Psycho-Babble Medication Thread 809355

Shown: posts 1 to 18 of 18. This is the beginning of the thread.

 

Babbler VS Pdoc challange

Posted by XR on January 28, 2008, at 12:48:50

Babbler vs. Pdoc challenge


For grins and giggles and somewhat of a sanity check, here is your chance to be the doc and offer medication treatment based on my symptoms. After some expert analysis by fellow babblers Ill reveal my diagnosis and meds my doc has me on to see if we all in the ballpark. This is merely for fun and I certainly wont hold anyone liable for your medication analysis.

Brief history, Im a male 42 years old, married 15 years, two kids and a dog. I hold down a good job and exercise as much as possible. I sleep poorly maybe 6 hours a night. Constantly worry about things and getting things done. I become very anxious in public speaking situations. I have a low grade depression and never feel happy. Im always tired, but yet cant relax. Regardless of what others think I have low self esteem. I do get irritable and impatient at little things and lose my temper for things I shouldnt. Before I was married I would use methamphetamine any weekend I could Never during the week. Now I occasionally I have some beers and 1 cup of coffee everyday.
I have had I major depressive episode in my life which scared the hell out of me about 9 years ago. I couldnt sleep for weeks and slumped into a deep pit. This started my road to medication. I feel I need to step back and reevaluate my conditions and treatment options.

You be doc and make then call.

 

Re: Babbler VS Pdoc challange » XR

Posted by Phillipa on January 28, 2008, at 13:08:32

In reply to Babbler VS Pdoc challange, posted by XR on January 28, 2008, at 12:48:50

Not an expert by any means but will play social anxiety/ dysthymia now that could turn into major depression again may be trying a mood stablizer for the anger. Excercise is good on Klonopin and an SSRI and maybe lamictal low dose? Bet not even in the ballpark but that's okay as I can learn from what others say too. Love Phillipa

 

Re: Babbler VS Pdoc challange

Posted by bleauberry on January 28, 2008, at 17:38:51

In reply to Babbler VS Pdoc challange, posted by XR on January 28, 2008, at 12:48:50

Sounds like an interesting game. There is not enough information for me to play though. I think I'll watch. The info given on symptoms is pretty good. But the lack of detailed medications, doses, responses, and side effects, would provide a better picture. Results of thorough medical workups on T3, T4, 3 thyroid antibodies, cortisol, family history, amalgam fillings, weight and appetite, results of food reaction tests, and stuff like that, would be nice. Hey, it's all a guessing game anyway. Without the above information, it is even more of one.

 

Re: Babbler VS Pdoc challenge

Posted by xr on January 28, 2008, at 18:16:51

In reply to Re: Babbler VS Pdoc challange, posted by bleauberry on January 28, 2008, at 17:38:51

Not bad Phillipa. Give yourself some credit :-)

Some more info for Bleuberry.

Bleauberry, no issues with T3, T4, 3 thyroid antibodies. Never had any issues with appetite. I'm not overweight (could lose about 5 - 10 lbs) nor underweight. Majority of my family are smokers, I am not, but feel good after an occasional cigar. My younger brother is very hyper and my older sister seems prone to mood swings. Tried all the SSRI's at a low to a modest dose but none provided much if any antidepressant effects. Currrently I'm on one that you are familar with :) I also supplement with magnesium glycinate, and L-Theanine.

Your are 100% correct, it is a guessing game, and curious to see how well we do against some of the high priced "experts

That being said by all means I'm not minimizing the importance of finding and seeking a well qualified mental health care provider.

