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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by floatingbridge on June 6, 2011, at 16:36:20
For anyone curious.
Emsam is down to half patch daily, to be left on 24/7. I miss taking the full dose.
I'm experimenting with applying it at night so it kicks in by the a.m.
15mgs Valium in 5mg increments starting about two hours before bed. It's not the bomb, and I suspect it blurs my vision. I had this once before with Lyrica. Don't ask me why. Gaba something perhaps.
Xanax is gone. Amazing. Valium at night lasts all day. It's a mixed blessing. I suspect that if a sleep solution is found, I could cut back to even 5mg Valium nightly, and all other things working, that would be enough buffer from panic. The Valium isn't a whoopee sensation, but it is not nearly as depressing on my system as klonopin.
Posted by Phillipa on June 6, 2011, at 17:12:56
In reply to med update, posted by floatingbridge on June 6, 2011, at 16:36:20
FB excellent news!!!!! I'm thrilled for you. No sunburn? Hope now. Phillipa
Posted by henryo on June 6, 2011, at 17:29:15
In reply to med update, posted by floatingbridge on June 6, 2011, at 16:36:20
Thank you for keeping us up to date.
Posted by Christ_empowered on June 6, 2011, at 17:56:19
In reply to med update, posted by floatingbridge on June 6, 2011, at 16:36:20
sorry you're still struggling. In terms of sleep...if you need to be SEDATED on occasion, 30mgs restoril should do the trick. Its a benzo, and docs have gotten so used to writing for Ambien that when you ask for it they give you a look (did I mention its more abusable than other benzos?), but hey--that stuff works, and as long as you don't use it every night you won't have to worry too much about tolerance+dependence. I also comes in 7.5, 15, and 22.5mgs capsules, but I really think the 30mgs capsules are the way to go.
Posted by zonked on June 6, 2011, at 18:20:34
In reply to med update, posted by floatingbridge on June 6, 2011, at 16:36:20
Do you know what's up next for you, AD-wise? Any ideas?
Have you ever tried Nardil or Parnate? I'm starting (gradually, which is good!) to improve on Nardil again... Might be a good choice for you especially since anxiety seems to be one of your core symptoms.
Keep your head up girl,
-z
Posted by Christ_empowered on June 6, 2011, at 18:56:02
In reply to Re: med update » floatingbridge, posted by zonked on June 6, 2011, at 18:20:34
yeah, my initial post wasn't very supportive..sorry about pushing a sedative on you.
This battle--the battle against madness and sadness--is rough. I think you're doing quite nicely handling your situation. So, whatever you decide to do in terms of your medications (and I'm sure whatever you do will be quite reasonable), I just want you to know that I support you and I kind of "get" where you're coming from (not entirely, I mean, I don't live inside your brain or anything, but I can empathize).
Good luck!
Posted by floatingbridge on June 7, 2011, at 0:13:46
In reply to Re: med update, posted by Christ_empowered on June 6, 2011, at 18:56:02
CE, your post was supportive. And don't worry about benzo pushing. I respect your knowledge and sense. In fact, I was going to ask why the benzo you mentioned could be considered more addictive than some.
Of course, within a few hours of posting I had an anxiety episode--I prefer it to panic attack, but whatever. I took one,
then two Valiums. Shoots my compliance record, but hey! I was panicking!It's all a work in progress, ain't it?
My doc mentioned xyrem on the phone
in passing. I can see any possible trial of this taking years to come about, and the thought makes me, well, anxious. I haven't read about it much except to correspond a bit with someone who has
greatly recovered from fatigue, depression, anxiety with that onboard. She's going five years strong with it. I'm assuming a sleep study will be necessary.Thanks for your input, CE. Always welcome.
And thanks to Phillipa, henryo, and zonked, too!
Posted by Lepus on June 7, 2011, at 0:31:36
In reply to Re: med update » Christ_empowered, posted by floatingbridge on June 7, 2011, at 0:13:46
Are you giving up on the EMSAM?
Posted by floatingbridge on June 7, 2011, at 1:24:46
In reply to Re: med update, posted by Lepus on June 7, 2011, at 0:31:36
Lepus, I was just thinking about writing you.
This is the deal. I don't want to quit emsam. I feel better at the full 6mg patch, but it seems to further wreck my sleep.
My pdoc thinks it might not be the med for me, but when he realized how
disabling my fatigue had become, he relented for now. Thus the half dose.So I don't know what is in the future.
How are you doing with your med situation?
