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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by becksA on April 22, 2006, at 15:33:16
i have been dx'd with ADHD, cyclothemia, and social anxiety (extreme)....although we're not sure if that comes from depression through anxiety, it all kind of seems to tie together.
My biggest problem lately is becoming bigger and bigger, and that is of brain fogginess, causing me to become extreme intattentive at work. I'm on a heavy dosage of klonipin, but also depakote. The klonopin (at this dosage) has been the ONLY thing that has helped my severe anxiety, so I don't want to leave it at ALL COSTS. If my anxiety goes back up, so does my depression, i can't make friends, etc. Is it possible the depakote can cause the "brain fogginess"?
Please help
Thanks
Posted by ihadapony on April 22, 2006, at 16:21:16
In reply to PLEASE - IMPORTANT - job/life on the line, posted by becksA on April 22, 2006, at 15:33:16
> i have been dx'd with ADHD, cyclothemia, and social anxiety (extreme)....although we're not sure if that comes from depression through anxiety, it all kind of seems to tie together.
>
> My biggest problem lately is becoming bigger and bigger, and that is of brain fogginess, causing me to become extreme intattentive at work. I'm on a heavy dosage of klonipin, but also depakote. The klonopin (at this dosage) has been the ONLY thing that has helped my severe anxiety, so I don't want to leave it at ALL COSTS. If my anxiety goes back up, so does my depression, i can't make friends, etc. Is it possible the depakote can cause the "brain fogginess"?
>
> Please help
>
Hi becksA,
I don't know what causes that, but I had it bad. Treated with hydergine and DMAE and its substantially better. I can tell when I forget to take the DMAE. The hydergine is longer lasting so I can't tell how much of it is that. Side note: From my response to DMAE my doc says NOT to take anticholinergic drugs, that I'm naturally already there, so maybe assess what you are taking. Good luck, that's really really hard to deal with. I hope it gets better for you.
Posted by Crazy Horse on April 22, 2006, at 18:03:38
In reply to PLEASE - IMPORTANT - job/life on the line, posted by becksA on April 22, 2006, at 15:33:16
> i have been dx'd with ADHD, cyclothemia, and social anxiety (extreme)....although we're not sure if that comes from depression through anxiety, it all kind of seems to tie together.
>
> My biggest problem lately is becoming bigger and bigger, and that is of brain fogginess, causing me to become extreme intattentive at work. I'm on a heavy dosage of klonipin, but also depakote. The klonopin (at this dosage) has been the ONLY thing that has helped my severe anxiety, so I don't want to leave it at ALL COSTS. If my anxiety goes back up, so does my depression, i can't make friends, etc. Is it possible the depakote can cause the "brain fogginess"?
>
> Please help
>
> ThanksDepakotes most common side effects are sedation, dizziness, nausea and vomiting. I know you don't want to hear this, but i think your brain fog is being caused by your high dose Klonopin. How high is your dose? It is a good drug for social phobia but too much can cause drowsiness, also high doses have been reported to cause depression.
Have you ever considered trying an maoi? I've been doing very well on Parnate (an maoi) for over 2 1/2 months. I also have social phobia, but with Parnate my social phobia has disappeared! I've gone from using 8-10 mgs. of Ativan a day (a benzo like klonopin) to only 2 1/2 mgs. I plan to taper off ativan completely in the next month. With Parnate i don't need it anymore. Talk to your doc about MAOI's; Nardil, Parnate and EMSAM...they are the "Gold Standard" meds for social phobia, and are powerful antidepressants. I wish you the best.
-Crazy Horse
Posted by becksA on April 22, 2006, at 18:12:56
In reply to Re: PLEASE - IMPORTANT - job/life on the line » becksA, posted by Crazy Horse on April 22, 2006, at 18:03:38
:(
You're right, that's the last thing I wanted to hear....and it really seems like MAOI is what I need, but I just really didnt want it to come to that, because of the diet. I checked it out briefly once what I can and cannot eat, and its so extremely long.....but like I said, the super high dose (14mg daily) is the only thing that has helped my anxiety at ALL.. Ive tried every single AD, even a super high dosage of xanax did nothing at all.
thanks
Posted by blueberry on April 22, 2006, at 19:36:53
In reply to PLEASE - IMPORTANT - job/life on the line, posted by becksA on April 22, 2006, at 15:33:16
The klonopin is definitely a major player in the fogginess. But since it helps you so much, it probably needs to stay close to where it is, and instead of changing it much, look to counteract it with something. I wonder though, would it be possible to drop the dose slightly lower, or is that totally out of the question?