 

Re: Babbler VS Pdoc challenge » xr

Posted by Phillipa on January 28, 2008, at 19:34:48

In reply to Re: Babbler VS Pdoc challenge, posted by xr on January 28, 2008, at 18:16:51

I like this game after I posted the first time looked at you're posting name and now I bet it's effexor xr? How bout the klonopin and mood stabalizer? Phillipa

 

Re: Babbler VS Pdoc challenge

Posted by ExcellentCamper on January 29, 2008, at 16:22:01

In reply to Re: Babbler VS Pdoc challenge » xr, posted by Phillipa on January 28, 2008, at 19:34:48

> I like this game after I posted the first time looked at you're posting name and now I bet it's effexor xr? How bout the klonopin and mood stabalizer? Phillipa

My guess is also Effexor XR. If you're tired all the time and have struck out with SSRIs, the activating effects could be very beneficial. I had some days of vivid clarity on it but unfortunately experienced urinary retention and prostatis on it. My next step if higher-dose Lamictal doesn't do anything -- and so far it hasn't (now at 250 mg) -- is to try Remeron at higher doses (45 or 60).

My second guess for you is Wellbutrin XR.

Please pay me via PayPal if I am correct at my normal hourly rate.

Thank you, Will

 

Re: Babbler VS Pdoc challenge

Posted by XR on January 29, 2008, at 18:21:32

In reply to Re: Babbler VS Pdoc challange » XR, posted by Phillipa on January 28, 2008, at 13:08:32

I have to say you guys are good. I was on Effexor XR the longest of any med. Probably close to 3 1/2 years @ 150 mgs. Seems I need a norepinephrine or dopamine component.

As for the "XR" its Adderall XR, 15 mgs. Which leads me into my doctors diagnosis: Panic Disorder, GAD, ADHD and depression. Current meds are Fluoxetine 20 mgs, Adderall XR and 1 mg of Klonopin. I've been on Klonopin 8 years, which is much too long. Not sure if the Fluoxetine does anything or serves any purpose anymore. I think the Adderall XR helps which irritability and mood, but seriously how long can one sustain taking amphetamines? Never tried a mood stablizer and couldn't get by the sedation of Remeron. So there you have it.

I think Phillipa is dead on with dysthymia. I also believe anhedonia, performance anxiety and some ADHD are my issues. So where do I go from here?

Thanks for participating.

 

Re: Babbler VS Pdoc challenge » XR

Posted by Phillipa on January 29, 2008, at 20:28:54

In reply to Re: Babbler VS Pdoc challenge, posted by XR on January 29, 2008, at 18:21:32

Thanks was fun!!!!!Love Phillipa

 

Re: Babbler VS Pdoc challenge

Posted by ExcellentCamper on January 30, 2008, at 13:07:11

In reply to Re: Babbler VS Pdoc challenge, posted by XR on January 29, 2008, at 18:21:32


How high did you go on Remeron? It could work for you if you didn't go beyond 30 for panic, anxiety, and depression. I'm really curious to see if it affects me differently at a higher dose as they say its effects on norepinephrine kick in at 45 mg. (I might also be a little peeved if it works I have to say because it's been 5-plus years since I was on it with a LOT of grey days and mental suffering that might have been avoided with a dose switch!)

BTW, going higher on Lamictal is doing nothing for me. I've been on 150 for a couple of years. It puts a good floor under me so I don't get really down, but it doesn't raise the ceiling on my mood.

> I have to say you guys are good. I was on Effexor XR the longest of any med. Probably close to 3 1/2 years @ 150 mgs. Seems I need a norepinephrine or dopamine component.
>
> As for the "XR" its Adderall XR, 15 mgs. Which leads me into my doctors diagnosis: Panic Disorder, GAD, ADHD and depression. Current meds are Fluoxetine 20 mgs, Adderall XR and 1 mg of Klonopin. I've been on Klonopin 8 years, which is much too long. Not sure if the Fluoxetine does anything or serves any purpose anymore. I think the Adderall XR helps which irritability and mood, but seriously how long can one sustain taking amphetamines? Never tried a mood stablizer and couldn't get by the sedation of Remeron. So there you have it.
>
> I think Phillipa is dead on with dysthymia. I also believe anhedonia, performance anxiety and some ADHD are my issues. So where do I go from here?
>
> Thanks for participating.

