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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by CA 2 NJ on November 5, 2006, at 11:40:05
Hello everyone. I hope you all are well and enjoying your weekend.
I am really desperate and in need of some advice from those who have "been there" with the whole anxiety/depression thing. I respect Doctors and all but I think in order to truly understand what one is going through is to also have the same or similar experiences.
I am currently taking 100mg of Zoloft, 75 mg of Wellbutrin (Immediate release), 75mg of Lamictal, 3 to 3.5mg of Xanax and 3mg of Lunesta each day.
I recently tapered down from 150mg of Zoloft (going down 25mg/week) and the Wellbutrin was added at the same time. This all started 1 1/2 weeks ago.
The problem is that I have been depressed a lot of the time (or sometimes apathetic), am irritable and impatient, sometimes feel like I'm going nuts and out of control (like now), feel like I could cry at any given moment, feel like I could just run around screaming while pulling out my hair (funny-sounding scenario but true), feel either tired or anxious (it varies), can't concentrate and have racing and intrusive thoughts, and am ALWAYS wanting to eat (especially carbs and sweets). Even if I'm not at all hungry.
I realize that lessening my dose of the SSRI may be causing the cravings/hunger but I thought the Wellbutrin may help counteract that. I probably need more of the Wellbutrin as I am taking the smallest available dose.
I should mention that I have been diagnosed with Bipolar I, Major Depression, Generalized Anxiety Disorder, Panic Disorder w/o Agoraphobia, Obsessive-Compulsive Disorder, Borderline Personality Disorder, Social Anxiety Disorder, and a few other things.
All of the meds (except for the Xanax and Lunesta) seem to be activating to me. I can't take more than 75mg of Lamictal without feeling as though I'm jumping out of my skin. And at 150mg of Zoloft I always wanted to cut myself when I saw a knife and truly felt like I was crazy. I also then started gaining weight like crazy. And I am not yet sure if upping my Wellbutrin would be of help.
I have had 1 good day in the past week. And that was the day after I stepped my Zoloft down from 125mg to 100mg. Maybe I should just stay at 125mg?
Obviously I am very confused and am in need of help. I do have an appointment with my Psychiatrist on Wed., 11/8 but I don't know what to do until then.
The last time I saw my Psychiatrist she mentioned something about Lexapro. I have tried it in the past but I remember being really tired on it. At this point that sounds comforting.
I hope this all makes sense as my mind is racing and I feel on the verge of a panic attack or something. And I apologize for it being so lengthy.
Please is anyone has any ideas, suggestions, experiences, ANYTHING they would be willing to share, I would be so extremely grateful. I am really in a bad situation and am feeling out of control. And the last time I felt this way, the Emergency Room was of no help.
Thank you all so very much if you're still here reading. LOL Please take good care and God Bless!
Hugs,
Michelle
Posted by ronaldo on November 5, 2006, at 11:53:27
In reply to In Dire Need of Help! Feel Like I'm Going Nuts! :(, posted by CA 2 NJ on November 5, 2006, at 11:40:05
I have very little to offer, Michelle.
Would getting out of the house and going for a fairly long walk help? I guess it may be too dark for this? Going for a walk usually helps me... It gets the circulation going and increases the heart rate. It's a change of scenery and it takes your mind off your troubles...this is valuable even if it is for a short time only. Sorry this is all I have to offer.
...Alan
Posted by Phillipa on November 5, 2006, at 11:54:32
In reply to In Dire Need of Help! Feel Like I'm Going Nuts! :(, posted by CA 2 NJ on November 5, 2006, at 11:40:05
You must be my twin . I'm not on the same meds but feel the same way. And you're right the ER will only tx life threatening conditions. Just refer you to your doc. So what's the answer to the anxiety and depression at the same time. I'm unable to concentrate too. Are there others out there that feel the same? Love Phillipa
Posted by madeline on November 5, 2006, at 11:58:50
In reply to In Dire Need of Help! Feel Like I'm Going Nuts! :(, posted by CA 2 NJ on November 5, 2006, at 11:40:05
Okay,
Just because you feel like you are going nuts, doesn't mean you are.
