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Dr. Bob is Robert Hsiung, MD,
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Posted by B2chica on April 25, 2011, at 14:34:44
so i've had a lot of stressful things happen in the last two weeks.
just saw pdoc last friday and he didnt change any of my meds. i told him i was feeling a bit lower but that it could be coming down from the 4 weeks of Major high and constant anxiety. he agreed.Today i'm feeling low. crappy. becoming apathetic and not even wanting to try anymore.
*not suicidal and no SI.However, at what point do i call up pdoc again to check meds...i really dont want to try anything else right now. i'm kinda tired of this cr&p. i just want to take what i have and deal with the rest.
do you all think this down is psychological and phsycial from coming down from anxiety marathon and all the stressful things or is it a med thing.and whats my next step.
would i try to augment what i'm on or try different. (not much left to try)...b2c :(
crappy weather and no sun for weeks doesn't help.
Posted by B2chica on April 25, 2011, at 14:42:58
In reply to psychological or meds?, posted by B2chica on April 25, 2011, at 14:34:44
by "major high and constant anxiety" i actually meant "major....high and constant anxiety"
(not manic high).
Posted by mtdewcmu on April 25, 2011, at 16:36:09
In reply to psychological or meds?, posted by B2chica on April 25, 2011, at 14:34:44
> so i've had a lot of stressful things happen in the last two weeks.
> just saw pdoc last friday and he didnt change any of my meds. i told him i was feeling a bit lower but that it could be coming down from the 4 weeks of Major high and constant anxiety. he agreed.
>I think that in the past when I have gone through a period of being tortured with high anxiety, I have crashed into depression when it finally stopped.
> Today i'm feeling low. crappy. becoming apathetic and not even wanting to try anymore.
> *not suicidal and no SI.
>
> However, at what point do i call up pdoc again to check meds...i really dont want to try anything else right now. i'm kinda tired of this cr&p. i just want to take what i have and deal with the rest.
> do you all think this down is psychological and phsycial from coming down from anxiety marathon and all the stressful things or is it a med thing.
>By a med thing, do you mean side effects, or the meds not working well enough? If you didn't just change your meds recently, then it's probably not side effects. And if you are feeling miserable, I think it's safe to say your meds are not working very well.
> and whats my next step.
> would i try to augment what i'm on or try different. (not much left to try)...
>
> b2c :(
>
> crappy weather and no sun for weeks doesn't help.I don't know what your med regimen is right now, but it's always a tough call between staying the course vs changing meds that once worked. If your current meds have never worked, then there's no reason to stick with them (unless you have not given them at least a few weeks). I'm finding that meds that once pooped out may deserve a second chance after you've been off them for a while. So if you have had any past successes, you may want to give them another look.
Posted by Phillipa on April 25, 2011, at 19:29:42
In reply to Re: psychological or meds?, posted by mtdewcmu on April 25, 2011, at 16:36:09
B2chica why not let the doc know again how bad you are feeling and fear a depression which you don not need. Phillipa
Posted by Zyprexa on April 26, 2011, at 3:21:15
In reply to psychological or meds?, posted by B2chica on April 25, 2011, at 14:34:44
Your taking perphenazine now, right? I think you are coming down from a high anxiety state and the perphenazine is depressing you. What I mean by that is its sedating and probably helping anxiety. I think if you give it more time the anxiety will come down more as you stablize. You also may need a higher dose. Also an AD might help for the depression. I find that APs don't help depression and can actualy make you more depressed.
Posted by B2Chica on April 26, 2011, at 12:29:38
In reply to Re: psychological or meds?, posted by mtdewcmu on April 25, 2011, at 16:36:09
2mg perphenazine BID
50mg pristiq
20mg adderall bid or tid
1mg xanax to sleep
between 600mg and 1500mg gabapentin as needed for anxiety during the day.i'm beginning to wonder if the pristiq ever really worked or if the augmentation of zyprexa made me think it worked, or it was just the zyprexa that worked.
i had to go up to 10mg zyprexa and i put on about 25lbs. so i went off.
now finally after 2 months i'm back down to what i was at christmas.i texted pdoc and told him my mood was still slipping and id let him know when it got bad.
we talked on friday and he agreed that the low was from coming off the anxiety (3-4 week) extreme.
but i know this state. it is depression creeping in. regardless of what got me here...i'm here.
but i am so fricking sick and tired of switching meds. i just want to stop. stop it all and let myself crawl in a hole and stare at the dirt. maybe just close my eyes and be done. (not dead...just done).b2c.
> I don't know what your med regimen is right now, but it's always a tough call between staying the course vs changing meds that once worked. If your current meds have never worked, then there's no reason to stick with them (unless you have not given them at least a few weeks). I'm finding that meds that once pooped out may deserve a second chance after you've been off them for a while. So if you have had any past successes, you may want to give them another look.
Posted by mtdewcmu on April 26, 2011, at 14:12:16
In reply to Re: psychological or meds? » mtdewcmu, posted by B2Chica on April 26, 2011, at 12:29:38
It seems to me that you may be over-treated for psychosis and under-treated or improperly-treated for depression/anxiety.
