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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by LlurpsieNoodle on July 23, 2007, at 10:28:53
300mg lamictal
240 mg geodon (recently inc. from 180mg)
1mg klonopin (recently inc from .25-.5 prn)
200mg provigil
sonata prn for sleepI'm walking around in this medicated funk. trying to feel or think a rational thought or have an emotional reaction to something. I will give this cocktail 1 week of adjustment time. pretty sure my charts will read "sign. suicide risk" goody. but what I'd give to feel anything?
what prompted med changes was extreme mood lability and sense of losing mind. call it a quiet psychosis?
I can't have happy thoughts or sad thoughts. I cut myself to feel a reaction to anything.
suggestions for supplements (stimulants? coffee? vitamins). did I mention I'm on a low calorie diet to lose seroquel and dissertation blubber. working.
-Ll
Posted by Phillipa on July 23, 2007, at 11:41:46
In reply to [over?] medicated haze. help. triggers, posted by LlurpsieNoodle on July 23, 2007, at 10:28:53
Lurpsie can you call the pdoc and tell him what happened? This is not good. Someone needs to help you. I wish I was there at least I would try. Love Phillipa
Posted by bart on July 23, 2007, at 12:51:06
In reply to [over?] medicated haze. help. triggers, posted by LlurpsieNoodle on July 23, 2007, at 10:28:53
yes, I also hope you tell your doctor. Maybe you're over-medicated or they can switch some things around.
since you mentioned losing "blubber" (I know how that goes with serquel by the way!), do you exercise? Have you ever utilized the mood benefits of anything like that?
really helps me for sure.good luck
Posted by scratchpad on July 23, 2007, at 13:09:22
In reply to [over?] medicated haze. help. triggers, posted by LlurpsieNoodle on July 23, 2007, at 10:28:53
Hi, Llurpsie. Didn't your medications just get bumped up by your doctor a few days ago? I'm finding that my body is a slow learner and changes take a l-o-n-g time for me to adjust to. Do you think you've given them enough time?
And maybe losing weight at the same time is making the Klonipin klobber you harder?? There's less of you to medicate, you know.
Make sure you are hydrating yourself well and getting enough nutrients in your diet.
Any change in my medications is enough to send me into a tail spin for a week at least.
And, above all, we ALL want you to keep yourself safe. Do you have emergency phone numbers handy? Do you want another one?
take good care,
her Scratchieness
Posted by LlurpsieNoodle on July 23, 2007, at 14:43:52
In reply to Re: [over?] medicated haze. help. triggers, posted by bart on July 23, 2007, at 12:51:06
> yes, I also hope you tell your doctor. Maybe you're over-medicated or they can switch some things around.
> since you mentioned losing "blubber" (I know how that goes with serquel by the way!), do you exercise? Have you ever utilized the mood benefits of anything like that?
> really helps me for sure.
>
> good luckThanks for your kind response bart, nice to meet you :)
I get a temporary boost from exercise, but then I crash again. Recently I went hiking and biking and to a yoga class. That probably helped.
Posted by LlurpsieNoodle on July 23, 2007, at 14:45:42
In reply to Re: [over?] medicated haze. help. triggers » LlurpsieNoodle, posted by Phillipa on July 23, 2007, at 11:41:46
Hi Phillipa,
I'm going to give this med change a week and then I'll give him a call. Scratchpad's probably right. This is only my 3rd day on the higher doses. Maybe I need some more time to adjust.I made H drive me to starbucks and enjoyed a venti skim cappucino. it's even on my diet.
feeling a little better now. I even called the insurance companies.
-Ll
Posted by LlurpsieNoodle on July 23, 2007, at 15:04:31
In reply to Re: [over?] medicated haze. help. triggers » LlurpsieNoodle, posted by scratchpad on July 23, 2007, at 13:09:22
> Hi, Llurpsie. Didn't your medications just get bumped up by your doctor a few days ago? I'm finding that my body is a slow learner and changes take a l-o-n-g time for me to adjust to. Do you think you've given them enough time?
no, of course not! ;)
>
> And maybe losing weight at the same time is making the Klonipin klobber you harder?? There's less of you to medicate, you know.
