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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Unh on October 26, 2005, at 7:51:33
Hello, I'm new here, if you have some spare time, please read this.
I'm currently taking:
- 7,5 mg of abilify (I'd really would like to
stop taking it, since I really don't know how
it could help me (I'm more anxious, my mind
seems more disperse, fogged or blocked, my
instant memory seems worst, my emotions
seem flattened, yet I still feel "distressed",
I'm too focused on how I physically am, I still
don't feel like doing anything at all, etc.).
I've been taking it for a week and a half: how
much longer should I wait to see positive
changes?- 200 mg of Lamictal. I've been taking it
for about three years, and the one time I dropped
it I had a manic episode, though I've had one of
them while on it.- 150 mg of Lyrica. I've been taking it for
three months. Its problems have been an
increased appetite, sedation and more frequent
visits to the bathroom (does this have anything
to do with it being metabolized in the
kidneys?). My doctor suggested to rise the
dose another 75 mg, but I'm afraid of taking
any more medication because of my liver (some
enzymes showed slightly high in one recent
blood exam) and of the weight gain.- 20 mg of Ambien. I took 10 mg for years, but
the insomnia caused by abilify forced me (the
doctor "suggested" it) to rise the dose.- 20 mg of Isotretinoine for acne. I've been
noticing myself more depressed after starting
it, but I don't want to stop taking it, since it
has helped it with my skin, and I will stop
it in a few months anyway.- 2000 mg of Vitamin C. For preventing respiratory
problems.- A Multi-Oil Formula from GNC (three pills a day,
180 mg of EPA, 120 mg of DHA, 222,9 mg of
linoleic acid, 63,9 mg of alfa-linoleic acid and
50,4 mg of gamma-linoleic acid in total.My psychiatrist suggested that I started
taking Lexapro for my depression (I'm bipolar
II with a hight anxiety factor) and ocd, but
I'm afraid of what I've read here about
SSRI antidepressants, specially the weight
gain part (I'm not overweight, but I just finished
a program for losing weight and gaining it
back really scares me, since I've been going up
and down for the past 8 years) since my confidence
and self-steem seem to depend too much on that
(I suffer from social anxiety too).I've read about Cymbalta, and on how some
people lost weight on it and that it was also
activating. I'm worried though, that it could
erase the little motivation I currently have,
cause me to have more anxiety or affect me on
the opposite way (get sleepier, gain weight, feel
my head "cloudier").Which one, Lexapro or Cymbalta, has less effect
on weight, is lighter on the liver, is easier
to withdraw and has less side effects? (I'm
concerned about getting mentally numb too,
getting an even worst memory yet.)Another thing, I was thinking of changing
the antipsychotic for the antidepressant (or
should I keep it both?) for preventing further
damage to my liver.Aside from that, what would you recommend me,
that's light for the liver (my liver enzymes
are a little high right now) and it's not a
stimulant (I'm afraid of getting manic, too
anxious or that it may damage my heart, which
hasn't been working at its best lately) for
my memory, focus and general mental capacities?
I would like to know which of the medications
I'm currently taking could affect that in a
negative way.Thanks! Have a nice or at least a better day.
Bye.
J.
P.S: Sorry for my bad English and for the length
of this message, I hope you were able to read
it complete.
Posted by Unh on October 26, 2005, at 8:04:41
In reply to Cymbalta or Lexapro? Need help and patience., posted by Unh on October 26, 2005, at 7:51:33
I forgot something about abilify. My
heart feels sometimes irregular since
I started it, but it's slighter than
what happened on geodon (I started
having arrithmia which caused me
panic attacks, which, by themselves,
caused me arrithmia again). Does
this have anything to do with abilify
or it's just because of my anxiety?
Posted by Glydin on October 26, 2005, at 9:00:19
In reply to Cymbalta or Lexapro? Need help and patience., posted by Unh on October 26, 2005, at 7:51:33
My diagnosises are a secondary issue of unipolar depression with a primary problem of an anxiety disorder. I'm not sure my experience will be of use to you, but.... I trialed Cymbalta and found I could not take the increased norepi with such a high sensitivity to anxiety. I found the same thing with Wellbutrin and the norepi influence. I have been on Lex for about 9 months. It has been great for me for the depressive symptoms and EVEN BETTER - for the anxiety symptoms. I no longer require a daily use of a benzo and my use of a benzo has decreased to rare.
