Psycho-Babble Medication Thread 838031

Shown: posts 1 to 22 of 22. This is the beginning of the thread.

 

agitation, anxiety, fatigue and insomnia

Posted by llurpsienoodle on July 4, 2008, at 15:20:45

ah yes. the unholy triumvirate. The dark side of hypomania.

It's time to tweak my meds around. The only thing I've found that helps with agitation has been wellbutrin. I took an extra one of those today. I will see if it helps.

WellbutrinSR generic 150mg
Abilify 10mg
lamictal 300mg
sertraline (zoloft generic) 100mg
sonata prn 10mg

I'm very nervous about my new job. This is causing me to lose sleep, and sonata 10mg is not cutting it.

klonopin seems to make the agitation worse. screw klonopin.

And the anxiety and agitation makes it hard to think.

OKAY- so this may sound crazy, but anything [civil] goes on psychobabble-

1)what about adding provigil to my mix? I took it for a year with no adverse events. It would replace caffeine for my fatigue symptoms. I think the wellbutrinSR helps with anxiety and agitation because it enables me to sit down and focus on the task at hand rather than run around like a mother chicken looking for her chickies.

2)what about upping my dosage of wellbutrin to 300mg SR or something like that XL, whatever?

enough. I go lie in bed and twitch aimlessly now, hoping that the WB kicks in

 

Re: agitation, anxiety, fatigue and insomnia

Posted by Quintal on July 4, 2008, at 17:33:03

In reply to agitation, anxiety, fatigue and insomnia, posted by llurpsienoodle on July 4, 2008, at 15:20:45

What is the problem with sleep? Is it falling asleep or staying asleep? If it's the latter you might want to ask your doctor for a sample of Lunesta because it lasts longer than Sonata. I think Sonata is the shortest-acting hypontic on the market (1-2hours). You may just need more than 10mg Sonata until this stress is over. I would give Lunesta a try though (pdoc permitting).

Congratulations on the new job!

Q

 

Re: agitation, anxiety, fatigue and insomnia Quintal

Posted by llurpsienoodle on July 4, 2008, at 18:03:37

In reply to Re: agitation, anxiety, fatigue and insomnia, posted by Quintal on July 4, 2008, at 17:33:03

> What is the problem with sleep? Is it falling asleep or staying asleep?

I have no problems falling asleep- blame the sertraline and the abilify. It's staying asleep. I arise early- between 3 and 5 am. Sometimes I stay awake, sometimes I putz about for an hour or two and go back to bed, emerging very groggy after a few more hours of tossing and turning

>If it's the latter you might want to ask your doctor for a sample of Lunesta because it lasts longer than Sonata. I think Sonata is the shortest-acting hypontic on the market (1-2hours). You may just need more than 10mg Sonata until this stress is over. I would give Lunesta a try though (pdoc permitting).
>

I'm sure he'd be permitting. he Rx xanax, klonopin, zyprexa zydis, etc. The reason I use sonata is because I can take it at 3am and still feel fully alert by 7am. It's a good crutch, but not if it doesn't work right!!!


> Congratulations on the new job!
>
> Q

Thank you Q- it's so nice to see Q around again. How are you doing?

-Ll

 

Re: agitation, anxiety, fatigue and insomnia

Posted by undopaminergic on July 4, 2008, at 19:39:11

In reply to agitation, anxiety, fatigue and insomnia, posted by llurpsienoodle on July 4, 2008, at 15:20:45

> ah yes. the unholy triumvirate. The dark side of hypomania.
>
> It's time to tweak my meds around. The only thing I've found that helps with agitation has been wellbutrin. I took an extra one of those today. I will see if it helps.
>
> WellbutrinSR generic 150mg
> Abilify 10mg
> lamictal 300mg
> sertraline (zoloft generic) 100mg
> sonata prn 10mg
>
> I'm very nervous about my new job. This is causing me to lose sleep, and sonata 10mg is not cutting it.
>

Have you tried codeine cough syrup or tablets? It might work great for occasional use, but there's a serious risk that it would lose its effects if used too often. However, you may be able to extend its usefulness by adding memantine or dextromethorphan.

>
> And the anxiety and agitation makes it hard to think.
>

And on the other hand, too much benzodiazepines might also make it hard to think - otherwise something like diazepam (Valium) might be useful. Perhaps Valium in combination with piracetam (or other nootropic, for restoring thinking)?