>
probably. And this diet isn't carb limiting, but it's designed to keep the blood sugar highs to a minimum. perhaps I need more sugar right now. oh well. don't want to undo all my 13 lbs of progress.> Make sure you are hydrating yourself well and getting enough nutrients in your diet.
>HYDRATION!!! that's probably a very good idea. all this caffeine is probably not so hydrating. I doubt I'm getting all my nutrients. maybe I should take a round of supplements. I was hoping someone would tell me exactly which bottles to open. so apathetic. I can at least track down a bottle of multivitamins, though.
> Any change in my medications is enough to send me into a tail spin for a week at least.
And you've had a few changes recently. hope you're maintaining altitude ((((Scratchpad))))
>
> And, above all, we ALL want you to keep yourself safe. Do you have emergency phone numbers handy? Do you want another one?I'm very very bad at calling emergency phone numbers. e-mail is about as close as it comes. I called grandmom and grandpa to tell them I couldn't come to the family get together. Must have sounded pretty bad, 'cause they sent me a check for 2,000. I'm going to use it to pay for my therapist, who hasn't been paid since Feb.
Even given such powerful reinforcement to reach out, I rarely do so. I can convince myself that I feel "okay" enough not to, and then when I'm truly in crisis, I am powerfully compelled NOT to reach out. so pathological, I know. Something I'm working hard in therapy. Only took me 6 sessions with this T to ask him if I could call him after hours. My first T I never even got the nerve to ask. I just sent him one suicidal email and wham! next thing I know I got a pile of cymbalta samples. lucky girl I am.
>
> take good care,
> her Scratchienessthanks scratchie. I'm feeling "okay" now. I will imagine a sticky hug. you know what would hydrate me on a gloomy day? a pot of organic herbal tea...
_ll
Posted by med_empowered on July 23, 2007, at 18:24:44
In reply to Re: [over?] medicated haze. help. triggers » LlurpsieNoodle, posted by scratchpad on July 23, 2007, at 13:09:22
your Geodon dosage is way-high, as in...above FDA limits high. Maybe a dosage reduction is in order? The lamictal is also kinda high, but the Klonopin is pretty low...1-4 is pretty normal, 2 is standard, and above 4 happens alot. Maybe you should lower the antipsychotic and try ramping up the benzo and the Provigil (dosages of Provigil can be pushed to 400, 600mgs/day).
Good luck.
Posted by LlurpsieNoodle on July 23, 2007, at 20:13:21
In reply to Re: [over?] medicated haze. help. triggers, posted by med_empowered on July 23, 2007, at 18:24:44
> your Geodon dosage is way-high, as in...above FDA limits high. Maybe a dosage reduction is in order? The lamictal is also kinda high, but the Klonopin is pretty low...1-4 is pretty normal, 2 is standard, and above 4 happens alot. Maybe you should lower the antipsychotic and try ramping up the benzo and the Provigil (dosages of Provigil can be pushed to 400, 600mgs/day).
>
> Good luck.
MedEmP,
will you be my pdoc?
fondly,
-Ll
no seriously! I mean it. I *know* that my geodon is way high. I'm lucky I don't have any of the twitchie EPS that afflict others on high doses of this drug. Actually, it cured my EPS that I was getting on seroquel.What does it mean to have psychotic episodes while on 180mg of geodon? perhaps I'm immune to it's charming effects?
Maybe it's pooped out on me? I dunno. Time ticks on. and the next appt is in September. ugh.
-Ll
Posted by med_empowered on July 23, 2007, at 21:07:48
In reply to Re: [over?] medicated haze. help. triggers » med_empowered, posted by LlurpsieNoodle on July 23, 2007, at 20:13:21
hey, sorry--I didn't mean to overstep. I'm just a poster here...the thing is that higher doses of antipsychotics will increase your neuroleptic load, which over time increases your risk of tardive syndromes, which is already a little elevated since you have mood problems and you're female.
Benzos have mild antipsychotic properties, and can help augment neuroleptics. I thought you might want to talk about that with your doc since some studies (a lot of them from the 70s, though) showed that higher doses of benzos often helped out tremendously with psychosis and "other" symtpoms (agitation, anxiety, insomnia) in schizophrenia.
Have you had an AIMS test while you've been on neuroleptics? If you're going above the approved dosages, I would think it would be particularly important.
