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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 40. Go back in thread:
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
Posted by Krazy Kat on November 8, 2001, at 10:33:54
In reply to Re: med combo » sar, posted by noa on November 7, 2001, at 19:17:57
Re: your comments re: free therapists and diggin into your past drug and alcohol use as an explanation - I agree totally. I'm sure they're not all like this, but my experiences have been similar.
I had to lie to some.
Posted by Dinah on November 8, 2001, at 11:04:41
In reply to Re: med combo- Judy, posted by sar on November 8, 2001, at 0:01:39
Sar,
It really isn't that bad. I felt more zombified on Neurontin and Luvox. It's just that I use dissociation so much as a defense mechanism that Depakote really exaggerates the effect. It it continues to work for the anxiety, I think I will put in the effort to "unlearn" my dissociative techniques. If that doesn't work, I may have to give up on it.
For what it's worth, the Depakote seems to have reduced my ruminations as well. I have trouble with suicidal ruminations at times as well as other ruminations. I've never been tempted to act on them but they are disturbing. You might try Depakote before switching to the big guns like Zyprexa, which I've read here does a lot to reduce suicidal ruminations.
IMHO a little weight gain on Zyprexa or Depakote is a small price to pay. After all, your weight won't matter at all if you ever decide to act on the ruminations.
I hope you and your pdoc are able to find a combo that works for you. It sounds as if you are in a lot of pain. I'd try therapy again too. In my own experience, and I know a lot of people might disagree, a good therapist is as helpful as medications. Notice I said a good one.
Posted by Elizabeth on November 8, 2001, at 17:28:47
In reply to Re: med combo » sar, posted by noa on November 7, 2001, at 19:17:57
> I think the approach of that clinic, of attributing the depression to the drug use is too simplistic.
It's very common, though. Some doctors and nurses still believe that taking LSD more than a certain number of times (7 is a common number I hear tossed around) causes "permanent brain damage, and a lot of them think that psychedelics cause depression (studies have failed to confirm this rumor). The "amotivation syndrome" from marijuana is also a common myth among healthcare professionals. (I mean, I don't take pot at all, and I'm completely amotivated! < g >)
> Drug use can exacerbate the depression, though, as you probably know, so it can become a chicken-and-egg thing.
I think this is true of some drugs, but it's best not to generalize. Which drugs do you think make depression worse? (Anyone who's reading, feel free to consider this a survey.) I think alcohol is the worst nonmedical drug for depressed people to use.
-elizabeth
Posted by noa on November 9, 2001, at 15:40:21
In reply to Re: med combo- Judy » sar, posted by Dinah on November 8, 2001, at 11:04:41
Elizabeth, Although I have read a few accounts, here at Babble, of people with possible lingering adverse effects from E, when I said drugs can exacerbate depression, I was thinking more about how ongoing drug use can affect mood and complicate treatment, not so much about past use. In any event, I don't really think focusing on past drug use as the supposed *cause* of depression is even useful for treatment, (even if they could show they were right). And you're right, I shouldn't overgeneralize. All this is just my opinion, anyway.
Posted by judy1 on November 9, 2001, at 20:54:30
In reply to Re: med combo- Judy » sar, posted by Dinah on November 8, 2001, at 11:04:41
Hi,
I was interested in your feelings that depakote worsened your dissociative feelings. I also use dissociation to cope and I guess I never made that connection. I work A LOT in therapy in grounding myself (w/o using SI to return) and I've noticed an improvement after several months. I was curious if anyone else had a depakote-dissociation connection- judy
Posted by Elizabeth on November 9, 2001, at 21:50:39
In reply to Re: med combo- Judy, posted by noa on November 9, 2001, at 15:40:21
> Although I have read a few accounts, here at Babble, of people with possible lingering adverse effects from E, when I said drugs can exacerbate depression, I was thinking more about how ongoing drug use can affect mood and complicate treatment, not so much about past use.
Either way, I would like to know which drugs you mean. They're not all the same, and we shouldn't forget that Prozac and Remeron and Lamictal and all the other things that we take are drugs, too. Whether they're legal, or what they're marketed for, isn't a chemical or pharmacological property of the drug; it's a result of the associations that society attaches to it.
> In any event, I don't really think focusing on past drug use as the supposed *cause* of depression is even useful for treatment, (even if they could show they were right).
That's a good point, too.
