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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by joebob on August 1, 2003, at 10:06:32
i wake up anxious............sometmes almost paralyzed with it, emotionally speaking
i am taking:
trazadone 100 at night for sleep
depakote 750-1000 mg during day and night
just started lexapro, 5mg for 5 days so far at night
sometime valium for extra sleep boostexternal stressors are high now and have been for 3 years
the anxiety has been going on since before the meds, sometimes lifts later in the a.m., sometimes it gets worse and i take a valium and/or drink a beer
any ideas?
Posted by Larry Hoover on August 1, 2003, at 10:38:38
In reply to for larry hoover and jrbecker....anxiety on waking, posted by joebob on August 1, 2003, at 10:06:32
> i wake up anxious............sometmes almost paralyzed with it, emotionally speaking
>
> i am taking:
>
> trazadone 100 at night for sleep
> depakote 750-1000 mg during day and night
> just started lexapro, 5mg for 5 days so far at night
> sometime valium for extra sleep boost
>
> external stressors are high now and have been for 3 years
>
> the anxiety has been going on since before the meds, sometimes lifts later in the a.m., sometimes it gets worse and i take a valium and/or drink a beer
>
> any ideas?The first thing I'd consider is magnesium. Stress depletes magnesium. Chronic stress virtually guarantees magnesium deficiency. Use any mag supplement you want, but not magnesium oxide. Start low dose (200 mg), as it can cause diarrhea. Take 20 minutes before bedtime.
Also, niacinamide. It has natural anxiolytic effects, acting at the same receptor complex as does valium. 500 mg, up to four times a day.
General calming might come with soya lecithin granules. One tablespoon a day. Phosphatidylserine (somewhat more expensive) might also help.
Make sure you're getting your B-vitamins. Get a high potency B-complex, and take it every day.
Lar
Posted by joebob on August 1, 2003, at 11:29:50
In reply to Re: for larry hoover and jrbecker....anxiety on waking » joebob, posted by Larry Hoover on August 1, 2003, at 10:38:38
i get my supps at wholesale and don't really pay that much for phos serine
i can get you them if you like....i'm in l.a.
i did hear yesterday on the radio a neurotoxicologist say that he likes neuro phoa, also known as leci ps
see:
http://www.degussa-bioactives.com/bioactives/html/e/products/brands/lecips/phosphat.htm
and:
as for the book and author see:
TITLE: BrainGate: The New Science to Enhance Emotions, Fight Disease
and Feed Your Most Vital Organ
by Author: J. Robert Hatherillhe's very sharp
joebob
Posted by jrbecker on August 1, 2003, at 11:53:45
In reply to Re: for larry hoover and jrbecker....anxiety on waking » joebob, posted by Larry Hoover on August 1, 2003, at 10:38:38
Stick with Lar's recommendations, they're sure to help.
As you said yourself, you've got a lot of stress on your shoulders right now. But some of the meds you are taking definitely make me think they are adding to the situation.
Lexapro is the first culprit. If I remember correctly, you said it made you slightly hypomanic the first couple of days you had tried the Lex last time. Related to that, many people, including myself, report an underlying anxiety on Lex. For most, this fades with time to an un-noticeable level. For a smaller minority, this is still present after a few months; leading them to switch off of it. At this point, there's no way to know how you'll adjust to it. It's only five days in, and you should give it at least 3-4 weeks before you really make a judgement on this.
Secondly, the Trazodone might be adding to a sense of irritability/anxiety as you first come off of it in the morning. I don't have any first-hand experience with it myself, but this sometimes is what I've heard people are reporting. This would seem to make sense though, here's why: Traz is a 5HT2 antagonist with a short half-life. The 5HT2 receptor is known to help both sleep as well as anxiety. And coming off of that every morning is going to have a slight jarring effect for some people.
Here's my reco's for you: do what you can to manage the stress in the meantime (exercise, relaxation techniques, and all the other suggestions people give us that we usually never take them up on), wait out the Lex for a couple more weeks then talk to your doc about maybe looking into another AD if the anxiety is still latent. Thirdly, I would consider right now what other options you have in terms of a sleep aid -- you can always add the Trazodone back in later if you feel the need. But my belief is that you might find something that works in a combo like Ambien or Sonata with a benzo like Ativan or Xanax, to help you get a good night's rest (try the sleep agent like Ambien first, then add in the benzo little by little to see how much you really need). The addition of a little benzo will also probably cut out most of that early morning anxiety too. Just make sure you're not getting too much overhang sedation the next day, that's why you need to be cautious in adding in too much.
