![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by sar on November 2, 2001, at 13:41:30
jeez, where's Sal??
i would appreciate if anyone could comment on this med combo:
40 mg prozac
1 mg klonopin twice daily
1800 mg neurontin
25 mg lamictal, to titrate up to 50 mgi feel like a druggie...
thanks.
Posted by JohnL on November 2, 2001, at 18:34:32
In reply to med combo, posted by sar on November 2, 2001, at 13:41:30
> jeez, where's Sal??
>
> i would appreciate if anyone could comment on this med combo:
>
> 40 mg prozac
> 1 mg klonopin twice daily
> 1800 mg neurontin
> 25 mg lamictal, to titrate up to 50 mg
>
> i feel like a druggie...Just my opinion, but I think a med combo of 4 different meds is OK, if they are really doing some good. I mean, it would be a bummer to be on 4 meds and just be so-so. I've been there, and it made no sense to me to be taking so many drugs if they weren't bringing me remission. So basically, I think it all depends on how you feel. If you like it, just go with it and don't worry about it. If it is lacking however, then you might have to rethink one or two of those meds.
John
>
> thanks.
Posted by Dr. Bob on November 3, 2001, at 1:19:47
In reply to med combo, posted by sar on November 2, 2001, at 13:41:30
> jeez, where's Sal??
Blocked until he doesn't try posting for 4 weeks. If he'd just waited out his initial (or even his second) "sentence", he'd already be back, but...
Bob
PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration; otherwise, they may be deleted.
Posted by Elizabeth on November 3, 2001, at 11:01:11
In reply to med combo, posted by sar on November 2, 2001, at 13:41:30
> i would appreciate if anyone could comment on this med combo:
>
> 40 mg prozac
> 1 mg klonopin twice daily
> 1800 mg neurontin
> 25 mg lamictal, to titrate up to 50 mgWhat purpose is each of those drugs supposed to serve, and are they all serving their respective purposes?
(BTW, I don't think a "druggie" would be interested in any of the stuff you're on, so don't worry about that, at least! :-) )
-elizabeth
Posted by sar on November 3, 2001, at 22:07:10
In reply to Re: med combo, posted by Elizabeth on November 3, 2001, at 11:01:11
> > i would appreciate if anyone could comment on this med combo:
> >
> > 40 mg prozac
> > 1 mg klonopin twice daily
> > 1800 mg neurontin
> > 25 mg lamictal, to titrate up to 50 mg
>
> What purpose is each of those drugs supposed to serve, and are they all serving their respective purposes?
>
> (BTW, I don't think a "druggie" would be interested in any of the stuff you're on, so don't worry about that, at least! :-) )
>
> -elizabeththe drugs are for depression/anxiety/purported bipolar II.
is there a drug for people who are obsessively suicidal? often all i can think about is hanging myself from a tree, and i chose the rope at Home Depot yesterday. i want a drug to make these thoughts go away...
Posted by Mair on November 4, 2001, at 16:36:08
In reply to Re: med combo, posted by sar on November 3, 2001, at 22:07:10
Sar - did you buy the rope or just identify it?
Mair
Posted by sar on November 4, 2001, at 17:49:16
In reply to Re: med combo » sar, posted by Mair on November 4, 2001, at 16:36:08
just identified it.
Posted by shelliR on November 4, 2001, at 22:41:06
In reply to Re: med combo, posted by sar on November 3, 2001, at 22:07:10
> > > i would appreciate if anyone could comment on this med combo:
> > >
> > > 40 mg prozac
> > > 1 mg klonopin twice daily
> > > 1800 mg neurontin
> > > 25 mg lamictal, to titrate up to 50 mg
> >
> > What purpose is each of those drugs supposed to serve, and are they all serving their respective purposes?
> >
> > (BTW, I don't think a "druggie" would be interested in any of the stuff you're on, so don't worry about that, at least! :-) )
> >
> > -elizabeth
>
> the drugs are for depression/anxiety/purported bipolar II.
>
> is there a drug for people who are obsessively suicidal? often all i can think about is hanging myself from a tree, and i chose the rope at Home Depot yesterday. i want a drug to make these thoughts go away...Hi Sar. I'm be interested to know why your doctor wants you to take both neurotin and lamictal since both act as mood stabilizers. Klonopin would be for your bad anxiety, prozac depression. Pretty much all makes sense. Maybe when you get higher on the lamictal, it will help your suicidal thoughts.
