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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Noa on April 1, 2002, at 17:50:58
Dr. Kramer-
Thanks for being here to answer questions.
I have had chronic, recurrent "double" depression, currently in remission. I take the following cocktail of medications:
Effexor XR 262.5 mg (once in am)
Adderall 10 mg (3 times a day)
Serzone 500 mg (at night)
Lorazepam .25 mg (at night)(helps counter the activating effects of effexor, so I can fall asleep)I also take:
cytomel 12.5 mcg (twice a day)
synthroid 50 mcg (once in am)
glucophage xr 2000 mg (once in am)
allesse 28 (supposedly also helps with mood issues related to reproductive cycle)
tetracycline
This combination of psych. meds seems to keep my depression at bay, with only infrequent breakthrough depressions that don't last very long at all, although I suppose I am still a bit dysthymic.Any thoughts on the following?
1. The main problem is some of the side effects: two are especially bothersome: bladder problems, such as frequent and extreme urgency, and extreme tightness in my face and jaw, sometimes causing headaches. I think the bladder problems are from the serotonergic effects of the Effexor. I think this is also what causes the jaw clenching, but I wonder if it could be the adderall, too.
2. I also wonder about the so-called "SSRI apathy" problem. I know I am not on any SSRIs, but I wonder if Effexor can cause the same problem. During the past few years, while I have been on all of these medications, I feel that I have had difficulty with motivation and initiative. Of course it could be dysthymia, but the suggestion of a SSRI-apathy link on this board and on Psychopharmocology Tips, and in some abstracts on Pubmed, all make me wonder about it.
3. Is it possible to figure out which medicines are doing what--I have built up this cocktail over the years, and it feels like it is hard to distingush at this point which ones are essential and which are not, which are helping the most, etc.
4. Finally--what do you think about dopamine agonists (mirapex?)? Could it possibly allow me to reduce some of the serotonergic medications and therefore hopefully help with the side effects? Could it add further antidepressant benefit?
Thank you!
Posted by Dr. Kramer on April 2, 2002, at 9:50:29
In reply to Dr. Kramer-med cocktail questions, posted by Noa on April 1, 2002, at 17:50:58
> Dr. Kramer-
>
> Thanks for being here to answer questions.
>
> I have had chronic, recurrent "double" depression, currently in remission. I take the following cocktail of medications:
>
>
> Effexor XR 262.5 mg (once in am)
> Adderall 10 mg (3 times a day)
> Serzone 500 mg (at night)
> Lorazepam .25 mg (at night)(helps counter the activating effects of effexor, so I can fall asleep)
>
> I also take:
> cytomel 12.5 mcg (twice a day)
> synthroid 50 mcg (once in am)
> glucophage xr 2000 mg (once in am)
> allesse 28 (supposedly also helps with mood issues related to reproductive cycle)
> tetracycline
>
>
> This combination of psych. meds seems to keep my depression at bay, with only infrequent breakthrough depressions that don't last very long at all, although I suppose I am still a bit dysthymic.
>
> Any thoughts on the following?
>
> 1. The main problem is some of the side effects: two are especially bothersome: bladder problems, such as frequent and extreme urgency, and extreme tightness in my face and jaw, sometimes causing headaches. I think the bladder problems are from the serotonergic effects of the Effexor. I think this is also what causes the jaw clenching, but I wonder if it could be the adderall, too.
>
> 2. I also wonder about the so-called "SSRI apathy" problem. I know I am not on any SSRIs, but I wonder if Effexor can cause the same problem. During the past few years, while I have been on all of these medications, I feel that I have had difficulty with motivation and initiative. Of course it could be dysthymia, but the suggestion of a SSRI-apathy link on this board and on Psychopharmocology Tips, and in some abstracts on Pubmed, all make me wonder about it.
>
> 3. Is it possible to figure out which medicines are doing what--I have built up this cocktail over the years, and it feels like it is hard to distingush at this point which ones are essential and which are not, which are helping the most, etc.
>
> 4. Finally--what do you think about dopamine agonists (mirapex?)? Could it possibly allow me to reduce some of the serotonergic medications and therefore hopefully help with the side effects? Could it add further antidepressant benefit?
>
> Thank you!If you're on a cocktail that basically works, I'd hang in there. There are no side effect (s/e)free med regimens. Period. Meds work in concert so you can never really say one does this or that.