Posted by Lepus on June 7, 2011, at 12:32:39
In reply to Re: med update » Lepus, posted by floatingbridge on June 7, 2011, at 1:24:46
Sorry to hear that, FB.
I'm still too paranoid to take anything although things are getting worse so I assume I will start something soon.
Posted by floatingbridge on June 7, 2011, at 13:43:48
In reply to Re: med update, posted by Lepus on June 7, 2011, at 12:32:39
Oh, it's o.k. Lepus. I don't feel hopeless like I did last week. Something will work. I am improved. Anything is good, and I think we're finding treatment direction.
You can do it Lepus. I don't minimize your hesitation at all. In fact, it's real sane to me. I feel that we each have to make a risk/benefits analysis and factor in our current misery level.
Hang in there.
fb
Posted by hyperfocus on June 7, 2011, at 14:44:11
In reply to med update, posted by floatingbridge on June 6, 2011, at 16:36:20
It's good you were able to come off the Xanax fb. Valium will be easier to discontinue when you choose to. It's progress - you're moving forward.
Is your insomnia due to the Emasam you think? I know you mentioned the anxiety it was giving you, but could you describe the anxiety - like what does it feel like? Is it like a revved up stimulation thing? Or is it more like persistent worrying or doubt or fear? Or like more physical - hands shaking, trembling? Only thing I could suggest to add to help would be like a small dose of Risperdal. You'd have to ask your doctor about taking it with the other stuff though.
Posted by Christ_empowered on June 7, 2011, at 15:40:38
In reply to Re: med update » Christ_empowered, posted by floatingbridge on June 7, 2011, at 0:13:46
I'm not really sure why restoril is considered to be more problematic than other benzos. I was given the medication in a detox facility. Can't be that bad, right? (Honestly, I think they were willing to give me anything to make me shut up).
In some countries (I think the UK, not sure), restoril is more tightly regulated than other benzos. It comes in a breakaway capsule, so some people have injected it. Maybe that's it? Anyway, its definitely not a long-term, every night sort of thing (I doubt most benzo sleeping pills are), but it is nice now and then to get some good sleep and also get that benzo-induced muscle relaxation.
I wouldn't worry about being "non-compliant." Even though Valium has a bad reputation ("Mother's Little Helper," etc. etc.), its a very safe, effective medication, and its not as potent as xanax or klonopin. I think the rule is 10mgs valium=.5mgs klonopin or xanax. I could be wrong, though. Valium is also easier to taper than the newer, higher-potency benzos. For some reason, though, everyone I know on Valium gets the 5mgs pills, not the 10mgs pills. I wonder what's up with that? Its like, docs will load you up on Klonopin, but they try to under-dose Valium. Weird. (Actually, I think the same thing happens with antipsychotics; people end up on reasonable doses of low-potency drugs, but relatively high doses of high potency antipsychotics.)
I hope things get better. Have you tried supplements? I don't want to force my vitamin-popping lifestyle on you, but since I'm in a benzo-free environment (public health, gotta love it), I've had to treat my anxiety with "alternative" remedies. My magic combo: 3 grams niacinamde (I do 2 doses, lots of people do 3+) and 6 grams taurine (1 dose at night). I take other stuff, too, but its those two that really seem to keep the agitation+anxiety away. Niacinamide makes benzos and anticonvulsants work better (something about "potentiating" them through GABAergic something or other...I dunno, it worked when I took it w/ Klonopin+depakote), so you might get more mileage out of your Rx if you take an adequate amount of niacinamide. Taurine is apparently something of an anti-manic; I wouldn't say it helps anxiety per se, but it does help with the agitation I used to get.
I really hope you can find relief.
Posted by floatingbridge on June 7, 2011, at 18:00:06
In reply to restoril, supplements, posted by Christ_empowered on June 7, 2011, at 15:40:38
CE, that info does help, esp to explain why my gp suggested taurine. Do you think I packed a single supplement for my trip?
Your post also answers why (Larry brought this up) that you take so much taurine.
Now niaminicide. Is that niacin? It must be different, because niacin gives that 'flush' feeling, right?
I ran that benzo chart past my pdoc, too. His response was to say that he doesn't rely on the charts because Valium dosage and effect varies greatly person to person. Wiki has something about it that I didn't quite catch. About accumulative levels. (He capped me at 15mg but sent me off with way more. Now my gp. She just gave me 5mg period and scripted me for ten pills for ten days. Again, period. She would not budge. That was my first go round. When I looked up equivalency afterwards, I was shocked at the discrepancy and really worried about going into some kind of withdrawal. She's a zealot. She scares me. That seems to be a harsh way to deal with someone struggling with anxiety.)
