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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Meltingpot on December 6, 2009, at 8:43:25
Hi,
Well at the end of this month I will have finished my third month of being medication free (apart from Zyprexa now and again. During being medication free I have had less energy, have felt very flat and empty, no interest in anything, awful anxiety which doesn't seem to go away for days and then I am back to feeling just empty again.
At the beginning of January I plan on going back on medication but I'm not sure what to do given that I've tried pretty much everything.
I was thinking of going back on high dose Seroxat given that this is the only drug that has really working for me (when it did work) over the past eight years. However, when it did work it only took about a week so I think that if I don't feel better on it after two weeks then I'll ditch it.
I'm also not sure about what do psychiatrist wise. This new psychiatrist who I am paying to see privately (£150 a time) is very good, she listens and seems to know her stuff but there seems to be no point in going to see her just to tell her that I want to go back on Seroxat when I can get it off my Doctor. Also, she tends to leave me on a start up dose for too long but then again I do need professional advice and support.
I've been thinking about possible medication options if the Seroxat doesn't work. I was thinking of high dose Effexor (although I don't think Norepinephrine activation does much for me, neither Reboxetine or Wellbutrin seemed to do anything. I was also thinking of Parnate plus Nortryptaline but then the Nardil didn't seem to help so I'm not sure if Parnate would. I was thinking of Sertraline/Zooloft (high dose) but that only worked a little bit for me last time I took it (for about three months). Then there is Seroxat and moclobemide but that seems to be quite risky (but who cares really). Zyprexa has always seemed to help with the anxiety but I don't particularly like the way I feel on that, I still feel depressed on it just less anxious.
All of this is just making me feel worse as I can see another wasted year of failed drug trials. I wish they would just give me ECT.
I've listed all of the drugs I have tried over the past eight years, can anyone give me some encouragement and advice.
2001 to 2003. Tried the following medications:-
Started 20mg of Seroxat which seemed to exacerbate anxiety and suicidal thoughts
Olanzapine now and again which helps with the anxiety but if I take just a small amount every day I feel too numb.
Mirtazapine No improvement and increased anxiety.
Prothiaden 300mg exacerbated anxiety
Prothiaden and Sertraline Slight lift of depression but not significantly. Passed out.
Prozac and lithium Slight lift of depression but not significant.
Venlafaxine 150mg Slight improvement in depression but still experiencing anxiety.
Lamictal 200mg No improvement.
Sertraline 100mg Slight improvement in depression.
Phenelzine very spaced out on it, in some ways experienced a worsening of depression.
Seroxat 40mg Experienced a significant lifting of depression and anxiety went away.
2004 Went to Vancouver to try out rTMS. Curious to see if it would have any effect. If it was beneficial I wanted to use it another tool if needed in the future. Didnt seem to do anything.
2005 Seroxat seemed to stop working, tried increasing the dose to no avail2005 2009
Seroxat plus Buspirone (for a month) Just increased fatigue.
Seroxat plus Lamictal (for a month) No improvement.
Seroxat plus thyroxine (for a month) No improvement.
Seroxat plus Mirtazapine (for a month) Increased fatigue.
Cymbalta (for a month) Really bad anxiety.
Escitalopram (over a year) Helped with depression but not as effective as the seroxat was when it worked.
Clomipramine (for almost a year) Helped with depression but still not as effective as the Seroxat was when it worked.
Clomipramine with Reboxetine No improvement than on Clomipramine alone.
Also tried adding adding Wellbutrin now and again to the Seroxat but Wellbutrin didnt seem to do anything at all. It didnt even increase the anxiety (which I thought was a common side affect with it).