Depakote is also guilty. I was on depakote for a few months and it definitely caused major fogginess for me, even more than xanax or klonopin ever did. So in my opinion the klonopin and depakote together is a double whammy on fogginess.
But what to do about it? That's hard. Drop klonopin dosage a little if you can? Drop depakote dosage a little if you can, or drop it altogether?
If you need a mood stabilizer, it might be worth looking at zyprexa instead. I generally shy away from the antipsychotics, but in your case it could be great. That's because it will provide good anti-anxiety action, possibly allowing a lower dose of klonopin, and because it increases dopamine levels in the parts of the brain where you need it for cognitive function. One of the benefits schizophrenic patients get with the atypicals is improved cognitive function due to the increased dopamine. Also, zyprexa is the only one in the bunch that has some affinity for the GABA receptors, so will help klono work better too. To make it work even better, add in just a touch of prozac for no other reason than to turn up the volume on the dopamine, like maybe 5mg to 10mg prozac. That will really get the dopamine and norepinephrine juices flowing, and yet give anti-anxiety at the same time...more dopamine in the brain overall for cognitive function, but also partially blocked from the dopamine receptors preventing anxiety. Mood boosting, cognitive boosting, anti-anxiety, and mood stability all at once.
You've tried all the ADs. Does that include cymbalta? I ask because its norepinephrine effects and its ability to increase dopamine levels could be a big help. And you may only need a little bit, like 1mg to 20mg (by emptying out the capsule and counting 10 beads = 1mg). For me anyway, just a hint of norepinephrine is a big cognitive boost. And after the start-up anxiety is past, there is decent anti-anxiety from it too. Just a touch of strattera might be good.
With ADHD involved, do the stimulants cause too much anxiety?
Just some ideas. But yeah, the klono and the depakote are both guilty as far as I'm concerned. You obviously do not have the option of changing the klono, but maybe one of the other options I mentioned could be considered. Any one of them would be pretty easy and not too drastic of a change. Want to destabilize things as little as possible and not make any huge changes all at once. That's why I was looking at real low doses.
Right off the bat, if it were an emergency, I would lower the depakote, add 5mg prozac and 2.5mg zyprexa, with the possibility of later going up to 10mg prozac and 5mg zyprexa. Like I said, that would be anti-anxiety, mood elevating, mood stability, and cognitive enhancing all at the same time.
> i have been dx'd with ADHD, cyclothemia, and social anxiety (extreme)....although we're not sure if that comes from depression through anxiety, it all kind of seems to tie together.
>
> My biggest problem lately is becoming bigger and bigger, and that is of brain fogginess, causing me to become extreme intattentive at work. I'm on a heavy dosage of klonipin, but also depakote. The klonopin (at this dosage) has been the ONLY thing that has helped my severe anxiety, so I don't want to leave it at ALL COSTS. If my anxiety goes back up, so does my depression, i can't make friends, etc. Is it possible the depakote can cause the "brain fogginess"?
>
> Please help
>
> Thanks
Posted by becksA on April 22, 2006, at 19:50:52
In reply to Re: PLEASE - IMPORTANT - job/life on the line » becksA, posted by blueberry on April 22, 2006, at 19:36:53
thanks, that was incredibly informative and i'm actually going to jot some of those things down to show my pdoc when i meet with him. i would be willing i guess to drop the klonopin only slightly, maybe from 14 to 12 or so, but like i said , my entire life i've been EXTREMELY immune to all drugs. i always use 2 examples: First, I was on Effexor XR for a good 6 months at the maxed out dosage....and when it was doing ZERO for me, I went off it practically cold turkey. I think something like 2 or 3 days. The second is Xanax XR. I was on an incredibly high dosage of that, equal to the Klonopin if not higher for about a year, and I weaned off (and stopped feeling withdrawal within about 7 - 10 days). So something is up. I have not heard of stories like these.
thanks again....
Posted by MidnightBlue on April 22, 2006, at 19:51:57
In reply to PLEASE - IMPORTANT - job/life on the line, posted by becksA on April 22, 2006, at 15:33:16
For what it is worth, I had HORRIBLE brain fog on depakote!
Posted by becksA on April 22, 2006, at 20:01:32
In reply to Re: PLEASE - IMPORTANT - job/life on the line » becksA, posted by MidnightBlue on April 22, 2006, at 19:51:57
thank you, its worth alot....ill mention it....