 

Re: Babbler VS Pdoc challenge

Posted by xr on January 30, 2008, at 18:48:55

In reply to Re: Babbler VS Pdoc challenge, posted by ExcellentCamper on January 30, 2008, at 13:07:11

Only 15 mgs. I know the higher doses are less sedating, but I couldn't bring myself to believe that taking more of drug that knocked me on my *ss would have less side effects. Let me know how you do on 45 mgs.

Thanks


> How high did you go on Remeron? It could work for you if you didn't go beyond 30 for panic, anxiety, and depression. I'm really curious to see if it affects me differently at a higher dose as they say its effects on norepinephrine kick in at 45 mg. (I might also be a little peeved if it works I have to say because it's been 5-plus years since I was on it with a LOT of grey days and mental suffering that might have been avoided with a dose switch!)
>
> BTW, going higher on Lamictal is doing nothing for me. I've been on 150 for a couple of years. It puts a good floor under me so I don't get really down, but it doesn't raise the ceiling on my mood.
>
> > I have to say you guys are good. I was on Effexor XR the longest of any med. Probably close to 3 1/2 years @ 150 mgs. Seems I need a norepinephrine or dopamine component.
> >
> > As for the "XR" its Adderall XR, 15 mgs. Which leads me into my doctors diagnosis: Panic Disorder, GAD, ADHD and depression. Current meds are Fluoxetine 20 mgs, Adderall XR and 1 mg of Klonopin. I've been on Klonopin 8 years, which is much too long. Not sure if the Fluoxetine does anything or serves any purpose anymore. I think the Adderall XR helps which irritability and mood, but seriously how long can one sustain taking amphetamines? Never tried a mood stablizer and couldn't get by the sedation of Remeron. So there you have it.
> >
> > I think Phillipa is dead on with dysthymia. I also believe anhedonia, performance anxiety and some ADHD are my issues. So where do I go from here?
> >
> > Thanks for participating.
>
>

 

Re: Babbler VS Pdoc challange » XR

Posted by bleauberry on January 30, 2008, at 19:20:12

In reply to Babbler VS Pdoc challange, posted by XR on January 28, 2008, at 12:48:50

Just for grins, if I had guessed I would have been mostly wrong. I was getting the feeling your doctor was leaning in the bipolar spectrum direction. Thanks to your clue I had concluded one of your meds was prozac. With a bipolar, anxiety, depression, mood disorder of whatever kind component, I figured zyprexa was in order. I mean, prozac and zyprexa pretty much cover the whole ballfield.

Klono is hard to beat. Adderall is hard to beat. Those are heavy hitters. The amount of time on them will probably be hard to undo. So that does make the whole thing trickier.

I know you mentioned you don't know what prozac is doing anymore. Well, just so you know, I felt the same way. I wasn't depressed, didn't have much anxiety, but I did have a lot of anhedonia. I really had no side effects and prozac felt invisible to me. I figured it was doing nothing. Bad mistake to drop the dose. That's when all hell broke loose and going back to up the original dose did not work. Somehow when I messed with prozac I pulled the plug on the whole works.

 

Re: Babbler VS Pdoc challenge

Posted by ExcellentCamper on January 31, 2008, at 12:52:14

In reply to Re: Babbler VS Pdoc challenge, posted by xr on January 30, 2008, at 18:48:55


I will definitely let everyone know and hopefully it will be a success story. We need those. Or at least I need those and specifically one for me!

Can relate with your depression as mine's been a sleepy, anhedonic one for the most part, with one deep dark patch.