Denise
Posted by bleauberry on December 6, 2009, at 9:24:53
In reply to New year new drugs - Advice needed., posted by Meltingpot on December 6, 2009, at 8:43:25
1. Parnate.
2. Zoloft, Paxil, or Effexor with Nortriptyline.
3. Zoloft, Paxil, or Effexor with Amitriptyline.
4. Ritalin augmentation.
5. Low dose Naltrexone augmentation (1.5mg-3mg bedtime).
6. Tramadol.Whatever you do, don't go back in the past. Try new stuff.
And look for a cause. Take Diflucan 200mg for a week and see what happens. Take Doxycyline 200mg for a week and see what happens. Take Artemisin for a week and see what happens. All harmless safe trials in such a short time. What you are doing is looking for profound reactions that would highlight a definite cause of your fatigue, depression, and anxiety. Better and infinitely more accurate than a 100 lab tests at ruling in or ruling out a bunch of stuff.
In your post I perceive a lot of "over-thinking". Someone for example might think, "Oh gosh, I could never try Ritalin because I have bad anxiety and a stimulant would make it much worse". Or maybe, "I've tried the most potent serotonin TCA on the planet, so that rules out all other TCAs." When in fact, the TCAs are as different from each other and unpredictable from each other as pine trees are from oak trees or maple trees. In the real world, a significant portion of patients experience relaxation/energy with Ritalin instead of a stimulation/energy. Someone may feel dysphoric on Nortriptyline, yet more like their real self on Amitriptyline, even though Amitriptyline is metabolized into Nortriptyline in the body. Ya know? We can't theorize this stuff or predict this stuff because it aint that simple. For every bit of information we know about a drug or what it does, there are a hundred bits we don't know. We can't predict this stuff. You have to actually try things, especially things you have doubts about.
Everything about drugs, herbs, and the body is much more complicated than what we know. I think we are all guilty at some point or another of thinking theory too much and not actually doing something creative.
Open new chapters. With as many drugs as you've tried, you've actually not tried that many, and you have omitted some of the best ones.
Posted by bulldog2 on December 6, 2009, at 10:18:06
In reply to New year new drugs - Advice needed., posted by Meltingpot on December 6, 2009, at 8:43:25
> Hi,
>
> Well at the end of this month I will have finished my third month of being medication free (apart from Zyprexa now and again. During being medication free I have had less energy, have felt very flat and empty, no interest in anything, awful anxiety which doesn't seem to go away for days and then I am back to feeling just empty again.
>
> At the beginning of January I plan on going back on medication but I'm not sure what to do given that I've tried pretty much everything.
>
> I was thinking of going back on high dose Seroxat given that this is the only drug that has really working for me (when it did work) over the past eight years. However, when it did work it only took about a week so I think that if I don't feel better on it after two weeks then I'll ditch it.
>
> I'm also not sure about what do psychiatrist wise. This new psychiatrist who I am paying to see privately (£150 a time) is very good, she listens and seems to know her stuff but there seems to be no point in going to see her just to tell her that I want to go back on Seroxat when I can get it off my Doctor. Also, she tends to leave me on a start up dose for too long but then again I do need professional advice and support.
>
> I've been thinking about possible medication options if the Seroxat doesn't work. I was thinking of high dose Effexor (although I don't think Norepinephrine activation does much for me, neither Reboxetine or Wellbutrin seemed to do anything. I was also thinking of Parnate plus Nortryptaline but then the Nardil didn't seem to help so I'm not sure if Parnate would. I was thinking of Sertraline/Zooloft (high dose) but that only worked a little bit for me last time I took it (for about three months). Then there is Seroxat and moclobemide but that seems to be quite risky (but who cares really). Zyprexa has always seemed to help with the anxiety but I don't particularly like the way I feel on that, I still feel depressed on it just less anxious.
>
> All of this is just making me feel worse as I can see another wasted year of failed drug trials. I wish they would just give me ECT.
>
> I've listed all of the drugs I have tried over the past eight years, can anyone give me some encouragement and advice.
>
> 2001 to 2003. Tried the following medications:-
>
> Started 20mg of Seroxat which seemed to exacerbate anxiety and suicidal thoughts
> Olanzapine now and again which helps with the anxiety but if I take just a small amount every day I feel too numb.
> Mirtazapine No improvement and increased anxiety.
