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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by shelliR on June 25, 2001, at 9:55:12
My hospital plan was to start selegiline after a 5 day washout from Nardil and to add oxycontin. My depression was so painful that I didn't have the fortitude to try selegiline first so oxycontin was added almost immediately. Came home on 20mg of selegiline and 20mg oxycontin (10mg bid: supposed to be 12 hour release, but it lost any effect for me after hour 8). I was feeling okay to get out and I had a big work thing scheduled for Friday which I didn't want to cancel.
Plan was to continue going up of selegiline to 40mg. I was shakey on the selegiline; also had back pain which I did not associate with it As I continued at home on 20mg I became much more sweaty (clammy sweat) and my back pain moved into my legs. My pdoc did not answer my page either Saturday or Sunday, so I decreased on the selegiline to 10mg, 5mg, and today none.
I see my pdoc this afternoon. What does one do about a pdoc who does not answer pages? Word on him among colleagues is brilliant but not reliable. So I was not absolutely shocked this weekend, just made my own plan.
I tried prozac many years ago and had no bad effects from it, but also no improvement. I wondered if it might be a good base to mix with mirapex. Any feelings about wellbutrin and prozac together? Read some old posts from people who were successful with the mix. Or I could hop back on nardil and hope that if I go up really fast on it, I might get an effect again. (Someone just posted that, but I couldn't find it this morning). Any ideas will be welcome.
I had very bad suicidal feelings Friday and Saturday, but the oxycontin pulled me through once it kicked in.
Shelli
Posted by Marie1 on June 25, 2001, at 15:11:11
In reply to Back from the hospital, re: meds, eliz et al., posted by shelliR on June 25, 2001, at 9:55:12
Shelli,
Have you read *Unchained Memories* by Lenore Terr, MD? She explains alot of the physiological detail about memories and brain functioning. I found it interesting.
Marie
Posted by Lorraine on June 25, 2001, at 16:49:34
In reply to Back from the hospital, re: meds, eliz et al., posted by shelliR on June 25, 2001, at 9:55:12
> I had very bad suicidal feelings Friday and Saturday, but the oxycontin pulled me through once it kicked in.
>
> ShelliJust wanted to let you know that I hear you and changing meds sucks. It helps me to know that I'm just riding a wave and that the darker thoughts pass if I can just distract myself. Distraction is pretty under-rated, i think.
Posted by rmshed on June 25, 2001, at 17:35:45
In reply to Back from the hospital, re: meds, eliz et al., posted by shelliR on June 25, 2001, at 9:55:12
> My hospital plan was to start selegiline after a 5 day washout from Nardil and to add oxycontin. My depression was so painful that I didn't have the fortitude to try selegiline first so oxycontin was added almost immediately. Came home on 20mg of selegiline and 20mg oxycontin (10mg bid: supposed to be 12 hour release, but it lost any effect for me after hour 8). I was feeling okay to get out and I had a big work thing scheduled for Friday which I didn't want to cancel.
>
> Plan was to continue going up of selegiline to 40mg. I was shakey on the selegiline; also had back pain which I did not associate with it As I continued at home on 20mg I became much more sweaty (clammy sweat) and my back pain moved into my legs. My pdoc did not answer my page either Saturday or Sunday, so I decreased on the selegiline to 10mg, 5mg, and today none.
>
> I see my pdoc this afternoon. What does one do about a pdoc who does not answer pages? Word on him among colleagues is brilliant but not reliable. So I was not absolutely shocked this weekend, just made my own plan.
>
> I tried prozac many years ago and had no bad effects from it, but also no improvement. I wondered if it might be a good base to mix with mirapex. Any feelings about wellbutrin and prozac together? Read some old posts from people who were successful with the mix. Or I could hop back on nardil and hope that if I go up really fast on it, I might get an effect again. (Someone just posted that, but I couldn't find it this morning). Any ideas will be welcome.
>
> I had very bad suicidal feelings Friday and Saturday, but the oxycontin pulled me through once it kicked in.
>
> ShelliMy experience with prozac and wellbutrin will never be forgotten. I was actually taking the wellbutrin as help to stop smoking aid. My psych doctor prescribed the prozac and my pulmonary doctor prescribed the wellbutrin. Since the pulmonary doctor knew what other medications that I was on, I just assumed that taking the two together would be ok. I was ok until the wellbutrin got into my bloodstream, about 7 days after starting it, I felt like I was high or drunk and I don't smoke grass or drink, but the feeling was awlful. I was so spaced out that I couldn't drive. I finally went to the psych doctor and he told me that my body couldn't handle the two as a combination. Since prozac had never given me those type of side effects, I ditched the wellbutrin. It took 10 days before I started to feel like myself again. I didn't drive anywhere for a week, my parents took me and picked me up from work. The wellbutrin is a stimulating antidepressant and it also created anxiety for me. Some people might like to feel high, but I personally could not function. BTW, I decided I would try another time to stop smoking.
