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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Roslynn on May 17, 2012, at 15:50:29
Looking for any suggestions here...so frustrated.
My diagnosis is MDD with some possible soft bipolar components.I am taking the following:
Anafranil (clomipramine) 50mg
Seroquel 100mg at night
Ativan 2-3 mg prn
lithium ER 450 mg1. I've tried a lot of different meds and the anafranil is the only one that gave me any help. BUT, whenever I try to increase it to the therapeutic range (or even up to 100) I get dizzy. Yet if I reduce it below 50 I feel worse.
2. Lithium I am stuck at 450mg, I can't tolerate more, and if I try to reduce it I get hypomanic symptoms.
3. Seroquel was originally prescribed to me short-term for panic, however, I've not been able to get off it without the panic returning. I take 100mg an night which puts me to sleep.
My pdoc right now is either trying to substitute a different med for anafranil ( he tried with Viibryd most recently and that was a disaster) or he tries to augment my meds which doesn't work because I get too many side effects from all the meds interacting.
Does anyone have any thoughts on this pleease?
Thank you so much.
Roslynn
Posted by Lou Pilder on May 17, 2012, at 22:38:40
In reply to CAN ANYONE PLS HELP ME WITH MY MEDS?????, posted by Roslynn on May 17, 2012, at 15:50:29
> Looking for any suggestions here...so frustrated.
> My diagnosis is MDD with some possible soft bipolar components.
>
> I am taking the following:
>
> Anafranil (clomipramine) 50mg
> Seroquel 100mg at night
> Ativan 2-3 mg prn
> lithium ER 450 mg
>
> 1. I've tried a lot of different meds and the anafranil is the only one that gave me any help. BUT, whenever I try to increase it to the therapeutic range (or even up to 100) I get dizzy. Yet if I reduce it below 50 I feel worse.
>
> 2. Lithium I am stuck at 450mg, I can't tolerate more, and if I try to reduce it I get hypomanic symptoms.
>
> 3. Seroquel was originally prescribed to me short-term for panic, however, I've not been able to get off it without the panic returning. I take 100mg an night which puts me to sleep.
>
> My pdoc right now is either trying to substitute a different med for anafranil ( he tried with Viibryd most recently and that was a disaster) or he tries to augment my meds which doesn't work because I get too many side effects from all the meds interacting.
>
> Does anyone have any thoughts on this pleease?
>
> Thank you so much.
> Roslynn
>Roslynn
You wrote,[...Can anyone...Does anyone...?
I see that the drugs that you are taking together could cause death. There are CNS depressants taken together, drugs together that could cause heart attack, drugs taken together that could cause a toxic reaction and induce psychotic symptoms. Also hypothermia.
My position here is that if you want to continue the taking of all those drugs together, there is the potential of them killing you. So if I was you, I would ask the prescriber of those drugs, if there is one, that wants you to take them together, to make an immediate plan for you to elimninate the potential of death by somehow modifying the regimine of drugs, if that can be done safely.
I would also question the prescriber's rationale for having you take these drugs in combination. If death is a potential outcome from taking the combination, what benifit outweighs that risk?
Lou
Posted by bleauberry on May 18, 2012, at 7:43:02
In reply to CAN ANYONE PLS HELP ME WITH MY MEDS?????, posted by Roslynn on May 17, 2012, at 15:50:29
The first thing that popped into my mind was Savella. That's because like Anafranil it has a fairly balanced impact on both norepinephrine and serotonin, except it has far less impact on other stuff (histamine, cholinergic, etc) so the dizziness side effects would be either minimal or non existent. Side effects overall would be a lot cleaner than anafranil.
From your response we get the clue that the mechanism of anafranil is generally in the right direction for you. Other than savella, another way to attempt to play on that would be a combo of TCA with SSRI, such as zoloft with nortriptyline first choice desipramine second choioce, or prozac with either of those two meds in the same order.
Hopefully when the primary med is more on target there will be less need, or no need at all, for some of the other meds.