Yeah, so underscripting seems to reign. I am doing alright on the 15mg. I didn't go over yesterday after all. I took one more near bed and slept.
I think my anxiety episodes are breakthrough, like certain pain is referred to as break through.
But seems I write something here one day, only to have the next day surprise me :-/
Thanks tons for the info & support.
fb
Posted by floatingbridge on June 7, 2011, at 18:28:48
In reply to Re: med update » floatingbridge, posted by hyperfocus on June 7, 2011, at 14:44:11
> It's good you were able to come off the Xanax fb. Valium will be easier to discontinue when you choose to. It's progress - you're moving forward.
>Hi hp,
Yes, I agree with you about the above.
> Is your insomnia due to the Emasam you think?Yes, in part. But the insomnia dates back to childhood. Before emsam came aboard, my garden variety sleep aids like
(lovely, lovely) Sonata had cr*pp*d out.
Xanax was already beginning to ramp up.So here's a possible complication. My thyroid was becoming unstable on armour thyroid. I had the gp up my dose. Armour contains some t3. The last time I had t3, well that's what sent me back to the shrink three years ago. Doh.
I get it now. My tsh was measured at .05. Not .5. I was becoming hyper-thyroid. Hence the agitation.>I know you mentioned the anxiety it was giving you, but could you describe
the anxiety - like what does it feel like? Is it like a revved up stimulation thing? Or
is it more like persistent worrying or
doubt or fear? Or like more physical - hands shaking, trembling?Emsam, revved up. It helps push away
the persistent worrying you mention. It's
so mixed.As soon as I took away the armour thyroid, it's like my body said good grief Thank you! I'm back to straight t4, and my pdoc is monitoring it with me.
So an unexpected double whammy.
>Only thing I could suggest to add to
help would be like a small dose of Risperdal. You'd have to ask your doctor about taking it with the other stuff though.It's not off the table, nor is ami. My pdoc somehow is looking at me with new eyes. Good. I'm responding to emsam, but then, it is related to amphetamines, the first bullet to pierce my condition.
Thanks hp, for sharing your knowledge and for your concern. It's a great help.
fb
Posted by zonked on June 7, 2011, at 20:48:24
In reply to restoril, supplements, posted by Christ_empowered on June 7, 2011, at 15:40:38
> I hope things get better. Have you tried supplements? I don't want to force my vitamin-popping lifestyle on you, but since I'm in a benzo-free environment (public health, gotta love it), I've had to treat my anxiety with "alternative" remedies.OMG. Your clinic has patently excluded an entire *class* of drugs for its clients, no matter what? That's evil. What the heck do they do for like, people with panic disorder who do not respond to other treatments? Severe social anxiety disorder?
That's too bad. Benzos get such a bad rap. I've never found anything "abusable" about them. I mean, I can definitely see why prescription opiods are in CII and docs are cautious (I won't lie! I can't say I didn't feel unpleasant the times I've had pain bad enough to warrant a narcotic Rx.. transient and infrequent as such pain has been.)
But benzos? Good grief... denying an entire population (the uninsured where you live, yourself included) an entire class of drugs which may treat their ailment because *some* people have abused them is, IMO, inhumane...
There's a reason they're in Schedule IV instead of III or II...
Having said that, I am glad you found a treatment that works! If I had more money to spend, I'd invest more time in OTC treatments myself...
-z
Posted by Christ_empowered on June 8, 2011, at 12:33:55
In reply to Re: restoril, supplements » Christ_empowered, posted by zonked on June 7, 2011, at 20:48:24
Yeah, it kinda sucks. I mean, for me at this point, its not a big deal; I take my Abilify, sometimes an antidepressant in addition, lots of supplements, and I'm more or less good to go. But to think--there are people coming in who are uninsured or have less-than-stellar insurance, and they can't get benzos. I think the shrinks use a lot of seroquel and antidepressants for anxiety, not sure though.
Benzos do have a pretty bad reputation, for not really much reason. I think its really ridiculous when doctors (and some private practice docs do it too) refuse to write for them, or only give tiny amounts. I mean, they've been around for decades and they're safe, non-toxic, and effective. And CHEAP.
A lot of psychiatry really doesn't make sense. It almost makes me wish we could have a free and open market on drugs currently available only on Rx; that would drive prices down and also prevent people from being put on treatments that suck.