Posted by Phillipa on April 22, 2006, at 21:32:39
In reply to Re: PLEASE - IMPORTANT - job/life on the line, posted by becksA on April 22, 2006, at 20:01:32
But don't forget to research the MAOI's. The patch appeals to me put it on absorbed into your skin if bad side effects take it off the med is out of your system in 2-6 hours. No food restrictions except at highter doses. Conflicting advise about a washout period my pdoc says no but someone else says yes. Love Phillipa
Posted by Crazy Horse on April 23, 2006, at 9:07:45
In reply to Re: PLEASE - IMPORTANT - job/life on the line, posted by becksA on April 22, 2006, at 18:12:56
> :(
>
> You're right, that's the last thing I wanted to hear....and it really seems like MAOI is what I need, but I just really didnt want it to come to that, because of the diet. I checked it out briefly once what I can and cannot eat, and its so extremely long.....but like I said, the super high dose (14mg daily) is the only thing that has helped my anxiety at ALL.. Ive tried every single AD, even a super high dosage of xanax did nothing at all.
>
> thanksThe diet you looked at was probably outdated. The "New" updated maoi diet isn't bad at all. Seriously, the only thing i miss is cheddar cheese. I can have american cheese, mozzarella, cottage and cream cheese. If you are interested i'll send you the new list. Also, let's say you tried Nardil and it worked for you, you could still take klonopin, but you would probably find you don't need even near as much as you take now. Read up on MAOI's, many people who don't do well on other ad's do very well on maoi's. :)
-Monte
Posted by whoami on April 23, 2006, at 10:55:06
In reply to PLEASE - IMPORTANT - job/life on the line, posted by becksA on April 22, 2006, at 15:33:16
Have you considered a stimulant? That's what it took to ease my "brain fog", and as it is, you say you have ADHD, so you probably need a stimulant for that.
Posted by Crazy Horse on April 23, 2006, at 12:59:20
In reply to Re: PLEASE - IMPORTANT - job/life on the line, posted by whoami on April 23, 2006, at 10:55:06
> Have you considered a stimulant? That's what it took to ease my "brain fog", and as it is, you say you have ADHD, so you probably need a stimulant for that.
The only thing about a stimulant is that it would increase your anxiety, and with all that klonopin it could be one wild roller coaster ride..up,down, up,down....
-CH
Posted by greywolf on April 23, 2006, at 16:26:48
In reply to Re: PLEASE - IMPORTANT - job/life on the line, posted by becksA on April 22, 2006, at 20:01:32
What's your dosage of Depakote? Also, if you're cyclothemic, I would suspect that Klonopin at higher dosages would be more likely to contribute to depression.
Have you considered going back to the Xanax? It has a shorter half-life, but has the same or greater potency without as much of a risk of high-dose depression.
Posted by Jay on April 23, 2006, at 16:43:40
In reply to PLEASE - IMPORTANT - job/life on the line, posted by becksA on April 22, 2006, at 15:33:16
> i have been dx'd with ADHD, cyclothemia, and social anxiety (extreme)....although we're not sure if that comes from depression through anxiety, it all kind of seems to tie together.
>
> My biggest problem lately is becoming bigger and bigger, and that is of brain fogginess, causing me to become extreme intattentive at work. I'm on a heavy dosage of klonipin, but also depakote. The klonopin (at this dosage) has been the ONLY thing that has helped my severe anxiety, so I don't want to leave it at ALL COSTS. If my anxiety goes back up, so does my depression, i can't make friends, etc. Is it possible the depakote can cause the "brain fogginess"?
>
> Please help
>
> Thanksok...i'LL Try my best. It's time to get *really* serious about the drugs you take (I'm sure you are) just need to experiment in ways many haven't. First, you might want to ask for Depakote ER (extended release). Actally, *demand* it. It just came out within the past year or two. It is supposed to be WAY better than regular depakote, possibly with less drowsiness, fatigue, and weight gain.Second, Depakote alone, in particular with your Dx, just isn't going to cut it. I know you also take klonopin, but that won't do anything if the Depakote is in the way. A number of prominent doctors and researchers have talked about using *two* mood stabalizers (like depakote, plus another), and slowy add on a dose of an antidepressant. It's all about balance...you have to be careful from letting the m.s's from letting you fall into despair, which it sounds like you have. With two m.s's, PLUS and a.d. AND the klonopin, you may find more harmoney. Just watch your dose levels. You can also go to adding TWO antidepressants and see how it works, Also, you could go the atypical antipsychotic route. Either m.s. +a.p....if it doesn't work than two a.p.'s. Seroquel is good for bedtime dosing, and either Risperdal or Zyprexa for 24 hour coverage. I've used the a combo of some of the above for over a year now and, knock on wood, I am back to living and enjoying a normal life (still..with it's ups and downs.) Oh ya...about the Risperdal...I would ask for that, as it seems not to have the blood-sugar problems Zyprexa does.