But everyone is different with medication. Good Luck.
Posted by shelliR on June 25, 2001, at 21:18:53
In reply to Re: Back from the hospital, re: meds, eliz et al., posted by Lorraine on June 25, 2001, at 16:49:34
> > I had very bad suicidal feelings Friday and Saturday, but the oxycontin pulled me through once it kicked in.
> >
> > Shelli
>
> Just wanted to let you know that I hear you and changing meds sucks. It helps me to know that I'm just riding a wave and that the darker thoughts pass if I can just distract myself. Distraction is pretty under-rated, i think.The distraction thing is the reason I am trying to stay out of the hospital right now. Even when depressed I still love my garden, enjoy seeing the neighbor's kids etc. But when the depression feels like it is hitting my core, it is so hard to hang in there and really hard to distract from that intensity of pain. Wow, I never thought that when I came to this board around this time last year, I would still be going through this. I am so thankful my doctor is supporting my use of an opiate to give me some control over the depression.
Shelli
Posted by shelliR on June 25, 2001, at 21:23:26
In reply to Re: Back from the hospital, re: meds, eliz et al. » shelliR, posted by Marie1 on June 25, 2001, at 15:11:11
> Shelli,
> Have you read *Unchained Memories* by Lenore Terr, MD? She explains alot of the physiological detail about memories and brain functioning. I found it interesting.
> MarieI did read that a couple years ago I think. About repressed memories--each chapter about a different person. I remember in paperback it had a really strange violent cover, if it's the same book. I think she has a chapter on Marilyn Vanderbuilt, a former Miss America. I heard her speak several years back at a conference and she is awesome.
Shelli
Posted by shelliR on June 25, 2001, at 21:28:59
In reply to Re: Back from the hospital, re: meds, eliz et al., posted by rmshed on June 25, 2001, at 17:35:45
Thanks for the warning. I haven't even passed that one by my pdoc. I did bring up mirapex and prozac, and I think I may be headed in that direction, starting with prozac. I think I'll put the prozac and wellbutrin idea on hold. I actually at this point don't believe that anything will work for me and I'd sort of like to give up and go back on the Nardil which has carried me for years. It feels so strange not to be taking it; like I am in life now with no safety net.
Shelli
Posted by Lorraine on June 26, 2001, at 9:50:22
In reply to Re: Back from the hospital, re: meds, eliz et al. » Lorraine, posted by shelliR on June 25, 2001, at 21:18:53
> > > I had very bad suicidal feelings Friday and Saturday, but the oxycontin pulled me through once it kicked in.
> > >
> > > Shelli
> >
> > Distraction is pretty under-rated, i think.
>
> The distraction thing is the reason I am trying to stay out of the hospital right now. But when the depression feels like it is hitting my core, it is so hard to hang in there and really hard to distract from that intensity of painAnother thing that helps me is having a plan. If this doesn't work, then on (date), I will try _____; if that doesn't work, then on (date), I will try ______ and so forth on and until I reach ECT. And then I think having an emergency plan--just a plan of action for what you do when things really get bad--I call so-and-so and check into _____. None of these things takes away the pain. What they do is provide me an autopilot system for making decisions at a time when any decision that I would make could not be trusted. You know how they say never think globally when you are in the throws of a deep depression. I'm reading a book right now that I am really enjoying in a crying sort of way "Noon Day Demon" by Andrew Solomon. This man has clearly been there and when I read some of his passages, they are so real that I weep. I think he tore off a bit of his soul and put it in the book.