> All this is just my opinion, anyway.
Hey, I responded because I care about your opinion!
-elizabeth
Posted by Dinah on November 9, 2001, at 23:18:18
In reply to Dinah- dissociation, posted by judy1 on November 9, 2001, at 20:54:30
I have tried to do some internet research on the subject, and haven't found anything so it must not be a common side effect of Depakote. It may just be me, since I had some of the same problems on Luvox. My theory is that it upsets the careful balance I usually maintain in using dissociation by changing my base emotional state. This causes me to have problems with depersonalization and derealization.
On the other hand, it just may be a problem with perception. Psychotropic drugs definitely have an effect on perception in my experience. The worst derealization I ever had was while withdrawing from Luvox. Perhaps this is just an initial side effect from increasing my Depakote dosage.
All of this is so hard to figure out. I guess I'll know more after a few more weeks on Depakote.
I really admire your hard work in learning to ground yourself. I think I cling to my dissociative skills too much, to the detriment of other coping skills. Oddly enough, I have used SI to help me dissociate rather than to bring me back.
Posted by Mitch on November 10, 2001, at 10:01:09
In reply to Re: Dinah- dissociation, posted by Dinah on November 9, 2001, at 23:18:18
> I have tried to do some internet research on the subject, and haven't found anything so it must not be a common side effect of Depakote. It may just be me, since I had some of the same problems on Luvox. My theory is that it upsets the careful balance I usually maintain in using dissociation by changing my base emotional state. This causes me to have problems with depersonalization and derealization.
> On the other hand, it just may be a problem with perception. Psychotropic drugs definitely have an effect on perception in my experience. The worst derealization I ever had was while withdrawing from Luvox. Perhaps this is just an initial side effect from increasing my Depakote dosage.
> All of this is so hard to figure out. I guess I'll know more after a few more weeks on Depakote.
> I really admire your hard work in learning to ground yourself. I think I cling to my dissociative skills too much, to the detriment of other coping skills. Oddly enough, I have used SI to help me dissociate rather than to bring me back.Hi Dinah,
I just now followed this thread and it is very interesting. I never "used" dissociation (at least not that I can consciously recall) to cope with stress. However, you obviously seem to be concerned that an anti-epileptic drug like Depakote could worsen this. Well many AED's are notorious for causing depersonalization/derealization FWIW-especially at higher doses (even exacerbating psychosis). I defintely had that problem with Gabitril. I DO have some troubles with derealization/panic, etc. Have you ever been on different mood stabilizers? If so, what was your response to them?
Mitch
Posted by shelliR on November 10, 2001, at 12:49:38
In reply to Re: Dinah- dissociation, posted by Dinah on November 9, 2001, at 23:18:18
>My theory is that it upsets the careful balance I usually maintain in using dissociation by changing my base emotional state. This causes me to have problems with depersonalization and derealization.
.....
From another dissociator: I don't understand what you mean by a careful balance in using dissociation. Aside from having children inside, the other way I dissociate is to not feel myself physically at all. I guess it developed in childhood to get through by not feeling present, or being invisible. My inside kids are pretty much under control, but I still can't control my lack of physical being except to change scenery, despite trying grounding techniques. I would rather not have this dissociation; it doesn't seem to have a positive function now. So I am interested in what type of dissociation you still find useful as an adult. (when carefully controlled)
. I think I cling to my dissociative skills too much, to the detriment of other coping skills. Oddly enough, I have used SI to help me dissociate rather than to bring me back.That doesn't seem odd to me. I have also used SI to help me dissociate, although I have never thought of it that way. When I feel really bad about myself (different than depressed) is when this sometimes happpens. It has become less effective for me, i.e., still have bad feelings after, so I am much less inclined to try that route anymore.
Shelli
Posted by Dinah on November 10, 2001, at 16:35:08
In reply to Re: Dinah- dissociation » Dinah, posted by Mitch on November 10, 2001, at 10:01:09
Everything feels less odd today, so I'm hoping the derealization was an effect of the dose increase of Depakote. I'm starting to get night time anxiety again as well, so I guess I'm getting used to the new dose. I'll have to remember not to worry about any derealization I experience if I increase the dose again. It's interesting to find out that anti-epileptics can be responsible for derealization. I obviously need to work with my internet research skills.
I was on Neurontin for about a week and had to stop because of half awake vivid dreaming.
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