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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 merry-dove on July 24, 2012, at 9:44:49
I suffer from chronic depression, CFS and GAD. I currently take 300mg Effexor ER, 250 mg Hydrocodone, 1 mg Klonopin and 72mg Concerta each morning, 500 mg Hydrocodone and 1 mg Klonopin at lunch, and 1 mg Klonopin and 5 mg. Abilify at bedtime. (also take melatonin and tylenol PM at bedtime. I feel great during the day. Around 5:00 I start going downhill. My evenings are shot. I get very tired and depressed and anxious. I go to bed at 7:00 as an escape. Needless to say I have no social life. My dr. has tried increasing the Effexor and also tried adding Wellbutrin but this did not help me. I am sleeping half my life away. Does anyone have any suggestions on what may help me? All responses appreciated.
Posted by emmanuel98 on July 24, 2012, at 19:58:33
In reply to Need medication for depression in evenings, posted by merry-dove on July 24, 2012, at 9:44:49
Do you have the dosages right for hydrocodone. 750mg/day is like taking 160mg of oxycontin. If these numbers are right, no wonder you're depressed when you don't take it at night. You are in opiate withdrawal, a classic symptom of which is severe depression. I can't believe these dosages are correct.
> I suffer from chronic depression, CFS and GAD. I currently take 300mg Effexor ER, 250 mg Hydrocodone, 1 mg Klonopin and 72mg Concerta each morning, 500 mg Hydrocodone and 1 mg Klonopin at lunch, and 1 mg Klonopin and 5 mg. Abilify at bedtime. (also take melatonin and tylenol PM at bedtime. I feel great during the day. Around 5:00 I start going downhill. My evenings are shot. I get very tired and depressed and anxious. I go to bed at 7:00 as an escape. Needless to say I have no social life. My dr. has tried increasing the Effexor and also tried adding Wellbutrin but this did not help me. I am sleeping half my life away. Does anyone have any suggestions on what may help me? All responses appreciated.
Posted by merry-dove on July 25, 2012, at 6:18:51
In reply to Re: Need medication for depression in evenings, posted by emmanuel98 on July 24, 2012, at 19:58:33
The bottle says 5/500. I take 1/2 of a 5/500 tablet of hydrocodone in the morning, and a whole tablet at lunch. Less than 2 tablets a day does not seem like much. I take it for back pain for which they cannot determine the cause. I couldn't work if I didn't take it. Believe me, I have tried every other OTC pain killer out there.
Posted by brynb on July 25, 2012, at 7:54:45
In reply to Re: Need medication for depression in evenings, posted by merry-dove on July 25, 2012, at 6:18:51
> The bottle says 5/500. I take 1/2 of a 5/500 tablet of hydrocodone in the morning, and a whole tablet at lunch. Less than 2 tablets a day does not seem like much. I take it for back pain for which they cannot determine the cause. I couldn't work if I didn't take it. Believe me, I have tried every other OTC pain killer out there.
Merry-Dove,
That would mean you're only taking 7.5mg of Hydrocodone (the "5" is the Hydrocodone while the "500" is acetaminophen (Tylenol). So that's a low dose.
You might want to look at something like Tramadol. It's pretty effective for pain (especially back pain) AND it works great for mood (it works on serotonin and norepinephrine). You would need to take a low dose of it because you're on an AD, but even at low doses, it's quite good.
Another option is something like Subutex. It's typically used for opiate withdrawal, but it's also good for controlling pain and combating depression. Additionally, there are benzos other than Klonopin that aren't as much of a depressant (Xanax is one example).
Good luck!
-B
Posted by merry-dove on July 25, 2012, at 8:20:19
In reply to Re: Need medication for depression in evenings, posted by brynb on July 25, 2012, at 7:54:45
Thank you, I will look into those.
Posted by Phillipa on July 25, 2012, at 10:06:49
In reply to Re: Need medication for depression in evenings, posted by merry-dove on July 25, 2012, at 8:20:19
Also PT setting up an excercise plan can help. I have one and do it at home and it works. Phillipa
Posted by Phillipa on July 25, 2012, at 10:09:11
In reply to Re: Need medication for depression in evenings, posted by merry-dove on July 25, 2012, at 8:20:19
Have you had any testing to see what the backpain is from or is it a result of other. Phillipa
Posted by brynb on July 25, 2012, at 11:43:31
In reply to Need medication for depression in evenings, posted by merry-dove on July 24, 2012, at 9:44:49
Also, you're taking a decent size dose of Klonopin, which is great for anxiety, but definitely not for depression. It could be helpful to cut down on it and to take it only once a day (at night, for instance). It has a very long half-life, so technically rebound anxiety shouldn't be an issue, and it doesn't require frequent dosing.
-b
Posted by emmanuel98 on July 25, 2012, at 20:06:18
In reply to Re: Need medication for depression in evenings, posted by merry-dove on July 25, 2012, at 6:18:51
Oh. The 500 is mg of acetaminaphine (tylenol). The 5 is mg of hydrocodone. So you're actually taking very little hydrocodone.