Lexapro did have a moderate amount of startup upramp of anxiety which I treated with Klonopin. This was a startup finding for me and it did passed after a few weeks. I have not experienced weight gain. I had sworn off SSRI's prior to Lex as I had not had good experiences with them. Lexapro has been very different - in a great way - for me.
I'm not sure I'm really helpful, but that's my experience.
Your post was just fine, BTW.
Posted by Sebastian on October 26, 2005, at 10:15:13
In reply to Cymbalta or Lexapro? Need help and patience., posted by Unh on October 26, 2005, at 7:51:33
Cymbalta is hard on the liver. Lexapro is not.
I gave up on abilfy for a lot of the reasons you mentioned. I take geodon and zyprexa now. I don't know if geodon is hard on livers or not, probably not though. Geodon does not have weight gain.
Posted by Sebastian on October 26, 2005, at 10:17:09
In reply to Abilify, posted by Unh on October 26, 2005, at 8:04:41
Abilify can cause anxiety. that was a major reason that I stoped it.
Posted by Racer on October 26, 2005, at 10:50:55
In reply to Re: Abilify, posted by Sebastian on October 26, 2005, at 10:17:09
Aside from the recent news that Cymbalta is associated with hepatotoxicity, it does have withdrawal issues to consider. It's not nearly as bad as Effexor was for me, but the times I ran out or forgot to take it, I certainly knew about it.
The only other practical advice I can offer is about acne: have you tried attacking it externally? The best thing I ever found for acne -- much better than the antibiotics I took for it -- was Hibiclens soap. It's a red liquid soap, which my doctor had me try. She said that it did the same thing the antibiotics did, only externally and more safely. I can safely say that it was a very successful choice for me, on acne that had been pretty awful for a very, very long time. (I was sure that I'd never recover from it, because I thought I'd tried everything short of Accutane.)
Good luck.
Posted by Unh on October 26, 2005, at 10:59:15
In reply to Re: Cymbalta or Lexapro? Need help and patience. » Unh, posted by Glydin on October 26, 2005, at 9:00:19
> My diagnosises are a secondary issue of unipolar depression with a primary problem of an anxiety disorder. I'm not sure my experience will be of use to you, but.... I trialed Cymbalta and found I could not take the increased norepi with such a high sensitivity to anxiety. I found the same thing with Wellbutrin and the norepi influence. I have been on Lex for about 9 months. It has been great for me for the depressive symptoms and EVEN BETTER - for the anxiety symptoms. I no longer require a daily use of a benzo and my use of a benzo has decreased to rare.
>
> Lexapro did have a moderate amount of startup upramp of anxiety which I treated with Klonopin. This was a startup finding for me and it did passed after a few weeks. I have not experienced weight gain. I had sworn off SSRI's prior to Lex as I had not had good experiences with them. Lexapro has been very different - in a great way - for me.
>
> I'm not sure I'm really helpful, but that's my experience.
>
> Your post was just fine, BTW.Hello.
Thanks a lot for your reply.
I tried welbutrin, and it worked well for a
while, until I had a seizure and had to
forcibly stop. I was taking it along with
clonazepam, but I developed tolerance to it,
and it no longer did anything (the seizure
happened, indeed, when I stopped). I suppose
it was masking the possibility of anxiety
from welbutrin. That's why I'm afraid of
trying anything which could trigger a
higher deal of anxiety or a seizure (I
wouldn't have a back up, except for a rise
of lyrica). Is there anything
beside benzos or antipsychotics that could
help with the startup anxiety? How long did
you try cymbalta? Was the anxiety increased
with the doses or time?Sorry for the excess of questions.
Have a good day,
Bye.
J.
