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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 32. This is the beginning of the thread.
Posted by johnj on January 6, 2008, at 1:02:17
I am at the end of my rope. One night on Depakote, slept well. Second night nothing. I feel like I will lose my wife, job and everything I know. Where will I go? Will I be homeless? the world seems to have no place for us.
My body seems to fight the meds. I guess it is telling me I need to be by myself. My poor wife, I love her but she doesn't understand what is going on and neither do I. I guess I don't like my job either. Does it mean if I was satisfied with life I wouldn't have the anxiety? I guess it is all in my head but I don't have a clue on how to figure it out. Maybe I am bored with life and can't figure out what I want or need. In the mean time I will probably lose it all. Then what do I do? Just wait until my body just gives out as meds are not working. I pray that god will just take me. I am not suicidal as I don't want to go to hell. My diagnosis is not even clear anymore. I just can't sleep or shut off my mind.
Posted by tecknohed on January 6, 2008, at 10:47:32
In reply to When meds don't work, posted by johnj on January 6, 2008, at 1:02:17
What meds have you tried? Whats your diagnosis?
Posted by johnj on January 6, 2008, at 11:39:43
In reply to Re: When meds don't work » johnj, posted by tecknohed on January 6, 2008, at 10:47:32
My dx is chronic anxiety/ocd. I have a hard time shutting off my brain. Frontal lobe seems so active and then I can't sleep. Dr. thinks maybe I have some comorbid disorder as my brain seems to go and go. I realize later that what I worried about was unfounded but when I can't sleep it seems so real. For example, last night I worried about my wife, job, and where I would end up. Hence caused more panic.
I was on pamelor, lithium and tranzene for 10 years and then work stress seemed to make it all stop working. I'm not really on anything right now as I tested depakote for two nights. I then tried remeron and was on it for 3 years but I finally had enough with the sponge brain and terrible anger. Briefly tried paxil, luvox and some other benzos but had very bad reactions to ssri's (anxiety) and the benzo's would wear off and things would sky rocket. Seroquel caused akathisa.
Last week I started worrying very bad and anger wouldn't go away. Anger doesn't last days for me so it was scary. Sleep issues got worse too. Last night 3 hours max. Night before 8 hours. It seems like I have a couple bad nights and seem to crash, and then it starts over again.
I don't know if what is wrong or if it is all something in my life? I don't think so but don't know. I don't have major stressors but maybe that is a problem. I just want to go to work and enjoy the simple stuff again. I'm very afraid right now. I worry about life a lot. Depakote was very blunting and got me down. Thanks for responding.
johnj
Posted by Phillipa on January 6, 2008, at 12:11:34
In reply to Re: When meds don't work » tecknohed, posted by johnj on January 6, 2008, at 11:39:43
May I just say I understand and have similar things going on in my life too with meds. Don't know the answer either. Good luck Johnny Love Phillipa
Posted by tecknohed on January 6, 2008, at 13:12:46
In reply to Re: When meds don't work » tecknohed, posted by johnj on January 6, 2008, at 11:39:43
Tried clomipramine? That might be a good next step. Its a tricyclic but works like a potent SSRI. Great for sleep (you take it at night) & is at least as good as the best SSRIs for OCD. Good for most anxieties, except social. One of it's metabolites has a significant NRI effect too.
IMO the MAOIs Nardil & Marplan are also good OCD meds when taken on thier own. Nardil is generally better for anxiety than what Marplan is.
teck
Posted by bleauberry on January 6, 2008, at 18:12:10
In reply to Re: When meds don't work » tecknohed, posted by johnj on January 6, 2008, at 11:39:43
Have you had a full thyroid workup? TSH, free T3, free T4, and thyroid antibodies? If not, you need one to rule it out or confirm.
How about a 24 hour 4 sample saliva cortisol test? That would be very informative in which way to go with treatment.
Right now you need FAST relief. I mean, family, work, wife. Wife. Very important. The more you suffer, the more she doesn't understand (and she never will so don't push that) the more you guys drift apart. Not cool. You need relief now, and a longer term solution after that.
One thing that can bring both immediate and longterm control of what you are feeling is...Zyprexa. You want to bring all that fast furious worry and OCD down to a soft cushion in a mere 2 hours? Zyprexa. I know your symptoms. Been there. I know Zyprexa. Been there.
Maybe it is a week or a month until you can see the doc. What until then? The healtfood store. Get a tincture bottle of Passionflower and Skullcap, and maybe Valerian. Try passionflower first, add the others if you want. They can really take the edge off in just an hour or so. They can be your ticket to buy some time and not lose ground. They have saved me several times when I did not have pharmaceuticals handy.