> The bottle says 5/500. I take 1/2 of a 5/500 tablet of hydrocodone in the morning, and a whole tablet at lunch. Less than 2 tablets a day does not seem like much. I take it for back pain for which they cannot determine the cause. I couldn't work if I didn't take it. Believe me, I have tried every other OTC pain killer out there.
Posted by rjlockhart04-08 on July 27, 2012, at 21:57:05
In reply to Re: Need medication for depression in evenings, posted by emmanuel98 on July 25, 2012, at 20:06:18
you should check into remeron or Doxepin. They both are useful in the evenings and they both are antidepressants....and of course the worst thing I could recommend is trazadone or paxil at night. It just depends but really I see those meds as nasty....paxil made me so serotonin calm I could not ever get feel like who I was.
you may want to check into buspar but its not offically a night med but its good for anxiety because it increases some serotonin transmission.
rj
Posted by merry-dove on July 28, 2012, at 5:47:07
In reply to Re: Need medication for depression in evenings, posted by rjlockhart04-08 on July 27, 2012, at 21:57:05
Do you mean to add Remeron or Doxepin to my current medications? I heard Remeron causes weight gain which I definitely don't need. I was a zombie on Paxil as well. I tried buspar with no results.
> you should check into remeron or Doxepin. They both are useful in the evenings and they both are antidepressants....and of course the worst thing I could recommend is trazadone or paxil at night. It just depends but really I see those meds as nasty....paxil made me so serotonin calm I could not ever get feel like who I was.
>
> you may want to check into buspar but its not offically a night med but its good for anxiety because it increases some serotonin transmission.
>
> rj
Posted by rjlockhart04-08 on July 28, 2012, at 22:43:31
In reply to Re: Need medication for depression in evenings » rjlockhart04-08, posted by merry-dove on July 28, 2012, at 5:47:07
yea...doxepin its sometimes used for a night med...its an tryclic antid. it effects serotonin...but I have little research on its effects. I just know of it because people used to take at this rehab I was in for sleep. Trazadone was and is widely used as a sleep med... which is really nasty in my opinion. Get doxepin.
Also...maybe at night too...hydroxyzine but its just known for sedation...its not really good for depression. They use this alot amoung public health psychiatrists for its zero addictive properties.
Yea...you know this is another thought that may not get much credit but Lyrica at night would really be a good try....but it would be difficult to tell your doctor because its mainly used offlabel for anxiety. It has antidepressant properties.
anyways....just ask me other options and ill see what info I can put together.
rj
Posted by merry-dove on July 29, 2012, at 6:49:22
In reply to Re: Need medication for depression in evenings, posted by rjlockhart04-08 on July 28, 2012, at 22:43:31
I've heard bad things about Lyrica but maybe it would be ok as a low dose in the evening. I do have terrible anxiety with the depression in the evenings.
> yea...doxepin its sometimes used for a night med...its an tryclic antid. it effects serotonin...but I have little research on its effects. I just know of it because people used to take at this rehab I was in for sleep. Trazadone was and is widely used as a sleep med... which is really nasty in my opinion. Get doxepin.
>
> Also...maybe at night too...hydroxyzine but its just known for sedation...its not really good for depression. They use this alot amoung public health psychiatrists for its zero addictive properties.
>
> Yea...you know this is another thought that may not get much credit but Lyrica at night would really be a good try....but it would be difficult to tell your doctor because its mainly used offlabel for anxiety. It has antidepressant properties.
>
> anyways....just ask me other options and ill see what info I can put together.
>
> rj
Posted by rjlockhart04-08 on July 29, 2012, at 23:55:22
In reply to Re: Need medication for depression in evenings » rjlockhart04-08, posted by merry-dove on July 29, 2012, at 6:49:22
yea....lyrica also its brother relative Nuerontin work well with offlabel use for anxiety. Nuerontin sometimes can be good for depression but it and lyrica are both considerated a antisiezure medication. Here's some info on it:
http://en.wikipedia.org/wiki/PregabalinThe max dose for it is 600mg yet with nuerontin it can go vary high as much like 4000mg and above. I used to take Nuerontin 800mg tablets and I have to say it and Lyrica are really good for anxiety but they will provide some kind of antidepressant effect, but its not strong.
But still its kinda of silly to talk about meds that will never be used....the smart thing to do is know what is widely used with doctors. I went to my doctor and asked her for outdated antidepressants, even though they are used widely here on this website like parnate, nardil...i just don't understand why its not used in my case. Anyways...
Let's see:
Wellbutrin
Vyvanse
Effexor
Provigil
Prozac
Adderallthese are good for the mornings...but in the evening...im really thinking of doxepin.I used to drown my depression out with benzos at night, still its not vary good choice I did that for a couple years. You know there's Focalin which lasts not long....its stimulant but you could take like seroquel after it at night...well...nevermind that's kinda a crude way of thinking. Still talk to alot more people here on babble here about this issue.
rj
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