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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on August 27, 2010, at 19:51:28
In reply to Re: I feel horrible, posted by Dima on August 27, 2010, at 14:42:42
Dima that's great. Best of luck and keep posting. Phillipa
Posted by Dima on August 28, 2010, at 11:11:06
In reply to Re: I feel horrible » Dima, posted by Phillipa on August 27, 2010, at 19:51:28
I don't usually seem to experience side effects from any antidepressants. Could it be that not enough is being absorbed for some reason? Or is that crazy?
Posted by ed_uk2010 on August 28, 2010, at 13:46:08
In reply to Re: I feel horrible, posted by Dima on August 28, 2010, at 11:11:06
>I don't usually seem to experience side effects from any antidepressants. Could it be that not enough is being absorbed for some reason? Or is that crazy?
It's great that you didn't get any side effects. Wait a few days before you increase. Did you pdoc tell you to go up to 100mg next?
I think you probably are absorbing it just fine. Metabolism of drugs is much more variable.
Posted by Dima on August 28, 2010, at 14:25:43
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on August 28, 2010, at 13:46:08
She only gave me the 50 mg dosage. Is it necessary to increase it higher to get effects?
Posted by ed_uk2010 on August 29, 2010, at 11:49:31
In reply to Re: I feel horrible, posted by Dima on August 28, 2010, at 14:25:43
>She only gave me the 50 mg dosage. Is it necessary to increase it higher to get effects?
Not always, but I suspect that it will be for you because you seem to be quite resistant to antidepressants. 125mg to 150mg per day is claimed to be optimal (on average), but higher doses are sometimes used.
Assuming that you are still experiencing no side effects, I think you should get in touch with your doctor to ask about increasing.
Posted by floatingbridge on August 29, 2010, at 13:13:11
In reply to Re: I feel horrible, posted by Dima on August 28, 2010, at 14:25:43
Dima, good luck!
Posted by ed_uk2010 on August 30, 2010, at 15:36:10
In reply to Re: I feel horrible, posted by Dima on August 28, 2010, at 14:25:43
Dima, we need an update!
Posted by floatingbridge on August 30, 2010, at 19:40:51
In reply to Re: I feel horrible, posted by ed_uk2010 on August 30, 2010, at 15:36:10
Ed's right. Let us know how you're doing when you have a chance.
Posted by Dima on August 31, 2010, at 8:30:10
In reply to Re: I feel horrible, posted by ed_uk2010 on August 30, 2010, at 15:36:10
I still feel the same. Tomorrow morning, I'm going to see a walk-in doctor to ask about increasing the dosage to 100 for a couple days then 150.
Posted by ed_uk2010 on August 31, 2010, at 12:44:34
In reply to Re: I feel horrible, posted by Dima on August 31, 2010, at 8:30:10
> I still feel the same.
Ok, well that's good news to be honest. Clomipramine is not a rapid acting medication. In many cases, all people experience initially is side effects. The lack of side effects is encouraging because it suggests that you should be able to increase up to the 'target dose' without any major problems. Although I'm not a great fan of the concept of a 'target dose', it makes sense to aim for this dose if you're not experiencing any adverse effects.
>Tomorrow morning, I'm going to see a walk-in doctor to ask about increasing the dosage to 100 for a couple days then 150.
That's a good idea, but where is your regular doctor? I suggest staying on 100mg for about four days or so. If no problems, go to 150mg. You should have come off citalopram by this point. Once you're on a full dose of clomipramine, there shouldn't be any need for citalopram.
Posted by Dima on August 31, 2010, at 13:36:53
In reply to Re: I feel horrible, posted by ed_uk2010 on August 31, 2010, at 12:44:34
I took 100 mg last night and I may be experiencing increased fatigue, but it's hard to tell, since my energy goes up and down on its own anyway. I can deal with fatigue, though, if it means no depression or anxiety.
I'm off the citalopram.
I don't see my regular doctor until the 19th, and she doesn't really listen to me anyway. It's hard to reach her by phone, too. The walk in doctor was much friendlier and was open to suggestions when I saw her last. They work at the same place.