> Only 15 mgs. I know the higher doses are less sedating, but I couldn't bring myself to believe that taking more of drug that knocked me on my *ss would have less side effects. Let me know how you do on 45 mgs.
>
> Thanks
>
>
> > How high did you go on Remeron? It could work for you if you didn't go beyond 30 for panic, anxiety, and depression. I'm really curious to see if it affects me differently at a higher dose as they say its effects on norepinephrine kick in at 45 mg. (I might also be a little peeved if it works I have to say because it's been 5-plus years since I was on it with a LOT of grey days and mental suffering that might have been avoided with a dose switch!)
> >
> > BTW, going higher on Lamictal is doing nothing for me. I've been on 150 for a couple of years. It puts a good floor under me so I don't get really down, but it doesn't raise the ceiling on my mood.
> >
> > > I have to say you guys are good. I was on Effexor XR the longest of any med. Probably close to 3 1/2 years @ 150 mgs. Seems I need a norepinephrine or dopamine component.
> > >
> > > As for the "XR" its Adderall XR, 15 mgs. Which leads me into my doctors diagnosis: Panic Disorder, GAD, ADHD and depression. Current meds are Fluoxetine 20 mgs, Adderall XR and 1 mg of Klonopin. I've been on Klonopin 8 years, which is much too long. Not sure if the Fluoxetine does anything or serves any purpose anymore. I think the Adderall XR helps which irritability and mood, but seriously how long can one sustain taking amphetamines? Never tried a mood stablizer and couldn't get by the sedation of Remeron. So there you have it.
> > >
> > > I think Phillipa is dead on with dysthymia. I also believe anhedonia, performance anxiety and some ADHD are my issues. So where do I go from here?
> > >
> > > Thanks for participating.
> >
> >
>
>

 

Re: Babbler VS Pdoc challange

Posted by xr on February 1, 2008, at 17:01:03

In reply to Re: Babbler VS Pdoc challange » XR, posted by bleauberry on January 30, 2008, at 19:20:12

Hey bleuberry thanks for the advice on the Prozac. As for the adderall, I've only been on it 4 months. As you say "The amount of time on them will probably be hard to undo", so I hesitate with every adderall dose. I may ask to change to Wellbutrin plus fluoxetine?

As for zyprexia and other AP's, it sounded like hell getting off them too. My doctor doesn't like I'm BP, becuase I don't experience highs or low low's, but it could fit the description of BP II. Alas, with GAD, ADHD, and BP II it's a such a fine line to distinguish the true diagnosis.

> Just for grins, if I had guessed I would have been mostly wrong. I was getting the feeling your doctor was leaning in the bipolar spectrum direction. Thanks to your clue I had concluded one of your meds was prozac. With a bipolar, anxiety, depression, mood disorder of whatever kind component, I figured zyprexa was in order. I mean, prozac and zyprexa pretty much cover the whole ballfield.
>
> Klono is hard to beat. Adderall is hard to beat. Those are heavy hitters. The amount of time on them will probably be hard to undo. So that does make the whole thing trickier.
>
> I know you mentioned you don't know what prozac is doing anymore. Well, just so you know, I felt the same way. I wasn't depressed, didn't have much anxiety, but I did have a lot of anhedonia. I really had no side effects and prozac felt invisible to me. I figured it was doing nothing. Bad mistake to drop the dose. That's when all hell broke loose and going back to up the original dose did not work. Somehow when I messed with prozac I pulled the plug on the whole works.

 

Re: Babbler VS Pdoc challange

Posted by rickoshay on February 1, 2008, at 22:20:28

In reply to Re: Babbler VS Pdoc challange, posted by xr on February 1, 2008, at 17:01:03

Seems to me the Docs feeling its not bipolar aren't founded by lack of mood swings, since irritability can be the mood swing as I understand it in soft bipolar, it aint always a euphoric swing. The adderall would indeed address some issues in adhd if this were your case, as well as augment the prozac antidepressant effect. My situation med wise is very similar to yours, and looking at my situation in retrospect, I wonder if some of my own irritability is possibly cycling from dysthymia to a "higher" state of being plain old "pissy" big time. Sorry to ramble, but this is a question that I've been asking myself for a while
regards, Rick

 

Re: Babbler VS Pdoc challange

Posted by xr on February 2, 2008, at 16:12:23

In reply to Re: Babbler VS Pdoc challange, posted by rickoshay on February 1, 2008, at 22:20:28

I hear you Rick. What meds are you on? Maybe between ExcellentCamper, and Bleuberry etc we can find something to shake this irritable pissy feeling without too many other side effects...

 

Re: Babbler VS Pdoc challange » XR

Posted by CareBear04 on February 2, 2008, at 22:42:46

In reply to Babbler VS Pdoc challange, posted by XR on January 28, 2008, at 12:48:50

This is fun! I wish I'd seen the post earlier.

