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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 TylerJ on March 11, 2006, at 8:38:35
Went to my Pdoc yesterday, and he agreed I was on too much Trazodone causing daytime sedation. He also said he thinks reducing my ativan too quickly is part of the prob. One month ago I was on 8mgs. or more ativan daily, two days ago i was down to 3 a day...remember i've been on ativan over 20rs. At verious doses for 3-12 mgs. going down to 3 in one month was too much for me, I increased it wed. or thurs and immediatly felt a little better at 4 1/2 mgs. He wants me to stay right at 4 1/2 to 5 mgs. a day for awhile- he thinks and I agree, the reduced ativan is making the insomnia worse, and that's why I needed so much Trax to get to sleep. He reduce my Traz to 250 for a few nights and then further to 200. Last night it worked! I slept really well and woke up this morn. at 6:00 am without hangover or drowsiness.
Tyler
Posted by Phillipa on March 11, 2006, at 20:32:05
In reply to Doc decreases Traz while increasing Ativan, posted by TylerJ on March 11, 2006, at 8:38:35
Congratulations Tyler. Fondly, Phillipa
Posted by TylerJ on March 11, 2006, at 20:51:11
In reply to Re: Doc decreases Traz while increasing Ativan » TylerJ, posted by Phillipa on March 11, 2006, at 20:32:05
> Congratulations Tyler. Fondly, Phillipa
Thank you Phillipa...you're such a sweetie.Tyler :)
Posted by yxibow on March 13, 2006, at 3:27:58
In reply to Doc decreases Traz while increasing Ativan, posted by TylerJ on March 11, 2006, at 8:38:35
Fantastic too -- I would add that when you get into the 200 to 300 range you are actually starting to take an adult dose of an antidepressant (which was eventually a nonstarter for the drug because it was so sedating for patients until Serzone came around and started causing jaundice...) and it can cascade further and further up.
I did the Trazodone updose and downdose and updose merrygoround at various points -- its really a yucky medication to go to sleep, dizzyness, and that male black box problem.. mrm, it happens more than you think.
Thank goodness for more modern pseudobenzodiazepine meant only for sleep (Ambien, etc) medications except that some doctors are reluctant to prescribe them to depressed patients because they think they'll overdose or they're just benzophobic or whatever.
Posted by TylerJ on March 13, 2006, at 5:18:53
In reply to Re: Doc decreases Traz while increasing Ativan » TylerJ, posted by yxibow on March 13, 2006, at 3:27:58
> Fantastic too -- I would add that when you get into the 200 to 300 range you are actually starting to take an adult dose of an antidepressant (which was eventually a nonstarter for the drug because it was so sedating for patients until Serzone came around and started causing jaundice...) and it can cascade further and further up.
>
> I did the Trazodone updose and downdose and updose merrygoround at various points -- its really a yucky medication to go to sleep, dizzyness, and that male black box problem.. mrm, it happens more than you think.
>
> Thank goodness for more modern pseudobenzodiazepine meant only for sleep (Ambien, etc) medications except that some doctors are reluctant to prescribe them to depressed patients because they think they'll overdose or they're just benzophobic or whatever.Yeah, I don't understand why my pdoc won't just give me Ambien or Lunesta...Instead he insists on Trazodone. When I ask him, he say's he doesn't want to add another "depressant"..Yet he prescribes ativan for me which doesn't even work after 20 years!! I don't get it..it frustrates the hell out of me.
Posted by yxibow on March 15, 2006, at 3:07:13
In reply to Re: Doc decreases Traz while increasing Ativan » yxibow, posted by TylerJ on March 13, 2006, at 5:18:53
> > Fantastic too -- I would add that when you get into the 200 to 300 range you are actually starting to take an adult dose of an antidepressant (which was eventually a nonstarter for the drug because it was so sedating for patients until Serzone came around and started causing jaundice...) and it can cascade further and further up.
> >
> > I did the Trazodone updose and downdose and updose merrygoround at various points -- its really a yucky medication to go to sleep, dizzyness, and that male black box problem.. mrm, it happens more than you think.
> >
> > Thank goodness for more modern pseudobenzodiazepine meant only for sleep (Ambien, etc) medications except that some doctors are reluctant to prescribe them to depressed patients because they think they'll overdose or they're just benzophobic or whatever.
