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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 hockeygirlcanada on May 26, 2005, at 17:12:15
Hi,
I have been battling depression and g.a.d. for 7 years, it has been hell, three pdocs later I am on Celexa, 60mg, 400mg of Seroquel, trazadone as needed for sleep and up to 3 mg of clonazepam each day.
i have to drink lots of coffee to stay awake, which is not good for my anxiety.
I don't know what to do with this med? ANy help/suggestions would be greatly appreciated!
Posted by ace on May 26, 2005, at 22:59:45
In reply to All SEROQUEL USERS-HELP!!!, posted by hockeygirlcanada on May 26, 2005, at 17:12:15
> Hi,
> I have been battling depression and g.a.d. for 7 years, it has been hell, three pdocs later I am on Celexa, 60mg, 400mg of Seroquel, trazadone as needed for sleep and up to 3 mg of clonazepam each day.
> i have to drink lots of coffee to stay awake, which is not good for my anxiety.
> I don't know what to do with this med? ANy help/suggestions would be greatly appreciated!
OK...I've been on Seroquel 150mg for OCD - it has done a good job. But even at thast dose I battle with sedation (fall asleep in class). I am changing to the most potent anti=OCD AP medication- Risperidone.This sounds crazy but i would recommend this (especially considering your past)
1. Try Nardil -- up to 105mg (with a good 6-8 week trial - it is an awesome med,,,best AD ever)
2. Drop Seroquel
3. Drop Celexa
4. Drop Trazadone
5. Keep ClonazepamIf Nardil doesn't produce full remission (i think it will)
add
low dose Lamictal
Low dose Zyprexa
L-tryptophan
Plenty moredon't loose hope!!!
Look up on the net all the BRILLIANT stories on Nardil....a great shrink once said (I paraphrase) "there is no comparing to Nardil -- In 95% of cases it is a huge success"
Nardil rules
Go to the MAOI!!!!!!
Ace
Posted by med_empowered on May 26, 2005, at 23:08:15
In reply to All SEROQUEL USERS-HELP!!!, posted by hockeygirlcanada on May 26, 2005, at 17:12:15
hey! 400mgs of Seroquel is pretty sedating for anybody. If you don't mind you asking...did your doc explain the use of **ANY** antipsychotic, and the use of this amount of Seroquel in particular? If you're dealing with schizophrenia, schizoaffective disorder, or severe depression with psychotic features, this amount of seroquel might be understandable. With depression that is treatment resistant but **not** at all psychotic in nature, though, using seroquel at all, particularly at 400mgs plus klonopin and trazadone seems a bit much. Antipsychotics plus antidepressants can help a lot with depression, but there's no point in fixing the depression if you're just going to sleep all day or be lethargic all the time. Personally, I'd try a switch. I hated seroquel for other reasons (it made me melancholy and gave me terrible dreams). When necessary, I took Abilify and it was OK. Not great--I'm not an antipsychotic fan--but OK; no sedation, no weight gain, no major side effects at all. Zyprexa has the best data in terms of treating depression (hence the prozac+zyprexa combo that is Symbyax), but Abilify *seems* to have antidepressant effects without weight gain, diabetes, heart problems, or tardive dyskinesia. Risperdal is another option although I think its a pretty "rough" atypical...Geodon is pretty good, though there are some heart-issues (qTC interval thing...you see it also with tricyclic anti-depressants; so far, it doesn't look like a BIG problem, but Mellaril did the same thing and now its been linked to some deaths, so who knows). Anyway, personally, I'd pump up the antidepressant (remeron instead of trazadone, maybe add cymbalta or effexor, perhaps use Surmontil, an old tricyclic), add some BuSpar (helps with anxiety AND boosts antidepressants) and maybe do low-dose Abilify (10mgs--smallest effective dose for psychotic disorders; definitely effective for depression)...but, hey, im not a doc...just my suggestions. Anyway, good luck!
Posted by hockeygirlcanada on May 27, 2005, at 5:46:56
In reply to Re: All SEROQUEL USERS-HELP!!! » hockeygirlcanada, posted by ace on May 26, 2005, at 22:59:45
Thank you for your suggestions, I see my pdoc this afternoon. I did look up alot of into on Seroquel and was very surprised that I was put on a high does as I have no psychosis at all, my diagnosis is major depressive disorder with gad.
I have been on MAOI's both nardil and parnate. Parnate was a nightmare, and I don't think my doc knew how to administer Nardil correctly.
I do agree, what is the point of being on these if I sleep all day.
I am in Canada, so some of the meds are not even here yet, but I will certainly ask.
Thanks again!!
Posted by yesac on May 27, 2005, at 13:33:41
In reply to All SEROQUEL USERS-HELP!!!, posted by hockeygirlcanada on May 26, 2005, at 17:12:15
I know I'm a bit late here, but I agree with what the other person said---- 400mgs of Seroquel is a lot. Does it help with your anxiety? Maybe you could try lowering it and/or lowering the Klonopin. I don't know what usual dosages are for Klonopin but I occasionally take 1 or 1.5 mgs and that's enough to pretty well drug me out, although I often take it along with ativan.