Posted by ed_uk2010 on August 31, 2010, at 14:09:26
In reply to Re: I feel horrible, posted by Dima on August 31, 2010, at 13:36:53
>I took 100mg last night and I may be experiencing increased fatigue, but it's hard to tell, since my energy goes up and down on its own anyway. I can deal with fatigue, though, if it means no depression or anxiety.
In that case, perhaps it would be best to stay on 100mg for a week or so to give your body chance to adjust.
>I'm off the citalopram.
Good. What about your other meds?
>The walk in doctor was much friendlier and was open to suggestions when I saw her last. They work at the same place.
It would be best if you could see the same doctor again. Is that possible?
Posted by Dima on August 31, 2010, at 14:36:24
In reply to Re: I feel horrible, posted by ed_uk2010 on August 31, 2010, at 14:09:26
I believe she is the default walk in doctor, so I think so.
Currently I'm on the Anafranil 100, Lithium 300 twice per day, and Seroquel 50 at night.
I'm hopeful about my low carb diet, too. It's been three weeks and the acne on my arms is disappearing, which is a good sign. The weird thing is that my hunger and cravings are still around, which most people see disappear on low carb. Last time I ate like this in December, the day my hunger disappeared was the day I started to feel alive for the first time in months. Diet was the only thing different both times I felt better last year, so I really hope it happens again.
I really appreciate the fast responses. Thanks ed and everyone else.
Posted by ed_uk2010 on September 1, 2010, at 5:36:48
In reply to Re: I feel horrible, posted by Dima on August 31, 2010, at 14:36:24
>I believe she is the default walk in doctor, so I think so.
Ok. well that's good. There's nothing worse that having to 'tell your story' to a different doctor each time.
>Currently I'm on the Anafranil 100, Lithium 300 twice per day, and Seroquel 50 at night.
As you increase clomipramine, you might find that you feel some tiredness during the day. This is common during the early stages of treatment with tricyclics antidepressants (except desipramine). If you doctor agrees, stopping Seroquel might reduce the daytime drowsiness. You could go to 25mg for a few days before stopping. What do you think? I don't think it's a good idea to be on overly complex med combos! Taking clomipramine as a single dose in the evening might be sufficient to help you sleep.
As far as lithium is concerned, I don't think it's clear just yet whether (or not) you actually need it. 150mg to 300mg twice a day seems to be the norm for unipolar depression. Have you noticed any side effects? Clomipramine is fairly potent on its own so I'm not sure how much benefit lithium adds, except in bipolar disorder. Anyway, I think it's best that you continue lithium until you are feeling more stable - you don't want to make too many changes at once.
>I'm hopeful about my low carb diet, too. It's been three weeks and the acne on my arms is disappearing, which is a good sign. The weird thing is that my hunger and cravings are still around, which most people see disappear on low carb.
Also, if you can stick to a low carb diet, that might prevent the weight gain from your meds. You still need your fruit and veg though!
Are you going to the walk in clinic today? I forgot what you said.
Posted by Dima on September 1, 2010, at 7:08:44
In reply to Re: I feel horrible » Dima, posted by ed_uk2010 on September 1, 2010, at 5:36:48
I'm here now waiting to see her. I'll ask about lowering Seroquel.
And I love the weight loss with the low carb. I weigh the most I've ever weighed due to Remeron, but now that I don't eat carbs, I can eat as much as I want and the weight is slowly getting back to normal every day.
Posted by Dima on September 1, 2010, at 9:20:40
In reply to Re: I feel horrible, posted by Dima on September 1, 2010, at 7:08:44
I saw her and she would not raise the dosage. She said I have to wait before raising it further due to side effects and serotonin toxicity. She said ask about raising it when I see my regular pdoc on the 20th, so I guess I'm taking 50 mg again until then.
Posted by ed_uk2010 on September 2, 2010, at 12:15:16
In reply to Re: I feel horrible, posted by Dima on September 1, 2010, at 9:20:40
> I saw her and she would not raise the dosage. She said I have to wait before raising it further due to side effects and serotonin toxicity. She said ask about raising it when I see my regular pdoc on the 20th, so I guess I'm taking 50 mg again until then.