Posted by Unh on October 26, 2005, at 11:06:05
In reply to Re: Cymbalta or Lexapro? Need help and patience., posted by Sebastian on October 26, 2005, at 10:15:13
Thanks for the information on the effect
of cymbalta over the liver. I guess that
will keep me from trying it for a while
(until my liver recovers, if it does).Geodon made me feel ok for a while, though
on a low dose it filled my head with racing
thoughts which kept me from sleeping at
night and when I rised the dose it made
my heartbeat irregular. On the "weight side"
it helped me control my eager to eat, which
made me lose 5 pounds in about a month.Have a good day,
Bye.
J.
Posted by Unh on October 26, 2005, at 11:24:08
In reply to Cymbalta, posted by Racer on October 26, 2005, at 10:50:55
Thanks for your answer
I tried almost everything I was recommended
in here for fighting acne externally,
also antibiotics and antiandrogens, but it
didn't work, isotretinoine/accutane was the
last resort and it gives results. It's difficult
for me finding many topical products that
may help me since their availability in the
place where I live is very low and I'm afraid
of buying anything through internet because
of the card theft, the importation of products
(they could be kept in the frontier) and the
lack of trusting in virtual shops (maybe I'm
being too distrusting, and since I'm putting the
health of my liver on stake here I should give
it a try). I'm hoping something like silimarine
may work in the recovery, though maybe taking
medications for a lifetime will play against.
Posted by Glydin on October 26, 2005, at 12:51:37
In reply to Re: Cymbalta or Lexapro? Need help and patience. » Glydin, posted by Unh on October 26, 2005, at 10:59:15
>
> Hello.~~~ Hello J. - Welcome to here.
>
> Thanks a lot for your reply.~~~ You are welcome.
> I tried welbutrin, and it worked well for a
> while, until I had a seizure and had to
> forcibly stop. I was taking it along with
> clonazepam, but I developed tolerance to it,
> and it no longer did anything (the seizure
> happened, indeed, when I stopped). I suppose
> it was masking the possibility of anxiety
> from welbutrin. That's why I'm afraid of
> trying anything which could trigger a
> higher deal of anxiety or a seizure (I
> wouldn't have a back up, except for a rise
> of lyrica). Is there anything
> beside benzos or antipsychotics that could
> help with the startup anxiety?~~~ I've only taken AD's (SSRI's, Wellbutrin, and Cymbalta) and benzos, so I couldn't speak with personal experience on other drug classes on how well they might help with anxiety control. There are a lot of folks here who could answer based on their experiences.
How long did
> you try cymbalta?~~~ I believe it was about a month. The anxiety did not abate and it was not easy for me to control with Klonopin.
Was the anxiety increased
> with the doses or time?With the Lex, it took a few weeks. I increased dose once and the upramp of anxiety lasted about a week and was not as intense as with initial startup. At ths point, I have better control of my symptoms than I've ever had. My functioning, outlook, mood, and in general, my life, is good.
>
> Sorry for the excess of questions.~~~ No problem at all.
>
> Have a good day,
~~~ Same to you and I hope you work things out for yourself.Best,
Glydin
Posted by Emily Elizabeth on October 26, 2005, at 16:35:58
In reply to Cymbalta or Lexapro? Need help and patience., posted by Unh on October 26, 2005, at 7:51:33
I haven't read what everyone else posted, but I was wondering if you have ever tried Seroquel instead of Abilify. It is also an antipsychotic, but many people find it very helpful with anxiety and sleep--two things you mention as problems.
I don't have personal experience with it though, so you might do a "google" search of the boards and/or post a question about it.
Best,
EE
Posted by Racer on October 26, 2005, at 21:13:54
In reply to Re: Cymbalta » Racer, posted by Unh on October 26, 2005, at 11:24:08
> It's difficult
> for me finding many topical products that
> may help me since their availability in the
> place where I live is very low and I'm afraid
> of buying anything through internet because
> of the card theft, the importation of products
> (they could be kept in the frontier) and the
> lack of trusting in virtual shops (maybe I'm
> being too distrusting, and since I'm putting the
> health of my liver on stake here I should give
> it a try).
http://walgreens.com/store/product.jsp?CATID=100951&navAction=jump&navCount=0&id=prod352989This is the stuff I was recommending. It's more available than you might think, and it's at least worth discussing with your doctor.
