![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by Chloe on July 21, 2001, at 17:11:05
I started Geodon 1 week ago, 20 mgs at bedtime for obsessive thoughts. After 2 days on Geodon, I got so racy, couldn't sleep my usual amount, and I was talking a blue streak. I did not shut up until yesterday, when my mood finally crashed. I felt very depressed and shaky after a day of feeling very pressure, elated and excited.
So, I took the Geodon earlier than usual and began to feel a bit better in the evening. My pdoc said to discontinue the Celexa, because Geodon has some seratonin in it. I stopped that today, and I was much more relaxed and less pressured.
Has anyone else had this hypomanic type response to Geodon? Did the agitation where off? And does anyone else feel shaky and nervous before the next dose? What is the half life of this stuff? If I increase the dose I am afraid that I might get hypomanic again, or even seratonin syndrome (I am so sensitive to anything with seratonin, it's ridiculous!). I was really confused the for a day or two, dizzy, nauseated. I feel ok now, but if the med begins to runout, I start feeling "funny" and shaky again.
Can anyone help me figure out what is going on? Just now, a whole week, the med seems to be kicking for the obsessive thinking. I have never known an antipsychotic that needs to "build up" before it works. Mellaril used to work in 15 minutes for me, years ago.
Any info so appreciated
Chloe
Posted by medlib on July 21, 2001, at 20:53:59
In reply to Help! GEODON, hypomania?, posted by Chloe on July 21, 2001, at 17:11:05
Hi Chloe--
The Geodon lit from Pfizer states that the mean terminal half life is approx. 7 hours and that it takes 2-3 days to reach a "steady state." I had what was probably a brief hypomanic reaction ("flight of ideas", rapid speech) for 2 days about a week into my trial.
It *does* seem to have the potential for significant "wearing off" or withdrawal side effects. Much to my dismay, I had to discontinue Geodon after developing extrapyramidal symptoms on Day 17--very weird, in fact, unheard of. Although I was only taking one 20mg. capsule, when I stopped the drug I began having *severe* panic attacks ("false suffocation syndrome") every 12 hours for about l0 days. (I'd never experienced anything resembling anxiety, much less panic.) Needless to say, this, too, was a completely idiosyncratic response; undoubtedly, no one else in the universe will ever react to Geodon this way. Before all hell broke loose, I thought Geodon was finally "it" for me--the closest I've ever come (or probably ever will come) to normal.
Geodon, like most antipsychotics, is a "dirty" drug--that is, it acts on many different neurotransmitters. So, teasing out exactly what action is responsible for which effect probably is an exercise in futility--especially when individual responses to the *same* substance are so varied.
If you would like to continue on Geodon, I have a suggestion: open the capsule, divide the powder into 2 portions and take half with breakfast, the other half with dinner. Geodon is poorly soluble in water. Also, it is 60% more bioavailable when taken with meals.
Good luck and well wishes---medlib
Posted by Chloe on July 22, 2001, at 8:12:35
In reply to Re: Help! GEODON, hypomania? » Chloe, posted by medlib on July 21, 2001, at 20:53:59
Medlib,
Thanks so much for your post. I am very anxious this morning, since my last dose was 5 pm last night. Once a day dosing seems really silly to me. But more than 20 mgs at this point seems too heavy a dose for me, I am petite. I too think this drug may be the "one", but then I run into feelings and effects I don't understand. Your post has helped alot.But could you elaborate why you stopped it? What do you mean "all hell broke loose?" What happened to make you stop? And it must have been bad if you traded it for "panic" type feelings during withdrawal for 10 days!
My pdoc said quit my 1.5 mgs of Celexa. But now I am thinking that was not such a good idea. I could be having anxiety from lack of that, too.
This is a very difficult med trial for me, and I am quite scared. I hate feeling anxious and energized. Though I am less pressured, thank gawd. I wish I could call my pdoc, but it's not an emergency, and it's a blasted Sunday.
BTW, If I am just licking up the powder, which seems to get absorbed through my tongue!, why must it be with a meal? I don't think the powder even reaches my stomach! And is a snack, like some crackers ok? I like to take some before bed.
Thank you so much for your reply and well wishes. I am sorry this med did not work out for you.
Chloe (on the brink!)PS, leave it to good ol' Pfizer to put this in a capsule form so dividing the dose is a PAIN!
>
> The Geodon lit from Pfizer states that the mean terminal half life is approx. 7 hours and that it takes 2-3 days to reach a "steady state." I had what was probably a brief hypomanic reaction ("flight of ideas", rapid speech) for 2 days about a week into my trial.
>
> It *does* seem to have the potential for significant "wearing off" or withdrawal side effects. Much to my dismay, I had to discontinue Geodon after developing extrapyramidal symptoms on Day 17--very weird, in fact, unheard of. Although I was only taking one 20mg. capsule, when I stopped the drug I began having *severe* panic attacks ("false suffocation syndrome") every 12 hours for about l0 days. (I'd never experienced anything resembling anxiety, much less panic.) Needless to say, this, too, was a completely idiosyncratic response; undoubtedly, no one else in the universe will ever react to Geodon this way. Before all hell broke loose, I thought Geodon was finally "it" for me--the closest I've ever come (or probably ever will come) to normal.
>
> Geodon, like most antipsychotics, is a "dirty" drug--that is, it acts on many different neurotransmitters. So, teasing out exactly what action is responsible for which effect probably is an exercise in futility--especially when individual responses to the *same* substance are so varied.