Like a few other people, I was leaning toward cyclothymia or something in that spectrum. I guess a question in diagnosis and treatment is how much you're willing to diagnose separate co-morbid disorders and whether and when you should look for a simpler explanation that might account for a variety of the symptoms. My pdoc once said something to this effect in a funny adaptation of the old caution against looking for zebras when you hear hoofbeats. I forget his exact words, but it was something along the lines of "if you hear hoofbeats, you should expect to see a four-legged animal, not four one-legged animals."

The reason I tended to think something in the bipolar spectrum is that issues of mood, anxiety, attention, and self-esteem frequently present together, but they don't always rise to the criteria of the seperate diagnoses. From the little information you provided, I got the impression that an umbrella diagnosis that incorporates all your symptoms might be more appropriate than 3-4 distinct diagnoses. For one thing, you describe what sounds to be a pretty fuctional life. You're constantly tense and worried and you mention low self-esteem, but it sounds like others aren't so aware of it and you're able to keep up appearances. Re: the public speaking anxiety-- most people have this to some extent, so I'm not sure it's necessarily pathological. When you used meth, was it purely recretaional, or did it help you focus and improve your functioning? This might be relevant to your attention issues. In any case, an accurate assessment of ADHD needs to be made in the absence of confounding mood symptoms. Since you have chronic low mood and anxiety, these could account for lack of focus-- which you didn't mention specifically-- and also for the irritability.

Of course, a bipolar spectrum diagnosis does fall short in some areas. It doesn't sound like you have episodes of elevated mood, although most people with bipolar do spend much more time depressed than manic. Still, the mix of low mood and racing thoughts and anxiety are what I experience in mixed states. I also don't know about how you fit into the general timeframe for onset. The more severe forms of bipolar usually become apparent in adolescence, though maybe the "softer" bipolar categories emerge later?

Anyway, for treatment, I would probably focus first on the mood and anxiety. Like some other posters suggested, Effexor XR is approved to treat general anxiety disorder as well as depression. An SSRI might increase your anxiety and sleep problems, so I might try the other newer ADs first. I might add low-lose lithium to your AD; even if you're not bipolar, it can augment the effect of an AD, and if you do respond well to it, it can even you out generally, helping with anxiety, sleep, and irritability. Ideally, I would give this regimen a few weeks to see if it works at all, but your anxiety is probably very uncomfortable, so I would prescribe a long-acting benzo like Klonopin or even Xanax XR. I'd also give you a script for some prn propranolol for public-speaking anxiety. The only potential problem with benzos and Adderall is the breakthrough anxiety as the benzos wear off and the energy crash and extreme irritability when Adderall stops working. And as you grow tolerant to them, you usually need higher doses to get the same effect.

Of course, this is all good and well for me to say, but my own med regimen is no good example of restraint in prescribing though no one is really to blame.

Anyway, just my thoughts. thanks for the challenge!
cb

 

Re: Babbler VS Pdoc challange

Posted by XR on February 3, 2008, at 12:57:34

In reply to Re: Babbler VS Pdoc challange » XR, posted by CareBear04 on February 2, 2008, at 22:42:46

Wow! I'm impressed. I do agree individually these symptoms present themselves as part of a larger issue. Your dead on with the propranolol PRN. I take that before large meetings. As for the meth, it was purely recreational and was used to enhance socialability/enjoyment. MAYBE I WAS SELF MEDICATING? I never did more than one night any given weekend.

As for mixed states how do you cope and what is treatment?