As for the rest of it, the new warning on Cymbalta ain't a happy-making prospect, although it does seem to be mostly directed at those with pre-existing liver pathology, but you do know that the liver will regenerate pretty quickly? And you can keep an eye on your blood work to see if it creates a problem.
And, for what it's worth, a beta blocker like propranalol might help with your anxiety symptoms, if they're primarily physical. Won't do much, of course, if it's mostly thought driven. :-}
Good luck.
Posted by grammy on October 26, 2005, at 21:47:40
In reply to Cymbalta, posted by Racer on October 26, 2005, at 10:50:55
How do you know it's hard on the liver?
Posted by Racer on October 27, 2005, at 0:39:33
In reply to Re: Cymbalta, posted by grammy on October 26, 2005, at 21:47:40
Posted by Unh on October 27, 2005, at 7:00:55
In reply to To: » Unh, posted by Glydin on October 26, 2005, at 12:51:37
> >
> > Hello.
>
> ~~~ Hello J. - Welcome to here.
>
> >
> > Thanks a lot for your reply.
>
> ~~~ You are welcome.
>
> > I tried welbutrin, and it worked well for a
> > while, until I had a seizure and had to
> > forcibly stop. I was taking it along with
> > clonazepam, but I developed tolerance to it,
> > and it no longer did anything (the seizure
> > happened, indeed, when I stopped). I suppose
> > it was masking the possibility of anxiety
> > from welbutrin. That's why I'm afraid of
> > trying anything which could trigger a
> > higher deal of anxiety or a seizure (I
> > wouldn't have a back up, except for a rise
> > of lyrica). Is there anything
> > beside benzos or antipsychotics that could
> > help with the startup anxiety?
>
> ~~~ I've only taken AD's (SSRI's, Wellbutrin, and Cymbalta) and benzos, so I couldn't speak with personal experience on other drug classes on how well they might help with anxiety control. There are a lot of folks here who could answer based on their experiences.
>
>
> How long did
> > you try cymbalta?
>
> ~~~ I believe it was about a month. The anxiety did not abate and it was not easy for me to control with Klonopin.
>
>
> Was the anxiety increased
> > with the doses or time?
>
> With the Lex, it took a few weeks. I increased dose once and the upramp of anxiety lasted about a week and was not as intense as with initial startup. At ths point, I have better control of my symptoms than I've ever had. My functioning, outlook, mood, and in general, my life, is good.
>
> >
> > Sorry for the excess of questions.
>
> ~~~ No problem at all.
>
> >
> > Have a good day,
>
>
> ~~~ Same to you and I hope you work things out for yourself.
>
> Best,
> GlydinHello
I'm glad Lexapro is working for you.
A last question, if it doesn't bother
you much: Do you know why Lexapro may
cause an increase of weight? Does it slow
the metabolic rate or i's because the
anxiety it provokes? (I tend to eat
a lot when I'm anxious, that's why I'm
worried)Thanks a lot for your reply, I think I'm
leaning towards Lexapro now.Have a good day,
J.
Posted by Unh on October 27, 2005, at 7:23:23
In reply to Re: Cymbalta or Lexapro? Need help and patience., posted by Emily Elizabeth on October 26, 2005, at 16:35:58
> I haven't read what everyone else posted, but I was wondering if you have ever tried Seroquel instead of Abilify. It is also an antipsychotic, but many people find it very helpful with anxiety and sleep--two things you mention as problems.
>
> I don't have personal experience with it though, so you might do a "google" search of the boards and/or post a question about it.
>
> Best,
> EE
Hello,Thanks a lot for your answer.
