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Dr. Bob is Robert Hsiung, MD,
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Posted by MB on July 12, 2000, at 21:48:45
It's so hard to figure what's doing what when on a med combo. I'm taking Wellbutrin in the morning, Remeron at night, and Buspar b.i.d. for anxiety. I wake up feeling completely drugged from the Remeron...can't get it together. I take my 150mg SR Wellbutrin, but it'll be an hour or so before it wakes me up, so I grab a cup of coffee. Now I feel fine. WB kicks in and I get anxious (maybe WB mixing badly with the coffee?). Anyhow, time for first dose of Buspar. Buspar takes the edge of the anxiety, but also leaves me feeling fatigued and depressed. So...I drink another cup of coffee to wake up, and the anxiety's back with horrible nausea and headache. Time for second Buspar. Headache goes away, feel good for the second time today. Bedtime: feel *great*, but can't sleep. That's where the Remeron comes in. I take Remeron, fall into coma, and wake up drained. That's my cycle. The two times a day that i feel good, I feel *great*, so I believe that somewhere in this drug combo is the answer, but I just can't work it out. I'm so frustrated. Does anybody else on a med combo like this cycle this drastically throughout the day? It's about my fifth day on this combo. I hope it evens out, or I can eliminate the variable making me feel "bad". One unecessary variable I should eliminate is the coffee. Then what? Obviously, I should talk to my prescribing doc. I see him on the 19th. Should I do anything until then?
MB
Posted by shellie on July 13, 2000, at 8:33:27
In reply to Med Combos So Hard To Figure, posted by MB on July 12, 2000, at 21:48:45
>MB--it is such a fine line between energy and anxiety. After the coffee, the second thing I'd look into is the remeron. Maybe a smaller dose, or taking it a few hours earlier. Also I'd be concerned about the buspar making you so tired and depressed. I would talk to your pdoc about both dose and possible replacement. Now that you know how it feels to feel good, he may be able to use that as a clue for other meds which don't make you so tired. I'm sure, you've seen that stimulants are a big thing for combinations these days. That might be what your missing from your combination that makes you so tired.
Read through the posts and get some ideas before you see your pdoc. shellie
Posted by MB on July 13, 2000, at 15:03:01
In reply to Re: Med Combos So Hard To Figure » MB, posted by shellie on July 13, 2000, at 8:33:27
Unfortunately, there are only two pdocs in town, and niether will see patients without references. I have two GPs, and neither has refered me to a pdoc (most of my visits are depression related, and they'd lose money). Also, I don't think my insurance would pay (owch). I think the Remeron needs to be tossed out the window. Woke up this morning sooooo... tired. I'm only on 15 mg/day, and I still couldn't get up to let dogs out to pee, so they peed on the carpet. I tried not to drink coffee, but without it, I couldn't get up and feed them. My plan is to get rid of the Remeron (and therefore the need for the coffee).
I do see that they are using stimulants more for depressed people. Unfortunatlely, I am in a 12-step recovery program for my attemp to self medicate for the past 10 years. The past ten years of illicit drug use has, unfortunately, left me compulsive regarding the use of some chemicals (hence the Buspar instead of a benzo, etc.). I fear a stim like Ritilin or Dexidrin could be dangerous. Plus, I don't think GPs have much experience using stims as adjuncts to ADs. One of my GPs is in recovery too, which is kind of cool. He understands my issues...he even returned one of my phone calls in *person* (didn't know doctors even did that). The down side is that 12-step programs are so spiritually based, and so is he. He made a comment that I might just have to use the program and pray a lot to get better, which frightened me a little. I don't mind praying for help to stay sober. I believe some divine intervention has helped me stay sober, but his suggestion kind of made me freak out. I'd never heard a doctor talk like that before. I dunno...just feeling so lost.
MB
> >MB--it is such a fine line between energy and anxiety. After the coffee, the second thing I'd look into is the remeron. Maybe a smaller dose, or taking it a few hours earlier. Also I'd be concerned about the buspar making you so tired and depressed. I would talk to your pdoc about both dose and possible replacement. Now that you know how it feels to feel good, he may be able to use that as a clue for other meds which don't make you so tired. I'm sure, you've seen that stimulants are a big thing for combinations these days. That might be what your missing from your combination that makes you so tired.