You generally know when you are getting psychotic, and you have good insight regarding the delusions/illusions, right? So perhaps you could only take the perphenazine as needed, as I doubt it is helping your mood. Adderall could be worsening any anxiety and may paradoxically cause dysphoria, so I would experiment with lowering or eliminating that one.
Did you ever have a good response to Pristiq? There are 100mg tablets to try, or you could try switching to a different AD. Lexapro, Celexa, and Zoloft are good ones to try. And I could even see Effexor being good to try, even though Pristiq doesn't seem to be helping.
Posted by B2chica on April 27, 2011, at 10:21:28
In reply to Re: psychological or meds? » B2Chica, posted by mtdewcmu on April 26, 2011, at 14:12:16
Thanks for you comments mtdewcmu.
the perphenazine is actually not for psychosis but as a tranquilizer for the severe anxiety. (thats why its at such low dose). and pdoc already told me its not for mood.
yes i have pretty good insight and awareness of illusions.
Adderall only slightly increases anxiety, but helps greatly with my focus/concentration and helps with my mood.
if i were to eliminate adderall i would only do that if i could get back on ritalin...As for the pristiq... i know ive had good response in the past. just wondering if it just pooped out already. i only stopped before because i got pregnant.
Lexapro made me HORRIBLY tired to where i couldnt function well. zoloft pooped out and made me fat. and celexa i actually havent tried.
Effexor was probably the worst med to date for me. i had HORRIBLE reactions side effect to it. i was scared to even try pristiq but there werent too many options left for me so i wanted to give it a try...it seemed to work when i was first on it.thanks for the help.
b2c.
Posted by mtdewcmu on April 27, 2011, at 10:52:20
In reply to Re: psychological or meds?, posted by B2chica on April 27, 2011, at 10:21:28
> the perphenazine is actually not for psychosis but as a tranquilizer for the severe anxiety. (thats why its at such low dose). and pdoc already told me its not for mood.
It doesn't seem to be working very well even for anxiety, though.
> yes i have pretty good insight and awareness of illusions.
> Adderall only slightly increases anxiety, but helps greatly with my focus/concentration and helps with my mood.You may want to try skipping your dose when you are in a high-anxiety state. If that doesn't help, then start it up again. Just because it was a net positive in the past doesn't mean it always will be.
> if i were to eliminate adderall i would only do that if i could get back on ritalin...
>
> As for the pristiq... i know ive had good response in the past. just wondering if it just pooped out already. i only stopped before because i got pregnant.
>
> Lexapro made me HORRIBLY tired to where i couldnt function well. zoloft pooped out and made me fat. and celexa i actually havent tried.
> Effexor was probably the worst med to date for me. i had HORRIBLE reactions side effect to it. i was scared to even try pristiq but there werent too many options left for me so i wanted to give it a try...it seemed to work when i was first on it.If you have been away from Zoloft for a while, it may have un-pooped.
Trying Celexa is probably not necessary if you can't tolerate Lexapro (but stranger things have happened).
What was Lexapro like at a low dose? There might be a window where it is helpful, but not too sedating. Or you could possibly up the Adderall or Ritalin to overcome sedation, or add Wellbutrin.
Posted by B2chica on April 28, 2011, at 8:23:39
In reply to Re: psychological or meds? » B2chica, posted by mtdewcmu on April 27, 2011, at 10:52:20
Hi Mtdewcmu!
you got that right about the perphenazine. told pdoc that last time and he said he has no intention of increasing it...i have experimented with not taking adderall when my anxiety was so high. it seems to only add slightly to it and only about the first hour after i take it. but when my anxiety starts causing me nausea thats when i just stop taking it. only because it normally does help with mood as well.
ya i was thinking of trying celexa at one time. i'm glad you brought that up. the lexapro worked for the most part very well for me. i just couldnt tolerate the sleep effect...i did try different dosages but nothing seemed to help. course i was dealing with strictly depression at that stage a few years ago, hardly any anxiety. so maybe now even lexapro may be good to try again?? who knows.
and aaah wellbutrin. that was probably my best drug to date (second from zyprexa) i cant even tell you how well that worked for me. Great mood, energy to function, no side effects, even lost a few pounds on it.
i went off it from my first pregnancy. went back on it after that and never worked. i tried two different generics (dont get me started on those!!) and then the real thing...it was like taking sugar pills...nothing.
i mean i wish i understood that poop out thing. i just dont see how a med can work SO well for someone then suddenly not at all...oh well.but at next meeting i think i will talk more about wondering if the pristiq is working and either augmenting it or substituting it with another one.
i do tend to need to watch out with some SSRI's but since i was on lexapro i would think celexa would be ok right?
*****************************
i think one of my biggest issues is that i suffer from pretty rough PTSD. and sometimes its hard to tell the difference between what is psychologically causing symptoms and what is biological. i think the last really low time (tuesday) was psychological from the holiday weekend. cuz i had to leave work early so bad, went to friends house and sat like zombie and cried and curled up some. went home that night had big glass of wine and next day better some.
i still often wonder if i have rapid cycling like every few days? or if its psychological? or what.lets just say i'm a nice challange to my pdoc. :)
thanks much for your input mtdewcmu.
b2c.
