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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by sherry on March 14, 2000, at 7:05:56
I have just started taking 100 mg serzone, and I have to tell you the anxiety is pretty bad. If my memory serves me correctly from a previous post, JohnL told me that I may not be able to take serzone because of the NE action. I feel exactly like I felt when I took desipramine. I can not tolerate any of the ssri's. The sad part about this is that I can tell that it is helping with the depression in small tell tale ways. For instance, I don't sleep nearly as much, my appetite has decreased, and I don't find it as difficult to speak. I have been taking a small dose of Klonopin to counteract the anxiety, but I still feel really revved. My question is, is there anything I can do to smooth out the really speeded up feeling and continue taking this AD? I have been on several, so my options are getting pretty slim, and since I do see some improvements would like to be able to increase medication and see if it helps. Until JohnL brought to my attention that I may not be able to take AD's with NE action, and now looking back, he is right. None of the ones I have taken helped with anxiety. Not even the Parnate which did help my depression quite a bit. Do you think a mood stabilizer might help? Thanks to anyone and everyone that has any suggestions.
Posted by Cindy W on March 14, 2000, at 9:13:45
In reply to serzone to JohnL or anyone else for that matter, posted by sherry on March 14, 2000, at 7:05:56
> I have just started taking 100 mg serzone, and I have to tell you the anxiety is pretty bad. If my memory serves me correctly from a previous post, JohnL told me that I may not be able to take serzone because of the NE action. I feel exactly like I felt when I took desipramine. I can not tolerate any of the ssri's. The sad part about this is that I can tell that it is helping with the depression in small tell tale ways. For instance, I don't sleep nearly as much, my appetite has decreased, and I don't find it as difficult to speak. I have been taking a small dose of Klonopin to counteract the anxiety, but I still feel really revved. My question is, is there anything I can do to smooth out the really speeded up feeling and continue taking this AD? I have been on several, so my options are getting pretty slim, and since I do see some improvements would like to be able to increase medication and see if it helps. Until JohnL brought to my attention that I may not be able to take AD's with NE action, and now looking back, he is right. None of the ones I have taken helped with anxiety. Not even the Parnate which did help my depression quite a bit. Do you think a mood stabilizer might help? Thanks to anyone and everyone that has any suggestions.
When I took Serzone, I felt weird for about two weeks (anxious, very changeable in moods including anger for no apparent reason, dizzy); this then stopped and I felt great. You might want to give it at least two weeks before giving up, and talk to your pdoc.--Cindy W
Posted by sherry on March 14, 2000, at 14:06:51
In reply to Re: serzone to JohnL or anyone else for that matter, posted by Cindy W on March 14, 2000, at 9:13:45
Thanks Cindy, I have no intentions in giving up just yet. I do think however it will be awhile before I am able to increase the dose. So far I am able to keep the anxiety under control with an the Klonopin. Whatever needs to be done(augmenting, whatever) I want it done with this medication. I have pretty much tried most of the AD's.
> > I have just started taking 100 mg serzone, and I have to tell you the anxiety is pretty bad. If my memory serves me correctly from a previous post, JohnL told me that I may not be able to take serzone because of the NE action. I feel exactly like I felt when I took desipramine. I can not tolerate any of the ssri's. The sad part about this is that I can tell that it is helping with the depression in small tell tale ways. For instance, I don't sleep nearly as much, my appetite has decreased, and I don't find it as difficult to speak. I have been taking a small dose of Klonopin to counteract the anxiety, but I still feel really revved. My question is, is there anything I can do to smooth out the really speeded up feeling and continue taking this AD? I have been on several, so my options are getting pretty slim, and since I do see some improvements would like to be able to increase medication and see if it helps. Until JohnL brought to my attention that I may not be able to take AD's with NE action, and now looking back, he is right. None of the ones I have taken helped with anxiety. Not even the Parnate which did help my depression quite a bit. Do you think a mood stabilizer might help? Thanks to anyone and everyone that has any suggestions.
>
> When I took Serzone, I felt weird for about two weeks (anxious, very changeable in moods including anger for no apparent reason, dizzy); this then stopped and I felt great. You might want to give it at least two weeks before giving up, and talk to your pdoc.--Cindy W
Posted by JohnL on March 15, 2000, at 2:51:12
In reply to serzone to JohnL or anyone else for that matter, posted by sherry on March 14, 2000, at 7:05:56
> I have just started taking 100 mg serzone, and I have to tell you the anxiety is pretty bad. If my memory serves me correctly from a previous post, JohnL told me that I may not be able to take serzone because of the NE action. I feel exactly like I felt when I took desipramine. I can not tolerate any of the ssri's. The sad part about this is that I can tell that it is helping with the depression in small tell tale ways. For instance, I don't sleep nearly as much, my appetite has decreased, and I don't find it as difficult to speak. I have been taking a small dose of Klonopin to counteract the anxiety, but I still feel really revved. My question is, is there anything I can do to smooth out the really speeded up feeling and continue taking this AD? I have been on several, so my options are getting pretty slim, and since I do see some improvements would like to be able to increase medication and see if it helps. Until JohnL brought to my attention that I may not be able to take AD's with NE action, and now looking back, he is right. None of the ones I have taken helped with anxiety. Not even the Parnate which did help my depression quite a bit. Do you think a mood stabilizer might help? Thanks to anyone and everyone that has any suggestions.