After so many years of mood stabilization control, it may take just as many years to fully recover, if at all. I wonder, why not lithium again? You should do a google search on Magnesium and Taurine for anxiety and bipolar. Those are often effective longterm cures, and not surprisingly the actual root cause all along. Your symptoms are hard to pinpoint in terms of cause, but they sure fit the low serotonin profile. 5htp in 10mg to 25mg doses for a few days would be a telling test.
Depakote or lithium takes weeks to be therapeutic, and months to actually cause the brain changes needed. A short trial of a mood stabilizer tells you nothing, other than whether maybe you can handle a starting dose or not. Same with the SSRIs. If anxiety was worse, odds are it would have resolved in 6 to 10 weeks, but your doc should have given you a bandaid drug to get that far while waiting.
Based on your symptoms, I do believe in the gut that a longterm solution is found in one of these things...Zyprexa, lithium, depakote, magnesium, taurine, or any combination of 2 or 3 of them. For short term immediate relief, passionflower, skullcap, valerian, and of course the star of the show zyprexa.
Posted by SteelyDan on January 6, 2008, at 19:13:15
In reply to When meds don't work, posted by johnj on January 6, 2008, at 1:02:17
I hear you load and clear..I'm pretty much in the same boat. One thing i have felt that is very effective for anxiety is high dose Lyrica...it is very soothing/calming. Good luck to you.
Posted by Phillipa on January 6, 2008, at 20:01:40
In reply to Re: When meds don't work » johnj, posted by SteelyDan on January 6, 2008, at 19:13:15
Thought low dose was sedating and high dose stimulating? What is low dose Thanks Phillipa
Posted by SteelyDan on January 6, 2008, at 20:11:52
In reply to Re: When meds don't work » SteelyDan, posted by Phillipa on January 6, 2008, at 20:01:40
> Thought low dose was sedating and high dose stimulating? What is low dose Thanks Phillipa
Yes, low dose 100-200mgs. is sedating...increasing to 300-600mgs. is somewhat stimulating, but in a nice smooth way, if that makes sence?
Posted by johnj on January 6, 2008, at 20:23:53
In reply to Re: When meds don't work, posted by bleauberry on January 6, 2008, at 18:12:10
"Have you had a full thyroid workup? TSH, free T3, free T4, and thyroid antibodies? If not, you need one to rule it out or confirm."
Everything checks out.
How about a 24 hour 4 sample saliva cortisol test? That would be very informative in which way to go with treatment.
"Right now you need FAST relief. I mean, family, work, wife. Wife. Very important. The more you suffer, the more she doesn't understand (and she never will so don't push that) the more you guys drift apart. Not cool. You need relief now, and a longer term solution after that."
We had a long talk today. Thank you. My ocd goes haywire when I can't fall asleep and I make things out to be worse than it really is.
"One thing that can bring both immediate and longterm control of what you are feeling is...Zyprexa. You want to bring all that fast furious worry and OCD down to a soft cushion in a mere 2 hours? Zyprexa. I know your symptoms. Been there. I know Zyprexa. Been there."
Seroqeul gave me akathisia would zyprexa too. Anti-P scare me to be honest.
"Maybe it is a week or a month until you can see the doc. What until then? The healtfood store. Get a tincture bottle of Passionflower and Skullcap, and maybe Valerian. Try passionflower first, add the others if you want. They can really take the edge off in just an hour or so. They can be your ticket to buy some time and not lose ground. They have saved me several times when I did not have pharmaceuticals handy."
THANK YOU, great suggestions I am going tomorrow.
"After so many years of mood stabilization control, it may take just as many years to fully recover, if at all. I wonder, why not lithium again? You should do a google search on Magnesium and Taurine for anxiety and bipolar. Those are often effective longterm cures, and not surprisingly the actual root cause all along. Your symptoms are hard to pinpoint in terms of cause, but they sure fit the low serotonin profile."
I don't feel too well on magnesium, but i have some taurine I have never tried. I will break it out.
"5htp in 10mg to 25mg doses for a few days would be a telling test"
What do you mean telling?
"Depakote or lithium takes weeks to be therapeutic, and months to actually cause the brain changes needed. A short trial of a mood stabilizer tells you nothing, other than whether maybe you can handle a starting dose or not. Same with the SSRIs. If anxiety was worse, odds are it would have resolved in 6 to 10 weeks, but your doc should have given you a bandaid drug to get that far while waiting."