>
> Read through the posts and get some ideas before you see your pdoc. shellie
Posted by Ant-Rock on July 13, 2000, at 18:49:06
In reply to Re: Med Combos So Hard To Figure, posted by MB on July 13, 2000, at 15:03:01
MB,
Another frequent poster here takes 7.5 mg remeron at night and is convinced this dose works the best for him. Maybe give it a try.
Good luck.
Sincerely,
Anthony
Posted by JaneS on July 13, 2000, at 22:14:02
In reply to Re: Med Combos So Hard To Figure, posted by MB on July 13, 2000, at 15:03:01
> Unfortunately, there are only two pdocs in town, and niether will see patients without references. I have two GPs, and neither has refered me to a pdoc (most of my visits are depression related, and they'd lose money). Also, I don't think my insurance would pay (owch). I think the Remeron needs to be tossed out the window. Woke up this morning sooooo... tired. I'm only on 15 mg/day, and I still couldn't get up to let dogs out to pee, so they peed on the carpet. I tried not to drink coffee, but without it, I couldn't get up and feed them. My plan is to get rid of the Remeron (and therefore the need for the coffee).
>
> I do see that they are using stimulants more for depressed people. Unfortunatlely, I am in a 12-step recovery program for my attemp to self medicate for the past 10 years. The past ten years of illicit drug use has, unfortunately, left me compulsive regarding the use of some chemicals (hence the Buspar instead of a benzo, etc.). I fear a stim like Ritilin or Dexidrin could be dangerous. Plus, I don't think GPs have much experience using stims as adjuncts to ADs. One of my GPs is in recovery too, which is kind of cool. He understands my issues...he even returned one of my phone calls in *person* (didn't know doctors even did that). The down side is that 12-step programs are so spiritually based, and so is he. He made a comment that I might just have to use the program and pray a lot to get better, which frightened me a little. I don't mind praying for help to stay sober. I believe some divine intervention has helped me stay sober, but his suggestion kind of made me freak out. I'd never heard a doctor talk like that before. I dunno...just feeling so lost.
>
> MB
>
> > >MB--it is such a fine line between energy and anxiety. After the coffee, the second thing I'd look into is the remeron. Maybe a smaller dose, or taking it a few hours earlier. Also I'd be concerned about the buspar making you so tired and depressed. I would talk to your pdoc about both dose and possible replacement. Now that you know how it feels to feel good, he may be able to use that as a clue for other meds which don't make you so tired. I'm sure, you've seen that stimulants are a big thing for combinations these days. That might be what your missing from your combination that makes you so tired.
> >
> > Read through the posts and get some ideas before you see your pdoc. shellie
MB:Shellie's right! Read through the posts, especially relating to Remeron...in most cases less is more but with Remeron the opposite is true. If you're only on 15 mg THAT could be why you are soooo tired. That side effect greatly decreases when you increase the dosage....
Good Luck!
Jane
Posted by allisonm on July 13, 2000, at 22:39:25
In reply to Re: Med Combos So Hard To Figure, posted by JaneS on July 13, 2000, at 22:14:02
MB,
You might consider decreasing the Remeron as Shellie says and/or see about getting Wellbutrin SR to go with the Remeron. That combo has worked best for me.I did find that the sedation from the Remeron wore off after a time. I find the Wellbutrin gets rid of the Remeron cobwebs in the morning. It is activating enough that I cannot drink real coffee anymore.
And be sure that you are taking the remeron early enough in the evening. If I take it too late it's hard getting up in the morning. And if I stay up too late too many times, that throws me way off too.
Also, I've been putting together a Remeron site of links. You might find some useful information there: http://www.egroups.com/links/psycho-babble-tips/Remeron_000963366608/
Posted by MB on July 14, 2000, at 0:21:32
In reply to Re: Med Combos So Hard To Figure, posted by allisonm on July 13, 2000, at 22:39:25
I, too, take Wellbutrin during the day in adjunct to my night dose of Remeron. The past few days I have been *sick*...I mean, dizzy, nauseus, monstrous gas, etc. It would cycle so I'd be really sick one minute and feel fine the next. Weird. Today, I increased my Wellbutrin to 300mg/day. When the anxiety kicked in, I upped my Buspar to 20mg/day. For some reason, it made the sickness stop. ?????