Have you tried Risperdal or Abilify? They're both higher potency, so you might be able to get the effect you want/need w/ less drowsiness. Abilify has a weight profile similar to Geodon (sans the weird cardio issues), but Risperdal is a kind of fatty-making med.
Posted by OzLand on July 24, 2007, at 0:33:05
In reply to [over?] medicated haze. help. triggers, posted by LlurpsieNoodle on July 23, 2007, at 10:28:53
THIS IS NOT OKAY. These meds, at least some, are way over the limit. No wonder you feel in a haze. And, there is the potential for a drug reaction of significant negative consequences. I had that happen to me when I started to slur my speech, became confused, disoriented, and developed all sorts of other stuf besides not being able to remember anything 10 minutes later. You need to talk to your Pdoc (email) from where you were in school and also your therapist from before and tell them your symptoms. My God; what are these people doing to you.
OzLand
Posted by Zyprexa on July 24, 2007, at 4:38:14
In reply to Re: [over?] medicated haze. help. triggers » scratchpad, posted by LlurpsieNoodle on July 23, 2007, at 15:04:31
B-vitamins help with dead feeling nerve endings. Add a very high dose of biotin to the b-100 complex.
Posted by LlurpsieNoodle on July 24, 2007, at 10:07:33
In reply to Re: [over?] medicated haze. help. triggers, posted by med_empowered on July 23, 2007, at 21:07:48
> hey, sorry--I didn't mean to overstep. I'm just a poster here...
no problem. post away.
>the thing is that higher doses of antipsychotics will increase your neuroleptic load, which over time increases your risk of tardive syndromes, which is already a little elevated since you have mood problems and you're female.
oh, did I mention that my uncle had really bad TD by the time he died? (schizophrenia) that was with the old generation APs though.
> Benzos have mild antipsychotic properties, and can help augment neuroleptics. I thought you might want to talk about that with your doc since some studies (a lot of them from the 70s, though) showed that higher doses of benzos often helped out tremendously with psychosis and "other" symtpoms (agitation, anxiety, insomnia) in schizophrenia.
Actually my problem is that I'm not compliant with my benzos. I don't want to take any of them, because they make me feel vulnerable (one of the things about PTSD is that I feel this need to be aware of EVERYTHING in my immediate surroundings. benzos take that edge off and then I feel like this defenseless noodle. I'm glad that there is empirical research to back up my pdoc's increased Rx for klonopin. I thought he just found me neurotic and wanted me to stop feeling so antsy. So... I will henceforth put 2 yellow .5mg tablets in my pill planner, instead of the 1 tablet.
> Have you had an AIMS test while you've been on neuroleptics? If you're going above the approved dosages, I would think it would be particularly important.
I've done it to myself. I know the symptoms from when I was taking seroquel... so far geodon has not only failed to produce any tremors or such, but also completely resolved all my tremors and lumpy throat that I got on seroquel (300mg). pdoc gets a pretty good look at me every time, since I have to sit right next to him.
> Have you tried Risperdal or Abilify? They're both higher potency, so you might be able to get the effect you want/need w/ less drowsiness. Abilify has a weight profile similar to Geodon (sans the weird cardio issues), but Risperdal is a kind of fatty-making med.
I tried to push for abilify at my first appt with my new pdoc. his response "geodon has a wonderful calming effect, and I've found that the side effects continue to decrease even months after starting therapy". I will push for abilify later on. However, I am concerned by Honore's recent posts that abilify doesn't have the long-term studies to demonstrate its low potential for neuroleptic symptoms. I don't want to get the seroquel twitchies again. That's for sure.
>
Thanks for your kind suggestions. Have a lovely day. I feel somewhat better today. not as many dark thoughts (yet) just very low energy and very high apathy. I moved a table. that was my big accomplishment of the morning. and ate my breakfast. on to coffee.-Ll
Posted by LlurpsieNoodle on July 24, 2007, at 10:15:44
In reply to Re: [over?] medicated haze. help. triggers » LlurpsieNoodle, posted by OzLand on July 24, 2007, at 0:33:05
> THIS IS NOT OKAY. These meds, at least some, are way over the limit. No wonder you feel in a haze. And, there is the potential for a drug reaction of significant negative consequences. I had that happen to me when I started to slur my speech, became confused, disoriented, and developed all sorts of other stuf besides not being able to remember anything 10 minutes later.
were you cognizant of that? I will tell H to watch out for that stuff with me. Not that I haven't been confused and disoriented for the last 5 months, but still... slurred speech is a dead give-away.
