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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Tabitha on October 28, 2012, at 2:14:35
I've been unmedicated for years. Cancer treatment destabilized me enough to find a pdoc and go on meds again. He put me on lamictal and I felt like a new person, a fully functional and pretty happy person. Such relief, and realized how much of a struggle it's been dealing with so much depression and anxiety for so long.
I asked if poop-out is typical on this and he said no. But I'm back in the pit again the past couple days. Seems like nothing is working. He also put me on effexor for horrendous hot flashes and ambien for insomnia. Effexor seems to have pooped out as well.
The ambien was supposed to be better than the ativan I was using for sleep, but it's not working at all. I lie there kind of semi-sedated for a few hours but don't sleep. Then it wears off and my mind starts going and I don't sleep until dawn.
I'm so sick of feeling bad inside and having no escape from it. And I'm extra super sick of feeling better for a while and thinking I've found some fix, and then going back into the pit. When I'm in the pit it feels like it's forever, despite me trying to talk myself out of that belief.
Right now I think depression is worse than cancer.
Posted by schleprock on October 28, 2012, at 2:41:36
In reply to Thought I'd found the holy grail, posted by Tabitha on October 28, 2012, at 2:14:35
You say that you've been unmedicated for years, yet were using Ativan for sleep. If it is the case that you have been using Ativan for quite recently on a regular basis, then you may be suffering withdrawel from that medication if you stopped it abruptly. I would suggest you go back to the ativan and then slowly taper off of it when you feel more comfortable.
Increasing your doe of lamictal might also be of some benefit.
Posted by jono_in_adelaide on October 28, 2012, at 2:42:15
In reply to Thought I'd found the holy grail, posted by Tabitha on October 28, 2012, at 2:14:35
For the depression, ask about nortriptyline (75mg at night) and Zoloft 50-100mg in the morning. If Ambien isnt working, but Ativan did, then switch back. The nortriptylien also helps with sleep
Posted by Dinah on October 28, 2012, at 9:34:38
In reply to Thought I'd found the holy grail, posted by Tabitha on October 28, 2012, at 2:14:35
> I lie there kind of semi-sedated for a few hours but don't sleep. Then it wears off and my mind starts going and I don't sleep until dawn.
When you said that, I instantly thought of the effexor. Even with a mood stabilizer on board, that was the sort of effect it had on me.
I often think that holy grail feeling is a side effect of a change of medicine.
Posted by Phillipa on October 28, 2012, at 9:57:31
In reply to Thought I'd found the holy grail, posted by Tabitha on October 28, 2012, at 2:14:35
Are you taking tamoxifen or another med after the cancer treatment. If you are do they cause depression? I do wish you more than luck in finding the proper dose of lamictal. And surely you need sleep to heal. If a benzo worked in past maybe since if I read correctly you have been off them for years a return to ativan may work well again. Phillipa
Posted by Beckett on October 28, 2012, at 10:12:40
In reply to Thought I'd found the holy grail, posted by Tabitha on October 28, 2012, at 2:14:35
Ambien had the same effect on me, too. Right now I use temazepam for sleep though I agree with my pdoc that benzos are not ideal for sleep. Still my pdoc recognizes my anxiety level and how intractable my insomnia is-- I have tried every Z drug on the market. You might have success with a trial of Lunesta or Sonata. These worked for me for periods of time before they pooped out. Ambien never did.
I'm curiuos about your med timeline. Did you start the lamictal and Effexor together, or was there a time when you were on lamictal as monotherapy?
Posted by Christ_empowered on October 28, 2012, at 10:23:37
In reply to Re: Thought I'd found the holy grail » Tabitha, posted by Beckett on October 28, 2012, at 10:12:40
I think a bzd for sleep is sometimes the way to go. More full body relaxation. Ativan, Restoril, maybe some good ole fashioned Valium. Some people use xanax, but I think that can lead to trouble, at least more so than other bzd drugs.
Have you tried Ritalin? Its still used for depression, especially in cases of physical problems leading to depression. The sides are, for me at least, better than an AD, and its easy to stop if you start having problems. Cancer treament *must* have been draining, so I would think that a stimulant might give you a quick lift. I have a relative on lamictal+relatively low-dose Adderall xr, and that combo works quite well. Just try to keep the dose low and go for an XR formulation if you can. Just my thoughts.
Posted by Tabitha on October 28, 2012, at 15:44:53
In reply to Re: Thought I'd found the holy grail, posted by schleprock on October 28, 2012, at 2:41:36
> You say that you've been unmedicated for years, yet were using Ativan for sleep. If it is the case that you have been using Ativan for quite recently on a regular basis, then you may be suffering withdrawel from that medication if you stopped it abruptly. I would suggest you go back to the ativan and then slowly taper off of it when you feel more comfortable.