Effexor is an SSRI, but it's also an SNRI (N for Noradrenergic) which in most folks counterbalances the SSRI s/e's.
The jaw stuff is almost certainly the Adderall. You may want to talk to your doc about trying to decrease that. Adderall is a dopamine agonist effectively, so you've been there, done that.
Posted by dove on April 2, 2002, at 15:32:33
In reply to Re: Dr. Kramer-med cocktail questions, posted by Dr. Kramer on April 2, 2002, at 9:50:29
Some more med cocktail questions from the peanut gallery. The questions are at the bottom with my med history preceding them.
I have had my share of revolving P-Doc's and Therapists, as well as many different dxes. Started with a dx of Epilepsy, then Migraineur, then ADHD, then ADHD w/ BP (ultra rapid cycling), GAD, PTSD, Panic Disorder, Agoraphobia, and PMDD.
My last diagnosis (I can hope-the only one left that might fit is "Borderline") is in this order: ADHD, Major Depression possibly coupled with double depression (also dysphoria), PMDD, Panic Disorder, GAD, Classical Migraineur w/ syncope-like aura, SAD, mild OCD, and clinical mild hypoglycemia. I have been directed/advised to remain on a moderately high lean protein diet with moderately low carbs (preferably complex rather than simple). I have done extensive light therapy for two years with the only benefits being that I get half-an-hour of personal time away from my husband and five children. I have tried fixing myself with Natural Remedies (although, our refined chemical "Remedies" are merely their descendants), to no avail.
I am not as hopeless as I once was and am trying to give my children laughter and love despite the emptiness or pain I feel inside. Not one day passes that suicide does not enter my mind at least once, or my negative "talking to myself" appears. I am attentively working on those behaviors, but the suicidal thoughts really do pop out of nowhere, like a quick tap on the shoulder and there's no one there and you turn back just in time for a slap across the cheek.
I feel like I'm on a kiddy roller-coaster, the ups and downs aren't too extreme, and the underlying sadness and hopelessness never quite fades. Things that used to trip my happy wires offer me very little zap, maybe two days at the most. I have so many interests, compelling diversions, things I love to do, make, write, read... yet I feel frozen and unable to enjoy the very things that give me life and vitality.
My husband is no longer able to emotionally support me, and my best friend's husband has forbidden me to enter their lives due to my depressed crying jags that last all of 10-15 minutes (She is the only person I am able to talk with--and she with me.).
Currently, I'm in a place that appears very bleak to me. My latest P-Doc has been very supportive, working with me, not on me. He is in the process of finding a "talk-therapist" who might click with me, as so many others have not. I've had CBT, Desensitization for my agoraphobia and panic attacks, and plain old talk therapy with many a provider, but it seems to backfire for some reason. The meds are the only stability in my life, but I fear that my extreme tolerance to TCA's and the SSRI's will eventually lead to the loss of that minor but critical stability.
I am currently taking:
Adderall (40 mgs p/day),
Serzone (400 mgs p/day),
Amitriptyline (100 mgs p/day),
Neurontin (1800-2400 mgs p/day),
Prozac (40 mgs p/day), and
Klonopin (3 mgs p/day).
I have also taken Ativan for tortuous dental visits, but not in the last 5 months.
This has been my most successful med cocktail thus far.I have never had any blood work/Lab work done since beginning this quest years ago. Below, are all the meds I can clearly remember taking in the past. The only meds that were ever taken alone were the Adderall and the Amitriptyline. Adderall slowed me down quite a bit and caused a mild increase in my depressive state until my body adjusted to its one-task-mind effects.
Mood Stabilizers:
Carbamazepine
Gabapentin
Verapamil [Calan SR]
KlonopinCNS Stimulants:
Methylphenidate
AdderallBenzodiazepines:
alprazolam
Lorazepam
Clonazepam
DiazepamAntidepressants:
Fluoxetine
Nortriptyline
Sertraline
Nefazodone
Bupropion
Buspirone
AmitriptylineNatural Remedies:
Kava Kava
Valerian Root
Saint John's Wort
L-tryptophan
5-HTP
Omega 3s
B12
Inositol
Gingko Biloba
Melatonin1.) Is there a need for lab or blood work to be done when taking 6 or more psychopharmacological meds?
2.) My Dr. says I have a very high tolerance to these meds, including the fact that I have very few side-effects - unless I ramp too fast. Is that normal, to be taking that many meds and still feel depressed? Is there something we're completely missing?