I know this is a lot of info...you may want to print it out...or take it to your doc. I found adding one med at a time helps. Best of luck..and yes..there IS a place for a mentally healthy you out there.
Best,
Jayp.s. Just wanted to add...dexedrine seems to be a real asset to many....you could also consider that.
Posted by becksA on April 24, 2006, at 8:40:02
I have decided to go off the depakote because of the brain fog, and I have noticed several things. I really did not want to go off the Klonopin or even lower the dosage because it was helping my social anxiety SO MUCH. So far I have noticed a huge difference, my mood is up, brain fog is better, and even a problem I was having before, slight speech-slurring (I thought it may have been klonopin) is gone!) Is that really all possible with the depakote? The pdoc had said it was most likely the klonopin, but it seems like it's the depakote.
Thanks!
Posted by Crazy Horse on April 24, 2006, at 8:50:54
In reply to Following up on my Depakote brain fog posts...., posted by becksA on April 24, 2006, at 8:40:02
> I have decided to go off the depakote because of the brain fog, and I have noticed several things. I really did not want to go off the Klonopin or even lower the dosage because it was helping my social anxiety SO MUCH. So far I have noticed a huge difference, my mood is up, brain fog is better, and even a problem I was having before, slight speech-slurring (I thought it may have been klonopin) is gone!) Is that really all possible with the depakote? The pdoc had said it was most likely the klonopin, but it seems like it's the depakote.
> Thanks!That's good news...congrats. Yea, i would have though it was caused by the high dose klonopin. It's rare that a pdoc will treat social phobia with only a benzo, i'm surprised he hasn't mentioned an maoi or at least another AD for you. Be careful, high dose, or any dose for that matter, Klonopin can cause depression. All benzos are classified as depressents. Good luck to you. :)
Crazy Horse
Posted by greywolf on April 24, 2006, at 8:54:50
In reply to Re: Following up on my Depakote brain fog posts.... » becksA, posted by Crazy Horse on April 24, 2006, at 8:50:54
becks, what was your Depakote dosage?
Posted by med_empowered on April 24, 2006, at 12:18:25
In reply to Re: Following up on my Depakote brain fog posts...., posted by greywolf on April 24, 2006, at 8:54:50
personally i'd think the depakote would be more mind-clouding than Klonopin, even at high doses of Klonopin. Personally, I've found that Klonopin makes distractibility worse BUT if your anxiety is so severe it impairs normal thought, you actually can get clearer thoughts (I mean, I felt impaired but since the anxiety was gone I felt like I could focus a little more--not 100%, but much better). Anyway, depakote is rough stuff and watch the dosing of other drugs--depakote induces liver enzymes, so docs have to up doses of other stuff; as the depakote clears out, you should probably adjust the dosages of other stuff accordingly.
Posted by becksA on April 24, 2006, at 12:43:41
In reply to Re: Following up on my Depakote brain fog posts..., posted by med_empowered on April 24, 2006, at 12:18:25
i was on 1250 daily. going down gradually. you're right about the liver enzymes, though, i hadnt thought about that. previously in all my other meds i can come off things at the snap of a finger cold turkey but since you have to be so careful going on depakote i assume you have to be just as careful coming off? or no.
Posted by MidnightBlue on April 24, 2006, at 15:49:21
In reply to Following up on my Depakote brain fog posts...., posted by becksA on April 24, 2006, at 8:40:02
I might be in the minority here, but I would blame the depakote. I feel SO much better without it! Never took klonopin.
MB
Posted by greywolf on April 24, 2006, at 18:04:22
In reply to Re: Following up on my Depakote brain fog posts..., posted by becksA on April 24, 2006, at 12:43:41
The reason I ask is that I'm at the same dosage, but have been fortunate to experience little fogginess so far. But, as they say, YMMV.
Posted by willyee on April 24, 2006, at 20:59:13
In reply to Re: Following up on my Depakote brain fog posts..., posted by med_empowered on April 24, 2006, at 12:18:25
No offense here,and just my own personal opinion not a bit more,but DEPAKOTE is one of the most VIAL drugs i ever took,mind dulling and most depressiong,i remember being in a horrid mood while on it,wow i hate that drug.
Posted by Caedmon on April 28, 2006, at 0:48:47
In reply to Re: Following up on my Depakote brain fog posts..., posted by willyee on April 24, 2006, at 20:59:13
I can't think of an AED (besides maybe Keppra?) that isn't associated with some significant cognitive impairment. It's usually a lottery.
- C
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