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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 Catling on June 9, 2014, at 4:35:02
Hi, I haven't been around in a while because my cocktail was stable for a bit but now I'm in need of some ideas.
I have PTSD and the two primary symptoms that I take medication for with that are the depression with suicidal ideation and the anxiety. After trying a bunch of SSRIs and SNRIs my last good doctor put me on parnate (40 mg daily in two doses - although I'm going up to 60 now because the depression has worsened), which I've had moderate response to for my depression. One of the conflicts for me in treating my depression is that it makes my anxiety a lot more noticeable. I have general anxiety and social anxiety. I take lyrica for the general anxiety, 300 mg daily, in 3 doses. I wasn't getting enough effect from the parnate, so about a year ago we added geodon 20mg at bedtime. At first it was amazing. I could feel something other than anxiety and depression! I was getting up at 8 a.m., I was getting a lot accomplished, I felt really functional. But over time that effect has worn off. I can't go up on the geodon because it makes me sleep too much. (60 mgs will make me sleep for 22 hrs. 40 mgs makes me sleep for ~14.)
I've used benzos for the past eleven years, for panic attacks and also because my brain just never shuts up with anxiety and worry. After a few days of short sleep and lying awake for hours trying to get to sleep I will take a pill or two (lowest dose) and get eight to ten hours sleep. It gives me a break and resets my brain. Well, my clinic switched to a "new policy" where they will no longer prescribe benzos at all to anyone. This is a pretty big deal in my world. Also my old doctor moved her practice so I'm dealing with idiots now.
So, I need something to take that will help with the anxiety that the lyrica doesn't alleviate which is primarily the social based anxiety and also obsessive worrying/racing thoughts/anxiety. I'm looking for ideas to take to my next appointment.
Things I've already tried which had no impact on my anxiety:
trazodone
nefazodone
celexa
zoloft
remeron
effexor
cymbalta
vistaril
abilify
seroqueldid help but can no longer get rx for:
xanax
ativan
klonopin
Posted by Phillipa on June 9, 2014, at 9:44:47
In reply to anti-anxiety meds to try with parnate?, posted by Catling on June 9, 2014, at 4:35:02
What state do you live in as here ever since medicaire started to pay for benozs as safer than atypical antipsychotics it isn't a no no anymore. I've taken them for 43 years and never had a problem having them prescribed? Are you very young? As I have read that the tread is to use CBT or something similar? Phillipa
Posted by Catling on June 9, 2014, at 13:28:26
In reply to Re: anti-anxiety meds to try with parnate? » Catling, posted by Phillipa on June 9, 2014, at 9:44:47
> What state do you live in as here ever since medicaire started to pay for benozs as safer than atypical antipsychotics it isn't a no no anymore. I've taken them for 43 years and never had a problem having them prescribed? Are you very young? As I have read that the tread is to use CBT or something similar? Phillipa
---
Hi Phillipa,
I am in Louisiana, but I don't have medication insurance, I get my meds for free from a local clinic. For a while (3 years or so) they were writing me the benzo prescriptions with no problem and I got them filled elsewhere, but they started a new policy where they're not writing those prescriptions any longer. I'm 39, so no, not very young. ;)
I'm in therapy and have been doing a lot of dbt work this year, including two weeks in intensive inpatient back in January.
Thanks for reading,
Cat
Posted by Beckett on June 9, 2014, at 14:25:46
In reply to Re: anti-anxiety meds to try with parnate? » Phillipa, posted by Catling on June 9, 2014, at 13:28:26
Have you tried lithium for suicidal ideation? A subtherapithic dose helps me. Even 300 mg. For panic and out of control anxiety, can you suss out a sliding scale doctor? (I know it's probably difficult to impossible.) My doctor would write a scrip with like five refills. But then, he would want to see me at least every eight weeks, which would be very expensive at regular rates. Maybe your old doctor would call in or write a referral/recommendation that you should continue with your present anti anxiety meds.
Posted by Catling on June 9, 2014, at 18:07:40
In reply to Re: anti-anxiety meds to try with parnate?, posted by Beckett on June 9, 2014, at 14:25:46
> Have you tried lithium for suicidal ideation? A subtherapithic dose helps me. Even 300 mg. For panic and out of control anxiety, can you suss out a sliding scale doctor? (I know it's probably difficult to impossible.) My doctor would write a scrip with like five refills. But then, he would want to see me at least every eight weeks, which would be very expensive at regular rates. Maybe your old doctor would call in or write a referral/recommendation that you should continue with your present anti anxiety meds.
---
Hi Beckett, thanks for the response. I have not tried adding in lithium. At first glance it seems like there are a lot of potential side effects and a need for good medical monitoring, which is problematic for me at best. But I wasn't aware that it had been tested with parnate, so thanks for the heads up on that and I will certainly explore that option should it come to that. The suicidal ideation is mostly controlled by the parnate for me except when there are exacerbating circumstances and/or the anxiety gets out of control and then kicks my depression into high gear.
Thanks again,
Cat
Posted by Beckett on June 9, 2014, at 20:01:43
In reply to Re: anti-anxiety meds to try with parnate? » Beckett, posted by Catling on June 9, 2014, at 18:07:40
Hi Cat,
In the interest for good information, I didn't mean to say it had been tested w/parnate if you did think I did :-) Regarding sides, I don't think I have any at 600 mg. (However, i do particularly well on Li, but it does take monitoring.) I felt the ideation fade at 300 mg. (Good luck w/ the anxiety piece. I take lyrica too.)
Posted by phidippus on June 9, 2014, at 22:23:43
In reply to anti-anxiety meds to try with parnate?, posted by Catling on June 9, 2014, at 4:35:02
My recommendation would be Gabitril, which is a selective gaba reuptake inhibitor.
Eric
Posted by SLS on June 10, 2014, at 6:50:44
In reply to anti-anxiety meds to try with parnate?, posted by Catling on June 9, 2014, at 4:35:02
I saw someone respond well to Phenergan (promethazine) when Zyprexa didn't work. There's always perphenazine.
- Scott
Posted by Catling on June 10, 2014, at 10:51:10
In reply to Re: anti-anxiety meds to try with parnate?, posted by Beckett on June 9, 2014, at 20:01:43
Sorry, didn't mean to imply that you'd said it had been tested with parnate. I saw when I did my google research that it has been. ;)
Cat
Posted by Catling on June 10, 2014, at 10:58:05
In reply to Re: anti-anxiety meds to try with parnate? » Catling, posted by phidippus on June 9, 2014, at 22:23:43
Thanks Eric, that looks like it might be a good fit. :)
Posted by Catling on June 10, 2014, at 11:26:50
In reply to Re: anti-anxiety meds to try with parnate? » Catling, posted by SLS on June 10, 2014, at 6:50:44
Hi Scott, thank you for the suggestions. Perphenazine was my doctor's first choice of antipsychotic to use with the parnate. I didn't have a response to it and we switched to the geodon since I saw on some boards that a few people had luck with that combo.
This is the end of the thread.
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