Posted by judy1 on June 26, 2001, at 23:29:48
In reply to Back from the hospital, re: meds, eliz et al., posted by shelliR on June 25, 2001, at 9:55:12
Shelli,
I'm sorry- I have no idea what you have been going through. I find when I feel suicidal my shrink is the most powerful influence of all- I wish you had a therp that you were really close to, or do you? I mean like I will call several times a day, and he never complains. By the way he also is a great believer in opiates, is there any way to up your dose there? Are you in any physical pain now? Sorry that I don't understand stuff- please know my prayers are with you. Take care, judy
Posted by shelliR on June 27, 2001, at 11:53:55
In reply to Re: Back from the hospital, re: meds, eliz et al. » shelliR, posted by judy1 on June 26, 2001, at 23:29:48
> Shelli,
> I'm sorry- I have no idea what you have been going through. I find when I feel suicidal my shrink is the most powerful influence of all- I wish you had a therp that you were really close to, or do you? I mean like I will call several times a day, and he never complains. By the way he also is a great believer in opiates, is there any way to up your dose there? Are you in any physical pain now? Sorry that I don't understand stuff- please know my prayers are with you. Take care, judyHi Judy. Thanks for the note. I think last week was so hard because I was just out of the hospital and my therp was away. Yes, I do feel a good connection with my therp (as you cutely call it) and she is really good at centering me on the phone if I need that. She's back now and I do feel safer. I can't up the dose of oxycontin because it would make me feel too floaty. But this week is better than last and I am working again. Hope you are doing well, Shelli
Posted by Elizabeth on June 27, 2001, at 12:33:41
In reply to Back from the hospital, re: meds, eliz et al., posted by shelliR on June 25, 2001, at 9:55:12
> My hospital plan was to start selegiline after a 5 day washout from Nardil and to add oxycontin.
That's great news. Oxycodone is similar to morphine, but it has much better oral availability. And opioids are very good for getting you through antidepressant switches (especially those involving MAOIs).
> Came home on 20mg of selegiline and 20mg oxycontin (10mg bid: supposed to be 12 hour release, but it lost any effect for me after hour 8).
Yeah, 8 hours is about right for OxyContin. MS Contin doesn't last the full 12 hours either.
> Plan was to continue going up of selegiline to 40mg.
40 mg was where I gave up on it. I think more might be required, but I had the kind of side effects that you mentioned: jitters, shakiness, etc. It also made my sleep and appetite even worse than they had been previously. Tension can contribute to muscle and joint pain.
> I see my pdoc this afternoon. What does one do about a pdoc who does not answer pages? Word on him among colleagues is brilliant but not reliable.
I once had a pdoc who was really bright but flakey. Great guy, though. Absolutely ADHD, too, so I think he understood me better than most pdocs have. < g > (I never had the guts to enquire as to whether he took Ritalin or anything.)
I'm not sure what to say about your ideas about mixing Prozac with stuff. Mirapex seems like a good plan, though. It's on my to-do list. A friend has convinced me to try one a monstrous multi-AD combination that his pdoc says "always" works: Remeron + Effexor (substituting Meridia, probably, given my past problems with Effexor) + Wellbutrin SR + Lamictal + Provigil.
> I had very bad suicidal feelings Friday and Saturday, but the oxycontin pulled me through once it kicked in.
One caveat: there's nothing wrong with the way you're using the OC, but if you try to d/c it too rapidly you *will* get withdrawal symptoms, and these can be bad especially for depressives. One thing I really like about buprenorphine is the absence of serious withdrawal symptoms.
-elizabeth
Posted by shelliR on June 27, 2001, at 13:43:57
In reply to welcome back » shelliR, posted by Elizabeth on June 27, 2001, at 12:33:41
>
> One caveat: there's nothing wrong with the way you're using the OC, but if you try to d/c it too rapidly you *will* get withdrawal symptoms, and these can be bad especially for depressives. One thing I really like about buprenorphine is the absence of serious withdrawal symptoms.
My understanding from my doctor is that the OC is a permanent part of the developing cocktail--not for just temporary use while changing ADs. It will be interesting to watch my pattern, i.e., if I will need to go up in time, or if I am able to keep the 10mg bid dose. The time release of OC is a solid tablet. If I tried to get off, I would probably switch to hydrocodone first, so I can taper the dose.Shelli
Posted by shelliR on June 27, 2001, at 13:50:12
In reply to welcome back » shelliR, posted by Elizabeth on June 27, 2001, at 12:33:41
A friend has convinced me to try one a monstrous multi-AD combination that his pdoc says "always" works: Remeron + Effexor (substituting Meridia, probably, given my past problems with Effexor) + Wellbutrin SR + Lamictal + Provigil.
>
Wow, are you going to start them all at the same time? I've thought about wellbutrin as a base AD; lamictal was good for me, and provigil made me sleep for two full weeks, 18 hours a day. I never tried remeron because I was afraid of weight gain.Shelli
Posted by Elizabeth on June 28, 2001, at 0:06:24
In reply to Re: welcome back » Elizabeth, posted by shelliR on June 27, 2001, at 13:43:57
> My understanding from my doctor is that the OC is a permanent part of the developing cocktail--not for just temporary use while changing ADs.