> You need to talk to your Pdoc (email) from where you were in school and also your therapist from before and tell them your symptoms. My God; what are these people doing to you.
Hmm, well former pdoc had me on 240mg too (and 1.5mg of klonopin) when I got out of the hospital. About 6 weeks of that and I seemed more "well" and I went down to 240. Kind of dismaying to go back up to the high doses. I have always been treated with pretty aggressive pharmacotherapy, and responded pretty well. I hope that this increase in doses is transient. Perhaps old pdoc noticed in my records that I seemed to get my footing back when I was on high doses, and thought he'd try the same approach, since I'm slipping again.
> OzLand
Thanks for your concern, Ozland. I'm going to talk with T about this. I feel comfortable talking about my symptoms in some detached clinical way. I don't feel comfortable calling him in a crisis. I will try to talk about that too next appt. this is really hard :( Shoot. maybe I have to write it out. (and not on my arm either).
-Ll
p.s. typing is kind of goofy. frustrating. but my word-finding is okay for now. just the apathy and deadness which mimic a deep depression. and fatigue.
Posted by linkadge on July 24, 2007, at 10:54:51
In reply to Re: [over?] medicated haze. help. triggers » OzLand, posted by LlurpsieNoodle on July 24, 2007, at 10:15:44
So, are you officialy bipolar, or PTSD, or both?
I assume you've tried meds like depakote? Somtimes good for both.
Linkadge
Posted by LlurpsieNoodle on July 24, 2007, at 16:43:15
In reply to Re: [over?] medicated haze. help. triggers, posted by linkadge on July 24, 2007, at 10:54:51
> So, are you officialy bipolar, or PTSD, or both?
>
> I assume you've tried meds like depakote? Somtimes good for both.
>
> LinkadgeThere has been whispering "behind the scenes" of me being somewhere on some bipolar spectrum outside of diagnostic range. I Meet full Dx for PTSD and Major Depression, also my favorite: Depression not otherwise specified. the 311 of the DSM-IV. giddy up.
I have not tried depakote. I thought it was for treatment of mania? My main symptom right now (aside from the psycho episodes with visual and auditory "perceptual disturbances" and "disturbed thought") is depression. Not the unrelenting depression that I'm familiar with, but these rather sudden-onset depressive reactions. pretty dangerous, actually.
I will look back into the archives to find more on depakote. thanks much,
-Ll
Posted by linkadge on July 24, 2007, at 18:30:42
In reply to Re: [over?] medicated haze. help. triggers » linkadge, posted by LlurpsieNoodle on July 24, 2007, at 16:43:15
The problem (as I see it) is that you're not really taking meds suited to your dignosis. (IMHO)
You're taking a whole whack of essentially bipolar meds. These can tend to be a step or two heavier than unipolar.
Unless the lamictal gives you an antidepressant effect, I'm not sure why you would need it. There isn't much data to support its use in PDSD. Whatever it does for PTSD a benzo should do in a more direct way.
The geodon is really only approved to schizophrenia, and off lable for bipolar. (It would be even further off lable for depression or
pdsd.)How does the provigil affect you? I would tend to think it could make certain symtpoms of PTSD worse.
I assume you have tried meds approved for PTSD like zoloft or paxil? Also have you ever tried drugs like propranolol or attenolol? They can be good for PTSD.
Drugs like cymbalta are not always good for PTSD. Sometimes the norepinephrine reuptake effects can make symptoms worse, like hypervigilance, flashbacks etc.
I would personally try a more mainstream combination like say zoloft + attenolol.
Also, antipsychotics are not very effective antidepressants, and none (as far as I know) show any convincing evidence of efficacy in PTSD.
I would personally try to clean things up, and get some meds that hit the targets better.