Posted by mtdewcmu on April 28, 2011, at 13:29:47
In reply to Re: psychological or meds? » mtdewcmu, posted by B2chica on April 28, 2011, at 8:23:39
> i have experimented with not taking adderall when my anxiety was so high. it seems to only add slightly to it and only about the first hour after i take it. but when my anxiety starts causing me nausea thats when i just stop taking it. only because it normally does help with mood as well.
>That's good, then. I got in trouble for saying this on another board -- but you have to be willing to experiment a little on your own. Waiting for your next monthly appointment to test a new idea can delay relief for really long time.
> ya i was thinking of trying celexa at one time. i'm glad you brought that up. the lexapro worked for the most part very well for me. i just couldnt tolerate the sleep effect...i did try different dosages but nothing seemed to help. course i was dealing with strictly depression at that stage a few years ago, hardly any anxiety. so maybe now even lexapro may be good to try again?? who knows.
>I haven't tried Lexapro because it's too expensive. But it's supposed to have less side effects, not more. It could be worth a try, though, especially since it is so inexpensive. Celexa and Prozac are the cheapest SSRIs.
There had to be a dose low enough to where Lexapro was no longer sedating -- and I'm wondering if it would still benefit you at that dose.
> and aaah wellbutrin. that was probably my best drug to date (second from zyprexa) i cant even tell you how well that worked for me. Great mood, energy to function, no side effects, even lost a few pounds on it.
> i went off it from my first pregnancy. went back on it after that and never worked. i tried two different generics (dont get me started on those!!) and then the real thing...it was like taking sugar pills...nothing.
> i mean i wish i understood that poop out thing. i just dont see how a med can work SO well for someone then suddenly not at all...oh well.
>Did you try going all the way up to 450mg? Wellbutrin has a weak amphetamine-like stimulating effect, and it seems to be highly prone to developing a tolerance and pooping out. The problem is that above 450mg there is increasing risk of seizure. If not for that, I wonder if you could just keep piling on more as it pooped out.
> but at next meeting i think i will talk more about wondering if the pristiq is working and either augmenting it or substituting it with another one.
>From your posts, it seems safe to say that it isn't working.
> i do tend to need to watch out with some SSRI's but since i was on lexapro i would think celexa would be ok right?
>I think so. I can't make any promises, though.
> *****************************
> i think one of my biggest issues is that i suffer from pretty rough PTSD. and sometimes its hard to tell the difference between what is psychologically causing symptoms and what is biological. i think the last really low time (tuesday) was psychological from the holiday weekend. cuz i had to leave work early so bad, went to friends house and sat like zombie and cried and curled up some. went home that night had big glass of wine and next day better some.
> i still often wonder if i have rapid cycling like every few days? or if its psychological? or what.
>I don't think it matters what is psychological versus biological. The meds should help you deal with whatever it is. If there is something obviously non-biological that is making you suffer, like a bad relationship or a bad job, then you ought to change it. But if you still feel miserable after doing that, then you have to look to meds.
> lets just say i'm a nice challange to my pdoc. :)
> thanks much for your input mtdewcmu.
> b2c.yw
Posted by B2chica on April 28, 2011, at 15:29:19
In reply to Re: psychological or meds? » B2chica, posted by mtdewcmu on April 28, 2011, at 13:29:47
i hope you dont get in trouble for that, cuz i do that often. and like someone else told me, i know my body and myself way better than even the best doctor does...cuz i live with myself :)
so i trust my body.i think the dose of lexapro that did work is where the tired started, i couldnt stay up past 8:00 and with a little baby it didnt work well for me. (now i have two little ones...not an option) but we'll see.
i know i did go up to 450 with wellbutrin once and thats when they augmented with zoloft, i think they also added 5 of zyprexa it worked well but i gained about 50lbs...
ya they wouldt let me go over 450 due to siezures.i think the pristiq works very low. just because without it i KNOW i would either be curled up in the closet floor at home or in the hospital. i become very suicidal pretty quickly. so its doing something...just not enough.
but now im wondering something.maybe you can help.
i'm taking gabapentin for as needed anxiety. lately ive been taking between 900-1500 a day. tues when i was really bad i was maxing out. today i've only taken 600...you think the gabapentin could be exacerbating my depression?? when it fixes my anxiety>
or is it the lack of anxiety that makes the depression more noticealbe?thanks!
b2c.
Posted by mtdewcmu on April 28, 2011, at 17:17:13
In reply to Re: psychological or meds? » mtdewcmu, posted by B2chica on April 28, 2011, at 15:29:19
> i'm taking gabapentin for as needed anxiety. lately ive been taking between 900-1500 a day. tues when i was really bad i was maxing out. today i've only taken 600...you think the gabapentin could be exacerbating my depression?? when it fixes my anxiety>
> or is it the lack of anxiety that makes the depression more noticealbe?Depression is listed as a side effect of gabapentin, so I guess it's possible. It seemed like a pretty weak drug when I took it, though. Strong at first, but then I developed a tolerance. I think when I have gone through periods of high anxiety in the past, it has been followed by depression. So it's probably typical.
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