> 1)what about adding provigil to my mix? I took it for a year with no adverse events. It would replace caffeine for my fatigue symptoms.
>

Yes, that may be worth a try.

> I think the wellbutrinSR helps with anxiety and agitation because it enables me to sit down and focus on the task at hand rather than run around like a mother chicken looking for her chickies.
>
> 2)what about upping my dosage of wellbutrin to 300mg SR or something like that XL, whatever?
>

Yes, or maybe Ritalin would have a similar effect? Then adding some of that might be an alternative.

Also, you could try guanfacine. It helps reduce excessive adrenergic activity.

 

Re: agitation, anxiety, fatigue and insomnia llurpsienoodle

Posted by Sigismund on July 4, 2008, at 21:40:15

In reply to Re: agitation, anxiety, fatigue and insomnia Quintal, posted by llurpsienoodle on July 4, 2008, at 18:03:37

So you have early morning waking.

(I'm assuming that decent sleep is important for you.)

Any idea which of your meds might be implicated?

It's interesting that Wellbutrin eases the agitation and Klonopin makes it worse.

(Benzos are humane, but they aren't great for being organised.)

 

Re: agitation, anxiety, fatigue and insomnia

Posted by med_empowered on July 4, 2008, at 22:26:26

In reply to agitation, anxiety, fatigue and insomnia, posted by llurpsienoodle on July 4, 2008, at 15:20:45

have you tried any old-school stimulants, like Ritalin? If wellbutrin helps, but Klonopin sucks, maybe its some kind of ADD-ish disorganized stuff that would respond to something stimulating, like the Provigil you mentioned or something old school like Ritalin or Adderall.
I hear you on the sleep thing. Personally, I like old-school Ambien (not the CR) best b/c when it works it works on both ends of the sleep prob: getting to sleep and staying asleep. There's also bunches of benzo sleep aids out there (Restoril rocks, btw) that could help w/o too much of a hangover effect.
Just out of curiosity: does Klonopin make you dysphoric/pissed off? I was just thinking you might want to try xanax xr or serax...something with a little less of a "downer" effect on mood. Then again, I'm not your doc, lol.

I hope everything works out for you.

 

Re: agitation, anxiety, fatigue and insomnia

Posted by sunnydays on July 4, 2008, at 23:07:56

In reply to agitation, anxiety, fatigue and insomnia, posted by llurpsienoodle on July 4, 2008, at 15:20:45

I don't know for sure, but I would think that treating the insomnia might be what to focus on in terms of treating the fatigue - a good night's sleep can mean everything, as I know because I've been going through a bout of insomnia recently myself. Xanax helps sometimes for me, other times it doesn't touch it (same dose and everything). I don't think it's tolerance, just my state of mind or something.

Hope this is coherent. Overindulged on fried food at the fireworks tonight and am now regretting it.

sunnydays

 

Re: agitation, anxiety, fatigue and insomnia

Posted by Phillipa on July 4, 2008, at 23:56:27

In reply to Re: agitation, anxiety, fatigue and insomnia, posted by sunnydays on July 4, 2008, at 23:07:56

Li did you say hypomania was coming back? That would be reason for a call to the pdoc. Didn't know you had a new job but congratulations. My expereience is changes cause anxiety in me kind of I guess Like hypomania but not in your shoes. Not going to suggest a med regime as you just got a good combo. Could be changing. Seriously know it's a holiday weekend but is pdoc in town. Concerned Phillipa

 

Re: agitation, anxiety, fatigue and insomnia undopaminergic

Posted by llurpsienoodle on July 5, 2008, at 18:26:41

In reply to Re: agitation, anxiety, fatigue and insomnia, posted by undopaminergic on July 4, 2008, at 19:39:11


> Have you tried codeine cough syrup or tablets? It might work great for occasional use, but there's a serious risk that it would lose its effects if used too often. However, you may be able to extend its usefulness by adding memantine or dextromethorphan.

yikes! cough syrup! I prefer not to mess with narcotics/opiates unless I'm in grave pain. Which I'm not. I'm just trying to salvage a couple of low-quality hours in my day, which happen to coincide with a couple of important activities- driving, spending time "relaxing" at home, etc.