Anyway, how much Remeron, and how much Wellbutrin are you taking a day?
MB
> MB,
> You might consider decreasing the Remeron as Shellie says and/or see about getting Wellbutrin SR to go with the Remeron. That combo has worked best for me.
>
> I did find that the sedation from the Remeron wore off after a time. I find the Wellbutrin gets rid of the Remeron cobwebs in the morning. It is activating enough that I cannot drink real coffee anymore.
>
> And be sure that you are taking the remeron early enough in the evening. If I take it too late it's hard getting up in the morning. And if I stay up too late too many times, that throws me way off too.
>
> Also, I've been putting together a Remeron site of links. You might find some useful information there: http://www.egroups.com/links/psycho-babble-tips/Remeron_000963366608/
Posted by allisonm on July 14, 2000, at 19:12:33
In reply to Re: Med Combos So Hard To Figure » allisonm, posted by MB on July 14, 2000, at 0:21:32
This is weird. I thought I posted a reply earlier at work, but it must not have gone through.
Wellbutrin got added to my Remeron a year ago last June after a month-or-so break from a 7-month stint of lithium augmentation. My doctor and I thought I was feeling good enough to take me off the Li in April, but I was suicidal again by June. At the time I was on 45 mg Remeron. I started with 100mg of Wellbutrin.
I started backsliding last October and began to wonder whether I ought to be hospitalized. The WB was upped to 200mg. Rem was decreased to 30 after a time (if I remember correctly).
Another backslide this last April led to 300-350mg WB, then 400mg WB a week later on my own volition. We reduced the Rem from 30 to 15. So now the Remeron is augmenting the Wellbutrin.
I think this 400/15 combo is working as well as anything has so far. I don't really hope for remission anymore. I just want to stay relatively clear of the pit. This seems to be doing it.
Good luck.
Posted by ksvt on July 14, 2000, at 21:09:42
In reply to Re: Med Combos So Hard To Figure » allisonm, posted by MB on July 14, 2000, at 0:21:32
> I, too, take Wellbutrin during the day in adjunct to my night dose of Remeron. The past few days I have been *sick*...I mean, dizzy, nauseus, monstrous gas, etc. It would cycle so I'd be really sick one minute and feel fine the next. Weird. Today, I increased my Wellbutrin to 300mg/day. When the anxiety kicked in, I upped my Buspar to 20mg/day. For some reason, it made the sickness stop. ?????
>
> Anyway, how much Remeron, and how much Wellbutrin are you taking a day?
>
> MB
>
> > MB,
> > You might consider decreasing the Remeron as Shellie says and/or see about getting Wellbutrin SR to go with the Remeron. That combo has worked best for me.
> >
> > I did find that the sedation from the Remeron wore off after a time. I find the Wellbutrin gets rid of the Remeron cobwebs in the morning. It is activating enough that I cannot drink real coffee anymore.
> >
> > And be sure that you are taking the remeron early enough in the evening. If I take it too late it's hard getting up in the morning. And if I stay up too late too many times, that throws me way off too.
> >
> > Also, I've been putting together a Remeron site of links. You might find some useful information there: http://www.egroups.com/links/psycho-babble-tips/Remeron_000963366608/MB - I have no experience but it sounds like the Remeron is to counteract the WB at night. I've been taking Klonopin for some years right before bed while Ive been on 400mgs of WB. It's really worked pretty well. Klonopin seems to act for me like a relaxant. It doesn't knock me out and it doesn't make me feel drugged in the AM. You might talk to an MD about it.
Posted by Snowie on July 15, 2000, at 8:46:07
In reply to Re: Med Combos So Hard To Figure, posted by ksvt on July 14, 2000, at 21:09:42
ksvt,
Klonopin is a potent, yet effective, benzo. Since MB said he formerly self-medicated, he isn't allowed to take benzos for fear of abuse; the same goes for stimulants. Also, since benzos cause dependency with regular use (as do many psychotropic drugs), MB would be well served to avoid them. (No benzophobe here ... I take a benzo, but my first pdoc never gave me another option, which I regret.)
Snowie
>MB - I have no experience but it sounds like the Remeron is to counteract the WB at night. I've been taking Klonopin for some years right before bed while Ive been on 400mgs of WB. It's really worked pretty well. Klonopin seems to act for me like a relaxant. It doesn't knock me out and it doesn't make me feel drugged in the AM. You might talk to an MD about it.