I wouldn't cut them out if they are helping with depression +/or anxiety, but lowering them might really reduce your tiredness and still help your symptoms as well.
Also, do you need the trazodone at all? It sounds like you're tired enough without something extra for sleep.
Posted by hockeygirlcanada on May 27, 2005, at 14:13:52
In reply to Re: All SEROQUEL USERS-HELP!!! hockeygirlcanada, posted by yesac on May 27, 2005, at 13:33:41
I am going to try and lower it. There is no way for me to tell if it helps anxiety because it puts me to sleep everytime I take it. I don't take the trazadone very often at all, I have had the same prescription for 3 months now and still lots left.
And that is the reason I don't take it, because the seroquel makes me tired enough.
I have taken clonazepam for years and it has been the only thing to keep my anxiety in check. Maybe i was just too eager to have something else that might take away anxiety.
I definitely need to find a balance between the two for sure.
thanks:)
Posted by ed_uk on May 27, 2005, at 14:33:31
In reply to Re: All SEROQUEL USERS-HELP!!! yesac, posted by hockeygirlcanada on May 27, 2005, at 14:13:52
Hi!
>Parnate was a nightmare....
In what way???
Kind regards,
Ed.
Posted by yxibow on May 29, 2005, at 23:03:35
In reply to All SEROQUEL USERS-HELP!!!, posted by hockeygirlcanada on May 26, 2005, at 17:12:15
> Hi,
> I have been battling depression and g.a.d. for 7 years, it has been hell, three pdocs later I am on Celexa, 60mg, 400mg of Seroquel, trazadone as needed for sleep and up to 3 mg of clonazepam each day.
> i have to drink lots of coffee to stay awake, which is not good for my anxiety.
> I don't know what to do with this med? ANy help/suggestions would be greatly appreciated!Well, trust me, 400mg of Seroquel is not high... but it may be high for some. Agreed with the caffeine, I would cut down on that. I used to take lots of it when my body chemistry was different in the past, I can't take any now. I assume you are taking the Seroquel at night, if not, I would suggest taking the entire dose at night -- a number of people who take it regularly take it all at once and it would render the Trazodone unnecessary. Celexa at 60 is about average, some now take up to twice that, but that is a typical dose. Clonazepam is usually topped off at 4mg although some take twice; as long as you're not showing any signs of dependency and can focus on driving properly, 3mg shouldn't be a liability, but less is always better and could help with your drowsiness.
Its also possible you're not getting the "right kind" of sleep (enough rem hours)... and you're getting daytime tiredness because you're not actually getting good "sleep hygiene"; you might want to try a small dose of Lunesta or a pinch of Remeron for sleep although 400mg of Seroquel at once could suffice.
Just my 2c
Posted by hockeygirlcanada on May 30, 2005, at 6:39:01
In reply to Re: All SEROQUEL USERS-HELP!!! hockeygirlcanada, posted by ed_uk on May 27, 2005, at 14:33:31
SO seroquel is not at a high dose?
I know it can go up to 800mg.
I guess i figured because I am not bipolar or have any psychosis that this high dose was unnecessary?
If you take it all at night, do you still feel the same effects for anxiety?
Lots of questions,
thank you for your insight, much appreciated!!
Posted by ed_uk on May 30, 2005, at 6:58:04
In reply to Re: All SEROQUEL USERS-HELP!!! ed_uk, posted by hockeygirlcanada on May 30, 2005, at 6:39:01
Hi,
The 'usual' max. dose of Seroquel is 800mg/day. For anxiety, it might work better if you take it twice daily........but some people can get away with taking it once daily at night.
Ed.
Posted by hockeygirlcanada on May 30, 2005, at 12:09:30
In reply to Re: All SEROQUEL USERS-HELP!!! hockeygirlcanada, posted by ed_uk on May 27, 2005, at 14:33:31
Hi,
In response to your question about parnate, it was just way to stimulating for me, I would take it and feel great for three hours and then crash out, and it also increased my anxiety because it was so stimulating. I can see how it would work for treatment resistant depression. I also was on Nardil so I could compare the two. I wouldn't knock any medication other than in reference to myself, because we are all different.
Thank you:)
Posted by ed_uk on May 30, 2005, at 13:40:22
In reply to Re: All SEROQUEL USERS-HELP!!! ed_uk, posted by hockeygirlcanada on May 30, 2005, at 12:09:30
Hi!
What dose of Parnate did you take?
>it was just way to stimulating for me.....
Stimulating in a bad way??? How did you feel when you crashed? It sounds like you needed to take it every three hours to avoid the crash!
>I also was on Nardil so I could compare the two?
How did you find it?
Kind regards,
Ed.
This is the end of the thread.
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