Interesting. I took a bronkaid tablet yesterday (for stuffy lungs, not bipolar-- cat has been sleeping on my pillow, llurpsie is allergic to cat) and I felt so much better within a bit, moodwise. This tablet has Ephedrine Sulfate in it. perhaps there's something ADHD about my bipolar agitation?

> And on the other hand, too much benzodiazepines might also make it hard to think - otherwise something like diazepam (Valium) might be useful. Perhaps Valium in combination with piracetam (or other nootropic, for restoring thinking)?

Nootropic- what fun! I've tried xanax (makes me grumpy and sleepy for about 4 hours. llurpsie's husband HATES xanax, picks up on it everytime I take it!

> > I think the wellbutrinSR helps with anxiety and agitation because it enables me to sit down and focus on the task at hand rather than run around like a mother chicken looking for her chickies.
> >
> > 2)what about upping my dosage of wellbutrin to 300mg SR or something like that XL, whatever?
> >
>
> Yes, or maybe Ritalin would have a similar effect? Then adding some of that might be an alternative.

see ephedrine sulphate, above

> Also, you could try guanfacine. It helps reduce excessive adrenergic activity.

centrally or peripherally?
what about a betablocker?

lots of helpful ideas- thanks lots. Now I'm off to look up more nootropics.

 

Re: agitation, anxiety, fatigue and insomnia Sigismund

Posted by llurpsienoodle on July 5, 2008, at 18:31:10

In reply to Re: agitation, anxiety, fatigue and insomnia llurpsienoodle, posted by Sigismund on July 4, 2008, at 21:40:15

> So you have early morning waking.
>
> (I'm assuming that decent sleep is important for you.)

that's a fair assumption. To be honest, I don't mind only sleeping 5 hours a day, except for the extreme fatigue and concomitant mind fuzzies.
>
> Any idea which of your meds might be implicated?
>

I think that the zoloft 100mg makes my brain duller. Small chance is that lamictal (I take split 150mg - 150mg dose) makes me wakeful.

> It's interesting that Wellbutrin eases the agitation and Klonopin makes it worse.
>
Yeah, I think so too. I've always responded well to medication, except for these paradoxical effects. Think they could be diagnostic?

> (Benzos are humane, but they aren't great for being organised.)

lol. not even good for organizing my sleep! I have strange and terrible dreams on benzos.

-Ll

 

Re: agitation, anxiety, fatigue and insomnia med_empowered

Posted by llurpsienoodle on July 5, 2008, at 18:36:30

In reply to Re: agitation, anxiety, fatigue and insomnia, posted by med_empowered on July 4, 2008, at 22:26:26

> have you tried any old-school stimulants, like Ritalin? *****nope****If wellbutrin helps, but Klonopin sucks, maybe its some kind of ADD-ish disorganized stuff that would respond to something stimulating, like the Provigil you mentioned or something old school like Ritalin or Adderall.

That would be fun- to be able to fix this problem.

> I hear you on the sleep thing. Personally, I like old-school Ambien (not the CR) best b/c when it works it works on both ends of the sleep prob: getting to sleep and staying asleep. There's also bunches of benzo sleep aids out there (Restoril rocks, btw) that could help w/o too much of a hangover effect.

I will ask pdoc about it. ambien has worked well for me too. Gives me a feeling of well-being right before I fall asleep. It only lasts about 5 hours for me, but when I *do* wake up, I feel perfectly rested.

> Just out of curiosity: does Klonopin make you dysphoric/pissed off? I was just thinking you might want to try xanax xr or serax...something with a little less of a "downer" effect on mood. Then again, I'm not your doc, lol.
>
> I hope everything works out for you.
>
>
klonopin makes me psychomotorically agitated and kind of dysphoric, yeah. I've tried xanax, and it makes me very dizzy and sleepy and grumpily
Thanks med_e for your support
-Ll

 

Re: agitation, anxiety, fatigue and insomnia sunnydays

Posted by llurpsienoodle on July 5, 2008, at 18:38:29

In reply to Re: agitation, anxiety, fatigue and insomnia, posted by sunnydays on July 4, 2008, at 23:07:56

> I don't know for sure, but I would think that treating the insomnia might be what to focus on in terms of treating the fatigue - a good night's sleep can mean everything, as I know because I've been going through a bout of insomnia recently myself. Xanax helps sometimes for me, other times it doesn't touch it (same dose and everything). I don't think it's tolerance, just my state of mind or something.

