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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Sheilac on January 14, 2014, at 5:26:59
I've been taking 600mg of the new extended release version of Trileptal (Oxtellar XR) along with 1-2mg of Klonopin and 40mg of a Geodon for depression.
The Trileptal extended version knocks me out at bedtime and I sleep pretty good (since I have a terrible time sleeping). But I just feel so darn flat. During the day when the half life is gone I feel jittery and have to supplement with Klonopin which works.
The Trileptal also cures the irritability, but I feel so flat, like I've had a total shutdown of my personality. I don't do any of the things that bring me joy like reading. I used to read tons of books. I miss that.
I just have no motivation or enthusiasm, but on the other hand I'm nice, quiet and not agitated and irritable and don't fly off the handle.
What do I do? I. Having a love hate relationship with myself. I feel like a major couch potato! It kinda sucks.
Thoughts?
Posted by SLS on January 14, 2014, at 7:21:33
In reply to Flat feeling, no interests, posted by Sheilac on January 14, 2014, at 5:26:59
> What do I do? I. Having a love hate relationship with myself. I feel like a major couch potato! It kinda sucks.
>
> Thoughts?How can you be sure that it is the Trileptal that is causing your flat affect? I found Geodon to complicate my depression with brain fog, derealization, and flat affect. Perhaps you can work with your doctor to lower the dosage of Geodon to see how you do with it.
Alternative AP treatment for bipolar depression are Abilify, Latuda, Saphris, and Seroquel. I have seen Saphris work a miracle for a friend of mine. Her depression vanished. She now has more mental and physical energy, and is incredibly functional.
If Trileptal is the culprit for your flat affect and lack of motivation and interest, I feel that Topamax is a reasonable alternative. Most people don't. Topamax has a reputation for producing cognitive impairments. This is not always the case. I have seen two people, myself included, titrate the dosage of Topamax very slowly to a dosage of 200 mg/day without a hint of cognitive and memory impairments. I experienced a mild antidepressant effect, but it proved inadequate, so I discontinued it. The other person had a bipolar hypomanic mixed state with anger and irritability. Topamax made this vanish completely at a dosage of 200 mg/day. Ultimately, she was able to maintain her response at 100 mg/day.
There are, of course, other options.
- Scott
Posted by bleauberry on January 14, 2014, at 8:02:52
In reply to Flat feeling, no interests, posted by Sheilac on January 14, 2014, at 5:26:59
Flat emotions are a common outcome with most psychiatric drugs, but sometimes we get lucky and the drug works good. For a while anyway. They all do it....antidepressants, mood stabilizers, antipsychotics, benzos....but it completely depends on the person's unique physiology and how that drug works in that physiology. Mileage varies.
How do we know these effects are due to the drugs and not the thing you were trying to treat in the first place?
I don't feel confident adding anything in this thread except for this: use psychiatry as best you can to get the most relief you can....but not forever....it is for the time being only....the real goal is to correct what was causing the symptoms in the first place so that you can either lower or eliminate medications, along with the symptoms.
Those answer are not found in psychiatry. You will have to look outside the psychiatric toolbox because there are other great toolboxes that can take your journey to an improved outcome. The more tools the better, imo. The enemy is fierce, cunning, and strong. Lots of weapons are needed.
Where to look? Pretend you have Lyme disease. In my opinion, mine only, since you are here at pbabble, my personal journeys suggest you have a 7/10 or even 9/10 chance of having it or a similar co-infection. I don't want to get into a long book explanation of why I feel that way, it's just that I have yet to see this hypothesis proven false in real time real people.
When psychiatric patients focus on treating inflammation, toxin removal, and bacteria/fungal/viral reduction, they feel much improved. Sometimes cured. No meds needed. You do need the meds now however.
Every symptom you described, as side effects, are actually also what lyme commonly looks like. It looks confusing, bizarre, hard to treat, and is loaded with the stuff like "physical anxiety", irritable waves, lack of joy, lack of motivation. Looks exactly like depression actually. One of my lyme doctors said some of his lyme patients only had one symptom.....depression....it went away with antibiotics not antidepressants, though antidepressants were used during treatment until they could be successfully stopped later. Of note, those doses were often very small doses due to the exaggerated side effects and/or drug sensitivity.