> This is fun! I wish I'd seen the post earlier.
>
> Like a few other people, I was leaning toward cyclothymia or something in that spectrum. I guess a question in diagnosis and treatment is how much you're willing to diagnose separate co-morbid disorders and whether and when you should look for a simpler explanation that might account for a variety of the symptoms. My pdoc once said something to this effect in a funny adaptation of the old caution against looking for zebras when you hear hoofbeats. I forget his exact words, but it was something along the lines of "if you hear hoofbeats, you should expect to see a four-legged animal, not four one-legged animals."
>
> The reason I tended to think something in the bipolar spectrum is that issues of mood, anxiety, attention, and self-esteem frequently present together, but they don't always rise to the criteria of the seperate diagnoses. From the little information you provided, I got the impression that an umbrella diagnosis that incorporates all your symptoms might be more appropriate than 3-4 distinct diagnoses. For one thing, you describe what sounds to be a pretty fuctional life. You're constantly tense and worried and you mention low self-esteem, but it sounds like others aren't so aware of it and you're able to keep up appearances. Re: the public speaking anxiety-- most people have this to some extent, so I'm not sure it's necessarily pathological. When you used meth, was it purely recretaional, or did it help you focus and improve your functioning? This might be relevant to your attention issues. In any case, an accurate assessment of ADHD needs to be made in the absence of confounding mood symptoms. Since you have chronic low mood and anxiety, these could account for lack of focus-- which you didn't mention specifically-- and also for the irritability.
>
> Of course, a bipolar spectrum diagnosis does fall short in some areas. It doesn't sound like you have episodes of elevated mood, although most people with bipolar do spend much more time depressed than manic. Still, the mix of low mood and racing thoughts and anxiety are what I experience in mixed states. I also don't know about how you fit into the general timeframe for onset. The more severe forms of bipolar usually become apparent in adolescence, though maybe the "softer" bipolar categories emerge later?
>
> Anyway, for treatment, I would probably focus first on the mood and anxiety. Like some other posters suggested, Effexor XR is approved to treat general anxiety disorder as well as depression. An SSRI might increase your anxiety and sleep problems, so I might try the other newer ADs first. I might add low-lose lithium to your AD; even if you're not bipolar, it can augment the effect of an AD, and if you do respond well to it, it can even you out generally, helping with anxiety, sleep, and irritability. Ideally, I would give this regimen a few weeks to see if it works at all, but your anxiety is probably very uncomfortable, so I would prescribe a long-acting benzo like Klonopin or even Xanax XR. I'd also give you a script for some prn propranolol for public-speaking anxiety. The only potential problem with benzos and Adderall is the breakthrough anxiety as the benzos wear off and the energy crash and extreme irritability when Adderall stops working. And as you grow tolerant to them, you usually need higher doses to get the same effect.
>
> Of course, this is all good and well for me to say, but my own med regimen is no good example of restraint in prescribing though no one is really to blame.
>
> Anyway, just my thoughts. thanks for the challenge!
> cb

 

Re: Babbler VS Pdoc challange

Posted by KarenRB53 on February 22, 2008, at 11:07:44

In reply to Re: Babbler VS Pdoc challange » XR, posted by bleauberry on January 30, 2008, at 19:20:12

> Just for grins, if I had guessed I would have been mostly wrong. I was getting the feeling your doctor was leaning in the bipolar spectrum direction. Thanks to your clue I had concluded one of your meds was prozac. With a bipolar, anxiety, depression, mood disorder of whatever kind component, I figured zyprexa was in order. I mean, prozac and zyprexa pretty much cover the whole ballfield.
>

I've just found this post as I've been trying to find info on Prozac. I read that you did well on Prozac and Zyprexa, are you still on that combo? Hope you don't mind my asking but Prozac seems to be the only AD that lifts my depression (up until now at least) but if I take higher than 20mg. prozac I get hypomania. Thanks for sharing any information. Karen
> Klono is hard to beat. Adderall is hard to beat. Those are heavy hitters. The amount of time on them will probably be hard to undo. So that does make the whole thing trickier.
>
> I know you mentioned you don't know what prozac is doing anymore. Well, just so you know, I felt the same way. I wasn't depressed, didn't have much anxiety, but I did have a lot of anhedonia. I really had no side effects and prozac felt invisible to me. I figured it was doing nothing. Bad mistake to drop the dose. That's when all hell broke loose and going back to up the original dose did not work. Somehow when I messed with prozac I pulled the plug on the whole works.


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