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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 86 to 110 of 212. Go back in thread:
Posted by SLS on August 3, 2009, at 6:56:05
In reply to Question about an AD scott, posted by qbsbrown on August 2, 2009, at 23:37:36
> Yeah, they all suck and have adverse/paradoxical reactions in me. How long do you think i might have to be on tegretol before i tried (if needed, it might not be), like a minute, 2.5mgs of lexapro?
It is difficult to know for sure how an antidepressant would affect you right now. I guess I am in favor of letting your system settle right now. If you do go to Lexapro, I advocate starting at 10-20mg. I think that very low dosages might actually make you feel worse. I can't prove it, but I suspect that such low dosages produce a reduction in the synthesis and release of serotonin without a comparable stimulation of postsynaptic receptors. Lexapro can produce anxiety early in treatment, so I wouldn't recommend starting it at this point. It would be difficult evaluate your withdrawal symptoms with the additional anxiety.
How much diazepam are you taking right now?
Have you ever tried Lyrica (pregabalin)?
I still like the Tegretol right now. I would stay at 400mg for the next few days to see what happens. Perhaps you will need to take a higher dosage. I don't think it is out of the question to work up to 800mg. It will be necessary to exercise self-discipline and logic.
Continue to post. However, I would NOT look at Tegretol to be the culprit in your periodic worsenings. I think they would have happened anyway.
- Scott
Posted by qbsbrown on August 3, 2009, at 10:16:42
In reply to Re: Question about an AD scott, posted by SLS on August 3, 2009, at 6:56:05
> > Yeah, they all suck and have adverse/paradoxical reactions in me. How long do you think i might have to be on tegretol before i tried (if needed, it might not be), like a minute, 2.5mgs of lexapro?
>
> It is difficult to know for sure how an antidepressant would affect you right now. I guess I am in favor of letting your system settle right now. If you do go to Lexapro, I advocate starting at 10-20mg. I think that very low dosages might actually make you feel worse. I can't prove it, but I suspect that such low dosages produce a reduction in the synthesis and release of serotonin without a comparable stimulation of postsynaptic receptors. Lexapro can produce anxiety early in treatment, so I wouldn't recommend starting it at this point. It would be difficult evaluate your withdrawal symptoms with the additional anxiety.
>
> How much diazepam are you taking right now?
>
> Have you ever tried Lyrica (pregabalin)?
>
> I still like the Tegretol right now. I would stay at 400mg for the next few days to see what happens. Perhaps you will need to take a higher dosage. I don't think it is out of the question to work up to 800mg. It will be necessary to exercise self-discipline and logic.
>
> Continue to post. However, I would NOT look at Tegretol to be the culprit in your periodic worsenings. I think they would have happened anyway.
>
>
> - ScottI agree with you about not taking an AD at this point. And yes, there is/was already start up anxiety w/ lexapro. And risking any type of mania and/or worse racing thoughts isn't worth it.
I have taken lyrica, even doses up to 900mgs. Felt pretty stoned, super social, an extremely high sense of well being, derealization, edema.
But I do not have insurance, and it'd be very hard for me to obtain.
I think we're on the right track.
I went back to the generic tegretol this morning (200mgs), and it feels much more fitting, much better, a big difference.
How do we know when to raise it?
Today would be day 4 of 400mgs or more.
By the night yesterday, the dysphoria finally seemed to be wearing off. The ER version was acting WAY too much the trileptal was, in the good and bad ways, and i'd like to steer clear of that
I am at 16mgs of diazepam.Well I can tell that tegretol is part of the periodic worsenings, it is/was the culprit. I mean to feel that depression and dysphoria, which i never had tapering by itself. And when that happens, it's bound to raise my symptoms for a few days. So that's just part of the cycle.
So I say that we continue to raise when we think I'm ready. Do you think that 100mg incriments are more appropriate for me than 200?
It's easy for me to observe how i feel, it hits me right away.
But when to raise it, i don't know.
Thanks for the help.
Regards,
Brian
Posted by qbsbrown on August 3, 2009, at 10:44:38
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 10:16:42
Perhaps 200mg incriments would be fine, unless we think 100mgs is safer. I think my error was going from 300mgs on the first day, to 600 on the second.
I just fear the worsening of symptoms, and the dysphoria/depression that it might induce.