>
> Increasing your doe of lamictal might also be of some benefit.The Ativan is new in the last few months. I am doing chemotherapy and it is actually used as an anti-nausea med. I was using it a couple nights in a row, then cutting back to half, then going without. I was sleeping on and off without it. My pdoc said addiction probably wasn't an issue since I wasn't taking it around the clock.
After switching chemo drugs and adding effexor the total insomnia started. It's hard to say which is the culprit.
I will ask about increasing lamictal. I was doing so well on 75 mg I didn't even go to the original target dose 100 mg.
Posted by Tabitha on October 28, 2012, at 15:47:16
In reply to Re: Thought I'd found the holy grail, posted by jono_in_adelaide on October 28, 2012, at 2:42:15
> For the depression, ask about nortriptyline (75mg at night) and Zoloft 50-100mg in the morning. If Ambien isnt working, but Ativan did, then switch back. The nortriptylien also helps with sleep
Yeah I need to see pdoc earlier and get a change. I don't have a month's worth of ativan left. He thought the ambien would work. Funny it used to work for me years ago.
Posted by Tabitha on October 28, 2012, at 15:51:56
In reply to Re: Thought I'd found the holy grail » Tabitha, posted by Dinah on October 28, 2012, at 9:34:38
> > I lie there kind of semi-sedated for a few hours but don't sleep. Then it wears off and my mind starts going and I don't sleep until dawn.
>
> When you said that, I instantly thought of the effexor. Even with a mood stabilizer on board, that was the sort of effect it had on me.
>
> I often think that holy grail feeling is a side effect of a change of medicine.Ugh I'm really afraid the effexor may be the culprit. I hate to go off it, since it seemed to be helping enormously with hot flashes. The chemo caused instant menopause and I was having dripping sweats several times an hour all day and night. But then the weather cooled off at the same time I started effexor so I wasn't sure it was really helping or not.
Posted by Tabitha on October 28, 2012, at 15:56:30
In reply to Re: Thought I'd found the holy grail » Tabitha, posted by Phillipa on October 28, 2012, at 9:57:31
> Are you taking tamoxifen or another med after the cancer treatment. If you are do they cause depression? I do wish you more than luck in finding the proper dose of lamictal. And surely you need sleep to heal. If a benzo worked in past maybe since if I read correctly you have been off them for years a return to ativan may work well again. Phillipa
No not yet, but I will be on that and similar drugs later. For now the chemo shuts down the ovaries. I was having wild swings at first-- actually more hypmania than depression. Now the lamictal has dampened down the ups and did seem to be preventing the lows as well.
When I was not on psych meds I slept well enough with melatonin or else nothing.
Posted by Tabitha on October 28, 2012, at 15:59:35
In reply to Re: Thought I'd found the holy grail » Tabitha, posted by Beckett on October 28, 2012, at 10:12:40
> Ambien had the same effect on me, too. Right now I use temazepam for sleep though I agree with my pdoc that benzos are not ideal for sleep. Still my pdoc recognizes my anxiety level and how intractable my insomnia is-- I have tried every Z drug on the market. You might have success with a trial of Lunesta or Sonata. These worked for me for periods of time before they pooped out. Ambien never did.
>
> I'm curiuos about your med timeline. Did you start the lamictal and Effexor together, or was there a time when you were on lamictal as monotherapy?I started lamictal alone. I think I'd reached 75 mg for a couple weeks and felt really good before adding the effexor. As I mentioned the effexor was actually added for severe hot flashes. It's been shown to reduce them by quite a bit, and tends to work quickly. I was hoping for a mood lift too. I'm only on 37.5 mg which is quite low.
Posted by Tabitha on October 28, 2012, at 16:06:14
In reply to Re: Thought I'd found the holy grail, posted by Christ_empowered on October 28, 2012, at 10:23:37
> I think a bzd for sleep is sometimes the way to go. More full body relaxation. Ativan, Restoril, maybe some good ole fashioned Valium. Some people use xanax, but I think that can lead to trouble, at least more so than other bzd drugs.
>
> Have you tried Ritalin? Its still used for depression, especially in cases of physical problems leading to depression. The sides are, for me at least, better than an AD, and its easy to stop if you start having problems. Cancer treament *must* have been draining, so I would think that a stimulant might give you a quick lift. I have a relative on lamictal+relatively low-dose Adderall xr, and that combo works quite well. Just try to keep the dose low and go for an XR formulation if you can. Just my thoughts.Interesting thought on Ritalin. I've never tried it. I do think I've heard of it used for fatigue for people on long-term chemotherapy. I have 8 more weeks of mine then hopefully never again!
