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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by delna on July 7, 2010, at 10:40:05
Hi everyone,
I need some advice:I have started noticing a pattern to my moods. Although I know I rapid cycle(etc), within the same day I notice a very predictable change that I think is linked to my medication dosing. I wake up in an okay state but every evening I get negative, irritable and my nerve pain starts and gets unbearable(which is definitely tardive pain syndrome) I feel this all has something to do with Ritalin. Ritalin also plays a role in the pain, apparently.
I take Ritalin 20mg at 7am (otherwise I cannot wake up ) and then 20mg at 12 noon. I need this amount to stay awake (plus 400mg modafanil too) because of my crippling fatigue.
I would assume that the Ritalin peaks and then falls again (because it has such a short half life)but I *feel* like it (or something) is building up during the day and by evening is making me agitated, negative and uncomfortable. Then I need clonazapam to make me feel better. It's become an obvious pattern
Is this possible that Ritalin is causing this? I am thinking of switching to SR but I am afraid since I need that immediate 'kick' to actually wake up and stay awake.Any ideas?
Thanks
D
Posted by Phillipa on July 7, 2010, at 10:47:10
In reply to Mood shifts. Ritalin IR vs SR??, posted by delna on July 7, 2010, at 10:40:05
Just wanted to say hi. Did you ever see the doc in the states? So glad you're back missed you. And dispite this problem you sound so much better. Love Phillipa
Posted by SLS on July 7, 2010, at 12:06:24
In reply to Mood shifts. Ritalin IR vs SR??, posted by delna on July 7, 2010, at 10:40:05
Your daily pattern is typical of atypical depression (pun not intended), and is unlikely to be a rapid cycling phenomenon. Have you tried Parnate? You could remain on the Ritalin and Provigil while trying it, although not all doctors will agree to this.
- Scott
Posted by delna on July 7, 2010, at 12:25:47
In reply to Re: Mood shifts. Ritalin IR vs SR?? » delna, posted by SLS on July 7, 2010, at 12:06:24
> Your daily pattern is typical of atypical depression (pun not intended), and is unlikely to be a rapid cycling phenomenon. Have you tried Parnate? You could remain on the Ritalin and Provigil while trying it, although not all doctors will agree to this.
>
>
> - ScottHi Scott
Thanks for your reply.
I do have rapid cycling bipolar but that happens over weeks or days but not during the same day. I don't think these shifts are 'rapid cycling' in my case. I think its the Ritalin dosing. This is a new thing for me- since I started Ritalin. I'm just not sure how to dose it. Maybe its when it wears off that my mood worsens- not sure???
I have tried Parnate but I couldn't tolerate the sedation and hypotension.
Thanks
D
Posted by SLS on July 7, 2010, at 12:41:34
In reply to Re: Mood shifts. Ritalin IR vs SR?? » SLS, posted by delna on July 7, 2010, at 12:25:47
> I do have rapid cycling bipolar but that happens over weeks or days but not during the same day.
Weird how biological this thing is, you know? One would think that you could simply "think" your way out of it. There's no blood. Unfortunately, the shifts in perception and the injury to the psyche is quite real.
I'm sorry to hear that Parnate did not work out for you. Nardil and Marplan are alternatives, of course. I can't advise you on the Ritalin. I have no real experience with it. I tried it once in combination with Parnate, but it just made me uncomfortable and somewhat irritable. For me, Dexedrine feels "smoother".
I hope find an answer.
- Scott
Posted by delna on July 7, 2010, at 12:53:42
In reply to Re: Mood shifts. Ritalin IR vs SR?? » delna, posted by Phillipa on July 7, 2010, at 10:47:10
> Just wanted to say hi. Did you ever see the doc in the states? So glad you're back missed you. And dispite this problem you sound so much better. Love Phillipa
Hi Phillipa,
How are you?
Yes, I did see several doctors in the states. They all recommended one thing and that is ECT. That includes Dr Ivan Goldberg. I am not too keen on it as it is a real ordeal and I no longer have the commitment or fight left in me to get better. I'm just trying to make things more bearable for the moment because long-term things don't look good. I don't mean to sound negative- I am just accepting facts.Hope you are doing better.
Love
D
Posted by delna on July 7, 2010, at 12:55:52
In reply to Re: Mood shifts. Ritalin IR vs SR?? » delna, posted by SLS on July 7, 2010, at 12:41:34
> > I do have rapid cycling bipolar but that happens over weeks or days but not during the same day.
>
> Weird how biological this thing is, you know? One would think that you could simply "think" your way out of it. There's no blood. Unfortunately, the shifts in perception and the injury to the psyche is quite real.