>
> If you would like to continue on Geodon, I have a suggestion: open the capsule, divide the powder into 2 portions and take half with breakfast, the other half with dinner. Geodon is poorly soluble in water. Also, it is 60% more bioavailable when taken with meals.
>
> Good luck and well wishes---medlib
Posted by Mitch on July 22, 2001, at 14:49:38
In reply to Help! GEODON, hypomania?, posted by Chloe on July 21, 2001, at 17:11:05
Hi chloe,
I have taken other "atypical antipsychotics" and Seroquel (which also has a short half-life as Geodon) done something similar to me. I would only take it at bedtime and I noticed that at work the next day (12+hrs after last dose) that I would be all "speedy" and "wired". I think it is a rebound effect from the dopamine receptors being blocked and then it lifts and shazam!!
Mitch
> I started Geodon 1 week ago, 20 mgs at bedtime for obsessive thoughts. After 2 days on Geodon, I got so racy, couldn't sleep my usual amount, and I was talking a blue streak. I did not shut up until yesterday, when my mood finally crashed. I felt very depressed and shaky after a day of feeling very pressure, elated and excited.
>
> So, I took the Geodon earlier than usual and began to feel a bit better in the evening. My pdoc said to discontinue the Celexa, because Geodon has some seratonin in it. I stopped that today, and I was much more relaxed and less pressured.
>
> Has anyone else had this hypomanic type response to Geodon? Did the agitation where off? And does anyone else feel shaky and nervous before the next dose? What is the half life of this stuff? If I increase the dose I am afraid that I might get hypomanic again, or even seratonin syndrome (I am so sensitive to anything with seratonin, it's ridiculous!). I was really confused the for a day or two, dizzy, nauseated. I feel ok now, but if the med begins to runout, I start feeling "funny" and shaky again.
>
> Can anyone help me figure out what is going on? Just now, a whole week, the med seems to be kicking for the obsessive thinking. I have never known an antipsychotic that needs to "build up" before it works. Mellaril used to work in 15 minutes for me, years ago.
>
> Any info so appreciated
> Chloe
Posted by Chloe on July 22, 2001, at 16:08:31
In reply to Re: Help! GEODON, hypomania? » Chloe, posted by Mitch on July 22, 2001, at 14:49:38
> Hi chloe,
>
> I have taken other "atypical antipsychotics" and Seroquel (which also has a short half-life as Geodon) done something similar to me. I would only take it at bedtime and I noticed that at work the next day (12+hrs after last dose) that I would be all "speedy" and "wired". I think it is a rebound effect from the dopamine receptors being blocked and then it lifts and shazam!!
>
> Mitch
>
>Hi Mitch,
I think you might be on to something there. I too had that problem with Seroquel, but I became irritable, not hypomanic. Why are these meds being perscribed once a day if they have such short half lives??? My mood is enough of a rollercoaster, I don't need a med to exacerbate it!I have done what medlib suggested, and am taking 10 mgs of powder am and pm. Already I feel much calmer.
I so appreciate your responses. I was getting scared. I just couldn't figure what the heck was going on with me...And my pdoc didn't know either. Go figure!
Again, many thanks
Chloe
Posted by medlib on July 22, 2001, at 16:56:12
In reply to Re: Help! GEODON, hypomania? » medlib, posted by Chloe on July 22, 2001, at 8:12:35
Hi Chloe--
I had to stop taking Geodon because of extrapyramidal symptoms--extremely high tension in certain skeletal muscles, most pronounced in the jaw. My jaw felt like it was locked shut--it could only be opened manually. I also had resting tremors in my hands and quads (large muscles of the upper thighs). What is so baffling is that these effects began abruptly, after more than 2 weeks on the drug. All antipsychotic meds can cause EPS, but Geodon was supposed to be the least likely to do so; and these symptoms, if they appear at all, normally do so within 48 hrs. of beginning an antipsychotic.
I can relate somewhat to the feelings you expressed about Geodon; my impression while taking the drug was that it was much more powerful than the SSRIs and stimulants I have taken, and I had a subjective sense of heightened vulnerability. These were feelings that I was more than willing to cope with had I been able to continue the drug.
Re Geodon metabolism: Geodon probably is not being absorbed through your tongue, merely being dissolved in your saliva. I think that the reason it must be taken with food is that it is 99% bound to plasma protein, primarily albumin and glycoprotein. The reason I suggested taking the second dose at dinner rather than at bedtime was to help alleviate the "wearing off" effects you mentioned. Geodon has a moderate affinity for the H1 (histaminic) neurotransmitters; thus, it can make most takers drowsy, at least initially. Naturally, I felt more alert, not at all sleepy, so taking it at bedtime was not an option. If you take it with a snack rather than a meal, you might want to include some protein source.
Re: Celexa. It appears that there is very little overlap in the actions of Celexa and Geodon. Celexa acts *only* on seratonin receptors, but the specific receptor types that Celexa has a high affinity for are not the ones that Geodon affects. (Details available, if desired.) There is a very small potential for liver enzyme metabolism conflict, but, as the enzyme in question is not primary to the metabolism of either med, there is little likelihood of difficulties. If you feel that both drugs have some beneficial effects, I see no problem with the combo. *But*, what I mention comes from the drug literature--I'm not a psychopharm expert like Cam or Sunnely on this board; so, I'm sure that you'll want to be guided by your pdoc on this. If Celexa made you feel less anxious, and, if you do decide to d/c this drug, it may be wise to taper off, in order to minimize possible anxiety rebound; you might check with him on this, too.