But then again, i felt great after my first 2 200mg doses, and should have stopped there that night.
Let me know what you think.
Regards,
Brian
Posted by qbsbrown on August 3, 2009, at 13:34:31
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 10:44:38
what day do you say i give 500-600 a go? Today is 400, but basically starting over w/ 200-100-100. Although last 2 days have been 400 of er versions, they act and are totally different.
Regards,
Brian
Posted by SLS on August 3, 2009, at 17:14:46
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 13:34:31
> what day do you say i give 500-600 a go? Today is 400, but basically starting over w/ 200-100-100. Although last 2 days have been 400 of er versions, they act and are totally different.
>
> Regards,
>
> BrianI think the main thing that you should be looking for is stability. I don't think you have been on 400mg long enough to justify an increase. If you had been on a steady dosage for a week, I would say that it was time to go up to 600mg. Since you have not established an equilibrium at 400mg yet, I would suggest that you wait another 3-5 days before moving up. Since you have observed a worsening of your condition in association with Tegretol dosing, I think it makes sense to wait 5 days. What you do now at 400mg might determine how effective the BZD withdrawal strategy is. My advice is to wait 5 days and then try going up to 600mg. In the meantime, do not try to lower your dosage of diazepam, or else you defeat the purpose.
When do you take your doses of diazepam? Do you take the Tegretol and the diazepam together? I'm just curious.
- Scott
Posted by qbsbrown on August 3, 2009, at 17:45:34
In reply to Re: Question about an AD scott, posted by SLS on August 3, 2009, at 17:14:46
> > what day do you say i give 500-600 a go? Today is 400, but basically starting over w/ 200-100-100. Although last 2 days have been 400 of er versions, they act and are totally different.
> >
> > Regards,
> >
> > Brian
>
> I think the main thing that you should be looking for is stability. I don't think you have been on 400mg long enough to justify an increase. If you had been on a steady dosage for a week, I would say that it was time to go up to 600mg. Since you have not established an equilibrium at 400mg yet, I would suggest that you wait another 3-5 days before moving up. Since you have observed a worsening of your condition in association with Tegretol dosing, I think it makes sense to wait 5 days. What you do now at 400mg might determine how effective the BZD withdrawal strategy is. My advice is to wait 5 days and then try going up to 600mg. In the meantime, do not try to lower your dosage of diazepam, or else you defeat the purpose.
>
> When do you take your doses of diazepam? Do you take the Tegretol and the diazepam together? I'm just curious.
>
>
> - Scott
>Yeah, I agree. It has helped many things, much less paranoia, and i was able to eat many foods that i feared (i thought they were worsening symptoms), it allowed me to go to the gym for the first time in more than 2 months. So I have seen the benefits for sure. It was me messing around w/ the dosing that screwed me up. Yesterday was better than the day before, today is better than yesterday etc. So I hope that the storm is calming.
I dose diazepam 3mgs 6am, 3mgs 2pm, 10mgs, 10pm. I am dosing the tegretol at the same time, and I think it is to much benefit. Right now it's 200-100-100.
Regards,
Brian
Posted by qbsbrown on August 3, 2009, at 18:02:39
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 17:45:34
We could shoot for Friday as the test/trial date for 600mgs. It's a good day, because i don't teach on saturdays, i am supervised by my roommate in case i react badly etc. If I have a bad depressive/dysphoric reaction to it, and it worsens wd symptoms, then I could make it 500mgs.
What do you think?
My brain is so dead and fried from all of this. It literally needs a jump start lol. They only thing i could think of is lexapro, but given it's history of making me more anxious for a couple of days, give me insomnia, which i already have, induced mixed mood episodes, some dysphoria, worse racing thoughts etc, it's best to steer clear.
Probably best to just be retarded until all of this is over. The exercise will help much as long as i can continue, and it doesn't rev up symptoms. And if i can eat regular/normal foods, instead of a very restricted diet, then that should help much as well.
Thanks for the help Scott.
Brian
Posted by SLS on August 3, 2009, at 18:27:47
In reply to Re: Question about an AD scott, posted by qbsbrown on August 3, 2009, at 18:02:39
> We could shoot for Friday as the test/trial date for 600mgs. It's a good day, because i don't teach on saturdays, i am supervised by my roommate in case i react badly etc. If I have a bad depressive/dysphoric reaction to it, and it worsens wd symptoms, then I could make it 500mgs.