>
> I'm sorry to hear that Parnate did not work out for you. Nardil and Marplan are alternatives, of course. I can't advise you on the Ritalin. I have no real experience with it. I tried it once in combination with Parnate, but it just made me uncomfortable and somewhat irritable. For me, Dexedrine feels "smoother".
>
> I hope find an answer.
>
>
> - ScottThank you.
Unfortunately I am so sensitive to sedation that most drugs are not an option for me. Nardil will probably be worse than Parnate.
Posted by SLS on July 7, 2010, at 13:11:56
In reply to Re: Mood shifts. Ritalin IR vs SR?? » SLS, posted by delna on July 7, 2010, at 12:55:52
> Unfortunately I am so sensitive to sedation that most drugs are not an option for me. Nardil will probably be worse than Parnate.
Perhaps. You won't know unless you try. I recall some sedation early in treatment the first time I tried a full therapeutic dose of Nardil. It disappeared within a few weeks and was replaced by stimulation. Marplan is probably less apt to produce sedation than Nardil.
I hope someone chimes in with some advice on Ritalin. Some people actually wake up early to take their first dose and then return to bed. Perhaps you could do this with Ritalin SR if necessary.
- Scott
Posted by linkadge on July 7, 2010, at 16:44:44
In reply to Re: Mood shifts. Ritalin IR vs SR?? » SLS, posted by delna on July 7, 2010, at 12:55:52
I would recomend the SR version. For me, the biphentin (canadian) was best. Much less ups and downs.
You might also try some ginger root for chronic fatigue.
Linkadge
Posted by bleauberry on July 7, 2010, at 17:23:06
In reply to Mood shifts. Ritalin IR vs SR??, posted by delna on July 7, 2010, at 10:40:05
I don't have any advice on the ritalin except maybe that if fatigue is the problem, stimulants could worsen the problem in the longterm, despite short term help.
Fatigue. We're talking a vitamin thing, an unsuspected chronic infection, an immune system in disarray, adrenal gland weakness. All kinds of things are being discovered by accident that play into chronic fatigue, and the neurotransmitters we manipulate with psych drugs aren't among them. By manipulating them we can indeed improve the symptoms but do nothing to address the real problem which continues to progress over months and years.
Now, fatigue is listed as a symptom of depression. So the two are often lumped together as one stand alone thing. Which can be misleading.
I think you have to play with the ritalin and see what you can do. But more importantly you should embark on a dedicated research project on anything and everything you can find on google relating to chronic fatigue syndrome. The thing you are dealing with is much bigger than a stimulant is going to handle.
I would suggest three other things besides ritalin.
Low dose naltrexone. Study up on LDN.
Vitamin B12 patches, available on the net OTC.
Cordyceps herb.Those three things will cover a lot of ground in balancing whatever the real underlying problem is. And all have significantly increased energy as the primary benefit with most people, with improved mood as a secondary benefit though more modest or spotty.
The tiredness in the morning and irritability in the evening is probably partially due to ritalin wearing off, but I would suspect since it is so predictable it is more related to the adrenal glands and would still be happening on a more subtle level without the ritalin. Cordyceps is the one that can help there. Other popular ones are Siberian Ginseng (called Eleuthero, not a true ginseng, and Rhodiola Rosea.
At the very least, spend a few hours reading up on the substances mentioned here.
And of course keep it in perspective...just one person's input.
Posted by Phillipa on July 7, 2010, at 19:45:59
In reply to Re: Mood shifts. Ritalin IR vs SR?? » Phillipa, posted by delna on July 7, 2010, at 12:53:42
Delna what was the rationale for the doc suggesting ECT? What was his impression of your diagnois and did he change meds? Phillipa
Posted by delna on July 8, 2010, at 0:30:54
In reply to Re: Mood shifts. Ritalin IR vs SR?? » delna, posted by Phillipa on July 7, 2010, at 19:45:59
> Delna what was the rationale for the doc suggesting ECT? What was his impression of your diagnois and did he change meds? Phillipa
Hi Phillipa,
ECT was suggested because I was(am) very suicidal and depressed. He didn't change my diagnosis- he maintained that it was a complicated case of bipolar disorder with overlapping features. He felt nothing could help at this stage like ECT could. He sent me for an evaluation to an ECT specialist who said the same thing. Dr Goldberg didn't change my meds as he felt that I needed the ECT and then we could consider what drugs to add. I saw him about 5 times so he had given it alot of thought.
I also went to Columbia's diagnostic facility and was told the same thing. ECT. Because I was really rapidly cycling and she felt that it would help everything. She recommended hospitalization if I so decided to come back to the States for treatment.