Sar, I love your writing. I was thinking today that we should do a book together; my portraits, your words. (That's what I do for a living). I was thinking of some of the thoughts you've expressed and what images come to mind. Like your description of your visit to the shrink slightly high but not intoxicated, and your description of your halter top, etc, which made the doctor think you did not have social phobia. All my portraits are black and white and I'd love to capture the way I imagine you when you write something. Another that comes to mind is your description of the new boyfriend and how you're both at the fluttering stage.
Well, you're in Texas, and I'm outside of Wash, D.C., so it will probably won't happen. But I did some portraits of a painter that I really love, so it was fun to think about.
Where is the new boyfriend? How are you going to stay safe? If you can hang in there, I'm sure you'll get over this hump; it may take some time. I'm worried with no job you're going to get yourself completely isolated. Have you ruled out
community therapists. Just someone to talk to.If you really think you're going to do yourself in, go into the hospital. Remember, you felt kind good there?
Shelli
Posted by judy1 on November 4, 2001, at 23:27:36
In reply to Re: med combo » sar, posted by shelliR on November 4, 2001, at 22:41:06
> > > > i would appreciate if anyone could comment on this med combo:
> > > >
> > > > 40 mg prozac
> > > > 1 mg klonopin twice daily
> > > > 1800 mg neurontin
> > > > 25 mg lamictal, to titrate up to 50 mg
Hi Sar,
Personally I think neurontin is useless as a primary mood stabilizer so until you have lamictal at an effective dose, you're leaving yourself wide open to the prozac which can have horrendous effects in bipolar disordered patients. (The klonopin may help but it really is more for panic and anxiety). There are documented cases of people with suicidal ideation on prozac, you may be one of the unfortunate few. Did you have trouble with depakote? (the gold standard along with lithium) I hope you begin to feel better- judy
Posted by Krazy Kat on November 5, 2001, at 9:40:51
In reply to Re: med combo- Sar, posted by judy1 on November 4, 2001, at 23:27:36
Sar:
Depakote has helped my obsessive thoughts some. I believe Lamictal would as well but you're got to get up to a helpful dose.
- K.
Posted by Mair on November 5, 2001, at 10:03:21
In reply to Re: med combo- Sar, posted by Krazy Kat on November 5, 2001, at 9:40:51
Sar - I don't have much expertise about meds. Lamictal is in my immediate future but I haven't picked up the scrip yet. Klonopin has been a great drug for me (with prozac) but i always took it to help me sleep. I do know that several years ago my pdoc increased a prescription of prozac because my depression was worsening and I became very suicidal. I don't know what he thought at the time, but i always blamed the prozac.
Mair
Posted by dove on November 5, 2001, at 10:12:45
In reply to Re: med combo- Sar, posted by Krazy Kat on November 5, 2001, at 9:40:51
> > >
> > > 40 mg prozac
> > > 1 mg klonopin twice daily
> > > 1800 mg neurontin
> > > 25 mg lamictal, to titrate up to 50 mg
> >
>
> the drugs are for depression/anxiety/purported bipolar II.
>
>is there a drug for people who are obsessively suicidal? often all i can think about is hanging myself from a tree, and i chose the rope at Home Depot yesterday. i want a drug to make these thoughts go away...
> > >I'm taking a six med-combo, and I can relate somewhat (from your post at least) to how you are feeling. I've also held the same diagnoses, the only one that's been removed is the Bipolar--they couldn't pinpoint any single manic episode that lasted longer than a day.
Amitriptyline: 50mgs at bedtime (have moved in between 150 mgs. and 50 mgs.) It has positive effects on my sleep cycles, and has proved to act like a base stabilizer for my depression and anxiety.
Serzone: 400-450 mgs. per day. Softens the edges of anxiety and has a very good effect on my sleep and daytime moodiness.
Prozac: 35-40 mgs. per day, ramped up very slowly, 5mgs per day to 10mgs to 15mgs to 20, where I stayed for awhile, then 25mgs, 30mgs, 35mgs, and currently vacillating between the 35 and 40 mgs. per day dosage. This is being taken for energy, an uplift in mood, personal assertiveness, and anxiety.
Klonopin: 3 mgs. per day for panic attacks and anxiety. I rarely (*very* rarely) take this amount. I stick around 1.5 per day unless something is especially agitating to me.
Adderall: 40 mgs. per day, childhood dxed ADHD, it calms me down and helps keep me focused and not feeling so overwhelmed--which usually results in extreme mood-swings and suicidal impulses.
Neurontin: 1,200 mgs to 2,400 mgs. Stabilize mood, lift mood, lessen anxiety, seems to help....