Linkadge
Posted by med_empowered on July 24, 2007, at 19:53:48
In reply to Re: [over?] medicated haze. help. triggers, posted by linkadge on July 24, 2007, at 18:30:42
I think linkadge is on the money. Even with the psychosis, you don't *need* an antipsychotic; its kind of like psychotic depression or psychotic "fits" in bipolar:: both can respond to drugs already used (antidepresants and mood stabilizers, respectively) to treat the disorder at hand. No neuroleptic necessary.
Lithium+Lamictal is gaining popular use for bipolar; maybe it'd be a good combo for you?
I personally think ramping up the benzo would be a good call--that can help deal with mood swings (since its Klonopin, which has MS properties), anxiety, and take the edge off the psychotic fits. Adding propranolol might help, too. Have you had your coritsol checked? Just a thought...in some people with psychotic "issues," cortisol is pretty intensely elevated; using mifepristone (sp?) or other agents can lower the coritsol, which then makes other treatments work better.Good luck.
Posted by LlurpsieNoodle on July 26, 2007, at 11:58:45
In reply to yup yup, posted by med_empowered on July 24, 2007, at 19:53:48
I had crisis last night and found the courage to call his office this am.
He told me to go back to 180mg geodon (I was on 240 for a week)
Set up an appt. for tomorrow. Here's what I'm going to ask for
1) more benzos for antipsychotic and mood stabilizing purposes
2) keep lamictal the same 300mg for antidepressant
3) discuss increasing the provigil to 400mg, because my mom takes that much and gets a very very good antidepressant response from it.
4) discuss switching from geodon to abilify. Can't do seroquel because of the blubber. Worried about risperdol too. Fine. so I need an anti-psychotic at this point.My T told me that even in the midst of crisis I still sounded reasonable. that is reassuring. I'm going to need to sound reasonable tomorrow. Hope I've finally gotten pdoc's attention.
thank you all for your kind suggestions and I hope all is well with you today. my negative energy balance should make the rest of the world brighter.
-Ll
Posted by LlurpsieNoodle on July 27, 2007, at 12:11:20
In reply to taking my case to pdoc court » med_empowered, posted by LlurpsieNoodle on July 26, 2007, at 11:58:45
Good thing I wrote out a list of what I wanted to say, because my mind had iq in the 60's this am. All the classic symptoms of major depression, except the sleep disturbances (am taking sonata and sedating meds)
Was taking
180 mg geodon
200mg provigil
1mg klonopin
sonataNow taking
5-10 mg? Abilify
200mg provigil
small dose (forgot what it was) of Zoloft
1mg klonopin
sonataI hope that the abilify and the zoloft will help pull me out of this deep and suicidal funk I've been in for some time now. Help me do the things in life that will bring me satisfaction. Give me the courage to apply for jobs, knowing that I will probably be rejected. I'm not used to being rejected. Maybe I'll go work at Starbucks.
I also had the nerve to ask pdoc if I was being treated for bipolar disorder. At first he said yes, then he backtracked and said that he was treating bipolar-like symptoms, and that he took the approach of treating symptoms. the disorders and codes were just for insurance purposes.
I'm glad I asked.
-Ll
p.s. thank you all for your good ideas. I feel better about my treatment plan now
Posted by linkadge on July 27, 2007, at 19:25:34
In reply to I got new meds. YAY, posted by LlurpsieNoodle on July 27, 2007, at 12:11:20
Hey, that sounds like you've got a doctor who listens to you.
My doctor would listen to my suggestion then do the exact opposite.
Anyhow, good to hear you are making some changes. Hopefully for the better.
The abilify and zoloft combination sounds promising.
Linkadge
Posted by OzLand on July 27, 2007, at 22:47:01
In reply to Re: [over?] medicated haze. help. triggers » OzLand, posted by LlurpsieNoodle on July 24, 2007, at 10:15:44
In response to your question; no I was not aware I was slurring my speech not that I was stopping sentences in the middle and not finishing the thought. Very weird and scary. Otherwise, years ago I did not mind being zonked as it let me just sleep 24-7 or almost 24-7. I would sleep probably 20 to 21 hours per day and then got really goofy and psychotic-like because I though I was hearing voices and thought that things were reality when they were not. I thought I was actually in hell. So, I know now that to sleep that much will just make me worse.
This is the end of the thread.
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