Wouldn't it be nice if Pfizer offered 5 and 10mg. doses of Geodon? I don't think that they were considering the potential market as an adjunctive med for depression. (They should--there are far more depressives than schizophrenics.)
Hope your trial goes well.---medlib
Posted by Chloe on July 22, 2001, at 18:40:50
In reply to Re: Help! GEODON, hypomania? » Chloe, posted by medlib on July 22, 2001, at 16:56:12
Medlib,
What a great post. I am sorry you had that reaction. I had EPS once about 15 years ago, when I was given haldol for my anxiety! Wow, was that awful.
What you say rings true about Celexa and Geodon acting on different seratonin receptors. Celexa is the only SSRI that doesn't give me drenching sweats and heat intolerance. However, I only take 1.5 mgs of Celexa (who said it's a weak SSRI? Seems more powerful to me). Well, I am noticing the sweating and heat intolerance returning since I started Geodon. Damn!
I did decide to go back on the Celexa. My mood has crashed terribly. Partly, I think was from the initial agitation wearing off from Geodon (why wasn't I warned?), the second because my pdoc said just stop the Celexa. I started back up at 1 mg today.In regards to taking Geodon with supper, I tried that last night. About 2 hours later I feel asleep on the couch and didn't want to wake up to go to bed. When I did go to bed, I could NOT get back to sleep and tossed the whole night. Don't want that again! I do take Neurontin(TID) at supper, so I am hoping with Geodon BID I will be in better shape.
I would love more detail about the receptors, etc that Geodon hits. The more info about this drug the better I think. Any reason why this drug really tinkers with my memory and train of thought? Lately I have been as stupid as a post and can't remember what I just said. It's getting better, but it has been the weekend, so the real test begins tomorrow when it's back to the real world.
This has been a very tough med trial. I wish the med were more difinitive in it's results. On the one had I feel happier, more energetic, better sense of humor, on the other, I feel scared, and unsure of what is happening in and around me. I guess only time will tell.
Thanks for the great info....
Chloe
BTW, where is CamW? Haven't seen his name in a while.
Posted by Chloe on July 23, 2001, at 21:15:07
In reply to Re: Help! GEODON, hypomania? » medlib, posted by Chloe on July 22, 2001, at 18:40:50
I am really having a tough time with this med. Now I feel a ton of tension in my mouth, clenching down really hard and my tongue brushing my lower teeth.
Pdoc says it's probably EPS, try to hang in a few more days when she will have time to talk about it with me. How do you treat EPS? Is there anything? How about something for the excessive sweating, yuck!
I still am having problems with the spacing of this drug. 10 mgs BID just isn't enough. I need a suppertime dose too. But I can't be licking up powders when I am not at home when the med runs out...Do you think if I took 20 mg cap in the am, I could last til the evening? Or would I still get the rebound effect at 3 or 4 pm like I did with ten mgs?
Any thoughts on how to survive the EPS and the dosing. I did get the ok to increase the milligrams...I just am so confused AGAIN. That I know for sure!
Chloe
Posted by Mitch on July 24, 2001, at 0:43:27
In reply to Re: Help! GEODON, EPS?-Medlib,Cam?, posted by Chloe on July 23, 2001, at 21:15:07
Chloe,
Hope you don't mind me responding to this. But I am hypersensitive to EPS and had it with Risperdal (another atypical and at JUST .5mg DAY) and mildly so with Seroquel AND with some SSRI's. The EPS thing I had with Risperdal was tongue pushing up against the roof of my mouth (which I had with Stelazine eons ago-but was MUCH worse than that) and also brushing behind the back of my teeth as well (also choking sensations-difficulty swallowing).
There are two possibilities here: 1) By dividing the dose ("licking up powders") the medication is getting absorbed through the soft tissues in your mouth/tongue and getting to the nerves more directly that is aggravating the EPS, or 2) It is being caused soley by the med itself-not the route of administration.
Just by the description of your symptoms despite how you are currently taking the med makes me want to recommend discontinuing it-I would call your pdoc and put your foot down about it! The only thing I can say (short term and if you are planning on continuing Geodon despite these effects) is try some OTC Benadryl 25mg (2-3x/daily) and see if the symptoms back off (that should also help with the sweating). If they do-it sounds like EPS for sure. I had SEVERE EPS with Stelazine (a conventional phenothiazine anti-psychotic) in the past and had to go to the ER and get IV Benadryl 100mg to stop it (after one dose!).
I can't believe your pdoc is telling you to "hang in there for a few more days-like no big deal"!
understand where you are at,
Mitch
> I am really having a tough time with this med. Now I feel a ton of tension in my mouth, clenching down really hard and my tongue brushing my lower teeth.
>
> Pdoc says it's probably EPS, try to hang in a few more days when she will have time to talk about it with me. How do you treat EPS? Is there anything? How about something for the excessive sweating, yuck!
>
> I still am having problems with the spacing of this drug. 10 mgs BID just isn't enough. I need a suppertime dose too. But I can't be licking up powders when I am not at home when the med runs out...Do you think if I took 20 mg cap in the am, I could last til the evening? Or would I still get the rebound effect at 3 or 4 pm like I did with ten mgs?