Posted by allisonm on July 15, 2000, at 10:01:28
In reply to Re: Med Combos So Hard To Figure » MB, posted by allisonm on July 14, 2000, at 19:12:33
MB,
I meant to mention nausea in my earlier post. I have been light-headed at times with the Wellbutrin, especially when the dose has been increased, but that generally goes away along with the irritability and the shakes.
I've had nausea a couple of times, but I think both had to do with something I did. Once I had a half-glass of a sweet wine and something happened to my stomach and I had almost immediate and wrenching vomiting and then dry heaves for a good part of the rest of the evening. I couldn't get to the bathroom in time it happened so fast. I'd had small amounts of wine before, but a different kind. I've found alcohol also makes my stomach hurt the next day -- at least more than usual when I don't eat. Suffice to say I avoid alcohol.
The other time was a week or two ago. I find if I don't eat at regular intevals, sometimes my stomach starts hurting and then cramping. This happened one night as I was coming home late from work. I hadn't eaten much lunch and I hadn't eaten dinner and it was after 7. I stopped at the grocery store, to get something quick to eat when I got home. But by the time I got home I had waves of intense nausea with the cramping. At first I was afraid to eat anything, but as soon as I got something into my stomach (rice) it stopped.
Take care.
Allison
Posted by ksvt on July 15, 2000, at 10:07:27
In reply to Re: Med Combos So Hard To Figure » ksvt, posted by Snowie on July 15, 2000, at 8:46:07
> ksvt,
>
> Klonopin is a potent, yet effective, benzo. Since MB said he formerly self-medicated, he isn't allowed to take benzos for fear of abuse; the same goes for stimulants. Also, since benzos cause dependency with regular use (as do many psychotropic drugs), MB would be well served to avoid them. (No benzophobe here ... I take a benzo, but my first pdoc never gave me another option, which I regret.)
>
> Snowie
>
>
> >MB - I have no experience but it sounds like the Remeron is to counteract the WB at night. I've been taking Klonopin for some years right before bed while Ive been on 400mgs of WB. It's really worked pretty well. Klonopin seems to act for me like a relaxant. It doesn't knock me out and it doesn't make me feel drugged in the AM. You might talk to an MD about it.Snowie and MB - I figured that out sometime after the post and would like to apologize for the suggestion. I have certainly been told and have read that Klonopin can be pretty addictive, but I've been assured by my psychiatrist and by my internist that I take it in such low doses that this should not be an issue. It's worked very well for me, much better than the Trazadone I was taking before but I realize it's not for everyone. Nothing exacerbates my depressions more than a lack of sleep, so I've sort of resigned myself to taking this. Nonetheless, altho I may not be physically addicted I certainly recognize a psychological dependency, because most nights I'm too fearful of a lack of sleep to be willing to go without it. Good Luck MB and my apologies once again for being so stupid.
Posted by allisonm on July 15, 2000, at 10:36:21
In reply to Re: Med Combos So Hard To Figure, posted by ksvt on July 15, 2000, at 10:07:27
ksvt:
YOU are NOT stupid!!!!!
Best regards,
Allison
Posted by SLS on July 15, 2000, at 11:08:45
In reply to To ksvt, posted by allisonm on July 15, 2000, at 10:36:21
> ksvt:
>
> YOU are NOT stupid!!!!!
>
> Best regards,
> Allison
Agreed.
- Scott
Posted by dove on July 15, 2000, at 13:24:34
In reply to Re: To ksvt, posted by SLS on July 15, 2000, at 11:08:45
What about switching out the Remeron for a sedating AD, like Amitriptyline, Serzone, or something else. No benzo's, no stim's, need to stay with stimulating AD's to counteract the morning sedation from the sleep aids, and the sedation from the anti-anxiety med buspar. Remove the sleep aid, or lower it until there is no morning sedation. Make sure to take the Wellbutrin early in the day, no where near evening.
Get used to the effects of the buspar before making drastic changes. Allow yourself to feel lethargic if at all possible (I know it sucks), kinda get a feel for the buspar, and then act on what you know and feel. Wellbutrin can be a great AD with stimulating effects, but it can also be a very agitating AD. Prozac can also be stimulating, another possible option. You have to decide which effects are worse, lethargy or the anxiety and frazzled nerves, and try to balance between the two, leaning closer to the side that is the best fit.