All the doctors (plus other specialists) felt the fatigue, muscle pain etc was part of the psychiatric picture and that at this moment anything less than ECT would be not be enough.In general ECT, according to 5 pretty senior doctors is the most effective treatment for depression/bipolar/rapid cycling (although no one knows quite how it works)
D
Posted by Phillipa on July 8, 2010, at 19:59:01
In reply to Re: Mood shifts. Ritalin IR vs SR?? » Phillipa, posted by delna on July 8, 2010, at 0:30:54
Sounds like you seriously had a good evaluation. So will you go? Phillipa
Posted by delna on August 1, 2010, at 6:07:17
In reply to Re: Mood shifts. Ritalin IR vs SR??, posted by bleauberry on July 7, 2010, at 17:23:06
Hi,
I sincerely apologize for my really delayed response to your post so full of ideas.
Firstly I really appreciate your input and do agree with you but I am just too tired to do any more research and frankly quite fed up too. Merely typing is a huge effort for me.> Fatigue. We're talking a vitamin thing, an unsuspected chronic infection, an immune system in disarray, adrenal gland weakness. All kinds of things are being discovered by accident that play into chronic fatigue, and the neurotransmitters we manipulate with psych drugs aren't among them. By manipulating them we can indeed improve the symptoms but do nothing to address the real problem which continues to progress over months and years.
I do believe this fatigue is something more than depression. Unfortunately I have been checked and nothing was found. I saw a fantastic internalist in NYC who wanted to know every last detail of my problem and wasnt convinced that this was all psychiatric. He made me have some more tests and my inflammatory markers *were* raised so the insisted that I see a rheumatologist, to begin with. However the rheumatologist really checked and quite desperately looked for a cause for both my fatigue, my abnormal arm tiredness and breathlessness but he found nothing. Nevertheless he did some extra tests but nothing came up. He said he did not think the symptoms were in my head but he could not find an organic cause. He also refrained from using the term fibromyalgia as he said that that is just a dead end diagnosis- it means we dont know the cause of the problem. He told me that he hoped that this was indeed psychiatric and if my depression was treated these things would improve. He himself was frustrated.
I was checked for infections like lymes, sarcodosis and some others but again, nothing. Both the doctors said that one can spend an entire lifetime finding the cause of these vague symptoms and still not be successful as no one knows where to even look. It is frustrating for both the doctor and patient they agreed.
My fatigue was initially assumed to be D3 deficiency. However since treating that and getting the levels well up, I have had little improvement. My internist did add that sometimes trying to raise the level of Vit B helps even when it is well in the normal range. So I am giving that a go.
Having said that I was (and am) exteremly depressed so some fatigue may be coming form there.But I had a spontaneous hypomania episode in NYC (also observed by the psychiatrist) but despite the fact that I had classical symptoms (wildly racing thoughts, shopping, less need for sleep, talking others to death etc) my *physical* energy level didnt improve THAT much. Normally that level of hypomania makes me unable to sit still physically and I am all over the place. My arm fatigue and breathlessness did not go away either.
But when I was on Geodon and well, I had no fatigue whatsoever and not thing could sedate me which again makes me think it is psychiatric.
> I think you have to play with the ritalin and see what you can do. But more importantly
you should embark on a dedicated research project on anything and everything you can
find on google relating to chronic fatigue syndrome. The thing you are dealing with is much bigger than a stimulant is going to handle.As I am extremely fed up and have really given up I cant bear to do research. Im using the Ritalin to get by now and thats it. Lets see how long I last.
> Now, fatigue is listed as a symptom of depression. So the two are often lumped together as one stand alone thing. Which can be misleading. >
> I would suggest three other things besides ritalin.
>
> Low dose naltrexone. Study up on LDN.
> Vitamin B12 patches, available on the net OTC.
> Cordyceps herb.
>I did look up naltrexone ( I have a book, so that was easy) and it says its sedating.
If I have it in me I would look up the herbs too.> The tiredness in the morning and irritability in the evening is probably partially due to ritalin wearing off, but I would suspect since it is so predictable it is more related to the adrenal glands and would still be happening on a more subtle level without the ritalin.
My adrenal glands are normal.>Cordyceps is the one that can help there. Other popular ones are Siberian Ginseng (called Eleuthero, not a true ginseng, and Rhodiola Rosea. At the very least, spend a few hours reading up on the substances mentioned here. And of course keep it in perspective...just one person's input.
Thank you for sharing. I will try looking these herbs up if I find the energy. I was also suggested NAC by my psychiatrist but I havent tried it yet. Just so fed up.
Take care
DPS: Sorry for the ramble.
This is the end of the thread.
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