Would Zyprexa do better than Geodon? I think so. Nothing better than zyprexa in my opinion, abilify too. I don't have much faith in Geodon but that's just because I have not seen it perform as well at pbabble. Limited population, anecdotal, but that's what I have seen. Prozac+zyprexa, happened to be very good to this lyme person for quite a while....that says a lot!
Herbal and OTC treatment of inflammation.
Cholestyramine for toxin removal.
Meds for anti-lyme if you can get them.
Herbs for anti-lyme if no meds.Doesn't matter if you have Lyme or not. The above strategies nail a great array of the causes of psychiatric symptoms of all kinds, but especially the ones that are not cooperating well in treatment.
Posted by SLS on January 14, 2014, at 8:08:24
In reply to Re: Flat feeling, no interests, posted by bleauberry on January 14, 2014, at 8:02:52
Hi BB.
When you have a chance, please check your Babblemail.
Thanks.
Best wishes.
- Scott
Posted by Phillipa on January 14, 2014, at 8:57:56
In reply to Flat feeling, no interests, posted by Sheilac on January 14, 2014, at 5:26:59
Sheila. I just realized you haven't been on here in quite a while. Does this mean things generally are better? As for your question I wish I knew the answer. Phillipa
Posted by Sheilac on January 14, 2014, at 9:09:24
In reply to Re: Flat feeling, no interests » Sheilac, posted by Phillipa on January 14, 2014, at 8:57:56
Yes, Phillipa! Can you believe it?! I had a very, very, very stressful December, so I knew for sure that 600mg of Trileptal was where I needed to be and it's what works.
The Geodon is still my best AD so far.
I guess it just goes with the mood stabilizer territory that they make you a little flat, which sucks. But, on the good side, it has gotten rid of my social anxiety, agitation and severe irritability. The long acting version (Oxteller XR) is convenient, helps me sleep, but it's pretty expensive.
I should count myself lucky I'm such a light weight when it comes to meds.
I guess better to be boring than irritable and mean. I just wish I had some sort of motivation in me.
Posted by Phillipa on January 14, 2014, at 21:31:01
In reply to Re: Flat feeling, no interests » Phillipa, posted by Sheilac on January 14, 2014, at 9:09:24
I sure can relate to this!!! Phillipa
Posted by Christ_empowered on January 15, 2014, at 8:08:51
In reply to Re: Flat feeling, no interests » Phillipa, posted by Sheilac on January 14, 2014, at 9:09:24
Maybe switch out Klonopin for Xanax XR?
Posted by ed_uk2010 on January 15, 2014, at 14:43:32
In reply to Flat feeling, no interests, posted by Sheilac on January 14, 2014, at 5:26:59
> I've been taking 600mg of the new extended release version of Trileptal (Oxtellar XR).
As you say, Oxtellar XR is expensive. How about switching back to plain oxcarbazepine (Trileptal or generic) and taking a small dose in the morning or at some point during the day, and a larger dose in the evening. The larger evening dose should help you sleep and the smaller daytime dose might improve irritability without making you feel flat. Just a suggestion. You could try taking 150mg in the morning and 300mg at night... and then adjust according to response.
Posted by phidippus on January 18, 2014, at 2:48:44
In reply to Flat feeling, no interests, posted by Sheilac on January 14, 2014, at 5:26:59
Its hard to tell if your suffering from depression or whether your meds are making you flat. You're not on a lot of TRileptal, so I doubt its affecting you. 2 mg of Klonopin is a stronger dose and Klonopin can cause depression. Maybe bumpp up the Geodon?
Eric
Posted by Sheilac on January 18, 2014, at 7:46:29
In reply to Re: Flat feeling, no interests, posted by phidippus on January 18, 2014, at 2:48:44
Actually, I'm a lightweight when it comes to meds and I really do feel the 600mg. I don't take much Klonopin on 600mg of Trileptal.
I feel good, but very flat. My doc gave me Geodon 40mg to take either 1 or 2 pills. I've been taking 80mg and feel a bit more stable and have switched to the short acting Trileptal and spread it out over the day. We'll see how that works.
I like the new extended version, but it makes me a zombie!
This is the end of the thread.
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