>
> Any thoughts on how to survive the EPS and the dosing. I did get the ok to increase the milligrams...I just am so confused AGAIN. That I know for sure!
> Chloe
Posted by Chloe on July 24, 2001, at 19:12:03
In reply to Re: Help! GEODON, EPS?-Medlib,Cam? » Chloe, posted by Mitch on July 24, 2001, at 0:43:27
> Mitch
>
I am so glad you responded. I want anyone and all who has been down this road to reply!You are probably right that I need to get off of this one because of the mouth stuff...
I got the tongue wiggle from being mellaril for years and years and it never totally disappeared. I guess it's part of me to a greater or lesser degree. I still get that tongue wiggle and clenching under stress, or when I initially started Celexa. Really activating things cause that reaction in my mouth.
I have never had any success with the atypicals, because I always get the tongue thing with in a week. BUT maybe this tongue thing is not TD, but EPS? I always thought it was TD, so I never gave any of the atypicals a fair trial. My impression is that EPS is a more generalized large limb movement, not just an isolated area, like the mouth...Am I wrong?
I have tried benadryl in the past and haven't had much relief, jsut more side effects, like cottonmouth!
When I woke up this am, I was planning to stop this med. But I flipped out before I could do anything, even shower. I was so shaky, teary and and unstable, and I wasn't thinking straight. I did not know what to do. I was inconsolable and I had to give up a med that has made me more productive than I have been in years. I have gotten more done in one week than I have in the last two years! I tried extra valium, but it wasn't enough for me to face the day. So I licked up 10 mgs of my white powder and felt infinitely better. I mean amazingly better. If (or when?) I have to stop this drug I will be in trouble. Am I looking at rehab?My pdoc did say that she thinks that Geodon is NOT supposed to cause TD, hence I am guessing she thinks the mouth stuff is start up EPS. But these ap's are really not to be fooled around with. I just wish they didn't work so well for me.
I do need to have a sit down with my pdoc. But I have to say I am really starting to love life on this drug... ah, until the med begins to wear off!
Thanks for all the advice and support. Keep posting!
Chloe, feeling good now, but...it never lasts
Posted by Mitch on July 25, 2001, at 0:12:16
In reply to Now I am a dopamine junkie. » Mitch, posted by Chloe on July 24, 2001, at 19:12:03
Chloe,
I also had a definitely positive response to conventional and atypical AP's (at low-doses) in the past and recently. After listening to your experiences and comparing them with my similar ones I conclude this should be a rule of thumb for ANY pdoc:
IF THE PATIENT IS NOT HAVING PSYCHOTIC SYMPTOMS AND ESPECIALLY IF THEY ARE BIPOLAR, you SHOULDN'T BE PRESCRIBING ANY ANTIPSYCHOTICS!!! We are especially susceptible to their damaging effects upon dopamine function. Hey, it took me MONTHS to get over the dystonia caused by super-low-dose Risperdal over the course of just three weeks!!! And, I don't think I am back at "square one" like I was before I tried the med. I think Mellaril (thioridazine)and Thorazine (chlorpromazine) is no worse(at lower doses used for BP folks) compared to some of the newer stuff that is touted to be so "free from extrapyramidal symptoms". I was so fascinated with the *newer* AP's that "boosted serotonin to prevent EPS" that were developed and of course I wanted to try them (so I suggested them). I wished I would have kept my mouth shut (in hindsight).
It has already been proven that most people that present at the ER with florid manic symptoms can be controlled in most cases just as well with lorazepam or clonazepam or DEXEDRINE as they can by an antipsychotic. Well isn't it interesting that older meds just don't make any money nowadays?
Another thing is SSRI meds. We know that the extra serotonin decreases dopamine function and EVERY SSRI has "extrapyramidal syndrome" as a possible side-effect. I have also had similar problems with Celexa that you have described (and even worse dystonia with Paxil!).
"Start-up EPS" is not something like headache or nausea that goes away with continued treatment-it gets worse or it gets MASKED by the drug that is causing it.
I have no second thoughts recommending dx'ing of the Geodon. In my mind it is akin to damage control. I can tell from your posts that you have had no psychotic symptoms and you have not reported any.
Take care,
Mitch
Posted by Chloe on July 25, 2001, at 8:54:59
In reply to Re: Now I am a dopamine touchy » Chloe, posted by Mitch on July 25, 2001, at 0:12:16
I get your point. And you are right I am not hearing voices or hallucinating. But I do have very distorted thinking and perceptions that make it difficult to manage in this world.
I don't really feel comfortable being specific about my toubles out here on the www, however, surfice it to say, I have been hospitalized several times, and continue to seek ways to stay sane dispite my "psychotic features."
I know I am going to have big troubles when I stop this stuff. I am so much calmer and able to understand and communicate better. That is one of the hardest things for me. I get into situations where I don't understand the meaning of discussion. I tend to be a bit paranoid and self deprecating and obsessive about things. I will replay a conversation or event over and over in my head, putting a negative twist on everything. I am chronically anehedonic, until Geodon.
So, I really don't know what to do and my pdoc seems at sea as well. She knows me well, and knows the AP's work wonders for me. But at what cost?..I am on two mood stabilizers (Trileptal, neurontin), an AD(Celexa) and a benzo(Valium), which allow me to survive. But with little hope or lust for life. I cannot hold a paying job.