Take deep breaths, try to imagine yourself in a very calm, serene place, concentrate on imagining the sound of water running, count backward from 1000 by sevens.
All of these are interruption techniques that are designed to focus your thinking. Use at will.
As far as your meds are concerned, my guess is that wellbutrin is the culprit and this will probably pass.
However, you need to call your pdoc and tell them that this is an emergency and you need to be seen ASAP. This is not something that can wait until the 8th any longer.
How long have you been on the xanax and how often do you take it? Some of what you are experiencing could be the rebound hyperexcitability that the benzos cause. OR you may have developed a tolerance to xanax, but before you do anything, Talk to your doc about that too.
Finally, a lot of ADs make me VERY sensitive to caffeine or other stimulants. Is your scalp crawling? Skin itching? Heart racing or anything like that? Be sure you lay off the caffeine until this passes.
Remember your interruption exercises, call the doctor NOW and tell yourself over and over again you are not going nuts, your body is just telling you that you are.
I hope you feel better very very soon.
Maddie
Posted by CA 2 NJ on November 5, 2006, at 12:40:35
In reply to In Dire Need of Help! Feel Like I'm Going Nuts! :(, posted by CA 2 NJ on November 5, 2006, at 11:40:05
Hello everyone. Thank you all for your kind words of encouragement and compassion. I am very appreciative and thankful. :)
I do think getting out of the house will help and I will do that. As well as the deep breathing and visiualtion. I know both of these have worked in the past but I have this strange paralysing anxiety that makes me just want to sit here and stress.
And Phillipa I am so very sorry that you too are going through this. That makes me feel bad as I don't wish these feelings on anyone. I hope and will say a prayer that you feel better and are able to get someone who understands to help.
Again I thank you all for your kindness and will take each of your comments into definite consideration.
Take good care and God Bless each of you!
Hugs,
Michelle
Posted by Phillipa on November 5, 2006, at 12:58:05
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts! :(, posted by madeline on November 5, 2006, at 11:58:50
Maddie I've never heard of hyperexcitability from benzos could you tell what it is? Love Phillipa
Posted by Racer on November 5, 2006, at 13:10:45
In reply to In Dire Need of Help! Feel Like I'm Going Nuts! :(, posted by CA 2 NJ on November 5, 2006, at 11:40:05
My guess is that, while the Wellbutrin may be part of the agitation, a bigger issue is the lack of meaningful mood stabilization. 75mg of Lamictal isn't considered within the therapeutic range for mood stabilization. If you can't raise it to therapeutic levels, maybe a better idea is to swap it for a more effective mood stabilizer.
I agree with Maddie, about calling your doctor and asking to be seen ASAP. What you're describing is not OK, there's some med in there that isn't wanting to be your friend. The sooner you get to your doctor, the sooner that can be addressed -- and the sooner you can get to feeling better.
And Maddie's also right that you're not nuts. You don't look at all like a cashew, nor even an acorn. ;-) You're just sounding like someone who's having a reaction to medication changes, and probably feels pretty wretched because of it. I've experienced it myself, and I'll bet half the people here have had similar experiences. (In fact, one of my worst was on a combination of Zoloft, Lamictal, and Xanax. If you've been on that combination for a while, it's probably not that, but just in case that's a newer combo for you, it might be how all the drugs you're taking are interacting, not one specific drug.)
Good luck, and I hope you'll let us know what happens.
Posted by CA 2 NJ on November 5, 2006, at 13:38:21
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts » CA 2 NJ, posted by Racer on November 5, 2006, at 13:10:45
> My guess is that, while the Wellbutrin may be part of the agitation, a bigger issue is the lack of meaningful mood stabilization. 75mg of Lamictal isn't considered within the therapeutic range for mood stabilization. If you can't raise it to therapeutic levels, maybe a better idea is to swap it for a more effective mood stabilizer.
>
> I agree with Maddie, about calling your doctor and asking to be seen ASAP. What you're describing is not OK, there's some med in there that isn't wanting to be your friend. The sooner you get to your doctor, the sooner that can be addressed -- and the sooner you can get to feeling better.