Personal opinion, I think zyprexa is a better choice than seroquel. That said, my instincts suspect any of the antipsychotics can likely give undesired outcomes for you, where they mask immediate symptoms but underneath the surface they can actually making them worse. And as you've noted, they can be real hard to get off of. Took me 3 months to wean off of 5mg zyprexa and there was a lot of bad anxiety during that withdrawal but I was determined to find other natural means of managing it and I did. But the thing that really did the trick was Savella. Following an initial period of worsened anxiety and worsened sleep during the first few days, there was calm and peace after that, along with interest and motivation in hobbies and activities. I think people run into trouble with Savella due to what I perceive as incorrect or inappropriate dosing strategies. Basically I believe consensus dosing guidelines are extremely too aggressive and doses too high. While some may indeed do best at higher doses, as some in clinical trials did, I think it is a better strategy to start very low and increase slowly until a dose is found that feels right, regardless of what that dose size actually is. For example for someone else I remember it was 6mg per day (which is 1/2 of the lowest dose), and for me it was 3mg twice or three times a day. For someone else, 100mg twice a day. The point is, the risk of failure or dropout is increased whenever dose is pushed too fast or too high.
Anyway, just some thoughts.
> Looking for any suggestions here...so frustrated.
> My diagnosis is MDD with some possible soft bipolar components.
>
> I am taking the following:
>
> Anafranil (clomipramine) 50mg
> Seroquel 100mg at night
> Ativan 2-3 mg prn
> lithium ER 450 mg
>
> 1. I've tried a lot of different meds and the anafranil is the only one that gave me any help. BUT, whenever I try to increase it to the therapeutic range (or even up to 100) I get dizzy. Yet if I reduce it below 50 I feel worse.
>
> 2. Lithium I am stuck at 450mg, I can't tolerate more, and if I try to reduce it I get hypomanic symptoms.
>
> 3. Seroquel was originally prescribed to me short-term for panic, however, I've not been able to get off it without the panic returning. I take 100mg an night which puts me to sleep.
>
> My pdoc right now is either trying to substitute a different med for anafranil ( he tried with Viibryd most recently and that was a disaster) or he tries to augment my meds which doesn't work because I get too many side effects from all the meds interacting.
>
> Does anyone have any thoughts on this pleease?
>
> Thank you so much.
> Roslynn
>
Posted by Lou Pilder on May 18, 2012, at 8:32:36
In reply to Re: CAN ANYONE PLS HELP ME WITH MY MEDS?????, posted by bleauberry on May 18, 2012, at 7:43:02
> The first thing that popped into my mind was Savella. That's because like Anafranil it has a fairly balanced impact on both norepinephrine and serotonin, except it has far less impact on other stuff (histamine, cholinergic, etc) so the dizziness side effects would be either minimal or non existent. Side effects overall would be a lot cleaner than anafranil.
>
> From your response we get the clue that the mechanism of anafranil is generally in the right direction for you. Other than savella, another way to attempt to play on that would be a combo of TCA with SSRI, such as zoloft with nortriptyline first choice desipramine second choioce, or prozac with either of those two meds in the same order.
>
> Hopefully when the primary med is more on target there will be less need, or no need at all, for some of the other meds.
>
> Personal opinion, I think zyprexa is a better choice than seroquel. That said, my instincts suspect any of the antipsychotics can likely give undesired outcomes for you, where they mask immediate symptoms but underneath the surface they can actually making them worse. And as you've noted, they can be real hard to get off of. Took me 3 months to wean off of 5mg zyprexa and there was a lot of bad anxiety during that withdrawal but I was determined to find other natural means of managing it and I did. But the thing that really did the trick was Savella. Following an initial period of worsened anxiety and worsened sleep during the first few days, there was calm and peace after that, along with interest and motivation in hobbies and activities. I think people run into trouble with Savella due to what I perceive as incorrect or inappropriate dosing strategies. Basically I believe consensus dosing guidelines are extremely too aggressive and doses too high. While some may indeed do best at higher doses, as some in clinical trials did, I think it is a better strategy to start very low and increase slowly until a dose is found that feels right, regardless of what that dose size actually is. For example for someone else I remember it was 6mg per day (which is 1/2 of the lowest dose), and for me it was 3mg twice or three times a day. For someone else, 100mg twice a day. The point is, the risk of failure or dropout is increased whenever dose is pushed too fast or too high.