I wonder whether I should use my remaining 50 tablets of xanax for sleep?
>
> Hope this is coherent. Overindulged on fried food at the fireworks tonight and am now regretting it.
>
> sunnydays

coherence is overrated! I prefer chaos myself. Then I get to make my own sense of things, rather than have someone elses ideas influence me too much... Fried foodddd yum. did you get a funnel cake?

-Ll

 

Re: agitation, anxiety, fatigue and insomnia Phillipa

Posted by llurpsienoodle on July 5, 2008, at 18:40:04

In reply to Re: agitation, anxiety, fatigue and insomnia, posted by Phillipa on July 4, 2008, at 23:56:27

> Li did you say hypomania was coming back?

That's my belief

>That would be reason for a call to the pdoc.

I have an appt. next week

>Didn't know you had a new job but congratulations. My expereience is changes cause anxiety in me kind of I guess Like hypomania but not in your shoes. Not going to suggest a med regime as you just got a good combo. Could be changing. Seriously know it's a holiday weekend but is pdoc in town. Concerned Phillipa

yeah, transitions are hard for me. The med combo is working, I just want to tweak a couple things.
-Ll

 

main complaint is agitation

Posted by llurpsienoodle on July 5, 2008, at 18:42:47

In reply to Re: agitation, anxiety, fatigue and insomnia, posted by undopaminergic on July 4, 2008, at 19:39:11

I feel agitated even on days when I'm not working. Like clockwork- starting around 5-6 pm. jittery and psychomotor agitation. The only thing that helps is wellbutrin-- although possibly ephedrine sulphate works too. I will take a tablet of eph. right now and see what happens.

paradoxically yours,
-Ll

 

Re: main complaint is agitation llurpsienoodle

Posted by Midnightblue on July 5, 2008, at 20:45:51

In reply to main complaint is agitation, posted by llurpsienoodle on July 5, 2008, at 18:42:47

Actually I would get agitated when I was on Wellbutrin about that time of day. I thought it WAS the Wellbutrin, but maybe it is because it is wearing off some then.....

MB

 

Re: main complaint is agitation llurpsienoodle

Posted by Sigismund on July 5, 2008, at 20:53:30

In reply to main complaint is agitation, posted by llurpsienoodle on July 5, 2008, at 18:42:47

I'm just trying to get clear in my mind what agitation means to you.

Like you can't organise yourself and you are all in a flap?

 

Re: main complaint is agitation llurpsienoodle

Posted by raisinb on July 5, 2008, at 23:09:18

In reply to main complaint is agitation, posted by llurpsienoodle on July 5, 2008, at 18:42:47

When I was on Wellbutrin by itself (just a month or so), I'd get pretty hyped up in the late afternoon. It wasn't agitation--it was more like feeling "on" all the time. I'd be *extremely* interested in anything I did, and I never got tired though I slept about four hours a night.

I asked my dr if taking the WB earlier or later in the day would make a difference, but he didn't think it would.

Maybe you need less Wellbutrin and more of your SSRI? I don't know, ask your pdoc of course.

 

Re: agitation, anxiety, fatigue and insomnia llurpsienoodle

Posted by raisinb on July 5, 2008, at 23:24:29

In reply to agitation, anxiety, fatigue and insomnia, posted by llurpsienoodle on July 4, 2008, at 15:20:45

Also, if you haven't tried it, Lunesta is supposed to be stronger than Ambien and Sonata--I think Sonata is the least strong. Lunesta is the only thing that helped my insomnia.

Of course I haven't tried benzos.

 

Re: agitation, anxiety, fatigue and insomnia

Posted by undopaminergic on July 6, 2008, at 5:59:16

In reply to Re: agitation, anxiety, fatigue and insomnia llurpsienoodle, posted by raisinb on July 5, 2008, at 23:24:29

> Also, if you haven't tried it, Lunesta is supposed to be stronger than Ambien and Sonata--I think Sonata is the least strong. Lunesta is the only thing that helped my insomnia.
>

Zopiclone (which is 50% eszopiclone, the active ingredient of Lunesta) was absolutely useless as a sleep-aid for me. Zolpidem (Ambien) and benzos work, however.