I tried seroquel three years ago, but it made
me feel like a zombie (flattened emotions,
motivations, too sedated), I felt more depressed
and gained weight, besides not having the
improvements I was hoping for (a less disperse
mind, a better mood, motivation, etc.). I
haven't had much of what could be considered
"psychotic" episodes, but being on antipsychotics
make me feel like I'm not myself (I'm like a
mild version of myself, since I'm usually too
worried about controlling myself, adding
something like that to the mixture doesn't make
me feel better). Abilify has made me have
less negative (and a little intrusive) thoughts
about myself, which are very discomforting,
but make me really anxious around people
(I feel almost robotic and excessively alert)
and my head feels very blurry most of the time
(Putting aside the anxiety and the eagerness to eat).Well, seroquel did help with my sleep and
anxiety, but it made me feel even worst
that when I wasn't taking it.Anyway. I may not need an antipsychotic.
But I think that I would be better off
my meds, so I'm not very objective.Does anyone know how long does it takes the
insomnia and anxiety caused by abilify to
disappear? (if it does, of course). I've
been almost three weeks on it, and don't see
any improvement.Have a good day,
J.
Posted by Unh on October 27, 2005, at 7:37:57
In reply to Re: Cymbalta » Unh, posted by Racer on October 26, 2005, at 21:13:54
Hello,
Thanks (a lot) for your reply.
> > It's difficult
> > for me finding many topical products that
> > may help me since their availability in the
> > place where I live is very low and I'm afraid
> > of buying anything through internet because
> > of the card theft, the importation of products
> > (they could be kept in the frontier) and the
> > lack of trusting in virtual shops (maybe I'm
> > being too distrusting, and since I'm putting the
> > health of my liver on stake here I should give
> > it a try).
>
>
> http://walgreens.com/store/product.jsp?CATID=100951&navAction=jump&navCount=0&id=prod352989
>
> This is the stuff I was recommending. It's more available than you might think, and it's at least worth discussing with your doctor.
>Does that store ship to countries outside
North America?> As for the rest of it, the new warning on Cymbalta ain't a happy-making prospect, although it does seem to be mostly directed at those with pre-existing liver pathology, but you do know that the liver will regenerate pretty quickly? And you can keep an eye on your blood work to see if it creates a problem.
>
> And, for what it's worth, a beta blocker like propranalol might help with your anxiety symptoms, if they're primarily physical. Won't do much, of course, if it's mostly thought driven. :-}
>I'm afraid most physical symptoms I have are
thought driven, psychosomatics symptoms. My
exams, except the liver enzymes, have always
showed up normal, including the ECG. I have
a normal to low blood pressure, low cholesterol,
I exercise, I eat healthy, but those things
don't help much (excepting exercise, though
the effect doesn't last for more than two hours)
Do beta-blockers still help in those conditions?
> Good luck.To you too. Have a good day.
Bye,
J.
Posted by Glydin on October 27, 2005, at 7:39:22
In reply to Lexapro, Anxiety and Weigh Gain » Glydin, posted by Unh on October 27, 2005, at 7:00:55
Hi J.,
I don't really know the rationale as to why some folks have weight gain on SSRI's..... I think if it had been a problem for me, I would have researched that more, but, thankfully, that has not been a factor so I don't really know. I know some of the other drug class of AD's can have a fluid retention factor as cause of some weight gain but that's probably a small contribution overall when folks note gain on meds. Sorry about that, but I just don't know the physiological reasoning.
Lex has been a Godsend for me. Everyone is different and one person's "paradise" is another's "poison", but Lex has exceeded my expectations. My prayer is continued working of this med for me and so far, I'm really good. I think it's a med for you to consider but you do need to discuss it with your doc. You situation is different from mine - it may be a good choice for you and it may not be. I hope you have someone who can guide you well in your decision.
Best,
Glydin
Posted by Unh on October 27, 2005, at 8:52:49
In reply to Re: Lexapro, Anxiety and Weigh Gain » Unh, posted by Glydin on October 27, 2005, at 7:39:22
> Hi J.,
>
> I don't really know the rationale as to why some folks have weight gain on SSRI's..... I think if it had been a problem for me, I would have researched that more, but, thankfully, that has not been a factor so I don't really know. I know some of the other drug class of AD's can have a fluid retention factor as cause of some weight gain but that's probably a small contribution overall when folks note gain on meds. Sorry about that, but I just don't know the physiological reasoning.