>
> Anyway, just some thoughts.
>
> > Looking for any suggestions here...so frustrated.
> > My diagnosis is MDD with some possible soft bipolar components.
> >
> > I am taking the following:
> >
> > Anafranil (clomipramine) 50mg
> > Seroquel 100mg at night
> > Ativan 2-3 mg prn
> > lithium ER 450 mg
> >
> > 1. I've tried a lot of different meds and the anafranil is the only one that gave me any help. BUT, whenever I try to increase it to the therapeutic range (or even up to 100) I get dizzy. Yet if I reduce it below 50 I feel worse.
> >
> > 2. Lithium I am stuck at 450mg, I can't tolerate more, and if I try to reduce it I get hypomanic symptoms.
> >
> > 3. Seroquel was originally prescribed to me short-term for panic, however, I've not been able to get off it without the panic returning. I take 100mg an night which puts me to sleep.
> >
> > My pdoc right now is either trying to substitute a different med for anafranil ( he tried with Viibryd most recently and that was a disaster) or he tries to augment my meds which doesn't work because I get too many side effects from all the meds interacting.
> >
> > Does anyone have any thoughts on this pleease?
> >
> > Thank you so much.
> > Roslynn
> >
>
> Bleau,
You wrote,[...Savella...it has a fairly balaned impact on both norepinephrine and serotonin....Side effects overall would be a lot cleaner than anafranil...the mechanism of anafranil is generally in the right direction for you...].
I am unsure as to what you are wanting to mean here to that you are advising a person with taking Savella. If you could post answers to the following, then I could have the opportunity to respond accordingly.
A. What could you post here as a citation, if anything, to explain what you are wanting to mean by {a fairly balanced inpact on both norepinephrin and serotonin)?
B. What serotonin are you referring to, since there are over 20 serotonins?
C. How do you know, if at all, if the member requesting help here would not die if Savella was introduced into the mix of drugs already being taken?
D. Do you know that Savella is not approved in the U.S. for depression?
E. Are you wanting the member to tell the prescriber that they saw your post to her/him on "Dr Bob's" and that since the administartion does not intercede in what you are advising the member to take, even though the drug is not approved in the U.S. for depression, and could cause death via serotonin syndrome as combined with the other drugs the member takes, that (redacted by respondent) and overide (redacted by respondent) which is contrindicated in the medical liturature?
E. Now if the thinking of people that take mind-altering drugs is that people are different and one can not be certain that what one person experiances would be the same as another person taking the same drug, then what is your rational for advising the member here about Savella?
F. Would you take responsibility and assume all liability if the member here dies from taking Savella?
G. In your claim that the mechansim is generally in the right direction for the member, by what authority do you use , if any, to peost what could lead one to think that you are qualified to make such a claim?
Lou
Posted by Christ_empowered on May 18, 2012, at 13:56:49
In reply to CAN ANYONE PLS HELP ME WITH MY MEDS?????, posted by Roslynn on May 17, 2012, at 15:50:29
I'm not a huge seroquel fan myself, but have you considered switching to XR and upping the dose a bit? Then you might be able to drop the lithium w/o any major problems (although I think temporarily uppin gthe ativan while you drop the lithium might be a good idea).
I don't know much about antidepressants, sorry. Effexor XR popped into my mind, since its supposedly a "cleaned up" tca or something. Prozac with punch is what I think it was initially marketed as. Probably easier to tolerate than anafranil.
Maybe switch out the ativan for xanax xr? Its once daily, and it might help with the depression a little bit. You might need a bit of ativan (or...something...) at night so that you don't wake up with in-between dose anxiety.
That's all I can think of. I hope you and your doc can find a solution to your issues.
Posted by creepy on May 30, 2012, at 7:39:27
In reply to CAN ANYONE PLS HELP ME WITH MY MEDS?????, posted by Roslynn on May 17, 2012, at 15:50:29
Have you tried lexapro? Im assuming you have already.
Lamictal might be helpful. The titration isnt fun but it can help with depression quite a bit.
BTW, going hypomanic on an antidepressant isnt necessarily a sign of bipolar. Depends on who you ask though.
This is the end of the thread.
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