, at 20:28:46
Hi Jasmine:
Just spoke to my pdoc. We decided to start me up on Lexapro and to replace the immediate-release adderall with Concerta, which would probably have a less 'choppy' effect on my mood.
Wish me luck! I hope this renders me a bit more functional! Do you know if lexapro helps anxieties as well as the other SSRI's? I know it's pretty much the same as celexa, but with supposedly fewer side-effects. Does it start working more quickly?
Thanks,
Peter
p.s-enough about me, let's talk about me ! (-:
No, but seriously, how is everything going with you?
Posted by Jasmine Neroli on September 2, 2003, at 23:11:19
In reply to SPOKE TO DOC-NEW PLAN » Jasmine Neroli, posted by Peter on September 2, 2003, at 18:00:56
Hey Peter: Glad you got hold of your Doc and have a new course of action to follow...that must make you feel better, more in control. Have no first hand experience with Lexapro (loved Celexa, 'cept for the insomnia), but have read many good things about it. Has all the advantages of Celexa with fewer side effects. The only downside I've read consistently, is that people complain of lack of motivation, over time. But, for you, the Concerta will probably offset that! Sounds like a good combo, and well worth a try!! GOOD LUCK!
As for me, well I visited my GP today and got a referral to a Psych. I just wanted to be evaluated by someone with specific expertise, who would be willing to be more aggressive with meds, if necessary. (I'm in Canada and this is the process here). I should get an app't in about 3-4weeks. I wanted to try Provigil with the Klonipin, but I knew my GP would be too cautious to prescribe "off label". I am now taking 1mg Klonipin per day (in 2 doses), cuz I was finding irritablity/ crying and anxiety returning by late afternoon, on the extra .25mg. The second .5mg has an effect on my mood witin 30 mins :). I'm still very "flat" and low in energy. Also cycling dysphoria/irritability again. Which may mean that depression is returning, so my GP has insisted I try Effexor XR (75mg) as of tomorrow, as a preventive measure until I get to see the P.Doc. I'm resistant, but since I'm back at work (school) now, I can't risk a relapse. So I'm gonna be a good girl and comply. LOL. It's just that on this board, people constantly post horror stories about it and the side effects!. Can't be any worse than Remeron ( which I HATED!). At least it's a drug recommended for GAD, which I believe is my main diagnosis. Just can't wait to hear what the PDoc says in that regard tho'.BTW,I got the headache diagnosed ....It's chronic sinus congestion caused by the continual smoke from the forest fires burning around my home town for the past 2 weeks. Apparently it's very common! Phew, I was dreading it was a side effect of the Klonipin, which I love so much!!!
Well, we're both working hard and patiently to resolve our mental health issues! I think we should be proud that we are taking our health into our own hands and not giving up.Ha! Keep us posted as to your progress, and I'll let you know how I'm dealing with the "dreaded" Effexor:)
Jas
This is the end of the thread.
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