>
> What do you think?
Perfect!!!
- Scott
Posted by qbsbrown on August 3, 2009, at 21:13:15
In reply to Re: Question about an AD scott, posted by SLS on August 3, 2009, at 18:27:47
I've read that magnesium is one of the only minerals/vitamins/supplements that might provide some relief, especially muscular.
I was in great shape when i begun this. Now total muscle wastage, muscle spasms, pretty bad stuff.
Does/will magnesium interfere/compete for any of the neurotransmitters?
Regards,
Brian
Posted by qbsbrown on August 3, 2009, at 22:52:41
In reply to Magnesium Scott?, posted by qbsbrown on August 3, 2009, at 21:13:15
I was wondering about Neurontin for anxiety and insomnia during benzo wd.
Now lyrica was the 2nd most difficult drug to come off of after benzos, but i don't remember a problem w/ neurontin
Of course we'll go one step at a time w/ the tegretol, and i don't know if you can mix those 2 anticonvulsants at the same time, or is a good idea anyway.
It does scare me that neurontin gave me suicidal ideation out of no where a couple of times, for no reason. But other than that, it was more like being social and high.
But i don't know how the whole gaba part interacts w/during the benzo wd.
Regards,
Brian
Posted by SLS on August 4, 2009, at 6:35:32
In reply to Magnesium Scott?, posted by qbsbrown on August 3, 2009, at 21:13:15
> Does/will magnesium interfere/compete for any of the neurotransmitters?
The reason I have suggested magnesium to a couple of people is that it *theoretically* would compete with glutamate for binding to the NMDA receptor, the result of which might be to tone down neuronal excitability. Many people feel calmer with magnesium and sometimes use it as a sleep aid. You don't want to take too much, though. It can act as a laxative.
- Scott
Posted by SLS on August 4, 2009, at 6:37:22
In reply to Neurontin?, posted by qbsbrown on August 3, 2009, at 22:52:41
You can take Neurontin with Tegretol, but I wouldn't recommend adding it at this juncture. It can be somewhat unpredictable.
- Scott
Posted by qbsbrown on August 4, 2009, at 9:04:02
In reply to Re: Neurontin?, posted by SLS on August 4, 2009, at 6:37:22
Well a few wd symptoms that I was absolutely thrilled that it began to alleviate was; extreme sound and noise sensitivity. I would have to sleep w/ ear plugs and eye masks, and STIll, the smallest shade of light coming in the window would wake me up.
That is now back the past 2-3 days. Are you guessing that is because i went up to fast and aggrivated my wd symptoms, and the original ones came back, and/or that it's now metabolizing itself quicker, and that i need to raise the dose?
There are a couple other things that have come back as well.
I don't want to go too quick and too fast, as we saw where that landed me last time.
Stick to the original plan of Fri?
Regards,
Brian
Posted by qbsbrown on August 4, 2009, at 9:07:13
In reply to Re: Magnesium Scott?, posted by SLS on August 4, 2009, at 6:35:32
Can you recommend how much magnesium to take? MGS, and times per day?
Posted by qbsbrown on August 4, 2009, at 9:16:17
In reply to Re: Magnesium Scott?, posted by qbsbrown on August 4, 2009, at 9:07:13
Someone on the alternative board said that the magnesium can be stimulating. That kinda scares me. Don't know how my body will react to it at this juncture.
Is it worth the risk for sleep, calm, and muscle spasms?
Brian
Posted by qbsbrown on August 4, 2009, at 9:26:54
In reply to Tegretol, posted by qbsbrown on August 4, 2009, at 9:04:02
Perhaps a 4 day flare up is expected after my 600mg night experience huh
Posted by SLS on August 4, 2009, at 11:58:06
In reply to Re: Tegretol, posted by qbsbrown on August 4, 2009, at 9:26:54
> Perhaps a 4 day flare up is expected after my 600mg night experience huh
It is hard to say.
Friday is just a few days away.
You'll make it.
