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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Sandra62 on April 6, 2007, at 16:32:36
Sorry for the super long post but I feel I really need to give you some history in order for you to get an idea of what might be going on. I feel alone and desperately need your wisdom here.
I came to my PDOC about a year ago with a diagnosis of BP II from another doctor. I was taking 100 mg of Lamictal and 2 mg of Rivotril (Clonazepam/Klonopin). I was in a slight manic phase that presents with outburts of rage and crippling fear. She added 10 mg of Zyprexa which really seemed to be a Godsend. I felt serene and able to relax. Too much in retrospect. I have since ballooned in weight (of course) and my PDOC, my husband, and myself have noticed muscle rigidity and now a very annoying 'blunting' going on.
Recently my PDOC mentioned that she would like me to try stopping all of my medications so that she can see my symptoms med-free for herself. To start from scratch. To confirm a correct diagnosis. She didn't want me to do this until I get back from a short trip to Canada at the end of May, apparently so that she can keep a close eye on me, and since I always get anxiety when I travel she wanted me to stay on them until I return.
But my issue is this. Currently, with the med cocktail I'm on, this severe 'blunting' is ruining my life, I have no motivation, no zest for life, just basic BLAH. Sure I've been calm, but before medication I used to be a creative vibrant woman, an elementary school music teacher (I have since quit), and I am a talented musician and was performing my original songs in public and writing constantly. I would get anxiety but dealt with it with deep breathing and exercise without the benzo I now seem to depend on to do the smallest of things. Even going to the grocery store makes me anxious, it's ridiculous! Worse, I haven't written a song since I started taking these meds, let alone perform - this is a big piece of my spirit that is missing in action and sorely needed to thrive.
Before the diagnosis and medication, as I have said, my main symptom was a short-temper and I also had some impulsive reckless behaviour resulting in spending sprees and illicit drug use (interestingly enough I have gone to the mall recently and dropped $1000 on new clothes and got high from it and then I have had some weed and cocaine lately for the first time in 20 years - what is THAT?? Aren't the meds I'm on supposed to help with this?? I guess I'm self-medicating again, not getting what I need from the meds? ARRRRrrrgggh), plus the aforementioned anxiety/fear keeps creeping back in. However, overall, I tend to be more depressive than manic, and even with meds the depression hasn't lifted, nor the anxiety for the most part unless I up my dosage of Rivotril and that just makes me more depressed.
Where is my LIFE??? Even with the only sometimes impulsive behaviour and temper I was productive and alive. I have two University degrees and used to be a fine teacher! It just got to the point where I couldn't get to work because I was so depressed and when I did I would fly off the handle at the slightess bump in the road, so I left education. I feel that some of this present low phase is exasberated by the fact that both my parents passed away this year. I start therapy in a few days and will address this.
I am sleeping for 14 hours a day so getting out of bed is a problem, let alone getting out of the house to do a thing except maybe meeting friends at a bar once in awhile to drink. That activity is NOT helping balance my mood. Overall, I believe this lack of drive and low mood is the result of the AP I'm on. BTW, I never have had delusions. As for suicidal ideation...Once, years ago, when I was breaking off with a former fiance who fell off the wagon after being sober for 10 years and it was horrid because I loved him so much and saw him and us slipping away, I felt like I wanted to die, but never planned it. I just had a split second thought of opening the door of the truck on the highway and just 'letting myself out'. I had never before or since been at all suicidal. I am in a healthy relationship with another man, my husband of 11 years now and he is a great support.
I have decided to quit drinking altogether and I started exercising a few days ago and I feel a natural high from this. My husband has noticed this immediately and said that I'm in a better mood than I have been for sooooo long. My plan is to dive deeper into overall fitness and stay away from beer to help regain my old self back. Along with trying life again without the current meds I'm on. Perhaps there are others I should try instead. I'm open to that possibility.
Another drag is that I have completely lost my libido and I used to be a very sexual person.
The straw that broke the camels back happened last night. I haven't been able to achieve orgasm with my husband and it's been so frustrating. So I thought I would try masturbation. I could not reach orgasm even with that. I'm sick and tired of feeling this way.I know that meds have their place but I want to be without them to see how the real me is again. I realize that I may very well just run with my tail between my legs right back to them after trying to go without. But in the meantime...
Sooo, here's the deal. I want to do the wash out starting NOW. I guess this could be considered impulsiveness but I want some relief so badly. I feel like these meds are all wrong and screwing with my head, heart, and soul. I tried to page my PDOC to let her know and ask her advice but she is out of the country for Semana Santa (Holy Week) here in Costa Rica. I would like to know what your thoughts are about venturing out on my own with this. I am guessing at how to wean myself off of the meds I'm taking. I currently take:
5 mg Zyprexa
100 mg Lamictal
5 mg Lexapro
1 mg Rivotril (Clonazepam/Klonopin)I see my PDOC on April 12th. I also have my first pyschologist appointment for the start of therapy on April 9th.
I thought I would stop the Zyprexa slowly by cutting the pills in half for a week or so. The Lamictal should definately be taken down slowly as I know about the seizure risk. So maybe 75 for a few days, then 50 for another few days and so on. The Lexapro can't really be cut as I'm already cutting 10 mg in half so I thought maybe an every other day 5 mg for a week. I thought I'd keep taking the 1 mg benzo until I see my PDOC and go from there.
Thoughts?? Thanks in advance for taking the time to read this and respond.
Posted by bassman on April 6, 2007, at 18:00:36
In reply to Med Wash Out Advice - Please Help!, posted by Sandra62 on April 6, 2007, at 16:32:36
I'd definitely keep the Klonopin and taper that later if necessary. For the other drugs, maybe taper and monitor how you feel. Another possibility to to taper one at a time to see if there is one that is causing most of the problems. Lexapro might be the first choice....