OK, good then. FWIW, I've heard of a number of case reports where people used oxycodone, morphine, and in one case oxymorphone (!) for depression and were able to stay on a constant dose -- no tolerance.
> It will be interesting to watch my pattern, i.e., if I will need to go up in time, or if I am able to keep the 10mg bid dose. The time release of OC is a solid tablet. If I tried to get off, I would probably switch to hydrocodone first, so I can taper the dose.
Oxycodone comes in an immediate-release formulation too. (It's just oxy: you don't need to use Percocet or anything like that.)
About my AD combo plan:
> Wow, are you going to start them all at the same time?No, but I'm not going to wait a whole month before adding the next one. The order (for me) should be, I think: Remeron, Meridia, Wellbutrin SR, Provigil (or possibly Cylert, since that's helped me in the past and isn't as expensive), and then maybe Lamictal (might try Neurontin instead since it's a better anxiolytic). I'll probably need Klonopin too, at least to start with, because some of the newer ADs can exacerbate REM sleep parasomnias. Remeron probably won't hurt, but it might not help either (TCAs and MAOIs do help).
> I've thought about wellbutrin as a base AD; lamictal was good for me, and provigil made me sleep for two full weeks, 18 hours a day.
Oh, that's just weird. < g >
> I never tried remeron because I was afraid of weight gain.
I didn't gain any weight on it. I started out at 30mg and rapidly increased to 60. The H1-blocking effect seems to be overwhelmed by the NE-autoreceptor-blocking effect as the dose gets increased.
-elizabeth
Posted by Zo on June 28, 2001, at 2:27:56
In reply to Re: monstrous multi-AD combo » Elizabeth, posted by shelliR on June 27, 2001, at 13:50:12
and provigil made me sleep for two full weeks, 18 hours a day. I never tried remeron because I was afraid of weight gain.
>
> ShelliShelli, that's really interesting. . .Nardil did the same to me, and I've never read a reference to. . .!
Zo
Posted by Elizabeth on June 30, 2001, at 1:37:23
In reply to Re: monstrous multi-AD combo » shelliR, posted by Zo on June 28, 2001, at 2:27:56
> Shelli, that's really interesting. . .Nardil did the same to me, and I've never read a reference to. . .!
You mean the sleeping? Nardil is weird that way: it causes insomnia a lot at night, and drowsiness in the daytime, especially in the afternoon. Marplan and, to a lesser extent, Parnate, were the same for me.
For some people, though, they're just plain sedating. Who knows why?
-elizabeth
Posted by judy1 on June 30, 2001, at 18:46:31
In reply to Re: Back from the hospital, re: meds, eliz et al. » judy1, posted by shelliR on June 27, 2001, at 11:53:55
Hi Shelli,
I'm glad you got through your rough week; I just remembered that I was on a fentanyl (sp?) patch for a while which gave continual release of what felt like ms contin equivalent; so I avoided the peaks and valleys. I was prescribed this through a pain clinic, is this an option for you? BTW my shrink really approved this one- judy
Posted by shelliR on June 30, 2001, at 19:51:35
In reply to another thought for opioid use » shelliR, posted by judy1 on June 30, 2001, at 18:46:31
>
Thanks Judy. I think the oxycontin is doing pretty well. It takes a long time to kick in in the morning, but after that is pretty smooth. There is a nice period in the late afternoon when I take the second pill and the overlap causes a light, peaceful, short-lived high.At this point I am very grateful that a pdoc is giving me OC. He's really sticking his neck out because doctors are followed so closely for giving narcotic prescriptions. And I think, as Elizabeth alludes to in another post, once a doctor prescribes something unorthodox for you, it is probably easier to get it from another doctor. But I hope it works out with him, because OC is going to be a really hard to get, and it is better (peak and valley-wise) than vicidin.
I think you must have heard good news by now. If you posted it, I missed it, but in one thread regarding pregnancy and meds, it sounded like everything was going well for you. If that's the case, I'm really happy for you.
Shelli
Posted by judy1 on June 30, 2001, at 22:06:45
In reply to Re: another thought for opioid use » judy1, posted by shelliR on June 30, 2001, at 19:51:35
Thank you! So far everything is going well. I have had a lot of losses so I try not to be overly optimistic- which just makes everyone think I'm manic anyway :-). Take care, judy
This is the end of the thread.
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