Posted by floatingbridge on June 8, 2011, at 13:35:50
In reply to public health+benzos, posted by Christ_empowered on June 8, 2011, at 12:33:55
CE, your knowledge on this would be greater than my own. That said, the biggest drawback to chronic benzo use is memory loss which suggests brain damage/loss.
Then again, the effects of some AP use, I think, is just beginning to hit mainstream. Aren't some implicated in endocrine disruption in addition to
negative brain changes?Then again, I've read of an/some AP's helping preserve brain function. I can imagine someone laughing their head off (in a rather cynical way) over that last
statement. But my knowledge goes about deep as Readers' Digest.In benzos favor, they've been around longer, their effects are more known.
The regime I'm on (the Valium & norco part) and was on (dex, xanax, pristiq, & norco) made some well-intentioned
and caring folks shudder. But in the final shake down, other than escalation (in
both benzo & opiate), and, geez, not rebound affect, but more like how a med will create it's own need in the body, like norco making more opiate receptors, thus creating increased sensitivity to pain), I don't know how it could be worse, an AP or a benzo. And I was certainly was put through some paces to get me off norco.Not that I'm closed to other options.
At least my body feels much less agitated. It accepts these medications.
My only hospital stay. Some of the women were just crying and in terrible shape, not simply because of why they landed there, but, (imo), because some were sedated with seroquel at high doses & other meds I don't know. (I was very busy paying attention to myself there.)
I remember one lovely, lovely woman who had a very good reason to be in the hospital. She showed me how her beautiful face was doing this downward pull at the mouth. Look she said what the meds are doing she said, but they keep increasing it and I can't stop crying. God bless her.
I suppose they grandfathered me through. I did try the seroquel with great hope. I really didn't care what I took, you know, it was, yes, yes, make it go away. Well whew. Seroquel was not sedating. I've posted before that I wish AP's would work for me. And I haven't
dismissed them as a class though my pdoc seems to have.I think abuse potential factors highly into public medicine. Sadly, for a legitimate reason. But shutting off all access isn't the best solution, just maybe the easiest.
But as one babbler wrote, benzos are a humane medication.
Sigh. Yeah. I don't know how I would manage my anxiety w/o benzo use. AD's didn't put a dent in it.
It's not big for you, is it?
Unchecked anxiety itself will ravage the brain.
Maybe you could consider public health CE. That's a place to make a real difference, too. Besides, you get so fired up about it. That's good :-)
Posted by Christ_empowered on June 8, 2011, at 15:08:06
In reply to Re: public health+benzos » Christ_empowered, posted by floatingbridge on June 8, 2011, at 13:35:50
If I become a nurse, I've thought about doing psychiatric nursing in the wild world of Public Health. We'll just have to see, though.
I hate how mental hospitals put everybody on antipsychotics (but they call them "mood stabilizers"). When I was in a private facility, I refused antipsychotics and depakote, which made me really, really popular with the staff. I probably could have benefited from either, but I didn't want them to shut me up and call it "medicine," you know?
I don't know whats up with public mental health. I sometimes read the practice guidelines, and they mention careful, selective use of benzos, usually for short-term treatment, but I haven't seen or heard of anyone actually getting a benzo Rx from a public health shrink. I knew a guy who got a Ritalin Rx, but he had some kind of brain damage, so that's a special case I suppose.
The APs cause brain damage. Let's just go ahead and put that out there. For me, it sucks, because antipsychotics are really the only medication that make my "illness" better to the point that I can function w/o dumbing me down (in the short term, at least) or requiring blood work. That's one reason I take so many supplements; I'm trying to pump myself full of antioxidants to prevent TD and other antipsychotic-induced problems from developing.
I'm glad you're on meds that aren't compounding your problems. Was the switch over to more socially-acceptable meds terrible, or did they make it relatively painless? How do you manage pain now?
I wouldn't worry too much about benzo-induced brain damage. I mean, what's the alternative, an antipsychotic? Also, dosage is everything.
Thanks for your post.
Posted by floatingbridge on June 8, 2011, at 17:21:23
In reply to Re: public health+benzos, posted by Christ_empowered on June 8, 2011, at 15:08:06
Current meds,
Emsam
Valium
NorcoI couldn't tolerate any alt pain med (cymbalta, lyrica, no one willing yet to try amitriptyline yet. That's o.k.)