I do notice the physical relaxation with ativan. I have rapid heart beat (another chemo side effect) and it seems to slow it down a bit.
Posted by phidippus on October 28, 2012, at 22:29:03
In reply to Thought I'd found the holy grail, posted by Tabitha on October 28, 2012, at 2:14:35
>I'm only on 37.5 mg which is quite low.
Really low. At that dose, you really shouldn't be feeling any different on the Lamictal. When you reach the 100 mg level, the party starts.
>I asked if poop-out is typical on this and he said no.
What he really should have explained is that tachyphilaxis is actually a rarity. What really happens is symptoms get worse and the medication is not properly adjusted.
>Seems like nothing is working.
You're on too little of everything.
>I lie there kind of semi-sedated for a few hours but don't sleep.
You may need something stronger to help you sleep.
>my mind starts going and I don't sleep until dawn.
Do you experience racing thoughts?
>I'm so sick of feeling bad inside and having no escape from it.
It takes time, drive and patience to treat mental illness.
>I'm extra super sick of feeling better for a while and thinking I've found some fix, and then going back into the pit
You need to have realistic expectations of the medication you are on. With my cocktail, I've reached 80%-the last 20% is hard work.
>When I'm in the pit it feels like it's forever, despite me trying to talk myself out of that belief.
What sort of things do you say to yourself?
Eric
Posted by Tabitha on October 29, 2012, at 15:15:21
In reply to Re: Thought I'd found the holy grail » Tabitha, posted by phidippus on October 28, 2012, at 22:29:03
Hi Eric, thanks for your thoughts. Sorry I wasn't clear-- the 37.5 is effexor dose for hot flashes. I'm on 75 mg lamictal. "Tachyphylaxis"... I had to look that one up. I don't exactly have racing thoughts at night, just recycling worries and planning. When the bad days hit I try to tell myself it's not forever even though it feels like it. My cycles have been short lately-- one bad day followed by a good day. It seems like a night of poor sleep is a huge trigger for depression for me. I started using the ativan again for sleep and will bring all this up with pdoc. I think I minimized the bad days in our last meeting because I was feeling confident they were behind me. Yeah maybe I should go up in dose instead of stopping as soon as I think it's helping.
I'm curious what meds you're on. Do you have experience with lamictal?
Posted by phidippus on October 29, 2012, at 15:34:41
In reply to Re: Thought I'd found the holy grail » phidippus, posted by Tabitha on October 29, 2012, at 15:15:21
>37.5 is effexor dose for hot flashes
Yeah, way too low to treat depression-Doses in the range of 300 mg are typical for treating depression.
>I'm on 75 mg lamictal.
I wonder why your doctor has prescribed this. Does he think you might be bipolar or cyclothymic? Usually doses up to 300 mg are prescribed for mood stabilization.
I am on:
15 mg Abilify
1200 mg Lithium
60 mg Viibryd
70 mg VyvanseMy DX is ADHD/BP1/OCD
>Do you have experience with lamictal?
I do. It helped with my mood, but made my OCD worse.Eric
Posted by Tabitha on October 29, 2012, at 17:14:13
In reply to Re: Thought I'd found the holy grail » Tabitha, posted by phidippus on October 29, 2012, at 15:34:41
Hi again Eric,
Re lamictal, my dx is bipolar II, with much more depression than hypomania. The plan was to titrate up to 100 mg then see whether I needed to go higher. I think 100 is a standard low-end therapeutic dose but don't recall where I saw it. I was responding well to 75 and didn't want to risk the rash by going higher. Somewhere I read some people even respond to 50 mg.
Posted by alchemy on October 29, 2012, at 18:13:04
In reply to Re: Thought I'd found the holy grail » Beckett, posted by Tabitha on October 28, 2012, at 15:59:35
> I started lamictal alone. I think I'd reached 75 mg for a couple weeks and felt really good before adding the effexor. As I mentioned the effexor was actually added for severe hot flashes. It's been shown to reduce them by quite a bit, and tends to work quickly. I was hoping for a mood lift too. I'm only on 37.5 mg which is quite low.
>FYI - I have gone through a period of night sweats when I have started drugs. I do remember with Lamictal (which I am still on), I got a lot of acne (which went away)
I am sorry about your cancer (may I ask what type?) My mom says she remembers me saying to her when I was younger that I would have rather had cancer especially because it was socially acceptable. And my dad even died of cancer. Too bad I couldn't have taken his place, because he wanted to live. I don't want to discount cancer, but I find it interesting to hear from someone who has experienced both. I don't feel so bad about thinking it now.