That my story. I wonder how the next chapter is going to go...
Any ideas for a med for anehedonia and distorted thinking that doesn't cause EPS? :)
Chloe
Posted by Mitch on July 25, 2001, at 14:41:21
In reply to Re: Now I am a dopamine junkie » Mitch, posted by Chloe on July 25, 2001, at 8:54:59
Chloe,
There are only a couple of things I could suggest, that I can think of right now. One is lithium which is *supposed* to be more helpful for BP with psychotic features than AC's. You have probably been there done that, though. As far as all of the atypicals-Seroquel has the lowest EPS incidence (and it didn't bother me near as much as Risperdal). Another possibility may be a need to "juggle" your existing med combination without the Geodon. Maybe something is dosed too high or low, maybe one of your existing meds is actually creating more problems than it is solving. Some anticonvulsants (in some people) pushed to too high a dose level can *cause* psychosis and depression, by the way. Perhaps?? the *combination* of the Celexa and the Geodon is causing the EPS? I am taking a tiny dose of Zoloft right now (switched from Celexa) partly because the "tongue thing" happened to me with the Celexa. Hmmm. You said you were sweating excessively... Celexa makes me sweat like a pig-more so than the other SSRI's. You might be able to ditch the Celexa and the EPS might fade...maybe (a long shot). Hey, run all this by your pdoc and see what she thinks ok? I am going to be back in town Sunday.
good luck
Mitch> I get your point. And you are right I am not hearing voices or hallucinating. But I do have very distorted thinking and perceptions that make it difficult to manage in this world.
>
> I don't really feel comfortable being specific about my toubles out here on the www, however, surfice it to say, I have been hospitalized several times, and continue to seek ways to stay sane dispite my "psychotic features."
>
> I know I am going to have big troubles when I stop this stuff. I am so much calmer and able to understand and communicate better. That is one of the hardest things for me. I get into situations where I don't understand the meaning of discussion. I tend to be a bit paranoid and self deprecating and obsessive about things. I will replay a conversation or event over and over in my head, putting a negative twist on everything. I am chronically anehedonic, until Geodon.
>
> So, I really don't know what to do and my pdoc seems at sea as well. She knows me well, and knows the AP's work wonders for me. But at what cost?..I am on two mood stabilizers (Trileptal, neurontin), an AD(Celexa) and a benzo(Valium), which allow me to survive. But with little hope or lust for life. I cannot hold a paying job.
>
> That my story. I wonder how the next chapter is going to go...
> Any ideas for a med for anehedonia and distorted thinking that doesn't cause EPS? :)
> Chloe
Posted by chloe on July 26, 2001, at 20:30:31
In reply to Re: Now I am a dopamine junkie, posted by Mitch on July 25, 2001, at 14:41:21
I realize you are away at the moment....
But, thanks for the informative answer. I have used Li in the past and felt nothing for years on end. I think that is how I got through college.I also have to report, that dropping out the Celexa today has made a dramatic difference with the clenching and tension in my mouth. I did not realize I was so wired and wound up being on both Celexa and Geodon. I blamed all the symptoms soley on Geodon.
I just hope my queitness and ability to "sit still" doesn't turn into meloncholy! Hey at the moment anything is better than the clenching.
I do still have some tongue wag, but I only stopped my 1.5 mgs of Celexa this am...
Take care.
C
Posted by Mitch on July 28, 2001, at 19:36:52
In reply to Now I am a dopamine junkie » Mitch, posted by chloe on July 26, 2001, at 20:30:31
> I realize you are away at the moment....
> But, thanks for the informative answer. I have used Li in the past and felt nothing for years on end. I think that is how I got through college.
>
> I also have to report, that dropping out the Celexa today has made a dramatic difference with the clenching and tension in my mouth. I did not realize I was so wired and wound up being on both Celexa and Geodon. I blamed all the symptoms soley on Geodon.
> I just hope my queitness and ability to "sit still" doesn't turn into meloncholy! Hey at the moment anything is better than the clenching.
> I do still have some tongue wag, but I only stopped my 1.5 mgs of Celexa this am...
> Take care.
> C
Chloe,That is very interesting. While I have been gone I stopped my Zoloft and my "jaw clenching" has tapered off (not to mention improved sleep). Hmm. I am going to stay off it for a while and see what happens.
Mitch
Posted by chloe on July 29, 2001, at 16:43:42
In reply to Re: Now I am a dopamine junkie » chloe, posted by Mitch on July 28, 2001, at 19:36:52
Well, my pdoc has been AWOL for 4 days, so I finally paged her. She said to stop the Geo. Dah!
But I am in total despair. Geodon worked so well for me. I have never felt better or been more productive. I wanted the EPS to go away to badly...You were right that it was not a "start up" symptom, Mitch
The next few days are going to be hell withdrawaling from this stuff...
Pdoc did mention the possibility of trying topomax. Have you ever heard of that for distorted thinking, ruminating, short fused type feelings?
I am very upset that another very effective med
has to go in the crapper due to side effects :(
Chloe
Posted by Mitch on July 29, 2001, at 17:11:32
In reply to No more Geodon... » Mitch, posted by chloe on July 29, 2001, at 16:43:42
> Well, my pdoc has been AWOL for 4 days, so I finally paged her. She said to stop the Geo. Dah!