I sure wish there was an easy answer. But based on the clues provided by your reactions to other meds, can I make a couple suggestions to ponder?
First...an antipsychotic. No joke. Why? Because your symptoms could very well be a result of elevated dopamine, and have nothing at all to do with serotonin or NE. Your previous, and current, medication trials prove this. Zyprexa 5mg is wonderful for depression and anxiety. Sedation allows good sleep. After a couple days of adjustment, daytime sedation disappears. The cool thing is that if it is to work, you will know quickly. From my own experience as well as others, benefits were dramatically obvious by day 3. If your doctor is reluctant, remind him you only want to try a low dose. And to further convince him, tell him to just write a prescription for 2 weeks just to see. He can always call in a refill by phone if you report back to him you're doing much better. I've found this approach helpful in overcoming doctor resistance.
Other AP choices would be Stelazine which is more alerting. Risperdal is kind of inbetween. Zyprexa seems to be a favorite based on comments at this board. For antidepressant and antianxiety treatment, when conventional methods have been frustrating, an AP usually does the job nicely. It's just a matter of targeting the right chemistry. Your reactions so far indicate serotonin or NE might not be the right chemistry with you.
Two other good choices might be Lamictal or Neurontin. Personally I favor Lamictal for its antidepressant qualities, its smoothing qualities, and its very mild (if any) side effect profile. I just hope you have a doctor who is openminded enough to see the logic in trying either an antipsychotic or an anticonvulsant like Lamictal. You don't have to have any schizophrenic or bipolar symptoms to respond robustly to either of these approaches.
In the meantime, you can always reduce the Serzone dosage to a level that is more comfortable. I know one doctor who starts his patients at 50mg a day and then increases by 25mg every four days. Higher doses are sometimes just too much to start with. I hope some of this might be helpful to you. JohnL
Posted by Scott L. Schofield on March 15, 2000, at 7:29:37
In reply to Re: serzone to JohnL or anyone else for that matter, posted by JohnL on March 15, 2000, at 2:51:12
> Zyprexa 5mg is wonderful for depression and anxiety. Sedation allows good sleep. After a couple days of adjustment, daytime sedation disappears. The cool thing is that if it is to work, you will know quickly. From my own experience as well as others, benefits were dramatically obvious by day 3.
Are you still taking Zyprexa? If not, why did you stop?
Do you think Zyprexa has a therapeutic window for treating depression – is it possible to take too much and lose the antidepressant effect?
Thanks.
- Scott
Posted by sherry on March 15, 2000, at 15:31:44
In reply to Re: serzone to JohnL or anyone else for that matter, posted by JohnL on March 15, 2000, at 2:51:12
JohnL, thank you, thank you, thank you! I just have one more question. What are the side effects of these medications, and do they need to be taken with an AD? I am leary of anything that will cause more weight gain. Being depressed has caused me to gain about 45 pounds in 6 years not to mention the meds I've taken,but I will do anything to feel better. Oh yeah, are there any cognitive side effects associated with the AP's? Thanks so much for taking the time to help me out. I have come to respect your opinion. ~Sherry
> I have just started taking 100 mg serzone, and I have to tell you the anxiety is pretty bad. If my memory serves me correctly from a previous post, JohnL told me that I may not be able to take serzone because of the NE action. I feel exactly like I felt when I took desipramine. I can not tolerate any of the ssri's. The sad part about this is that I can tell that it is helping with the depression in small tell tale ways. For instance, I don't sleep nearly as much, my appetite has decreased, and I don't find it as difficult to speak. I have been taking a small dose of Klonopin to counteract the anxiety, but I still feel really revved. My question is, is there anything I can do to smooth out the really speeded up feeling and continue taking this AD? I have been on several, so my options are getting pretty slim, and since I do see some improvements would like to be able to increase medication and see if it helps. Until JohnL brought to my attention that I may not be able to take AD's with NE action, and now looking back, he is right. None of the ones I have taken helped with anxiety. Not even the Parnate which did help my depression quite a bit. Do you think a mood stabilizer might help? Thanks to anyone and everyone that has any suggestions.
>
> I sure wish there was an easy answer. But based on the clues provided by your reactions to other meds, can I make a couple suggestions to ponder?
>
> First...an antipsychotic. No joke. Why? Because your symptoms could very well be a result of elevated dopamine, and have nothing at all to do with serotonin or NE. Your previous, and current, medication trials prove this. Zyprexa 5mg is wonderful for depression and anxiety. Sedation allows good sleep. After a couple days of adjustment, daytime sedation disappears. The cool thing is that if it is to work, you will know quickly. From my own experience as well as others, benefits were dramatically obvious by day 3. If your doctor is reluctant, remind him you only want to try a low dose. And to further convince him, tell him to just write a prescription for 2 weeks just to see. He can always call in a refill by phone if you report back to him you're doing much better. I've found this approach helpful in overcoming doctor resistance.