Oh OK, but does she know that you're not taking citalopram anymore? Or perhaps she is concerned about the possibility of an interaction with lithium?
Good new about the weight loss! You do sound a little happier.
Posted by Dima on September 2, 2010, at 15:41:29
In reply to Re: I feel horrible, posted by ed_uk2010 on September 2, 2010, at 12:15:16
I did not tell her I stopped taking Celexa. I was too scared of her reaction to me not following her exact orders. My mind goes blank and I could barely tell her why I wanted to increase the dose.
Posted by ed_uk2010 on September 2, 2010, at 16:45:05
In reply to Re: I feel horrible, posted by Dima on September 2, 2010, at 15:41:29
> I did not tell her I stopped taking Celexa. I was too scared of her reaction to me not following her exact orders. My mind goes blank and I could barely tell her why I wanted to increase the dose.
I understand. The thing is, she's bound to be concerned about increasing your clomipramine dose when as far as she knows, you're still taking a full dose of another serotonergic antidepressant.
I think you will have to be 100% honest with your doc when you see him (her?) later in the month. You'll just have to say that you stopped citalopram because it wasn't helping....and also due to the risk of serotonergic side effects when combining with clomipramine.
In the mean time, let's hope that 50mg of clomipramine will start to provide some benefit over the next few weeks. The 50mg dose may not be optimal but it's certainly likely to help you up to a point.
So, you'll taper the Seroquel?
Posted by Dima on September 2, 2010, at 18:57:49
In reply to Re: I feel horrible, posted by ed_uk2010 on September 2, 2010, at 16:45:05
Even now, at 50 mg Seroquel, it takes a while to fall asleep and I wake up at 6 am and keep dozing off for a couple hours and waking up in the morning. Is it important to not take Seroquel?
Also, I just tried riding my bike, and it's terrible. A minute into it, my calves are in pain and my chest is burning as if I just biked for miles and miles. How am I so physically tired? Back when I still had energy in December, I ran three miles, now I can't run more than a tenth of a mile. Depression does this??
Posted by Phillipa on September 2, 2010, at 20:21:17
In reply to Re: I feel horrible, posted by Dima on September 2, 2010, at 18:57:49
Dima if you haven't excercised since December you're out of shape and it's natural to have to start all over again. Phillipa
Posted by floatingbridge on September 2, 2010, at 22:18:33
In reply to Re: I feel horrible » Dima, posted by Phillipa on September 2, 2010, at 20:21:17
Depression intensifies it. Did for me. It's a real illness.
Good news is that feeling like absolute sh*t will lift pretty quickly if you exercise a little every day and don't worry. You'll regain physical levels really soon.
Glad you're feeling better.
Posted by Dima on September 3, 2010, at 9:38:24
In reply to Re: I feel horrible » Phillipa, posted by floatingbridge on September 2, 2010, at 22:18:33
I'm not feeling better yet. It takes an enormous effort to motivate myself to exercise. And I'm not very hopeful about exercise making me feel better because I was already working out every other day when the depression hit and knocked me off my feet.
Posted by ed_uk2010 on September 3, 2010, at 10:14:49
In reply to Re: I feel horrible, posted by Dima on September 2, 2010, at 18:57:49
>Is it important to not take Seroquel?
No no, I just thought it might be contributing to your daytime tiredness. If you still need it for sleep, keep taking it for now.
How has lithium affected your energy?
Posted by morgan miller on September 3, 2010, at 10:37:32
In reply to Re: I feel horrible, posted by Dima on September 3, 2010, at 9:38:24
> I'm not feeling better yet. It takes an enormous effort to motivate myself to exercise. And I'm not very hopeful about exercise making me feel better because I was already working out every other day when the depression hit and knocked me off my feet.
Yeah, exercise won't help you until your mind is functioning better.
I know I've brought up the use of supplements before, but I really think some supplements along with medications could possibly help you feel better. Things like Cordyceps, Schisandra, and Fish Oil, can all help your mind and body function better and give you more energy. I think we should all be taking fish oil since it can improve brain function and help medications work better. What do you think about this?
Morgan
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