>
> But I am in total despair. Geodon worked so well for me. I have never felt better or been more productive. I wanted the EPS to go away to badly...You were right that it was not a "start up" symptom, Mitch
>
> The next few days are going to be hell withdrawaling from this stuff...
>
> Pdoc did mention the possibility of trying topomax. Have you ever heard of that for distorted thinking, ruminating, short fused type feelings?
>
> I am very upset that another very effective med
> has to go in the crapper due to side effects :(
> ChloeChloe,
Don't *automatically* assume you are going to have a hell of a withdrawal from the Geodon-you will self-fulfill it if you aren't careful! From what I understand you were not on much of a dose.
So, now you are just on Trileptal for a mood stabilizer right? Does she want to swap the Trileptal for the Topamax or just add it?? Does the Trileptal seem to be doing you any good?
I would suggest a trial of Topamax. It seems to be good for PTSD and OCD-like symptoms from what I have heard here and my own personal experience with it. I would start it at 12.5mg sprinkle caps once at bedtime and GO SLOW on the way up. I mean REAL SLOW. You are hypersensitive to meds like I am. I would stay at just 12.5mg for TWO weeks before increasing it to 25mg at bedtime and then hold it there for TWO more and titrate it in tiny 12.5mg dose increments and HEY, if you find it is working GREAT at 50mg at bedtime, say eight weeks from now, WELL JUST STAY THERE.
I screwed up and increased it rapidly up to 50mg (with a truckload of Neurontin and Klonopin on top of it) and my mind got all fogged up and I got the itchies too, so it wound up getting trashed for me. (not a rash just pruritis) If you are careful and patient (and maybe with less or no Trileptal later on) this might be the one for you. I found it had a very pronounced anxiolytic and antimanic effect. I guess to summarize it seemed to be a great "anti-agitative", good for mixed stuff.
take care,
Mitch
Posted by chloe on July 29, 2001, at 17:31:51
In reply to Re: No more Geodon...topamax? » chloe, posted by Mitch on July 29, 2001, at 17:11:32
Thanks Mitch
You are right about the withdrawal stuff. I have to be a positive thinker!I also am taking some nuerontin (400mgs) with the miniscle dose of Trileptal (375 mgs). I just posted something about it farther down this list in "Trilepal Experiences."
My pdoc also thinks going back to Li maybe a good idea. God, I just can't put up with the tremors and nausea and inability to feel anything good. It's the blah drug for me.
She also mentioned adding maybe 125 mgs of Depakote to my mood stabilizer hodge podge. I am not sure about that one either. I don't like being on so many at subtherapuetic doses... Have you heard of such a treatment stradegy?Ah, I am not really thinking straight. And can't decide what to do about anything right now. But I do think Top. sounds interesting. I need to research and hear more about it. My only concern is the weight loss that tends to come with that med. I am already thin and don't want to have any less of an appetite...
Top. sounds a little like Lamictal, in that you have to titrate slowly...But I hope Top. isn't as activating! I was too racy on Lamictal.I am sorry that Topomax didn't work out for you. But is a retry in the future ruled out?
Thanks for your timely post
Chloe
Posted by Mitch on July 29, 2001, at 23:05:30
In reply to Re: No more Geodon...topamax? » Mitch, posted by chloe on July 29, 2001, at 17:31:51
> Thanks Mitch
> You are right about the withdrawal stuff. I have to be a positive thinker!
>
> I also am taking some nuerontin (400mgs) with the miniscle dose of Trileptal (375 mgs). I just posted something about it farther down this list in "Trilepal Experiences."
>
> My pdoc also thinks going back to Li maybe a good idea. God, I just can't put up with the tremors and nausea and inability to feel anything good. It's the blah drug for me.
> She also mentioned adding maybe 125 mgs of Depakote to my mood stabilizer hodge podge. I am not sure about that one either. I don't like being on so many at subtherapuetic doses... Have you heard of such a treatment stradegy?
>
> Ah, I am not really thinking straight. And can't decide what to do about anything right now. But I do think Top. sounds interesting. I need to research and hear more about it. My only concern is the weight loss that tends to come with that med. I am already thin and don't want to have any less of an appetite...
> Top. sounds a little like Lamictal, in that you have to titrate slowly...But I hope Top. isn't as activating! I was too racy on Lamictal.
>
> I am sorry that Topomax didn't work out for you. But is a retry in the future ruled out?
>
> Thanks for your timely post
> Chloe
Chloe,Well, that is a lot of info! You can check off Lamictal obviously, and you had some negative reactions to Lithium (why revisit something that you had some neg reactions to if you have the time to check out other possibilities?) You know, given that you are on low-doses of everything that you are taking currently and you don't have a stressful demanding job to throw monkey-wrenches in the mix I would suggest you discuss further withdrawals of current meds with your pdoc (Trileptal first) and see how you are feeling...you know take it as it goes...one step at a time.
POSSIBLY: Get to a point where all meds are withdrawn except the one that currently works the *best* for you, say Neurontin, and optimize that ONE med.
When you are ONLY on the Neurontin, push THAT dose UP a *little* at a time and plumb your limits with that ONE med. When you have figured out what the max dose you can take of it that helps you, THEN,
*ADD* some Topamax (the lowest dose is actually 15mg sprinkle-not 12.5mg) at bedtime. You see, you don't want to blow off something that is helpful-if you think that it is causing a side effect when SOMETHING ELSE is really causing it-that is the problem with *modern* polypharmacy-not liver/kidney/CYPxxx interaction problems, but being able to DETERMINE what is REALLY causing problems. The bottom line is that you don't want to "throw out the baby with the bathwater" due to polypharmacy and the confusion that results from it.