>
> Yeah, I don't understand why my pdoc won't just give me Ambien or Lunesta...Instead he insists on Trazodone. When I ask him, he say's he doesn't want to add another "depressant"..Yet he prescribes ativan for me which doesn't even work after 20 years!! I don't get it..it frustrates the hell out of me.
He continues to prescribe lorazepam for 20 yrs ?? I know a lot of doctors are stuck on the Trazodone scripting for off-use because they think it has low abuse potential for extremely depressed patients but it has the potential -- quite likely to dose escalate itself into a zombie range until one has to reduce and then go back. Plus the priapism issue which is I believe a black box. (and yes, when I was on a prescribing situation with that I experienced it not once but several times, mildly, and I was even younger than now so it didnt do much harm thankfully.)Express yourself to your doctor -- I can see that he doesnt want escalation of benzodiazepine related drugs but by equivalence you are only on 2.5mgs of Klonopin, give or take -- only a medium range dose. Lunesta would seem to me to, besides that fresh and tasty metallic mouthful (only few people experience that side effect beyond sleep), provide a much less groggy after-night, as very short half life pseudobenzodiazepine like agents are supposed to. Or Ambien CR. Yes, the PDR cautions about depressed patients, but if Ativan came out now it would also, so it seems a non sequitor. But I'm not your doctor. If you truly want something other than Trazodone, convince your doctor that the Ativan isn't doing anything anyhow, and when you wash it out of your system maybe you can try a sleep drug. But I also dont know what other medications you're on, and I obviously can't supercede what your doctor is saying, only you can discuss -- it is your life too after all, doctor-patient relationships should be a two way street I think. Anyhow, if you're comfortable with the Trazodone for now, pleasant dreams.
Tidings
- Jay
Posted by TylerJ on March 15, 2006, at 6:13:20
In reply to Re: Doc decreases Traz while increasing Ativan » TylerJ, posted by yxibow on March 15, 2006, at 3:07:13
> > > Fantastic too -- I would add that when you get into the 200 to 300 range you are actually starting to take an adult dose of an antidepressant (which was eventually a nonstarter for the drug because it was so sedating for patients until Serzone came around and started causing jaundice...) and it can cascade further and further up.
> > >
> > > I did the Trazodone updose and downdose and updose merrygoround at various points -- its really a yucky medication to go to sleep, dizzyness, and that male black box problem.. mrm, it happens more than you think.
> > >
> > > Thank goodness for more modern pseudobenzodiazepine meant only for sleep (Ambien, etc) medications except that some doctors are reluctant to prescribe them to depressed patients because they think they'll overdose or they're just benzophobic or whatever.
> >
> > Yeah, I don't understand why my pdoc won't just give me Ambien or Lunesta...Instead he insists on Trazodone. When I ask him, he say's he doesn't want to add another "depressant"..Yet he prescribes ativan for me which doesn't even work after 20 years!! I don't get it..it frustrates the hell out of me.
>
>
> He continues to prescribe lorazepam for 20 yrs ?? I know a lot of doctors are stuck on the Trazodone scripting for off-use because they think it has low abuse potential for extremely depressed patients but it has the potential -- quite likely to dose escalate itself into a zombie range until one has to reduce and then go back. Plus the priapism issue which is I believe a black box. (and yes, when I was on a prescribing situation with that I experienced it not once but several times, mildly, and I was even younger than now so it didnt do much harm thankfully.)
>
> Express yourself to your doctor -- I can see that he doesnt want escalation of benzodiazepine related drugs but by equivalence you are only on 2.5mgs of Klonopin, give or take -- only a medium range dose. Lunesta would seem to me to, besides that fresh and tasty metallic mouthful (only few people experience that side effect beyond sleep), provide a much less groggy after-night, as very short half life pseudobenzodiazepine like agents are supposed to. Or Ambien CR. Yes, the PDR cautions about depressed patients, but if Ativan came out now it would also, so it seems a non sequitor. But I'm not your doctor. If you truly want something other than Trazodone, convince your doctor that the Ativan isn't doing anything anyhow, and when you wash it out of your system maybe you can try a sleep drug. But I also dont know what other medications you're on, and I obviously can't supercede what your doctor is saying, only you can discuss -- it is your life too after all, doctor-patient relationships should be a two way street I think. Anyhow, if you're comfortable with the Trazodone for now, pleasant dreams.
