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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Roslynn on February 15, 2012, at 16:10:50
Dear Scott,
I have a question, wondering if you can answer? This is from my question (from above on the board..)
"...all the add-ons my pdoc is trying, such as cytomel, Deplin, Strattera make me tired rather than more alert. I'm having zero luck as my pdoc tries to augment my current meds with what ever he can think of.
Why would the "augmenting" drugs make me tired, spaced out, reflexes slower, nauseous, dizzy, etc.?
Here is my med combo in case anyone is interested:
Anafranil 50mg
lithium 600mg
ativan prn
seroquel 100mg
Deplin 15mg (day 11 of trial) "Scott,
Do you have any insight into this? Is it possible the augmenting agents are interacting with the seroquel, lithium, etc and thus my side effects are magnified? Does this make any sense?
Thank you for any thoughts on this!
Sincerely,
Roslynn
Posted by jono_in_adelaide on February 15, 2012, at 16:58:58
In reply to To SLS..a question please, posted by Roslynn on February 15, 2012, at 16:10:50
You're already on 5 psychiatric meds, add an augmenter and you're upto six - it might be better to try increasing your antidepressant (50mg of clomipramine is a low doseage) rather ahan adding another chemical to the cocktail.
I'd suggest increasing the clomipramine by steps to 150mg/day before you consider adding any more drugs.
If clomipramine makes you tired, ask your doctor about channging to desipramine, which has virtualy no sedative effects.
You could also consider changing from seroqule, which is highly edating, to another, less sedating atypical, such as Risperdal or Geodon
Posted by g_g_g_unit on February 16, 2012, at 2:35:36
In reply to To SLS..a question please, posted by Roslynn on February 15, 2012, at 16:10:50
How long were you on Strattera? I believe it can activate autoreceptors at first - thus lowering NE-ergic transmission - which results in increased fatigue. The side-effect passed after about a week for me.
Posted by SLS on February 16, 2012, at 4:02:20
In reply to To SLS..a question please, posted by Roslynn on February 15, 2012, at 16:10:50
> Dear Scott,
>
> I have a question, wondering if you can answer? This is from my question (from above on the board..)
>
> "...all the add-ons my pdoc is trying, such as cytomel, Deplin, Strattera make me tired rather than more alert. I'm having zero luck as my pdoc tries to augment my current meds with what ever he can think of.
>
> Why would the "augmenting" drugs make me tired, spaced out, reflexes slower, nauseous, dizzy, etc.?Do you know which drug is producing which side effect?
Some people report being "med-sensitive". They seem to get intolerable side effects to even low dosages of drugs. For you, "brain-fog" might be one of your med-sensitive reactions.
To keep things simple, except for the Ativan, any of the other drugs you are taking can produce fatigue and brain-fog. I found Deplin to be somewhat depressogenic. I did not do well on it. If Deplin is making you feel worse in any way, I would consider discontinuing it.
You are taking 5 drugs. Someone suggested that this was too big a number. On what scientific grounds? None. I take 6 drugs, and have experimented with all of them to determine that each produces a contributory effect to my current improvement. More recently, I tried discontinuing Abilify. I relapsed after 2 weeks. Fortunately, I was able to recapture the antidepressant effect, although I lost a month in recovery time. My grandmother took 11 drugs to treat hypertension and heart-failure. So what?
> Here is my med combo in case anyone is interested:
>
> Anafranil 50mgToo low.
> lithium 600mg
Too high.
> ativan prn
> seroquel 100mg
Perhaps 25 mg twice a day if used for anxiety?
> Deplin 15mg (day 11 of trial) "
Perhaps counterproductive?
> Scott,
>
> Do you have any insight into this?None that I would call definitive.
> Is it possible the augmenting agents are interacting with the seroquel, lithium, etc and thus my side effects are magnified?
Yes. Sometimes, there are synergisms in the production of side effects.
> Does this make any sense?
It doesn't have to.
Empirical observations based upon trial-and-error is sometimes all we have to work with. For the sake of increasing therapeutic effect, I think it makes sense to explore higher dosages of Anafranil, to be increased very gradually. For the sake of reducing side effects, you could reduce the lithium, as long depression is the only consideration in its selection. I do well with 300 mg and avoid the sedative or mood flatteing side effects. You could try discontinuing the Seroquel if it is being used for depression, and consider restarting it if you deteriorate. You can always revisit it at a later time, but I think you really can't test any of these drugs as augmentors if the drug that is meant to be augmented - Anafranil - is not being used properly. You are probably being underdosed with Anafranil at 50 mg. You can go as high as 250 mg, but might find that a dosage between 100 - 150 mg works well.