>
> And Maddie's also right that you're not nuts. You don't look at all like a cashew, nor even an acorn. ;-) You're just sounding like someone who's having a reaction to medication changes, and probably feels pretty wretched because of it. I've experienced it myself, and I'll bet half the people here have had similar experiences. (In fact, one of my worst was on a combination of Zoloft, Lamictal, and Xanax. If you've been on that combination for a while, it's probably not that, but just in case that's a newer combo for you, it might be how all the drugs you're taking are interacting, not one specific drug.)
>
> Good luck, and I hope you'll let us know what happens.
Thanks so much for your kind reply. I appreciate it! :)As for upping my Lamictal, that always seems to bring on agitation, irritability, impatience, and just plain anxiety! I have tried before and to be honest my Psychiatrist thinks I am taking 100mg right now.
She's all about the higher the dose, the better but I am medication sensitive and usually require less than the average person. Especially with psychiatric meds. I've been this way since day 1 (and I have been trying medications for about 13 years now).
I am wondering if maybe I should just cut out the antidepressants completely and just stay on mood stabilizers, Xanax and the Lunesta? I am Bi-Polar and am not sure if this is what's causing the problem.
One big concern for me is weight gain. And it isn't a vanity issue. I had Gastric Bypass Surgery almost 1 year ago and since being diagnosed as Bipolar in January of this year, I have been struggling like crazy to lose or even maintain my weight. Not to mention my sanity! Or so it seems anyway.
I am game in trying anything that may be of help as I know there's a lot of trial and error involved in medication, but I really don't wanna start packing on the pounds since My Family and I have spent so much money, time, effort, etc. in my weight loss.
I just don't know what to do and am starting to feel hopeless. Man is this depressing! And it always seems like these issues come to a head on the weekend or after business hours so I have no access to professional help. It's maddening!
Again I thank you for your help as I am very grateful. It always makes me feel good when someone reaches out to another to lend a hand. :)
Take good care and God Bless!
Hugs,
Michelle
Posted by CA 2 NJ on November 5, 2006, at 13:55:34
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts! :(, posted by madeline on November 5, 2006, at 11:58:50
> Okay,
>
> Just because you feel like you are going nuts, doesn't mean you are.
>
> Take deep breaths, try to imagine yourself in a very calm, serene place, concentrate on imagining the sound of water running, count backward from 1000 by sevens.
>
> All of these are interruption techniques that are designed to focus your thinking. Use at will.
>
> As far as your meds are concerned, my guess is that wellbutrin is the culprit and this will probably pass.
>
> However, you need to call your pdoc and tell them that this is an emergency and you need to be seen ASAP. This is not something that can wait until the 8th any longer.
>
> How long have you been on the xanax and how often do you take it? Some of what you are experiencing could be the rebound hyperexcitability that the benzos cause. OR you may have developed a tolerance to xanax, but before you do anything, Talk to your doc about that too.
>
> Finally, a lot of ADs make me VERY sensitive to caffeine or other stimulants. Is your scalp crawling? Skin itching? Heart racing or anything like that? Be sure you lay off the caffeine until this passes.
>
> Remember your interruption exercises, call the doctor NOW and tell yourself over and over again you are not going nuts, your body is just telling you that you are.
>
> I hope you feel better very very soon.
>
> Maddie
Thank you for your reply Maddie. It is really an eye opener!It's funny that you mention the possibility of hyperexcitabilty with Xanax and other benzos because there are times where I feel as though I am MORE anxious after taking it than before. But this is not an all the time thing. Only on occasion.
I am one who tends to react differently to medications than others and also I tend to react differently to the same medication at different times. Sometimes a medication will make me drowsy, then other times it will send me through the roof with anxiety. Even when no other changes have been made in meds, diet (including caffeine), exercise, stress, etc. I am very hard to treat, I can't dent that! Wish I could!
As for the Xanax, I have been regularly taking it since January of this year. I started out taking 1.5mg/day of Xanax XR. Then as my anxiety kept increasing (when changing from Paxil to Zoloft). My Doc changed my Xanax to the immediate release formula and prescribed 2mg - 2.5 Then as I continued to go up in the Zoloft (she wanted me up to 200mg/day but I couldn't do it) she then raised it to 3mg.