>
> Tidings
>
> - Jay
Thanks Jay,
You're right, after 20 plus years, ativan isn't helping anymore, what we are trying to do is taper off the ativan which will take a LOOOOOng time. He thinks part of my insomnia is caused by reducing the Ativan too quickly . A week a go I was on 3 mgs. a day. But as of yesterday I went back up to 5-6 mgs. daily. Parnate takes care of my anxiety, so I don't feel i need the ativan for anxiety...However, I'm hooked on the ativan, and this is the main reason i still take it. Pdoc said when I'm off the ativan completely he will switch from Traz to Lunesta or Ambien. It's always something you know. :)Ty
Posted by yxibow on March 16, 2006, at 2:37:56
In reply to Re: Doc decreases Traz while increasing Ativan » yxibow, posted by TylerJ on March 15, 2006, at 6:13:20
> Thanks Jay,
> You're right, after 20 plus years, ativan isn't helping anymore, what we are trying to do is taper off the ativan which will take a LOOOOOng time. He thinks part of my insomnia is caused by reducing the Ativan too quickly . A week a go I was on 3 mgs. a day. But as of yesterday I went back up to 5-6 mgs. daily. Parnate takes care of my anxiety, so I don't feel i need the ativan for anxiety...However, I'm hooked on the ativan, and this is the main reason i still take it. Pdoc said when I'm off the ativan completely he will switch from Traz to Lunesta or Ambien. It's always something you know. :)
>
> TyI understand... don't blame yourself that you're "hooked" in the addictive sense.. its just that you've been on it a long time and unfortunately habituation has happened, for you, as in a number of people. A gradual taper, like 10% a week or something like that, or whatever your doctor is suggesting will eventually return you to square one in one piece rather than an insomniac. And then I hope you get some restful sleep from something more useful.
Tidings
Jay
Posted by TylerJ on March 16, 2006, at 9:34:22
In reply to Re: Doc decreases Traz while increasing Ativan » TylerJ, posted by yxibow on March 16, 2006, at 2:37:56
>
> > Thanks Jay,
> > You're right, after 20 plus years, ativan isn't helping anymore, what we are trying to do is taper off the ativan which will take a LOOOOOng time. He thinks part of my insomnia is caused by reducing the Ativan too quickly . A week a go I was on 3 mgs. a day. But as of yesterday I went back up to 5-6 mgs. daily. Parnate takes care of my anxiety, so I don't feel i need the ativan for anxiety...However, I'm hooked on the ativan, and this is the main reason i still take it. Pdoc said when I'm off the ativan completely he will switch from Traz to Lunesta or Ambien. It's always something you know. :)
> >
> > Ty
>
> I understand... don't blame yourself that you're "hooked" in the addictive sense.. its just that you've been on it a long time and unfortunately habituation has happened, for you, as in a number of people. A gradual taper, like 10% a week or something like that, or whatever your doctor is suggesting will eventually return you to square one in one piece rather than an insomniac. And then I hope you get some restful sleep from something more useful.
>
> Tidings
>
> Jay
>Yeah...Thank God I have a Great Pdoc. He even told me the other day "If it takes a year, it takes a year, we're not in a race here." I've heard others talk about how their Doc says, "Here's a prescription for 60 and that's all you're going to get. My doc really understands anxiety and how awful it can be.
Take care Jay.
Tyler
Posted by yxibow on March 17, 2006, at 2:48:47
In reply to Re: Doc decreases Traz while increasing Ativan » yxibow, posted by TylerJ on March 16, 2006, at 9:34:22
> Yeah...Thank God I have a Great Pdoc. He even told me the other day "If it takes a year, it takes a year, we're not in a race here." I've heard others talk about how their Doc says, "Here's a prescription for 60 and that's all you're going to get. My doc really understands anxiety and how awful it can be.
And how though I believe in benzodiazepines as one of the safest psych medications when used properly, tapering is necessary to avoid unnecesary withdrawal symptoms, as I well know, when I tried cold turkey on something years ago.. scalp spasms -- which may still be active for many years -- and I wasnt given enough back. Even though I still believe in the medications as they have useful place in a lot of disorders, the here's the 60 is an awful way to go. Glad your doc understands... good luck.
> Take care Jay.
You too
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