Feel better!
- Scott
Posted by papillon2 on February 16, 2012, at 8:48:10
In reply to Re: To SLS..a question please » Roslynn, posted by SLS on February 16, 2012, at 4:02:20
I agree with Scott. It looks like your anti-depressant is augmenting your other meds rather than the other way around.
Posted by Roslynn on February 16, 2012, at 15:12:12
In reply to Re: To SLS..a question please, posted by papillon2 on February 16, 2012, at 8:48:10
Thank you for everyone who took the time to answer me. I agree that I am on a low dose of anafranil. I get lightheaded whenever I have tried to increase it. My thought is, like others here said, is to decrease my lithium (I am strictly depressive, no hypomania). Maybe then I could increase the anafranil without too many side effects.
My doctor is scared to decrease my lithium because he feels it is protective against suicidal thoughts. I'm not finding that it is stopping these thoughts, however, anyway.
Seroquel was given to me several years ago because I was having panic/derealization that was terrible to go through. Now, I am afraid to go off Seroquel for fear of these thoughts coming back. But I don't think it's doing me any good, really. I liken it to hitting me over the head with a large mallet. The effect would be the same.
It basically makes me sleep for 4 hours.Anafranil has been the first drug that worked for me in several years. I agree with those who answered me here that the way to go is to try to decrease the other meds and increase the anafranil.
Thank you so much for your help and responses.
Roslynn
Posted by Roslynn on February 16, 2012, at 15:16:03
In reply to Re: To SLS..a question please, posted by g_g_g_unit on February 16, 2012, at 2:35:36
> How long were you on Strattera? I believe it can activate autoreceptors at first - thus lowering NE-ergic transmission - which results in increased fatigue. The side-effect passed after about a week for me.
I could not even tolerate it for more than 4 days.
Posted by Roslynn on February 16, 2012, at 15:22:39
In reply to Re: To SLS..a question please, posted by jono_in_adelaide on February 15, 2012, at 16:58:58
> You're already on 5 psychiatric meds, add an augmenter and you're upto six - it might be better to try increasing your antidepressant (50mg of clomipramine is a low doseage) rather ahan adding another chemical to the cocktail.
>
I agree with your thinking on this.
>
> If clomipramine makes you tired, ask your doctor about channging to desipramine, which has virtualy no sedative effects.Desipramine worked for a while for me, then stopped.
> You could also consider changing from seroqule, which is highly edating, to another, less sedating atypical, such as Risperdal or Geodon
Geodon knocked me out flat within an hour of taking it. Someone else suggested Abilify, which could be possible.
Thank you!
Roslynn
Posted by Roslynn on February 16, 2012, at 15:36:22
In reply to Re: To SLS..a question please » Roslynn, posted by SLS on February 16, 2012, at 4:02:20
Dear Scott,
Thank you so much for answering my question with your helpful and well thought-out response.
Roslynn
Posted by ed_uk2010 on February 16, 2012, at 15:41:37
In reply to Re: To SLS..a question please, posted by Roslynn on February 16, 2012, at 15:12:12
>I get lightheaded whenever I have tried to increase it.
Seroquel can also cause this. Perhaps if your Seroquel dose was reduced you could tolerate more Anafranil?
>Now, I am afraid to go off Seroquel for fear of these thoughts coming back. But I don't think it's doing me any good, really. I liken it to hitting me over the head with a large mallet.
No need to be frightened. Don't think about stopping it just yet, just ask your doctor about taking a lower dose. You can then review your progress. If you get the 25mg tablets you can try 75mg at night, and then adjust the dose according to response.
Hope this is useful.
Posted by SLS on February 16, 2012, at 15:54:07
In reply to Re: To SLS..a question please » Roslynn, posted by ed_uk2010 on February 16, 2012, at 15:41:37
> > I get lightheaded whenever I have tried to increase it.
> Seroquel can also cause this. Perhaps if your Seroquel dose was reduced you could tolerate more Anafranil?
That's a good thought.
- Scott
Posted by Phillipa on February 16, 2012, at 18:17:14
In reply to Re: To SLS..a question please, posted by SLS on February 16, 2012, at 15:54:07
Even 50mg of seroquel left me dizzy and unable to walk the next day. So yes it causes dizzyness. Phillipa
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