The changes in the Xanax only began about a month and a half ago. I don't think I am building a tolerance, but it is possible. Rather I believe that Zoloft is too activating for me and is causing a lot of unecessary agitation and anxiety. But I could be wrong. I just see a coincidence.
I don't know but I sure am tired of spending literally hours a day thinking about how I feel (I can't escape it unless I sleep all day which has been happening more), my medications, and rearranging my medications in my pill holder thingy. I spend sooo much time worrying about this that I think it is adding to my already anxious, agigtated, frustrated state of mind.
I just don't know what to do! I guess I just need to get into see my Psychiatrist and tell her (again) how I feel. I am probably her best customer! LOL
Thanks again for your support. I'm so happy there are kind people such as yourself who are willing to lend a hand when someone is going through a rough patch. I am sincerely thankful. It means a lot! :)
Hugs,
Michelle
Posted by CA 2 NJ on November 5, 2006, at 13:57:46
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts! :(, posted by madeline on November 5, 2006, at 11:58:50
> Okay,
>
> Just because you feel like you are going nuts, doesn't mean you are.
>
> Take deep breaths, try to imagine yourself in a very calm, serene place, concentrate on imagining the sound of water running, count backward from 1000 by sevens.
>
> All of these are interruption techniques that are designed to focus your thinking. Use at will.
>
> As far as your meds are concerned, my guess is that wellbutrin is the culprit and this will probably pass.
>
> However, you need to call your pdoc and tell them that this is an emergency and you need to be seen ASAP. This is not something that can wait until the 8th any longer.
>
> How long have you been on the xanax and how often do you take it? Some of what you are experiencing could be the rebound hyperexcitability that the benzos cause. OR you may have developed a tolerance to xanax, but before you do anything, Talk to your doc about that too.
>
> Finally, a lot of ADs make me VERY sensitive to caffeine or other stimulants. Is your scalp crawling? Skin itching? Heart racing or anything like that? Be sure you lay off the caffeine until this passes.
>
> Remember your interruption exercises, call the doctor NOW and tell yourself over and over again you are not going nuts, your body is just telling you that you are.
>
> I hope you feel better very very soon.
>
> Maddie
Oh yeah! I should mention that I do have the itchy thing going on but I don't really eat much caffeine. No coffee, tea, soda, very little chocolate so I don't think that's the culprit. But I sure do go through spells of itching attacks!Another interesting point you have brought to light. :) Thanks again!
Posted by madeline on November 5, 2006, at 14:32:04
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts! :( » madeline, posted by Phillipa on November 5, 2006, at 12:58:05
Sure,
the benzos are notorious for this. They are usually prescribed as anxiolytics, but paradoxically one of the side effects is anxiety.
When the drug is leaving your system, your body rebounds from the benzo-induced depression - often to a highly excitable state. Sometimes it's even worse than if you have never taken the drug.
It's called rebound hyperexcitability and you should ask your doctor about it.
Valium, I believe is the worst drug in the class for this, however, they all do it.
Think of it like compressing a spring, when you let it go, it pops up.
Alcohol does this too.
That is why most physicians prescribe these drugs to be taken regularly instead of PRN.
Maddie
Posted by madeline on November 5, 2006, at 14:36:08
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts! :(, posted by CA 2 NJ on November 5, 2006, at 13:55:34
One thing I thought of that has worked for my friends in the past...
When you call your doc, if you really don't think that they are being as helpful as you think they should be say
"okay, i'm going to the ER and I'm going to take all these pills with me, can the doctor just meet me there, because I really need to be seen."