The first item in your combo that gave me a flashing red light is your 40mgs of Prozac daily. When I first started taking Prozac in November-January of 1999 (or thereabouts...) I became extremely suicidal, I just wanted to get my house completely tidy before I did it. Luckily for me, I have five kids and a husband who find it extremely physically challenging to lift a toe--much less a hand--with household cleaning, so the house has never quite made it to tidy.
This time, currently--as opposed to my Prozac experience in 1999--the Prozac was ramped slowly, and in combo with those other meds already in place, it didn't numb me to the point of complete disillusionment, nor did it give me that extra push and energy to get rid of myself.
Klonopin is a mood stabilizer (and an anti-epileptic med) and can accentuate depression in many people, even at very low dosages.
So you have, with some certainty anxiety and depression, and a possible *maybe* for Bipolar II. The Second aspect of your med-combo would then be the excessive use of mood stabilizers and anti-epileptic meds rather than trying an older TCA, a SNRI, or an SSRI that doesn't have as long a history for causing suicidal impulses as Prozac. Your only true AD is the Prozac, and maybe that's not the med that's going to decrease the depression for you! There's Wellbutrin, Serzone, Effexor, and the other SSRI's aside from Prozac, there are MAOI's, atypical everythings, there are many more options awaiting you!
Try not to allow the Doc's to get stuck on the Bipolar treatment first, since it's quite obvious that it's not working. The depression may need to be treated first (and possibly immediately), and all the AE stabilizers and SSRI's in the world just might not do a decent thing for you!!!
I send my best wishes to you and hope your Doc will listen to you!
dove
Posted by sar on November 5, 2001, at 10:27:35
In reply to Re: med combo » sar, posted by shelliR on November 4, 2001, at 22:41:06
Shelli,
thank you for the kind words...that was a really good message... :)
i enjoy your writing too, by the way...
i started on the neurontin a couple of months ago (?) and told my pdoc that i didn't feel any different, so he gave me these sample packs of lamictal just the other day, and i don't know what he plans on titrating me up to.
ahhh hospitals, hospitals, don't get me started. they do love to send those bills for $5000, while EMS goes with the more conservative $300 or so. i can't even look at the mail anymore without a terrible feeling of dread. but i would go back if i weren't completely ready to do myself in and wanted some intensive care.
i tried a couple of community therapists and had to go through a litany of questions re: illicit drug use, as if smoking a joint every now and again has made me suicidally depressed. (the free places around here are funded by religious organizations.) ["So, you've experimented with Exstacy." "A couple of times." "would you do it again?" "Yes, probably." "Would you take it if it were right here on the table???" "Ahm, not with you!"]
but i might give it another try.
thanks, Shelli... :)
love,
sar
Posted by sar on November 5, 2001, at 10:40:09
In reply to Re: med combo- Sar, posted by judy1 on November 4, 2001, at 23:27:36
> Personally I think neurontin is useless as a primary mood stabilizer so until you have lamictal at an effective dose, you're leaving yourself wide open to the prozac which can have horrendous effects in bipolar disordered patients.i think neurontin is a big yellow sugarpill. i have become convinced.
i'm titrating up on the lamictal, to how much we don't yet know...prozac was the first med i was put on, and it really picked me and and dusted me off. gave me a backbone and some feelings of well-being. however, the background thoughts of suicide have never gone away.
(The klonopin may help but it really is more for panic and anxiety). There are documented cases of people with suicidal ideation on prozac, you may be one of the unfortunate few. Did you have trouble with depakote? (the gold standard along with lithium) I hope you begin to feel better-
i have a lot of anxiety so the klonopin has been a godsend...they've wanted to put me on depakote numerous times, but i tell 'em i'd rather be skinny and crazy than fat and happy... :) (too much eating disordered behavior in the past to mess with that)
i did read in newsweek or something about AD's causing suicidal ideation...the article (of course written in a mass-market magazine meant to rile people up, with a more heart-wrenching anecdotes than medical evidence) didn't clarify whether the patients were already suicidal or just suddenly became that way upon starting an AD.
thanks Judy, and you take care!
love,
sar
Posted by sar on November 5, 2001, at 10:41:18
In reply to Re: med combo- Sar, posted by Krazy Kat on November 5, 2001, at 9:40:51
> Sar:
>
> Depakote has helped my obsessive thoughts some. I believe Lamictal would as well but you're got to get up to a helpful dose.
>
> - K.fingers crossed...