- Scott
Posted by qbsbrown on August 4, 2009, at 13:06:32
In reply to Re: Tegretol, posted by SLS on August 4, 2009, at 11:58:06
Yeah, the WD symptoms are real bad right now. I think that starting the gym yesterday and today, plus huge dietary changes, are flaring up symptoms as well, but i think greatly beneficial for me in the long run. I won't raise my dose until these bad symptoms settle a bit.
God Scott, i hope this works.
Brian
Posted by qbsbrown on August 4, 2009, at 13:30:08
In reply to Re: Tegretol, posted by qbsbrown on August 4, 2009, at 13:06:32
When/if I can tolerate 600mgs, do I need to get some blood tests done Scott?
Regards,
Brian
Posted by SLS on August 4, 2009, at 14:55:48
In reply to Blood tests, posted by qbsbrown on August 4, 2009, at 13:30:08
> When/if I can tolerate 600mgs, do I need to get some blood tests done Scott?
I don't recall how often you are supposed to be tested. I would work with your doctor on this. The risk of developing a problem are remote, but still should be checked for regularly.
- Scott
Posted by qbsbrown on August 4, 2009, at 16:06:47
In reply to Re: Blood tests, posted by SLS on August 4, 2009, at 14:55:48
Well, still bad depression this morning. Bad wd symptoms in general. Went for a walk and things were really dysphoric and depressing looking/seeming, almost felt like a nervous breakdown. I for sure don't want to raise until that is gone (I even wonder if 300 is better), if it even does go away. And if it does, I wonder if 100mg increments are better suited for me given my sensitivity. I'll try to hold and see how it is over the next few days. I really hope that it goes away, and that I can continue forward. But I even had these things on 900mgs of Trileptal, which would probably be the same as 600 Tegretol, correct?
Regards,Brian
Posted by qbsbrown on August 4, 2009, at 16:09:47
In reply to Re: Blood tests, posted by qbsbrown on August 4, 2009, at 16:06:47
And although the starting dose of trileptal is 300mgs 2 times a day, i did well on 150mgs 2 times a day 3 years ago for my taper.
I hope my dose isn't too much right now.
Regards,
Brian
Posted by SLS on August 4, 2009, at 17:24:34
In reply to Re: Blood tests, posted by qbsbrown on August 4, 2009, at 16:09:47
I can't be sure, but you might be experiencing an instability of your primary depressive disorder. I encourage you to go up to 600mg. The sooner you can establish some stability, the sooner you can taper the diazepam and add an antidepressant.
- Scott
Posted by qbsbrown on August 4, 2009, at 17:45:24
In reply to Re: Blood tests, posted by SLS on August 4, 2009, at 17:24:34
> I can't be sure, but you might be experiencing an instability of your primary depressive disorder. I encourage you to go up to 600mg. The sooner you can establish some stability, the sooner you can taper the diazepam and add an antidepressant.
>
>
> - ScottI hear ya, but it was the messing around with doses and going too high too fast that revved up my symptoms, and induce the dysphoria and the depressive symptoms and feelings, as all if not most anticonvulsants do induce for me.
We saw what 500mgs of depakote did, which is the normal starting dose. 400mgs of tegretol is the normal starting dose, so why would we not expect the same thing? Maybe because i experienced a better mood after the first couple 100mg doses?
Are you saying get up to 600, then taper, then add an ad? I have horrible reactions to all ADs, so that's kinda sketchy.
Usually, if there was high enough anticonvulsant dosage, the lexapro might help take away the dysphoria/depression, but also induced many bad things in return.
Regards,
Brian
Posted by qbsbrown on August 4, 2009, at 17:54:07
In reply to Re: Blood tests, posted by qbsbrown on August 4, 2009, at 17:45:24
I never had any of these depressive feelings til messing around w/ the anticonvulsants. And i can tell if my symptoms are revved up if my typing becomes more difficult, and many many other symptoms that my wd is revved up which happened since going from 300-600 in one night.
Are you saying to get to 600 for a certain amount of time, then add an AD? Or 600, then taper, then an AD?
They all induce depression minus lexapro, which i mentioned can trigger mania, mixed moods, and even depression/dysphoria, maybe even suicidal ideation itself.
The goal is to be off of all meds. And what ever the best, quickets, safest route I'm all for.
Yes, usually the lexapro would take away the depression/dysphoria that i experience w/ anticonvulsants.
So it's a tough situation.
Regards,
Brian
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