Or, maybe you'll find the answer from someone else's advice :-) My thoughts are with you.
dove
p.s. I did experience nausea while on Wellbutrin, Serzone, Adderall, ect... Always went away if I ate something. The quickest method was eating a bread/starch product, and to keep the nausea away long-term complex carbs seem to be the ticket. I never experienced nausea if I was eating properly.
Posted by Snowie on July 15, 2000, at 15:14:26
In reply to Re: Med Combos So Hard To Figure, posted by ksvt on July 15, 2000, at 10:07:27
ksvt,
Gee, don't be so hard on yourself! For someone who writes so well, you can't be stupid. ;-) I'm glad Klonopin works so well for you as a sleep agent. It's also very effective for panic disorder and social anxiety.
Snowie
> > ksvt,
> >
> > Klonopin is a potent, yet effective, benzo. Since MB said he formerly self-medicated, he isn't allowed to take benzos for fear of abuse; the same goes for stimulants. Also, since benzos cause dependency with regular use (as do many psychotropic drugs), MB would be well served to avoid them. (No benzophobe here ... I take a benzo, but my first pdoc never gave me another option, which I regret.)
> >
> > Snowie
> >
> >
> > >MB - I have no experience but it sounds like the Remeron is to counteract the WB at night. I've been taking Klonopin for some years right before bed while Ive been on 400mgs of WB. It's really worked pretty well. Klonopin seems to act for me like a relaxant. It doesn't knock me out and it doesn't make me feel drugged in the AM. You might talk to an MD about it.
>
> Snowie and MB - I figured that out sometime after the post and would like to apologize for the suggestion. I have certainly been told and have read that Klonopin can be pretty addictive, but I've been assured by my psychiatrist and by my internist that I take it in such low doses that this should not be an issue. It's worked very well for me, much better than the Trazadone I was taking before but I realize it's not for everyone. Nothing exacerbates my depressions more than a lack of sleep, so I've sort of resigned myself to taking this. Nonetheless, altho I may not be physically addicted I certainly recognize a psychological dependency, because most nights I'm too fearful of a lack of sleep to be willing to go without it. Good Luck MB and my apologies once again for being so stupid.
Posted by ksvt on July 15, 2000, at 22:18:41
In reply to Re: Med Combos So Hard To Figure » ksvt, posted by Snowie on July 15, 2000, at 15:14:26
> ksvt,
>
> Gee, don't be so hard on yourself! For someone who writes so well, you can't be stupid. ;-) I'm glad Klonopin works so well for you as a sleep agent. It's also very effective for panic disorder and social anxiety.
>
> Snowie
>
>
> > > ksvt,
> > >
> > > Klonopin is a potent, yet effective, benzo. Since MB said he formerly self-medicated, he isn't allowed to take benzos for fear of abuse; the same goes for stimulants. Also, since benzos cause dependency with regular use (as do many psychotropic drugs), MB would be well served to avoid them. (No benzophobe here ... I take a benzo, but my first pdoc never gave me another option, which I regret.)
> > >
> > > Snowie
> > >
> > >
> > > >MB - I have no experience but it sounds like the Remeron is to counteract the WB at night. I've been taking Klonopin for some years right before bed while Ive been on 400mgs of WB. It's really worked pretty well. Klonopin seems to act for me like a relaxant. It doesn't knock me out and it doesn't make me feel drugged in the AM. You might talk to an MD about it.
> >
> > Snowie and MB - I figured that out sometime after the post and would like to apologize for the suggestion. I have certainly been told and have read that Klonopin can be pretty addictive, but I've been assured by my psychiatrist and by my internist that I take it in such low doses that this should not be an issue. It's worked very well for me, much better than the Trazadone I was taking before but I realize it's not for everyone. Nothing exacerbates my depressions more than a lack of sleep, so I've sort of resigned myself to taking this. Nonetheless, altho I may not be physically addicted I certainly recognize a psychological dependency, because most nights I'm too fearful of a lack of sleep to be willing to go without it. Good Luck MB and my apologies once again for being so stupid.Thanks for the positive reinforcement.
This is the end of the thread.
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