> Prothiaden 300mg exacerbated anxiety
> Prothiaden and Sertraline Slight lift of depression but not significantly. Passed out.
> Prozac and lithium Slight lift of depression but not significant.
> Venlafaxine 150mg Slight improvement in depression but still experiencing anxiety.
> Lamictal 200mg No improvement.
> Sertraline 100mg Slight improvement in depression.
> Phenelzine very spaced out on it, in some ways experienced a worsening of depression.
> Seroxat 40mg Experienced a significant lifting of depression and anxiety went away.
> 2004 Went to Vancouver to try out rTMS. Curious to see if it would have any effect. If it was beneficial I wanted to use it another tool if needed in the future. Didnt seem to do anything.
> 2005 Seroxat seemed to stop working, tried increasing the dose to no avail
>
> 2005 2009
>
> Seroxat plus Buspirone (for a month) Just increased fatigue.
> Seroxat plus Lamictal (for a month) No improvement.
> Seroxat plus thyroxine (for a month) No improvement.
> Seroxat plus Mirtazapine (for a month) Increased fatigue.
> Cymbalta (for a month) Really bad anxiety.
> Escitalopram (over a year) Helped with depression but not as effective as the seroxat was when it worked.
> Clomipramine (for almost a year) Helped with depression but still not as effective as the Seroxat was when it worked.
> Clomipramine with Reboxetine No improvement than on Clomipramine alone.
> Also tried adding adding Wellbutrin now and again to the Seroxat but Wellbutrin didnt seem to do anything at all. It didnt even increase the anxiety (which I thought was a common side affect with it).
>
>
> Denise
>Also try to be patient and go slow. You mentioned starting seroxat at 20 mg. Maybe that was to high and caused anxiety.I know that's hard when you're suffering. Starting to high can cause med failures because of sides.
Posted by Phillipa on December 6, 2009, at 12:09:18
In reply to New year new drugs - Advice needed., posted by Meltingpot on December 6, 2009, at 8:43:25
Denise not to anger you but didn't you say dysthymia or I'm mistaken in another thread? If so could no meds be the answer? Seriously. An evaluation by a therapist or you pdoc med free what do they feel that you need meds? So many meds. I'm kind of grabbing at straws. Find myself thinking these things. Sorry I suggested it. My bad. Love Phillipa
Posted by RocketMan on December 6, 2009, at 12:20:41
In reply to New year new drugs - Advice needed., posted by Meltingpot on December 6, 2009, at 8:43:25
Hi Denise,
I see your list does not include Effexor combined with Remeron. Neither one of them were particularly effective for me on their own, but together, they seem to turn into a completely different drug? I'm currently taking zoloft and remeron, but will be switching out the zoloft for effexor as I had a good run years age with the combo.
All the best,
Rick
Posted by Meltingpot on December 7, 2009, at 6:22:29
In reply to Re: New year new drugs - Advice needed., posted by bleauberry on December 6, 2009, at 9:24:53
Hi Bleauberry,
Thanks for the words of advice and encouragement. I would try Diflucan, Doxycyline and Artemisin but from checking the first one, I imagine that this is some kind of antifungal drug and it doesn't seem logical to me that the Seroxat might have stopped working because I suddenly developed some kind of fungal infection.
I will take your advice though on the other drugs though. I've definately been a lot worse since coming of the Clomipramine, to the point where I really don't want to live anymore.
I just had this plan that if I came off everything perhaps then the Seroxat would work again when I took it. I can't really see that happening though.
As far as stimulants go, I'm not worried about them making me more anxious at all, I'm more concerned about developing tolerance and then crashing when they stop working.
I confess, I woke up this morning feeling wretched again and I had a few Effexor lying around so I took 150mg just to see what would happen. It did seem to take the edge off the anxiety (unless it's just placebo) but now it seems to be wearing off.
Anyway, thanks again for the advice.Denise
Posted by floatingbridge on December 8, 2009, at 23:32:54
In reply to New year new drugs - Advice needed., posted by Meltingpot on December 6, 2009, at 8:43:25
Hi Denise,
I'm wishing you the best--and hope you get the info you need--and the meds that work for you. That's quite a list. I'm sorry the trials have lasted so long.