Went from xanax to Valium. Better in the long run. Though valium has it's challenges, what med is perfect?
So, no, I haven't been denied the old fashioned remedies yet.
Posted by sigismund on June 8, 2011, at 17:32:33
In reply to Re: public health+benzos, posted by Christ_empowered on June 8, 2011, at 15:08:06
> I haven't seen or heard of anyone actually getting a benzo Rx from a public health shrink.
So the private ones get benzos and the famous get opiates?
Posted by Christ_empowered on June 8, 2011, at 17:54:29
In reply to Re: public health+benzos, posted by sigismund on June 8, 2011, at 17:32:33
It would appear that more money=better drugs.
Posted by zonked on June 8, 2011, at 22:04:13
In reply to public health+benzos, posted by Christ_empowered on June 8, 2011, at 12:33:55
> Yeah, it kinda sucks. I mean, for me at this point, its not a big deal; I take my Abilify, sometimes an antidepressant in addition, lots of supplements, and I'm more or less good to go.
CE I have *tremendous* respect for you man, but I did want to ask you: you've mentioned psychosis is one of your symptoms - which came first, the psychosis or the antipsychotics? The reason I ask is because I know of one person I've met in real life who had rebound psychosis after D/Cing Abilify *when he had no prior history of psychosis*....> I think the shrinks use a lot of seroquel and antidepressants for anxiety, not sure though.
SSRIs (and some other antidepressants) can truly be effective for anxiety, and despite the fact that they no longer work for me, I think they are safe drugs. I have no problem with an MD preferring to try SSRIs first on a benzo-naive patient. I am sure BuSpar must work for some people although I've never found anybody with much good to say about it.
Using drugs with SERIOUS and potentially PERMANENT
side effects (TD, TP, NMS, EPS, Akathisia, metabolic syndrome, diabetes, weight gain) as a first-line treatment, off-label, for anxiety disorders, when much safer and more effective treatments (the benzodiazepines, in particular, Xanax) are available is irresponsible and immoral IMO. Benzos are controlled medication, sure, but in the next-to-least abusable category.
> Benzos do have a pretty bad reputation, for not really much reason. I think its really ridiculous when doctors (and some private practice docs do it too) refuse to write for them, or only give tiny amounts. I mean, they've been around for decades and they're safe, non-toxic, and effective. And CHEAP.Amen! Blame the Valium craze of the 1970s... (wasn't alive then, but have heard that everybody *and* their doctor had Valium in their medicine cabinet in those days...) But don't blame Valium itself - blame a branch of medicine that is highly subject to prescribing trends. 70s to mid 80s? Mass-market the Benzos. They're on patent! 90s? Get everbody on SSRIs, *they* are on patent! 2000s, 2010s? Let's start putting out TV ads for "atypical" antipsychotics. THEY are on patent!
> A lot of psychiatry really doesn't make sense. It almost makes me wish we could have a free and open market on drugs currently available only on Rx; that would drive prices down and also prevent people from being put on treatments that suck.
>
Let them eat pills!-z
Posted by floatingbridge on June 8, 2011, at 22:08:21
In reply to Re: public health+benzos » Christ_empowered, posted by zonked on June 8, 2011, at 22:04:13
zonked, what is EPS?
Plus, does Nardil cause insomnia? I know it can cause sedation, but I experience them as different issues.
Thanks.
fb
Posted by zonked on June 8, 2011, at 22:12:30
In reply to Re: public health+benzos, posted by Christ_empowered on June 8, 2011, at 15:08:06
> If I become a nurse, I've thought about doing psychiatric nursing in the wild world of Public Health. We'll just have to see, though.
>
> I hate how mental hospitals put everybody on antipsychotics (but they call them "mood stabilizers"). When I was in a private facility, I refused antipsychotics and depakote, which made me really, really popular with the staff. I probably could have benefited from either, but I didn't want them to shut me up and call it "medicine," you know?Amen amen!!! And good for you bro!
When I've been in the hospital (for DEPRESSION!) I've been offered APs to "help" with crying spells and other symptoms of *depression*. (In this case, does "help" mean turn him into a drooling zombie with no emotions at all?)
(It was never implied or stated that I had mania or psychosis.)
Most hospital folks are NOT prepared for a patient with some self-education in psychopharmacology...
One time, an RN was trying to convince me that anticholinergics (Cogentin, Benadryl) "prevent" EPS. Nope - they just mask the symptoms. She didn't like that one bit.
Glad people like you are around. :-)
-z
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