I just say this because I am also in a current state of low-dose polypharmacy where it is unclear what is helping/hindering progress.
I wouldn't worry about excessive weight loss with low-dose Topamax. I found Topamax NOT to be activating at all-quite anxiolytic almost neuroleptic-like (well here might be a Geodon replacement??). I would also try Topamax before Depakote.Mitch
Posted by chloe on July 30, 2001, at 10:27:49
In reply to Re: No more Geodon...topamax? » chloe, posted by Mitch on July 29, 2001, at 23:05:30
Hi Mitch
What you say about polytherapy makes sense. However, I don't have one med that I think is really "good" or effective except perhaps valium...And that is not a long term solution.I am not sure what neurontin dose except make me mildly sleepy (doesn't help with anger!). I still had hypomania when I added activiting drugs while being on neurontin and trileptal. Neurontin alone doesn't seem powerful enough. Trilepatal alone is too activating. And more than 1.5 Celexa and I am so racy I become suicidal.
So, I said all that to say I am in a terrible state of confusion, and though I don't have a *paying* job, I have many responsibilities and boyfriend who has a lot of difficultly with my med changes. When ever I got down on anything, at the moment Geodon, I get the worst anger streak and uncontrollable temper. And my dear friend, Anhedonia has also returned with a vengence!
So, if Topomax does have the neuroleptic type feel, it may be worth a try...I don't mind the brain cloud, some folks report. In fact it's a relief to me not to remember every single detail of my day. That's pretty pathetic!
During your short trial of Topo, do you recall it having any effect on your negative feelings (I am not sure if this is an issue for you...so you might not know!)?Thanks so much for you quick replies and thoughtful answers. I have so appreciated your support through this crappy time. Geodon was a BIG mistake. People on this board are much more informed than most pdocs!
Chloe
Posted by Mitch on July 30, 2001, at 12:35:49
In reply to Re: No more Geodon...topamax? » Mitch, posted by chloe on July 30, 2001, at 10:27:49
> Hi Mitch
> What you say about polytherapy makes sense. However, I don't have one med that I think is really "good" or effective except perhaps valium...And that is not a long term solution.Chloe, have you tried Klonopin??
>
> I am not sure what neurontin dose except make me mildly sleepy (doesn't help with anger!). I still had hypomania when I added activiting drugs while being on neurontin and trileptal. Neurontin alone doesn't seem powerful enough. Trilepatal alone is too activating. And more than 1.5 Celexa and I am so racy I become suicidal.I agree that Neurontin doesn't "do it" on it's own. I am taking it with Klonopin and a little Depakote right now. However, I must admit that I had the *best* *positive* response to it than ANY of the others-but then from what I understand people with comorbid ADHD with onset of bipolar while teenagers are supposed to be unique "responders" for Neurontin.
>
> So, I said all that to say I am in a terrible state of confusion, and though I don't have a *paying* job, I have many responsibilities and boyfriend who has a lot of difficultly with my med changes. When ever I got down on anything, at the moment Geodon, I get the worst anger streak and uncontrollable temper. And my dear friend, Anhedonia has also returned with a vengence!No bad vibes intended about being employed or not. It is just when you are undergoing experimentation it can really wreak havoc with either
a) doing the job-ability to focus and
b) temper tantrums can easily end in termination!! (getting hypomanic/dysphoric on an AD for example or failure for a "new" mood stabilizer to well, do it's job)
>
> So, if Topomax does have the neuroleptic type feel, it may be worth a try...I don't mind the brain cloud, some folks report. In fact it's a relief to me not to remember every single detail of my day. That's pretty pathetic!That may have something to do with its ability to help with PTSD. You should get less ruminations and mental churning about daily events which don't help any.
> During your short trial of Topo, do you recall it having any effect on your negative feelings (I am not sure if this is an issue for you...so you might not know!)?
Generally, I just felt a sense of "quiet" with it. No distinct AD activity. But, much less agitation, it really puts a lid on racing thoughts! It might work well with the Neurontin for you.
> Thanks so much for you quick replies and thoughtful answers. I have so appreciated your support through this crappy time. Geodon was a BIG mistake. People on this board are much more informed than most pdocs!
> ChloeNo problem, well we are the guinea pigs aren't we?
Mitch
Posted by chloe on July 30, 2001, at 20:26:48
In reply to Re: No more Geodon...topamax? » chloe, posted by Mitch on July 30, 2001, at 12:35:49
> Chloe, have you tried Klonopin??Yes, about 10 years ago. I found I couldn't function! I didn't stick with it very long, because I think I was totally knocked out from it.
People on this board seem to really have success with it. But I find no reason to switch from something that is working and has worked for years. I do hate the stigma associated with valium, however!I emailed my pdoc about the topamax and when I got home after a long day, she wrote back that she called it in! She said it has AD and antimanic qualities. And is sedating. Sounds too good to be true.
However, I am afraid to try it so soon. I still have Geodon swimming around in me. And I want to get my Celexa back up to 1.5 mgs or so again. I just have a lot equilibrating to do before I add another agent...