And I just have to mention it, the nicotine hit you are craving in the morning is a (small) part of this picture as well.
Lastly, what's up with the valium? It's a great drug, but hell so is pot. Why not trade it in for something more day-to-day "functional." Once again, the newer benzo's come to mind. Just a thought.
JB
> > i wake up anxious............sometmes almost paralyzed with it, emotionally speaking
> >
> > i am taking:
> >
> > trazadone 100 at night for sleep
> > depakote 750-1000 mg during day and night
> > just started lexapro, 5mg for 5 days so far at night
> > sometime valium for extra sleep boost
> >
> > external stressors are high now and have been for 3 years
> >
> > the anxiety has been going on since before the meds, sometimes lifts later in the a.m., sometimes it gets worse and i take a valium and/or drink a beer
> >
> > any ideas?
>
> The first thing I'd consider is magnesium. Stress depletes magnesium. Chronic stress virtually guarantees magnesium deficiency. Use any mag supplement you want, but not magnesium oxide. Start low dose (200 mg), as it can cause diarrhea. Take 20 minutes before bedtime.
>
> Also, niacinamide. It has natural anxiolytic effects, acting at the same receptor complex as does valium. 500 mg, up to four times a day.
>
> General calming might come with soya lecithin granules. One tablespoon a day. Phosphatidylserine (somewhat more expensive) might also help.
>
> Make sure you're getting your B-vitamins. Get a high potency B-complex, and take it every day.
>
> Lar
Posted by joebob on August 1, 2003, at 12:53:16
In reply to Re: for larry hoover and jrbecker....anxiety on waking » Larry Hoover, posted by jrbecker on August 1, 2003, at 11:53:45
and more recent info has led me to think that for me at least, it's no good in the long run
i have been wondering if i could cut back on the depakote as i originally started it as a predose to the ssri, re: daniel amen
i would prefer ativan at this point to valium...what do you think?
i did try the ambien a while back and found it very short acting. ie i woke up in the middle of the night
btw, something is making me get up in the middle of the night to urinate....a lot of volume, strong odor
thanks,
joebob
Posted by joebob on August 1, 2003, at 13:01:30
In reply to Re: for larry hoover and jrbecker....anxiety on waking » Larry Hoover, posted by jrbecker on August 1, 2003, at 11:53:45
as i said i have started on lex 5mg 1hr before bed, but have read that you are supposed to start with 10mg
any thoughts?joebob
Posted by Dr. Bob on August 1, 2003, at 18:30:40
In reply to larry thanks......great suggestions btw, posted by joebob on August 1, 2003, at 11:29:50
> TITLE: BrainGate: The New Science to Enhance Emotions, Fight Disease
> and Feed Your Most Vital Organ
> by Author: J. Robert HatherillI'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though, and doesn't *have* to be used. If people *choose* not to use it, I'd be interested why not, but I'd like that redirected to Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
Posted by jrbecker on August 1, 2003, at 18:54:36
In reply to Re: for larry hoover and jrbecker lexapro dosing, posted by joebob on August 1, 2003, at 13:01:30
why are you taking it at night, because you're still having issues with daytime sleepiness?
as I stressed before, I think it's smart starting with 5 mg considering your initial hypomania last time (even though you have the depakote in place now).
Posted by joebob on August 2, 2003, at 12:20:35
In reply to Re: for larry hoover and jrbecker lexapro dosing, posted by jrbecker on August 1, 2003, at 18:54:36
no daytime sleepiness, really
more morning anxietytoday i started taking 5mg lex at 9am and will decide later what to do tonight
i first took the lex at night to avoid/minimize side effects
thanks,
joebob
Posted by Capri on August 6, 2003, at 9:02:31
In reply to Re: for larry hoover and jrbecker....anxiety on waking » joebob, posted by Larry Hoover on August 1, 2003, at 10:38:38
JoeBob,
How do you feel on Depokate?? Any side effects?? Any info would be appreciated.
Doc wants me to try it after 10 or so AD's that haven't helped or can't be tolerated.
Thanks!
Capri
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