Depakote is too depressionogenic. I get the fever chills that affects sleep, it was really odd. That said, maybe I am giving up too soon? I was taking 250. If the chills were not so bad I could probably handle it. I think that kept me from sleeping.
Lithium didn't make me feel well and kind of reved me up a bit. The doctor wants to try lamictal. I wonder about tegretol?
"Based on your symptoms, I do believe in the gut that a longterm solution is found in one of these things...Zyprexa, lithium, depakote, magnesium, taurine, or any combination of 2 or 3 of them. For short term immediate relief, passionflower, skullcap, valerian, and of course the star of the show zyprexa. "
What about lamactil, lyrica, neurotnin? I would like something to help sleep that doesn't make me feel depressed.
The thing I know NOTHING about is what do bipolars do for the sleep issues? Can they take small doses of AD's? I was thinking something to slow me down and then some type of AD adjunct for sleep, etc., like anafranil for it's ocd help and anxiety help.
Thank you for such a long response, I appreciate it.
johnj
Posted by johnj on January 6, 2008, at 20:25:03
In reply to Re: When meds don't work » johnj, posted by SteelyDan on January 6, 2008, at 19:13:15
What have you been taking? What is your diagnosis? I was thinking of lyrica
Posted by SteelyDan on January 6, 2008, at 20:29:45
In reply to Re: When meds don't work » SteelyDan, posted by johnj on January 6, 2008, at 20:25:03
> What have you been taking? What is your diagnosis? I was thinking of lyrica
Chronic TR Atypical depression, and GAD. I would highly recommend you give it a try, be patient with it because at starting dose it will sedate you, as you ramp up it's almost euphoric at the 500-600 range. Good luck!
Posted by Phillipa on January 6, 2008, at 20:47:00
In reply to Re: When meds don't work » johnj, posted by SteelyDan on January 6, 2008, at 20:29:45
Thank-you Dan. Phillipa
Posted by bleauberry on January 8, 2008, at 19:19:15
In reply to Re: When meds don't work » bleauberry, posted by johnj on January 6, 2008, at 20:23:53
> Seroqeul gave me akathisia would zyprexa too. Anti-P scare me to be honest.
Yeah I know. Actually, all these drugs scare me. I was on zyprexa 8 years. Even though it is a powerful drug, it felt friendlier than all the rest, if that makes any sense. Seroquel gave me some akathisia too, but zyprexa never did.
> I don't feel too well on magnesium, but i have some taurine I have never tried. I will break it out.Yeah, magnesium bums me out bigtime. I can't take it. Instant depression worsener for me, though it is very calming. Taurine I liked, but only when combined with Tyrosine. Unpreictable though. I think these supps are good for longterm health and healing, but not as powerful for rightnow relief.
>
> "5htp in 10mg to 25mg doses for a few days would be a telling test"
>
> What do you mean telling?Well, if you have a low serotonin situation, getting the serotonin up immediately will show things to you. The first 3 days or so are adjustment periods and need to be ignored. After that though you can tell what is happening. One of several things will happen...you will feel calmer and better; you will feel calmer and more depressed; you will feel great all around; you will feel more anxious and irritable; you will feel nothing. It definitely calms me down, but gets a bit depressing too, probably because I need something else besides just serotonin alone. Sleep is much better, deep and yet with vivid dreams.
The herbs can help but please understand I am not endorsing them as longterm cures. Some people might. I see them more as stepping stone crutches to get through rough moments, to get from here to there, all the while knowing something else needs to be done longterm. No need to suffer the entire duration though. There is an herb that you can rely on kind of like a spare tire for a flat.
Posted by Phillipa on January 8, 2008, at 20:38:24
In reply to Re: When meds don't work, posted by bleauberry on January 8, 2008, at 19:19:15
Wait have a female problem that makes pooping hard to do so take extra magnesium not good? Could it affect anxiety? Thought it was calming? Phillipa
Posted by tecknohed on January 8, 2008, at 21:33:11
In reply to Re: When meds don't work » bleauberry, posted by Phillipa on January 8, 2008, at 20:38:24
> Wait have a female problem that makes pooping hard to do so take extra magnesium not good? Could it affect anxiety? Thought it was calming? Phillipa
For constipation I always use lactulose solution. Its the mildest yet most effective laxative I've used. Though it can take a week to settle. It tastes nice too - all it is is an undigestable sugar. Senna does nothing for me & fibre gels make things worse.