That usually gets you in for an appt.
maddie
Posted by Johnathan on November 5, 2006, at 17:41:38
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts! :(, posted by madeline on November 5, 2006, at 11:58:50
Hello Michelle, This is a slightly different perspective but I offer it in hopes that you feel better. Each medication rarely has a constant effect on the mind and body, they move in a varying pattern of usefulness and less useful. Each medication providing as best as possible what it was prescribed to do. Picture it as a biorythm with each medicating moving from high to low. There will be times when all medications are at there best and you will feel great and there will be times, hopefully infrequent that the medication will provide its lowest relief. It sounds like you are having one of those times. This is all a normal process and you are not going nuts. It is important to see your doctor as soon as possible as he may have to up your Xanax or another med. Sleeping is a good thing, perhaps he will up the xanax and you can sleep better at night. You have had some very helpful advice I am beginning to see there is a wealth of information among the members of this group. Avoiding coffee and cola was very good, exercise is a great one perhaps an activity you enjoy. Performing a routine task, or several routine tasks in a row. Brush your teeth, comb your hair, wash the dishes. A common repetitive task where little thinking is involved. Visit a pet store or a petting zoo. There is something about babys or small animals that release something in the brain. Take a long relaxing bath with your favorite relaxing music playing and do your visualization techniques. Tell yourself you feel great that the feeling is going away. and repeat this to yourself. force yourself to hold a smile for 5 minutes. This will send signals to your brain that you are well. Positive thinking is a great tool, and of course prayer. I pray that you are doing well Michelle, all bad feelings and difficulties will pass and this is what makes the better times more enjoyable. Johnathan
Posted by Phillipa on November 5, 2006, at 18:23:47
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts! :( » Phillipa, posted by madeline on November 5, 2006, at 14:32:04
Maddie thanks. I wonder if that may be part of my problem. I'm prescribed my valium 20mg all at night. And have been reassured that it will las the full 24hours. So that may not be true? And in the 35years of benzo use all prescribed by pdocs I been the route of valium, to ativan, to xanax, to klonopin, back to combos of them. Till back to the valium. But the first time I was on it I split the dose into 5mg increments. And when on xanax and going through the change had a long acting one to keep the rebound axiety away. Thanks so much Maddie. Love Phillipa
Posted by Phillipa on November 5, 2006, at 18:31:30
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts, posted by CA 2 NJ on November 5, 2006, at 13:38:21
Interesting as my pdocs have said that a stabalization with lamictal is personalized and can start as little as 25mg. And another thing to consider is the bypass surgery. Is it possible that because of it you're getting the full strenght of your meds all at once? I'm not that familiar with absorption rates after bypass but know the stomach is smaller. Love Phillipa
Posted by stargazer on November 5, 2006, at 21:22:48
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts » CA 2 NJ, posted by Phillipa on November 5, 2006, at 18:31:30
As Phillipa indicated, absorption rates are greatly increased after bypass surgery. Your meds are being mainlined into your bloodstream as a result so any effects of a stimulating med will be greatly exaggerated.
YOu have listed many diagnoses, are they all current and what diagnosis is the main one for which you have the most distressing symptoms. It's hard to say what your baseline is at present since you are obviously in a distress mode but it seems as though you need to have your mood stabalized and probably shouldn't be taking Wellbutrin at all. At any rate you should not be on the immediate release type but on the sustained (SR) or extended (XR) release type.
How long have you been seeing your current psychiatrist and are you happy with her? You have a very complicated list of diagnoses and need a great doctor to manage your care because of this. She should be able to see you immediately for the symptoms you are describing. My pdoc will always see me for any acute symptoms since he knows if I call it's a true emergency.Good luck.
SG
Posted by maggiedelena on November 6, 2006, at 16:07:48
In reply to Re: In Dire Need of Help! Feel Like I'm Going Nuts, posted by stargazer on November 5, 2006, at 21:22:48
It sounds like you're experiencing classic Bipolar mixed states and rapid cycling. I've been there -- it's really awful. And if that's the case, you're not on the best drugs to make you feel better, because you're mostly on antidepressants. It's very very common if you're bipolar to respond to antidepressants in exactly the way you describe. Eventually, most people with bipolar have a bad reaction to antidepressants, unless they're very carefully managed, and they're on a mood stabilizer that works. (The dosage you're taking of Lamictal is too low to have any mood stabilizing effects, and Lamictal doesn't even work as a mood stabilizer for everyone).
Definitely treat this as an emergency, and if you can, do some more reading about bipolar, mixed states and rapid cycling. You may be on several medications that are just not right for you, and your pdoc should help you sort that out right away.
Best of luck, hope you feel better soon.
This is the end of the thread.
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