>
> Lex has been a Godsend for me. Everyone is different and one person's "paradise" is another's "poison", but Lex has exceeded my expectations. My prayer is continued working of this med for me and so far, I'm really good. I think it's a med for you to consider but you do need to discuss it with your doc. You situation is different from mine - it may be a good choice for you and it may not be. I hope you have someone who can guide you well in your decision.
>
> Best,
> Glydin
>Don't worry, your answer was useful to me, It
was another push towards me trying Lexapro. As
you said, it may help, so why not (the only
SSRI I've tried was prozac, but I remember it
as taking water. It did nothing, it did't help
nor did damage).The only guidance I'm receiving right now is
from my psychiatrist, but he chooses what to
talk about, so communication between us isn't
very fluent (this may have to do that I have
seen him only three times)I increased in 75 mg the Lyrica dose I was
taking (150 mg) two nights ago because I
needed something to help with my sleeping
and anxiety problem, but the anxiety seems to
have increased as well, I'm not sleeping any
better either and my hunger got bigger too,
though it may be more due the expectations
or frustration that because of the
medication.Have a good day,
Bye.
J.
Posted by Glydin on October 27, 2005, at 9:08:32
In reply to Re: Lexapro, Anxiety and Weigh Gain » Glydin, posted by Unh on October 27, 2005, at 8:52:49
I really thought Lyica was going to be great for anxiety. It was something I considered when I needed to make a change from using Klonopin as montherapy as I was SO against doing another AD trial due to past bad experiences. But, the truth of the matter was: I did need something for the clinical level depression - it was a change of status for me.
From what I've read, Lyrica has not seemed to live up to the expectations - for some ---- another choice for treatment would have been nice to see.
I have a special place in my heart for anxiety suffers and I wish there were more options. I've been in that awful place of toxic anxiety. I think anxiety disorders are underrated as to the life impact they have. It can be h*llish. I'm so thankful (and I NEVER take it for granted) for the relief I've gotten.
Posted by Racer on October 27, 2005, at 12:27:08
In reply to Re: Lexapro, Anxiety and Weigh Gain » Glydin, posted by Unh on October 27, 2005, at 8:52:49
Beta blockers will not help the cognitive portion of your anxiety. I have a friend who told me about taking propranalol for anxiety once before flying, and how weird it was for him to have all the thoughts about it going on - but no physical symptoms. If you want to work on the cognitive part through CBT or something similar, a beta blocker might help with that, by keeping your body from overwhelming your thoughts, but it won't do anything to reduce the thoughts involved.
As for SSRIs and weight gain, no one really knows the mechanism, but there are a fair number of studies being done now to try to figure it out. Basically, though, 95% of the serotonin in your body is in your digestive tract, and there are two major 5HT receptors involved in feeding behavior. Since SSRIs increase the available 5HT in the synapse, I'd guess that the weight gain is related to down regulation of these receptors after a period of being over stimulated. That's not only just a guess, but it's just a wild @$$ guess by someone who didn't even major in a science. ;-P
Speaking as an anorexic who has gained about a ton and a half on these meds over the years, I will tell you that I started gaining weight on Paxil before anything changed in my ED symptoms. I was still restricting and over-exercising, even tried to cut back as much as I could on eating -- which was hard, since I wasn't eating much at all -- but still kept gaining weight. I was also constipated, which may have had something to do with it. {shrug} Yes, you have to watch for overeating on these drugs, but that's not enough to stop the weight gain. There are other medications that seem to help mitigate weight gain, though, so you should talk to your doctor about that.
I hope that helps.
OH! And I have no idea if Walgreens ships outside NA. Where are you located? Someone here will be local enough to steer you towards a source for nearly anything.
(And you don't have to hit the return key at the end of the little box. Just keep typing until you reach the end of your paragraph. It'll wrap around in the box, and be easier to read.)
This is the end of the thread.
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