 

Re: main complaint is agitation Sigismund

Posted by llurpsienoodle on July 6, 2008, at 7:30:37

In reply to Re: main complaint is agitation llurpsienoodle, posted by Sigismund on July 5, 2008, at 20:53:30

> I'm just trying to get clear in my mind what agitation means to you.
>
> Like you can't organise yourself and you are all in a flap?

1) motor component -jiggles, shakes and wanting to run around
2) thought component- racing thoughts, wanting to make exuberant plans to finish a 2nd phd, become a millionaire, learn to do a backflip
3) attention component- I start on a project and quit within 30 seconds, and then start on something else, all the while berating myself for never finishing anything and making a mess.

Eventually I berate myself into agitated paralysis.

-Ll

 

Re: agitation, anxiety, fatigue and insomnia

Posted by undopaminergic on July 6, 2008, at 7:40:28

In reply to Re: agitation, anxiety, fatigue and insomnia undopaminergic, posted by llurpsienoodle on July 5, 2008, at 18:26:41

>
> > Have you tried codeine cough syrup or tablets? It might work great for occasional use, but there's a serious risk that it would lose its effects if used too often. However, you may be able to extend its usefulness by adding memantine or dextromethorphan.
>
> yikes! cough syrup! I prefer not to mess with narcotics/opiates unless I'm in grave pain. Which I'm not. I'm just trying to salvage a couple of low-quality hours in my day, which happen to coincide with a couple of important activities- driving, spending time "relaxing" at home, etc.
>

"Relaxing" may be precisely the best term to describe my experience with codeine. On the other hand, buprenorphine, which I'm currently on, doesn't have the same effect, so not all opioids are the same.

Anyway, especially because you're not responding well to benzodiazepines, you should not discount opiates prematurely.

> Interesting. I took a bronkaid tablet yesterday (for stuffy lungs, not bipolar-- cat has been sleeping on my pillow, llurpsie is allergic to cat) and I felt so much better within a bit, moodwise. This tablet has Ephedrine Sulfate in it. perhaps there's something ADHD about my bipolar agitation?
>

Maybe. Ephedrine has lots of effects, so it's difficult to say which of its actions may be the useful one in your case.

However, for bronchial problems beta2-adenoceptors are known to be the important ones. For this effect, albuterol/salbutamol (Ventoline) tablets may be a better drug than ephedrine, and who knows, they might have a paradoxical calming effect on you although the opposite is more typically the case. Also for the allergy, combination with a non-sedating antihistamine may be a good idea.

> > > 2)what about upping my dosage of wellbutrin to 300mg SR or something like that XL, whatever?
> > >
> >
> > Yes, or maybe Ritalin would have a similar effect? Then adding some of that might be an alternative.
>
> see ephedrine sulphate, above
>

Methylphenidate is less adrenergic and more dopaminergic in comparison. Whether that's better or worse for your condition is another question.

> > Also, you could try guanfacine. It helps reduce excessive adrenergic activity.
>
> centrally or peripherally?

Both. It's known as a centrally acting antihypertensive agent (but don't worry, it's doesn't lower blood pressure very much). It's also used for ADHD, perhaps making it even more interesting from your point of view.

> what about a betablocker?
>

It would slow your heart rate and probably reduce tremor, if you have that. Unfortunately, betablockers may have depressive effects, and may worsen allergic problems, including bronchial constriction and possibly itching. However, atenolol and other beta1-selective agents are less likley to have those adverse effects than propranolol, timolol and other non-selective ones.

> lots of helpful ideas- thanks lots. Now I'm off to look up more nootropics.
>

I'm not sure whether these are correctly called nootropics, but they are frequently available from the same sources: phenibut, picamilon and L-theanine are said to be particularly useful for their calming or anti-stress effects. I personally didn't notice anything from picamilon, haven't tried phenibut, but theanine has definite focus-enhancing, calming and dose-dependent sedative effects.

 

Re: main complaint is agitation llurpsienoodle

Posted by Sigismund on July 6, 2008, at 18:18:44

In reply to Re: main complaint is agitation Sigismund, posted by llurpsienoodle on July 6, 2008, at 7:30:37

Agitated paralysis hey?

I wonder if I know what that's like?

I wish my thoughts would race sometimes.

When my mother was depressed it took an extremely strong old friend 3 hours to help her put a few things in a suitcase.


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