I remember reading once that they noticed that interferon was causing cancer patience to become depressed. It was some sort of "enlightenment" to the science community of how depression can be physical.
Posted by Phillipa on October 29, 2012, at 18:33:51
In reply to Re: Thought I'd found the holy grail » phidippus, posted by Tabitha on October 29, 2012, at 17:14:13
Tabitha you must be on estrogen lowering medications so this would in turn cause the night sweats. Phillipa
Posted by phidippus on October 29, 2012, at 21:24:23
In reply to Re: Thought I'd found the holy grail » phidippus, posted by Tabitha on October 29, 2012, at 17:14:13
I thought you might be Bipolar 2.
>The plan was to titrate up to 100 mg then see whether I needed to go higher
Most people find 200 mg the best dose for Lamictal.
>didn't want to risk the rash by going higher
If you haven't gotten it by now, you probably won't get it. If you do get it, by chance, then it might be a sign Lamictal isn't for you. There are plenty of other mood stabilizers to choose from.
You should up your Effexor dose.
Eric
Posted by Tabitha on November 1, 2012, at 12:00:00
In reply to Re: Thought I'd found the holy grail » Tabitha, posted by Phillipa on October 29, 2012, at 18:33:51
> Tabitha you must be on estrogen lowering medications so this would in turn cause the night sweats. Phillipa
Phillipa, the ovaries are fast-dividing cells so they are affected by chemotherapy. Most women go into temporary menopause during chemo, and depending on their age it may be permanent. My periods stopped immediately and hot flashes started up. I was told it's 80% probable I will stay in menopause afterward. I was close anyway, probably would have been there in a year or two.
Posted by Tabitha on November 1, 2012, at 12:02:08
In reply to Re: Thought I'd found the holy grail, posted by alchemy on October 29, 2012, at 18:13:04
Interesting you mention acne, I'd noticed more lately too. Glad to hear it went away for you.
When I said depression was worse than cancer I meant that in that moment it was harder to deal with. I have early stage breast cancer and am not sick from it, only experiencing difficult side effects from the treatment. I imagine the suffering of terminal cancer is a whole different thing.
I agree with you-- depression has a big physical component, as I can tell how much a bad night's sleep affects mine. I had barely had mood swings for years until I started the chemotherapy. I am not sure if it is the drugs directly or the associated fatigue and sudden drop in estrogen. Something set my moods into instability.
>
> FYI - I have gone through a period of night sweats when I have started drugs. I do remember with Lamictal (which I am still on), I got a lot of acne (which went away)
>
> I am sorry about your cancer (may I ask what type?) My mom says she remembers me saying to her when I was younger that I would have rather had cancer especially because it was socially acceptable. And my dad even died of cancer. Too bad I couldn't have taken his place, because he wanted to live. I don't want to discount cancer, but I find it interesting to hear from someone who has experienced both. I don't feel so bad about thinking it now.
>
> I remember reading once that they noticed that interferon was causing cancer patience to become depressed. It was some sort of "enlightenment" to the science community of how depression can be physical.
>
>
Posted by phillipa on November 1, 2012, at 20:51:05
In reply to Re: Thought I'd found the holy grail » alchemy, posted by Tabitha on November 1, 2012, at 12:02:08
Tabitha this is when I literally fell apart when menopausal, deveoped thyroid disorder and it fluctuated from hypo to hyper, lymes disese was discovered, and I took my first ever ad. I'm so glad your BC is in the early stages. I have heard from others with same that the treatment is what gets you. And you can't add hormones right? Phillipa
Posted by Tabitha on November 2, 2012, at 13:22:49
In reply to Re: Thought I'd found the holy grail » Tabitha, posted by phillipa on November 1, 2012, at 20:51:05
> And you can't add hormones right? Phillipa
That's right Phillipa, since estrogen and progesterone fed my cancer, they are now the enemies. Once chemo is done I will go on drugs to block estrogen. They can cause joint pain, hot flashes, hair thinning, bone loss, vaginal atrophy and all the other joys of menopause. Then I'll need other stuff to help with those side effects. I hear exercise can really help with the joint pain and bone loss. That's the one thing I'm looking forward to-- extra motivation to exercise. Plus there is evidence it lowers risk of cancer recurrence.
My days of taking few or no pills and rarely seeing the doctor are over!
Posted by phillipa on November 2, 2012, at 21:09:35
In reply to Re: Thought I'd found the holy grail » phillipa, posted by Tabitha on November 2, 2012, at 13:22:49
Tabitha I'm sorry what a letdown this must be for you. Phillipa
This is the end of the thread.
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