Here's to a good 2010 for you,
fb
Posted by Meltingpot on December 10, 2009, at 12:14:45
In reply to Re: New year new drugs - Advice needed. » Meltingpot, posted by Phillipa on December 6, 2009, at 12:09:18
Hi Phillipa,
My diagnosis has been a number of things, dysthymia, double depression etc. However, just because somebody is dysthymic does not mean that they don't need medication.
I think I suffered with dysthymia between 17 and 24 with anxiety to boot and when I started taking prothiaden the depression and anxiety was completely eliminated.
Since coming off the Clomipramine my anxiety has been horrible, I feel like I'm suffocating sometimes, I can't read a book or watch the television and a lot of days all I've wanted to is was walk and walk and walk and keep walking and then of course I have all of the suicidal thoughts on top because I don't seem to be able to enjoy anything, I don't look forward to anything, I can't concentrate and don't seem to have any interest in anything. I'm not this bad on medication.
Denise
Posted by Meltingpot on December 10, 2009, at 12:18:29
In reply to Re: New year new drugs - Advice needed., posted by RocketMan on December 6, 2009, at 12:20:41
Hi,
If you had a good run with Remeron and Effexor years ago then why did you switch out the Effexor for the Zooloft?
Also, how do you feel on Remeron and Zooloft? Remeron was added to my Seroxat when the Seroxat seemed to stop working so well and the Remeron didn't seem to make that much of a difference.
Denise
Posted by Meltingpot on December 10, 2009, at 12:19:21
In reply to Re: New year new drugs - Advice needed. » Meltingpot, posted by floatingbridge on December 8, 2009, at 23:32:54
.
Posted by RocketMan on December 10, 2009, at 12:33:47
In reply to Re: New year new drugs - To Rocket Man, posted by Meltingpot on December 10, 2009, at 12:18:29
Hi Denise,
For the past 10 years or so, my main A/D has been zoloft, but it seems to poop out every 2 years or so. Several years ago, I gave effexor a try and did quite well on it, then poop out. Zoloft appears to be pooping out again so I will be returning to effexor and hopefully get another good run.
I have been taking remeron for the last 8 years or so, primarily to help with my sleep, but I find it helps with my anxiety as well. It also seems to help augment the other A/D somewhat.
I was om clomipramine for 12 years and did quite well on it along with clonazepam. My p/doc wanted me to switch over to the "new and improved" ssri's in 2000, that's when the fun and games began. It's sounds as if our diagnosis is quite similar. I would have to say when zoloft is working, it does a good job in taming my depression/anxiety. I would take zoloft 50mg, remeron 15mg and clonazepam 0.5mg 3/day.Hope you feel well soon.
Rick
Posted by SLS on December 10, 2009, at 13:43:35
In reply to New year new drugs - Advice needed., posted by Meltingpot on December 6, 2009, at 8:43:25
If you decide to revisit venlafaxine (Effexor; Efexor), you must explore dosages higher than 150mg. I would suggest going to at least 300mg. I plan on combining venlafaxine 300mg with nortriptyline (Pamelor) 150mg. Is nortriptyline available in the UK? You could even try using nortriptyline with paroxetine (Paxil; Seroxat). I may have missed it, but have you tried bupropion (Wellbutrin; Zyban)? It often works well in combination with a serotonin reuptake inhibitor (SSRI; SNRI). A good friend of mine is very much improved now that she is taking a combination of escitalopram (Lexapro; Cipralex) and bupropion.