>
> Other AP choices would be Stelazine which is more alerting. Risperdal is kind of inbetween. Zyprexa seems to be a favorite based on comments at this board. For antidepressant and antianxiety treatment, when conventional methods have been frustrating, an AP usually does the job nicely. It's just a matter of targeting the right chemistry. Your reactions so far indicate serotonin or NE might not be the right chemistry with you.
>
> Two other good choices might be Lamictal or Neurontin. Personally I favor Lamictal for its antidepressant qualities, its smoothing qualities, and its very mild (if any) side effect profile. I just hope you have a doctor who is openminded enough to see the logic in trying either an antipsychotic or an anticonvulsant like Lamictal. You don't have to have any schizophrenic or bipolar symptoms to respond robustly to either of these approaches.
>
> In the meantime, you can always reduce the Serzone dosage to a level that is more comfortable. I know one doctor who starts his patients at 50mg a day and then increases by 25mg every four days. Higher doses are sometimes just too much to start with. I hope some of this might be helpful to you. JohnL
Posted by JohnL on March 16, 2000, at 3:05:52
In reply to Re: serzone to JohnL or anyone else for that matter, posted by sherry on March 15, 2000, at 15:31:44
The APs can work either alone or with an antidepressant. If your antidepressant is at least partially effective, then perhaps it can stay in the mix? An AP + AD is likely to work better than either alone.
AP side effects vary. Zyprexa is good for sleep. Stelazine is more alerting. Risperdal inbetween. I hear the best results with Zyprexa. Including myself. Unfortunately a common side effect of Zyprexa is weight gain. It blocks some of the receptors in the gut so you feel hungrier than you actually are. I have to fight the munchies to keep my weight stable, and eat healthy snacks instead of my beloved candy bars! :) At the healthfood store I discovered these $3 bags of dried blueberries or dried cranberries. These are fantastic snacks for the munchies.
Other than that, I can't really think of any side effects worth mentioning. As you know it will vary from person to person, so there's no way to tell without a personal trial. But I find 5mg Zyprexa to be quite tame. No sexual side effects either.
When an AP works, it does so quickly. You'll know inside two weeks, and maybe even a lot sooner. If your doctor will go along with it, you could try each of the three mentioned APs, one at at time, two weeks each. This allows comparison. Then choose the best to continue. Your chemistry will likely prefer one molecule over another dramatically. No way to tell without comparing. I can't think of any reason a doctor would object, so I hope he doesn't.
As an example, this is what my pdoc is doing with me right now...Effexor for two weeks, then add Adderall for a couple days. Then skip a day, start Desipramine for two weeks, add Adderall for a couple days at the end. The whole time there will still be some Prozac in my system. He believes I will get a good feel for each medication in these short trials, and then compare and pick the best to continue. He likes to continue with longer term trials only after superior drugs have been identified from relatively quick comparisons.
Anyway, hope all goes well. I'm on the sidelines cheering for ya! JohnL
Posted by Scott L. Schofield on March 16, 2000, at 7:48:11
In reply to Re: AP side effects, posted by JohnL on March 16, 2000, at 3:05:52
> As an example, this is what my pdoc is doing with me right now...Effexor for two weeks, then add Adderall for a couple days. Then skip a day, start Desipramine for two weeks, add Adderall for a couple days at the end. The whole time there will still be some Prozac in my system. He believes I will get a good feel for each medication in these short trials, and then compare and pick the best to continue. He likes to continue with longer term trials only after superior drugs have been identified from relatively quick comparisons.
Hi JohnL,It sounds like you have an excellent doctor. I would love to see someone who uses the type of treatment algorithm he is currently employing with you. Does he practice anyware near NYC? If it is not too much trouble, it would be a great favor if you would ask him if he could recommend someone in the NYC - NJ area. If you don't, that's O.K. I'll leave my e-mail address.
Thanks.
Good luck with the "bang-bang-bang".
- Scottsl.schofield@worldnet.att.net
Posted by JohnL on March 17, 2000, at 3:36:02
In reply to Re: AP side effects - Dear John, posted by Scott L. Schofield on March 16, 2000, at 7:48:11
Hi Scott,
I don't live near NYC. Maine is quite a drive. :) However, if you click on 'tips' at the top of the main page, it will take you to some good link choices. When you get there, look on the left hand side for Depression Central. Click on that.
I don't remember exactly where, but at Depression Central is a list of the best psychiatric hospitals in the country. And another list of the top psychiatrists. I bet NY has a fair amount of them.
I think the most important thing to consider with any pdoc is that they treat you the way you prefer to be treated, taking into account your unique personality and chemistry. I don't like pdocs who have a favorite strategy or some blanket strategy they use with everyone. My pdoc for example does all the suggesting and decision making with some of his patients because that's the way the want it. But I'm different. I prefer to make my own suggestions and decisions, and use him as a sounding board, a prescription writer, and a safety monitor. He'll offer suggestions as well, which are sometimes better than my own, sometimes not. But the bottom line is I am treated the way I want to be treated. I think that's an important thing to be aware of when screening potential pdocs.
This is the end of the thread.
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