I am hoping my mood stays as good as it is now. But I think I am just so relieved to be stopping the AP, that it has made me slightly elated! That mouth stuff was (IS, of course I still have it...and will for a while I am sure) scary and was making me obsess about everything I did with my tongue and lips. Ugh. I also started having a little galactorrea. Can you believe it? At the smallest dose possible too. When the drug works, I get the horrible side effects. NOT FAIR.
I am glad you are having some success with just neurontin/dep/klon. It's a constant balancing act. How are things without the Zoloft?
Thanks for the info on Top.
Chloe, the guinea pig :)
Posted by Mitch on July 31, 2001, at 0:18:29
In reply to Re: No more Geodon...topamax. » Mitch, posted by chloe on July 30, 2001, at 20:29:35
> > Chloe, have you tried Klonopin??
>
> Yes, about 10 years ago. I found I couldn't function! I didn't stick with it very long, because I think I was totally knocked out from it.Well, everything is relative..but could there have possibly been an interaction with or another med that caused it, or too much Klonopin?? I was also on diazepam for many years, but for some reason I got hostile and depressed on diazepam, and that is something I didn't experience with either Klonopin or Xanax..just thought I would let you know that..
> People on this board seem to really have success with it. But I find no reason to switch from something that is working and has worked for years. I do hate the stigma associated with valium, however!
Chloe, please forget STIGMAS about supposedly addictive meds-that is the LAST thing you need to be concerned about.
> I emailed my pdoc about the topamax and when I got home after a long day, she wrote back that she called it in! She said it has AD and antimanic qualities. And is sedating. Sounds too good to be true.
>
> However, I am afraid to try it so soon. I still have Geodon swimming around in me. And I want to get my Celexa back up to 1.5 mgs or so again. I just have a lot equilibrating to do before I add another agent...JUST BE CAREFUL to start the Topamax slowly and take your time with it-you don't want to blow it. I hope she didn't start you out too high..
I suppose taking a fragment of Celexa isn't going to be too harmful-just watch it, OK?>
> I am hoping my mood stays as good as it is now. But I think I am just so relieved to be stopping the AP, that it has made me slightly elated! That mouth stuff was (IS, of course I still have it...and will for a while I am sure) scary and was making me obsess about everything I did with my tongue and lips. Ugh. I also started having a little galactorrea. Can you believe it? At the smallest dose possible too. When the drug works, I get the horrible side effects. NOT FAIR.Don't forget that sometimes it is quite tough to figure out what is truly causing a *problem*! The Celexa could for real be aggravating any lingering EPS that you have.
> I am glad you are having some success with just neurontin/dep/klon. It's a constant balancing act. How are things without the Zoloft?
I feel more *pain* for some reason and I feel like I am procrastinating more than usual. That is probably a withdrawal effect. I sleep better however. I thought I would have a worsening of my social anxiety-but that hasn't happened! Of course I am taking a tiny dose of nortriptyline for my ADHD. But, I have also dropped my clonazepam dosage to .5-.75mg/day successfully..
>
> Thanks for the info on Top.
> Chloe, the guinea pig :)be careful,
Mitch
Posted by chloe on July 31, 2001, at 12:30:59
In reply to Re: No more Geodon...topamax. » chloe, posted by Mitch on July 31, 2001, at 0:18:29
I feel so "off" and agitated from the withdrawal of Geodon. I also have chills and sweats. So, I don't want to rush into a new med. Esp. one that can have some agitating or AD effects. I think I need to balance out my Trileptal/Celexa/Neurontin before I add anything. And would prefer to be off or lower on Trileptal before starting another AC.
Perhaps adding Top. would help with my agitation and feelings of insecurity and fear. But I am not sure what "normal" for me is right now. So adding another med, I think will only confuse me more.
At least I have it as an option...
I am sorry for increased *pain*, but it's nice that you have no increase of social anxiety so far. Sometimes I think the SSRI's make one more tense and anxious, not less. Better sleep is also a plus!!! The tad of nortrip. maybe a good med for you right now.
Thanks Mitch
Chloe
Posted by Mitch on August 1, 2001, at 0:05:47
In reply to Re: I think I'll wait on the Topamax » Mitch, posted by chloe on July 31, 2001, at 12:30:59
> I feel so "off" and agitated from the withdrawal of Geodon. I also have chills and sweats. So, I don't want to rush into a new med. Esp. one that can have some agitating or AD effects. I think I need to balance out my Trileptal/Celexa/Neurontin before I add anything. And would prefer to be off or lower on Trileptal before starting another AC.
>
> Perhaps adding Top. would help with my agitation and feelings of insecurity and fear. But I am not sure what "normal" for me is right now. So adding another med, I think will only confuse me more.
>
> At least I have it as an option...
>
> I am sorry for increased *pain*, but it's nice that you have no increase of social anxiety so far. Sometimes I think the SSRI's make one more tense and anxious, not less. Better sleep is also a plus!!! The tad of nortrip. maybe a good med for you right now.
>
> Thanks Mitch
> ChloeChloe,
That is probably good reasoning-with regard to Trileptal and waiting to start the Topamax. It is something I am doing right now with SSRI's. You just have to put up with some crap and get through it so you have some clearer idea of what is helping or hindering. You definitely don't want Topamax to get prematurely stopped (if it can really help you) because of some *other* med's withdrawal, etc.
The *pain* problems I have are currently being addressed by rapidly increasing my exercising schedule (boost those endorphins!).
Mitch
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