Posted by sar on November 5, 2001, at 10:47:07
In reply to Re: med combo- Sar, posted by Mair on November 5, 2001, at 10:03:21
hello sweet Mair,
are you on anything right now? could you have taken too much prozac too soon?
i've been on prozac for about 6 months now, never had a problem with it...i think my life circumstances are making me suicidal (broke, living with parents, lost everything in housefire, drink too much, lost friends due to crazy alcoholic/depressing behavior).
i guess for now i'll try to clean up my life and ramp up on the lamictal...
thanks Mair
love sar
Posted by sar on November 5, 2001, at 10:56:18
In reply to Re: med combo- Sar, posted by dove on November 5, 2001, at 10:12:45
dove,
your story about wanting to clean the house first made me laugh because i keep thinking i should get my room in order and throw away anything possible embarrassing, but i can't seem to lift a toe... ;)
i'm going to print your message out and take it to my pdoc...unfortunately, i won't see him for another month.
i don't know what to make of all of this BPII brew-ha-ha...which i told the pdoc, and he said that unipolars generally don't have the energy or inclination to do the impulsive things i do. still don't know what to make of that...might make a good discussion over on PSB...
thanks dove!
Posted by Greg on November 5, 2001, at 18:35:03
In reply to Re: med combo- Sar, posted by dove on November 5, 2001, at 10:12:45
Hi dove!
Just wanted to say hi and say that I hope that everything is well with you and yours. I should have put this on PSB but I wasn't sure you would see it there...
Greg
Posted by Elizabeth on November 6, 2001, at 15:19:53
In reply to Re: med combo, posted by sar on November 3, 2001, at 22:07:10
> the drugs are for depression/anxiety/purported bipolar II.
Well, do you think that all of the drugs you're taking are helping at least somewhat?
> is there a drug for people who are obsessively suicidal?
A lot of people with that problem seem to be helped by low doses of atypical antipsychotics such as Zyprexa (2.5-5 mg seems typical).
Do you feel like any of the medicines you're taking now have *worsened* the suicidal obsessions? If so, reducing or eliminating those, if you can, would be helpful.
> often all i can think about is hanging myself from a tree, and i chose the rope at Home Depot yesterday. i want a drug to make these thoughts go away...
I wouldn't go with hanging -- it takes a long time and is probably very painful.
I hope you feel better soon!
-elizabeth
Posted by Noa on November 6, 2001, at 17:42:40
In reply to Re: med combo » sar, posted by Elizabeth on November 6, 2001, at 15:19:53
Hey, Sar. Sorry you have such a frustrating situation finding a good therapist and the right med combo. I do hope you'll get help if you feel close to acting on your suicidal feelings. It is hard to tell with you when you are joking.....
As for the extacy, etc. this isn't probably what you want to hear, but I feel I should say it to you...I hope you take it as intended--as concerned, not judging.
I have no first hand experience with it, but there has been a fair amount of reporting here on this board from people who have had very difficult post-E experiences in responding to medications. My understanding (for what it's worth) is that E is potentially a serious threat to recovering from depression and/or anxiety, mood disorders, etc., and that it can cause problems in the brain's responsiveness to medications for these disorders. And while there has been less discussion of the effects of marijuana than of E, it, too, can be a depressant.
In any event, I would encourage careful consideration of the non-medical drugs as agents that can have a powerful impact on how you are feeling, and possibly that they could be undermining the success of your treatment. Not only because they are potent drugs in and of themselves, but also because unlike prescribed medications, where you and your doctor have some control over potency and dosage, etc., with street drugs, you often don't know what and how much and how strong, and how pure, etc.
Posted by sar on November 6, 2001, at 22:52:17
In reply to Re: med combo, posted by Noa on November 6, 2001, at 17:42:40
Noa,
thanks for your concern...no, i don't take it as judging, i think you're very kind.
regarding illicit drugs, i don't think i've used any in 9 months (and won't for another year, as i'm on probation now). what i meant about the free therapists was that they seemed eager to blame my depression on what i consider regular collegiate drug use--a lot of experimentation, but nothing i'd consider serious. in addition, my depression started at 12 or 13--years before i tried drugs. i just resented spending entire sessions saying yes or no and how often to every drug in the book, especially because i've been sober for periods of time (except for the occasional few-too-many beer saturday nights and some pot every now and again) but my depression seems malignant.
you wrote, "I do hope you'll get help if you feel close to acting on your suicidal feelings. It is hard to tell with you when you are joking..."
when i was in grade 8, we all had to memorize a poem to recite to the class. this is the poem i memorized, though i feigned illness when it was time for me to recite it. it's by Edward Arlington Robinson.