- Scott
Posted by RocketMan on December 10, 2009, at 15:22:57
In reply to Re: New year new drugs - Advice needed. » Meltingpot, posted by SLS on December 10, 2009, at 13:43:35
> If you decide to revisit venlafaxine (Effexor; Efexor), you must explore dosages higher than 150mg. I would suggest going to at least 300mg. I plan on combining venlafaxine 300mg with nortriptyline (Pamelor) 150mg. Is nortriptyline available in the UK? You could even try using nortriptyline with paroxetine (Paxil; Seroxat). I may have missed it, but have you tried bupropion (Wellbutrin; Zyban)? It often works well in combination with a serotonin reuptake inhibitor (SSRI; SNRI). A good friend of mine is very much improved now that she is taking a combination of escitalopram (Lexapro; Cipralex) and bupropion.
>
>
> - ScottHi Scott, I know for me, being a very anxious persons, with a chronic anxiety disorder, high doses of activating A/D's is just not an option. It's a hard act to try and balance the two out for us nervous depressives; lifting the depression while keeping the anxiety in check. I realize you require the higher dose options, but, I'm not familiar with your diagnoses. Do you suffer with a major anxiety disorder/panic attacks, or, primarily the god-awful depression?
Regards,
Rick
Posted by Meltingpot on December 11, 2009, at 13:49:42
In reply to Re: New year new drugs - To Rocket Man » Meltingpot, posted by RocketMan on December 10, 2009, at 12:33:47
Hi Rocketman,
It does sound like our diagnosises are very similiar. You are lucky to be able to keep switching back and forth if you get the same effect each time although not lucky to suffer from this horrible, horrible disorder.
When the Zooloft poops out what would you say happens, do you go back to rock bottom again or is it just a diminished effect. When the Seroxat pooped out on me after two years I didn't return to my former suicidally anxious state but I just seemed to be emotionally numb to everything. I later when on Lexapro and although it did help with the awful anxiety and suicidal thoughts but I couldn't recapture the good feelings, like pleasure and enjoyment and looking forward to things etc etc.
The same with the clomipramine which I had been taking for almost a year, it helped with the anxiety and depression but didn't give me back the feelings of pleasure I had with Seroxat.
Its been hell for me the past couple of weeks since coming off Clomipramine, although it's nice to have my feelings back again I have felt awful.
The other morning I woke up and not being able to face another day of constant anxiety and emptiness I took an Effexor (which I had lying around)it did definately take the edge of the anxiety but I had this emotional numbness again. If I went on Effexor would the emotional numbness be likely to continue?
Also, you say that you took clonazepan daily with the Zooloft and Remeron, sometimes I think clonazepan could help me but I worry about tolerance set in. How long have you taken clonazepan and have you not become tolerant to it?
Denise
Posted by Meltingpot on December 11, 2009, at 14:43:07
In reply to Re: New year new drugs - Advice needed. » Meltingpot, posted by SLS on December 10, 2009, at 13:43:35
Hi Scott,
Yes I would probably go up to 300mg but I'm not sure what norepinephrine will do for me as I think I respond to serotonin type drugs but then who really knows for sure. All I do know is that the Reboxetine seemed to do didley squat for me.
I did try Wellbutrin (I ordered it twice off the internet) and it didn't seem to have any effect at all which is strange as I was expecting it to be really stimulating.
Since coming off all medication I have got really bad as far as anxiety goes but it has reaffirmed my belief that over the last four years since the Seroxat stopped working and whilst on Lexapro and Clomipramine is that whilst they have helped all I have really felt has been a sort of emotional numbness, whilst it's been bearable it has just been sort of going through the motions. I want more than that.
I know that you want more than your 35% too (I've only managed to read two books over the last four years :-)) I hope you hit 75% with the Nortryptaline/Effexor combination. Who knows perhaps rTMS will help you too if you have it. I hope so.
Denise
Posted by meltingpot on December 25, 2009, at 14:33:12
In reply to Re: New year new drugs - To Rocket Man, posted by Meltingpot on December 11, 2009, at 13:49:42
Hi Rick,
You couldn't just answer my previous question about the clonazepam could you. One of my main symptoms seems to be chronic physical anxiety (not mental) and sometimes I really think adding clonazepam to my drug regimen would help but I worry about tolerance developing and then ending up in a worst state.
Have you been taking clonazepam for a long time without developing a tolerance?
Denise
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