How much magnesium are you taking & what form? Even though its essential & the RDA/RDI is 3-400mg I cant tolerate much more than 100mg of Mag citrate per day. Plus, I actually find anything that slows me down actually INCREASES my anxiety. Of course the sedative effects of my Klonopin have worn off a long time ago. Mag seems too keep that calming/sedating effect even over time. In fact it seemed to actually increase the longer I took 300mg.
teck
Posted by Phillipa on January 8, 2008, at 23:44:32
In reply to Re: When meds don't work » Phillipa, posted by tecknohed on January 8, 2008, at 21:33:11
Teck taking less than l00mg with my calcium/magnesium l:2 ratio as should be. I stay in a state of almost diarrhea can't believe we're talking about this. Love Phillipa
Posted by tecknohed on January 9, 2008, at 8:38:29
In reply to Re: When meds don't work » tecknohed, posted by Phillipa on January 8, 2008, at 23:44:32
> Teck taking less than l00mg with my calcium/magnesium l:2 ratio as should be. I stay in a state of almost diarrhea can't believe we're talking about this. Love Phillipa
What form of mag are you taking? Some poorly absorbable forms go strait through you and act as laxatives, hence why some magnesium salts are sold as laxatives.
Posted by Phillipa on January 9, 2008, at 19:45:19
In reply to Re: When meds don't work » Phillipa, posted by tecknohed on January 9, 2008, at 8:38:29
Tech mag citrate. Phillipa
Posted by tecknohed on January 10, 2008, at 7:51:17
In reply to Re: When meds don't work » tecknohed, posted by Phillipa on January 9, 2008, at 19:45:19
> Tech mag citrate. Phillipa
Same as me. Do you really need it? Make sure you're not drinking tea with it. Better laxatives to keep you regular without diarheo :)
Posted by Phillipa on January 10, 2008, at 22:47:21
In reply to Re: When meds don't work » Phillipa, posted by tecknohed on January 10, 2008, at 7:51:17
Thanks Teck no I take it at night before bed. Used to take an herbal laxative. Love Phillipa
Posted by bissie66 on January 18, 2008, at 14:43:29
In reply to Re: When meds don't work, posted by bleauberry on January 6, 2008, at 18:12:10
Same with the SSRIs. If anxiety was worse, odds are it would have resolved in 6 to 10 weeks, but your doc should have given you a bandaid drug to get that far while waiting.
>
I've been browsing and reading on anxiety bc I've been experiencing some lately. So you think anxiety really gets better on SSRI's after 6-10 weeks? I started Zoloft recently but have backed away bc of anxiety, and yet it helped me SO much in the past (with depression AND anxiety).Thanks!
Posted by deniseuk190466 on January 21, 2008, at 6:42:05
In reply to Re: When meds don't work » bleauberry, posted by bissie66 on January 18, 2008, at 14:43:29
Hi,
The first antidepressant medication I ever took was at the age of 24, it was a tricyclic and after 24 hours I felt so much better, no anxiety, no depression, I felt like I had died and gone to heaven.
Then later in my 20s I was switched to Seroxat, again no anxiety and they worked well within 4 days. Infact I wondered at the time if I felt too good.
Then I came off them at the age of around 31. Four years later the depression resurfaced and I tried many of the SSRIs, they all increased the anxiety, suicidal feelings and never ever really worked the same again.
I really don't know why that happened and I'd give anything to know because since the age of 35 my life has never been the same.
Denise
Posted by tecknohed on January 21, 2008, at 9:32:11
In reply to To Bissie66, posted by deniseuk190466 on January 21, 2008, at 6:42:05
> Hi,
>
> The first antidepressant medication I ever took was at the age of 24, it was a tricyclic and after 24 hours I felt so much better, no anxiety, no depression, I felt like I had died and gone to heaven.
>
> Then later in my 20s I was switched to Seroxat, again no anxiety and they worked well within 4 days. Infact I wondered at the time if I felt too good.
>
> Then I came off them at the age of around 31. Four years later the depression resurfaced and I tried many of the SSRIs, they all increased the anxiety, suicidal feelings and never ever really worked the same again.
>
> I really don't know why that happened and I'd give anything to know because since the age of 35 my life has never been the same.
>
>
>
> DeniseHormone issues I suspect. They change with age. Have you had them tested (esp Thyroid, Adrenal & sex hormones)? That might be a worthy next step.
teck
Posted by deniseuk190466 on January 21, 2008, at 14:41:08
In reply to Re: To Bissie66 » deniseuk190466, posted by tecknohed on January 21, 2008, at 9:32:11
Hi,
Do you think it is really that simple. I've had all of the tests and they all came back ok, apart from my oestrogen being a bit low that was all.
My theory is that in time and with age your brain just gets more resistant.
Thanks for the advice anyway......Denise
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