Richard Cory
Whenever Richard Cory went down town,
We people on the pavement looked at him:
He was a gentleman from sole to crown,
Clean favored, and imperially slim.And he was always quietly arrayed,
And he was always human when he talked,
But still he fluttered pulses when he said,
"Good-morning," and he glittered when he walked.And he was rich--yes, richer than a king--
And admirably schooled in every grace;
In fine we thought that he was everything,
To make us wish that we were in his placeSo on we worked, and waited for the light,
And went without meat, and cursed the bread;
And Richard Cory, one calm summer night,
Went home and put a bullet through his head.--end poem--
i'm no richard cory, it just hurt my feelings that you'd think i was joking about suicide. the topic is too close to my heart to joke about it--perhaps it seems like i do because i don't like to be all *dismal* about it all the time because i *feel* it all the time, so i make light of it the way--i don't know, the way an overweight person might make fun of their weight. my favorite aunt committed suicide in 1996, and the thoughts of my own suicide run so deeply in my mind that i'm near-incapacitated--functional yes, i drink my tea and go on walks and experience love--but my cognition is destroyed, i don't look forward to 60 more years of this shit.
enough rambling. yes, i agree with you...unfortunately, some street drugs suck!--they've been cut with so much shit...i'm more interested in my legal drugs right now that i am in the illegal, and if i could have one drug, it would remove that obsessive thought of, "I want to kill myself." none have done the trick yet, though they have helped me to be less anxious, depressed, etc--but not less suicidal.
i hope this is clear in some way...thank you, Noa, for your concern...
love,
sar
Posted by judy1 on November 6, 2001, at 23:31:00
In reply to Re: med combo- Sar » judy1, posted by sar on November 5, 2001, at 10:40:09
Hi Sar,
Didn't mean to eavesdrop on your note to Noa (just worried about you) as I'm sure she is. I was the queen of drug abuse in college but my pdoc thinks I was trying to self-medicate. I also have attempted suicide several times (my father died this way) and I wonder how much of that thinking is environmental or genetic depression. I do have an agreement with my pdoc that when I have suicidal thoughts I call and I've done the 3am pleas more than once, believe me he didn't mind. Is that something you can set up? I also wanted to try to convince you to not worry about weight right now (I was bulimic and understand), I don't know if depakote will help you but it wasn't as bad as zyprexa- maybe 5 pounds- and it is a very calming medication. Sorry to ramble, take care- judy
Posted by noa on November 7, 2001, at 19:17:57
In reply to Re: med combo » Noa, posted by sar on November 6, 2001, at 22:52:17
That is the second time this month I heard/saw a recitation of Richard Corey!! The other was on the TV show The Guardian a few episodes ago. Sorry I hurt your feelings, but thanks for the detailed response. I think the question about joking is due to how witty you are, and yes, I can relate to using the dark humor in trying to just get through it all. I just needed to check, you know? I think the question someone (was it Mair?) asked about whether you'd gone beyond just picking the rope out in your mind was a good question. Do you feel safe from acting on the suicidal feelings?
I think the approach of that clinic, of attributing the depression to the drug use is too simplistic. As you said, the depression came first. So many people find the drugs to self-medicate the depression/anxiety, etc. Drug use can exacerbate the depression, though, as you probably know, so it can become a chicken-and-egg thing. But the main thing is that you aren't using, ie, you are really trying to take better care of yourself.
As for THE ONE medicine--obviously you already know that the science of these meds is still unrefined and it's hard to get the combo right--it takes a lot of trial and error. I was discouraged so many times, but am glad I stuck around because I did finally find a "good enough" combo that made me feel much better (now if I could get rid of the remaining side effects it would be perfect rather than "good enough" but they aren't so bad--I am willing to put up with them because of the monumental difference between how badly I was doing and how much better I feel now).
;^) I would say "hang in there" as encouragement, but given the rope thing, maybe it is not prudent, and I should use a different expression.....:^)
Posted by sar on November 7, 2001, at 23:53:15
In reply to Re: med combo » sar, posted by noa on November 7, 2001, at 19:17:57
Posted by sar on November 8, 2001, at 0:01:39
In reply to Re: med combo- Sar, posted by judy1 on November 6, 2001, at 23:31:00
Judy,
hi, thanks for the input. did you see Dinah's message about depakote on psb? it's zombified her, it sounds like...but i think i'll try it if the lamictal doesn't work. 5 pounds--if i gave up the beer it'd come out even in the end, i suppose. also, a friend of mine just started it and i'll have to keep an eye on her to see if i notice any changes.
thanks, judy
love
sar
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.