3.) Can I take Gingko Biloba w/ my med-mix (my Dr wasn't sure but said he'd investigate)?
4.) What's your advice regarding a glass of wine or a beer every once and again when attending social-family events?
5.) Apathy, fatigue, hebetation, disinterest in things that I treasure, absolutely no motivation, that waxes and wanes throughout the day, week, month, and year. Any advice as how to jump this hurdle?
6.) Lastly, I've had 6 UTI's in the past 5 months, and have taken four different antimicrobial meds that seem to temporarily stall the infections. These UTI's just happen to coincide with upping my Prozac by another 20 mgs, any connection? And do antibiotics have any effects or interactions with all the other meds?
I know this is really long, but I've never pulled out all the stops before and I need to. Thank you for your precious time, I appreciate it immensely.
dove
Posted by Dr. Kramer on April 2, 2002, at 19:51:25
In reply to Dr. Kramer-med cocktail questions [LONG], posted by dove on April 2, 2002, at 15:32:33
Okay, I'll try...
1)You're not on any meds that require blood monitoring.
2)I doubt you're missing something. You've been taking meds of some kind for a while. As I posted earlier somewhere, the body tries to adjust after a while, and it's normal to need more meds to get the same effect.
3) I don't know of any problem with adding Ginko if you want to try it.
4) Wine or beer in moderation? Try it. (With a designated driver, of course...) I don't think one will hurt, and it may help.
5)Consider SAM-e as an activating drug to try.
6)Drink Water! lots! The more you pee, the lees likely UTI's are. Cranberry Juice is even better. No, I doubt Prozac or Antibiotics have much to do with anything.
Posted by Zo on April 3, 2002, at 0:28:41
In reply to Dr. Kramer-med cocktail questions, posted by Noa on April 1, 2002, at 17:50:58
I'd look to the Serzone as the apathy-culprit, it put me in a very unpleasant apathetic trance. But YMMV!
Zo
Posted by dove on April 3, 2002, at 9:07:08
In reply to Re: Dr. Kramer-med cocktail questions [LONG], posted by Dr. Kramer on April 2, 2002, at 19:51:25
Thank you *so* very much for your time and your answers!
You have come to the same conclusions that my Doctor and I have both landed on. I am taking Cranberry capsules everyday, and I do drink a lot of water, so the UTI's are probably just an untimely coincidence (I'm in the right age group for these things to start popping up).
And I'm very pleased with your advice regarding the Gingko Biloba (I'm looking forward to some cognitive/memory benefits).
1.) Regarding augmenting with SAM-e, any recommended initial dosage?
2.) I am under some financial strain regarding my meds, will SAM-e break the bank but be worth a trial anyway?
What I do find funny is the fact that I haven't built any tolerance to Adderall after all this time (actually lowered it over a year ago) nor to the Klonopin, which seems to be every Doctor's nightmare when writing out those Benzo's scripts. My Amitriptyline has to be played with (moved up and down) for better results, as well as the Prozac, and Neurontin.
3.) Have you seen or treated any major "Discontinuation" problems when merely trying to cut down on the daily dosage of Serzone?
We've also been playing with the timing of many of the meds, like taking 25 mgs. of Ami in the afternoon, or taking all my Neurontin spaced out over the day (which really works quite well).
4.) Do those sort of strategies conventionally work for fast metabolizing, highly tolerant, or atypical responders?I am concerned with weight gain also, and trying to figure out which med is tricking me into feeling hungry all the time. I think the Amitriptyline started it, but as soon as that leveled out, we added more meds and the weight race has been ongoing ever since. I have heard that SAM-e can be of some benefit in this situation as well.
Again, Thank You All for your Time!!!
dove
Posted by Dr. Kramer on April 3, 2002, at 20:34:39
In reply to Re: Dr. Kramer-med cocktail questions [shorter], posted by dove on April 3, 2002, at 9:07:08
1) Try 2-400mg/d to start, just to see if you tolerate it, if it's okay with your doc
2) this may be the deal breaker. SAM-e generally becomes effective in the 12-1600mg/d range, and that's VERY expensive. Price it to see if it's worth it for you.
3) My experience is people come off Serzone okay if they do it slowly.
4) Very hard to predict.
Be well.
This is the end of the thread.
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