Just a couple thoughts; good luck.
Posted by Sandra62 on April 6, 2007, at 18:06:26
In reply to Re: Med Wash Out Advice - Please Help!, posted by bassman on April 6, 2007, at 18:00:36
Posted by Quintal on April 6, 2007, at 18:29:44
In reply to Med Wash Out Advice - Please Help!, posted by Sandra62 on April 6, 2007, at 16:32:36
That was a refreshingly clear, well-structured post Sandra! I think Zyprexa is most likely the drug causing the blunting - it's notorious for that. Zyprexa, Lexapro and Klonopin are probably responsible for the anorgasmia, but mostly the Lexapro and Zyprexa (based on my own experiences). I'd keep the Lamictal for now, especially if you're staying on the Klonopin as benzos can cause emotional lability and a short temper (a bit like alcohol can) when taken alone. I had good results with Lamictal/Klonopin combo, so I know that can work. I've also experienced that feeling of fear starting to creep into every corner of life - far more pervasive than the original, and it's a common problem with long-term benzo use. Long term, it may be better to reserve them for p.r.n (as required) use, and Xanax (if you can get it in Costa Rica) is a probably better for that purpose and less likely to cause depression.
Q
Posted by Sandra62 on April 6, 2007, at 18:56:07
In reply to Re: Med Wash Out Advice - Please Help! » Sandra62, posted by Quintal on April 6, 2007, at 18:29:44
Thanks Quintal! I am surprised that the anorgasmia could be the result of Lexapro as I've been on it before as monotherapy and it was the only SSRI that didn't cause this unwanted side-effect. Shrug. Maybe just a different effect this second time around, I've heard changes can happen like that.
Yes I'm considering keeping the Lamictal...although I came to my PDOC with 100 mg of Lamictal and 2 mg of Rivotril (or more I forget), having been on the Lamictal for a couple weeks and I was cycling into mania with distress. That is why she added the Zyprexa. Maybe I won't react that way this time. Can always give it a try by getting rid of the Zyprexa and Lexapro first and see what happens. I always keep Zyprexa on hand for 'emergencies' anyways as there were times when I tried to stop it (at one point I was on 10 mg) and I got very uncomfortable with anxiety. So I'll also be interested to see how I do without it this time...
As for Xanax my PDOC won't prescribe that one for me. She says it's because of my previous substance abuse. Apparently it is not as long-acting, as you undoubtedly know, and therefor one wants to keep taking it for the same effect. I'm sure it's not like that for everyone but I could see myself getting into that. The only other one she'll consider is Valium. Apparently very similiar to Rivotril with it's longer half-life.
That is interesting that benzo's can cause a similiar reaction like alcohol if taken alone. Things that make you go hmmmm....thanks again for taking the time to read my post, even compliment it nonetheless!, and to respond. I really appreciate it.
Posted by UgottaHaveHope on April 6, 2007, at 19:04:57
In reply to Re: Med Wash Out Advice - Please Help! » Sandra62, posted by Quintal on April 6, 2007, at 18:29:44
It's hard to give a direct answer because you are taking four meds, but Zyprexa would be where the "blunting" is starting from. I have no idea how Zyprexa is interacting with the other meds, which may make it less "blunting" or more intense. There are others on this board that could provide a more educated answer. Stay on the Klonopin, great for anxiety. Michael
Posted by Sandra62 on April 6, 2007, at 19:28:46
In reply to Re: It's hard to give an exact answer, but ..., posted by UgottaHaveHope on April 6, 2007, at 19:04:57
Posted by Sandra62 on April 6, 2007, at 19:30:55
In reply to Re: Med Wash Out Advice - Please Help! » Sandra62, posted by Quintal on April 6, 2007, at 18:29:44
When you say that Lamictal and Klonopin worked well for you are you still on that combo? At what dosages and times of day? Anything else work for you? What is your diagnosis?
Posted by Phillipa on April 6, 2007, at 22:43:52
In reply to Questions for you Quintal, posted by Sandra62 on April 6, 2007, at 19:30:55
Sandra if you are bipolar I'd keep a mood stabalizer on board and if lexapro was good for you before I'd keep that as well as the klonopin. Not fond of Ap's so maybe that one first? one at a time you don't want to end up like me with the multiple switches messes up your brain big time. And yes to excercise. Love Phillipa
Posted by Sandra62 on April 7, 2007, at 13:20:09
In reply to Re: Questions for you Quintal » Sandra62, posted by Phillipa on April 6, 2007, at 22:43:52
Hi Jan, I have been thinking about it and have decided to keep the Lamictal and the Klonopin on board for now. I agree, getting rid of them all at once may not be the way to go.
Since I am Bipolar I need to be aware that one of the main reasons for noncompliance with meds is because one feels better and thinks they no longer need them. But then again, I am not feeling balanced and hate the weight gain so I want to get rid of the AP Zyprexa though as I also believe it is the root of my 'blunting'. I am weaning down the Lexapro too however. I said that it worked for anorgasmia but never felt less depressed with it. So my guess is it is not working at all. Shrug. We shall see. Thanks for taking the time to respond. Hope that you are feeling better soon!
Posted by Phillipa on April 7, 2007, at 20:03:59
In reply to Phillipa, posted by Sandra62 on April 7, 2007, at 13:20:09
Sandra thanks for your well wishes and it sounds like good judgement to me. Your mental health only in my opinion is the most important. Other things can be delt with later. Love Phillipa
This is the end of the thread.
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