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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by greywolf on September 23, 2008, at 18:52:01
I have been diagnosed with refractory depression, bipolar disorder (II) and OCD. The depression has become very severe, and I have experienced elevated anxiety. This, in turn, has increased the intensity and frequency of my OCD behaviors (in their multitudes).
While I am awaiting VNS surgery in a couple weeks, I am taking the following medications:
Abilify 10mg/day
Remeron 30mg/day
Xanax .5 mg (5x/day)
Seroquel 100/mg (as needed for primarily sleep purposes)
Deplin (L-methylfolate) to augment the above.
First, I'd love to know if anyone believes Deplin is truly helpful since it runs $59 per scrip and it's not covered by insurance. Second, I don't like the Seroquel at all (and avoid taking it), and I'm thinking of dropping it completely. Problem is that the anxiety problems aren't effectively controlled at night by the Remeron and Xanax (which might be partially the fault of the Abilify).
Anyway, was just wondering what the med experts here have to say/suggest. Anything would be helpful.
Thanks.
Greywolf
Posted by Zyprexa on September 23, 2008, at 19:06:16
In reply to Need opinion of the med experts here, posted by greywolf on September 23, 2008, at 18:52:01
I'm no expert, but didn't find deplin to do anything. I'm schitzoaffective. I actualy got better results from taking a inexpensive B complex, B-100. It seems to help with depression. And regrowing nerves. It also helps if you drink.
Posted by azalea on September 23, 2008, at 20:33:34
In reply to Need opinion of the med experts here, posted by greywolf on September 23, 2008, at 18:52:01
You can save $10+ on Deplin with ValueCard Rx. Go to deplin.com-->ValueCardRx Program-->Price Quote. Just print out the card and bring it to your pharmacy.
At 100mg/day, the Seroquel is likely not doing much as an anti-depressant. The recommended dosing for bipolar depression is 300mg taken in the evening before bed.
As you mentioned, Abilify can be quite activating which could be contributing to your anxiety. Have you tried Lamictal for mood stabilization?
If you decide to d/c Seroquel and are having difficulty falling asleep, perhaps Ambien or Lunesta would be an option. Not sure if you should combine those with Xanax as they have similar mechanisms of action.
> Seroquel 100/mg (as needed for primarily sleep purposes)
>
> Deplin (L-methylfolate) to augment the above.
>
> First, I'd love to know if anyone believes Deplin is truly helpful since it runs $59 per scrip and it's not covered by insurance. Second, I don't like the Seroquel at all (and avoid taking it), and I'm thinking of dropping it completely. Problem is that the anxiety problems aren't effectively controlled at night by the Remeron and Xanax (which might be partially the fault of the Abilify).
>
> Anyway, was just wondering what the med experts here have to say/suggest. Anything would be helpful.
>
> Thanks.
>
> Greywolf
Posted by med_empowered on September 23, 2008, at 20:54:21
In reply to Need opinion of the med experts here, posted by greywolf on September 23, 2008, at 18:52:01
hey..I'm not an expert, but I'll throw out some ideas...
1) drop the seroquel and get an actual sleeping pill. The costs will be lower and you'll probably have fewer side effects. You could try Lunesta, Ambien, Rozerem, Trazadone, Restoril, ProSom, more xanax at night, hydroxyzine...the list goes on and on.
2) Will your insurance over xanax xr? I've never taken it myself, but it seems to me that taking xanax xr a couple times daily at an equivalent or slightly higher dose might give you more even coverage so at the very least you won't experience anxiety b/c of mini-withdrawal from your last xanax dose.
3) Is the Abilify helping you? All antipsychotics can raise anxiety levels; abilify in particular tends to cause akathisia and can cause agitation, possibly b/c of the partial dopamine agonism. Anyway...my shrink claims that *higher* abilify doses are more "soothing" (or at least...less crazy-making). I was on 20mgs/day for a while and although I didn't exactly love the abilify, I didn't have any EPS, akathisia, or increased anxiety.
If you've had EPS or akathisia I would think upping the Abilify dose would be bad news, but...I'm not your doctor. Lowering/eliminating the Abilify might also help.3) I don't really know anything about Deplin, but have you tried Niacinamide? Its like niacin, without the flush and nausea; I take 4 grams daily to help with my "issues". It kind of acts like a natural tranquilizer, so it might potentiate your xanax.
4) Is increasing the Remeron an option? I think I've read about people taking 45-60mgs/day.
Posted by Phillipa on September 24, 2008, at 0:09:43
In reply to Re: Need opinion of the med experts here, posted by med_empowered on September 23, 2008, at 20:54:21
Yes you can combine xanax and lunesta or ambien been prescribed for me in the past. Love Phillipa
Posted by greywolf on September 24, 2008, at 17:31:50
In reply to Re: Need opinion of the med experts here » greywolf, posted by azalea on September 23, 2008, at 20:33:34
Thanks, azalea.
I forgot about the Deplin coupon. I still have samples left, so I'm putting purchases off for a little while. I'm just wondering if anyone truly believes Deplin actually works.
Greywolf
Posted by Geegee on September 24, 2008, at 19:30:58
In reply to Need opinion of the med experts here, posted by greywolf on September 23, 2008, at 18:52:01
Posted by greywolf on September 24, 2008, at 19:42:48
In reply to Nice to see you here (nm) » greywolf, posted by Geegee on September 24, 2008, at 19:30:58
Thanks, Geegee.
I periodically find the need to take a break from Babble, but I always enjoy coming back to all you nice people.
Greywolf
Posted by Phillipa on September 24, 2008, at 19:51:56
In reply to Re: Need opinion of the med experts here, posted by greywolf on September 24, 2008, at 17:31:50
Henyro believes it does I think not sure the jury is out with SLS and Ron Hill. Me starting to feel it's worthless. That's my opinion only. Phillipa
Posted by desolationrower on September 24, 2008, at 20:19:29
In reply to Re: Need opinion of the med experts here » greywolf, posted by Phillipa on September 24, 2008, at 19:51:56
I am not convinced it will help many people more than folic acid/methyl donors. Certainly for the price something like w-3 fats or zinc seem like a better option with more evidence.
-d/r
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