![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by trouble on March 1, 2002, at 20:41:50
I've never posted on this board b/c it hurts my pdoc's feelings when I go to the internet for answers. He doesn't even know about PSB yet, but that's another post.
Anyway, my question is about compliance. Is it crucial to take the same number of meds every single day according to the label? My problem is in forgetting, which I do at least twice a week, only at night, and when I realize it I just double up on the next day. So, for example, instead of taking 2 Wellbutrins the next morning, I'll take 4, and then my regular 2 that night.
I'm alot more on top of things than I was a few years ago, but still rarely manage a perfect medication week. I've been wondering if that's ok, or if I could be paying a price for it.I currently take Wellbrutin, Provigil and Gabitril.
Thanks for your response!
trouble
Posted by Mark H. on March 1, 2002, at 21:01:21
In reply to medication compliance?, posted by trouble on March 1, 2002, at 20:41:50
Dearest Trouble,
Being familiar with your beautiful and heartfelt writing on the PSB, I'm a bit distressed by your question, which I think you know the answer to.
Wellbutrin destroyed my short-term memory (happily, it does not have that effect on everyone), so I worry when someone so intelligent writes here that she's forgetting to take her meds a couple of times a week.
Compliance is extremely important if only to maintain credibility with your psychiatrist AND continue to have input into what you're taking. If our docs can't trust us to follow directions, why should they trust us to do good research or to manage difficult combination-meds?
I've seen more people lose control of their care through non-compliance than through any single other fault. Doctors have to worry so much about liability today, that anyone who cannot follow a treatment schedule or pill-taking regimen is likely not to be trusted with anything stronger than aspirin.
PLEASE, you brilliant and beautiful person you, buy yourself one of those little seven-day pill boxes and USE IT so you don't have to trust your memory to stay on track. And take a hard look at whether what you're taking is possibly CAUSING the problems you're experiencing with compliance. My little pea-brain was literally confabulating events on Wellbutrin that never happened, just because once I "thought" of something I imagined it was already done!
I hope you don't think I'm being harsh; I just don't want to see you lose the freedom to co-direct your own treatment.
With warm regards,
Mark H.
Posted by trouble on March 1, 2002, at 23:32:38
In reply to Re: medication compliance?, posted by Mark H. on March 1, 2002, at 21:01:21
Dear Mark,
Gosh. Thank you for your kind words. Your Wellbutrin (you did say Wellbutrin, right?) caused short term memory gave me new hope over something I've been fighting w/ for a long time.
Like I forgot my check yesterday, leaving it on the roof of the car to blow away, and now every time I go to a mall I need to get security to help me find my car, tonight I was wondering if I ever had a memory at all, and gosh, I had no idea it could be my presious Wellbutrin. I've been on 50 ADs or so, and one reason I dig WB is that it makes me very amorous and sexually keyed up, and I like that, in case I meet a possible suitor I'll be raring to go. When on all the other meds I had NO sex drive or interest, and when I did masturbate (oh, dear, we're adults though, so...) it was a horrible experience, approaching release and then ZIP, where'd it go? I'd usually just give up in disgust.So now I guess I'll be asking for something new.
I did like Serzone, but I don't know if that works like Wellbutrin, I imagine my pdoc will want to do something similar.
Any ideas?As for compliance, I'll do it! My pdoc and I have so many power struggles that I don't know what's driving his responses anymore, but the last time I mentioned non-compliance he acted like I'd slashed his tires. There's not a lot of linear verbiage from him, just these kinetically fascinating demonstrations of effrontery attenuated by an equally dramatic struggle for self-restraint. He also grunts at me and says things like
I don't care what you do trouble, you do what you want, fine, go ahead, (mumble, grunt, frantic note-taking).
It seems everyone else on PSB demands a lot more maturity from their pdoc, but I've been fired by all his predecessors so I guess I'm lucky. He's well known and respected, and that counts too.
I apologize for all this blathering, but just the thought of seeing him since last month's blow-up has got the anxiety cranking. I had an app't w/ him this week and I moved it to next month, but I guess it's time to force the issue. He's computer-phobic and I'm afraid he'll break my balls when he finds out what I've been doing lately. I shouldn't even be talking to you guys!By the way, I read your PB posts too and find them a breath of fresh air!
trouble
Posted by medlib on March 2, 2002, at 0:34:38
In reply to medication compliance?, posted by trouble on March 1, 2002, at 20:41:50
Hi Trouble--
I've wanted to post to you a number of times, but I've been afraid I'd succumb to my deplorable tendency to profer unasked-for advice. I try not to miss any of your messages, partly because what you've revealed of yourself reminds me so often of my brother. Anyway, be aware that your posts likely have affected many more than you know. BTW, the remarkable change in those messages over such a short time is, IMO, the antithesis of decompensation.
Now, about multiple-dose meds: the general rule of thumb is that if the time until the next dose is less than the time since the last dose, simply skip the missed dose. DO NOT change the amount of the next dose without MD approval; abrupt major increases in med dosage exacerbate side effects and make adverse events more likely. If you remember a missed dose within 2 hours after its scheduled time, go ahead and take it. Different rules apply for "critical" meds (i.e., anticonvulsants for epileptics, heart meds, etc.). One takes a missed dose of those meds as soon as it's remembered, making adjustments in the timing (not the amount) of future doses, as needed.
As Mark mentioned, 7 day pill boxes help, particularly if one has the self discipline to fill them each Saturday night. Advance warning about refill needs is a side benefit. I use a different box color for each dosage time, placing each where I usually am at that time. Ny son carries a pocket-sized timer to help him remember a 4x/day med (people think the timer's a pager). People who know me tease about my "purse pharmacy"--usually while they're asking for an Advil or Tums. Hey, you do what you have to to cope with what you don't have (in my case, a short-term memory and the ability to multitask*).
Well wishes---medlib
* sorry for using such an linguistic idiocy, but it's succinct and I'm not.
Posted by Cam W. on March 2, 2002, at 1:15:06
In reply to medication compliance?, posted by trouble on March 1, 2002, at 20:41:50
Trouble - It is not a good idea to double up meds. As Mark said, this can cause more harm than good in the long run. I am going to give you a partial (potential) answer to your problem, but I first need to know a bit more about all the meds that you are taking. I need to know:
• the strengths of the medication that you are taking.
• the dosing instructions.
• how often do you get refills (ie. how many days of medication does your doctor(s) normally write for)?
• how long you have been taking each medication.
• any other medications (incl. herbals and non-prescription drugs) that you are taking..
• are all the medications that you are taking prescribed by one doctor?
• do you have young children at home?Answering these questions will help me to figure out if your memory loss is medication-induced, or just old fashioned aging.
I may also be able to give you a few tips on remembering to take your meds. I strongly recommend using a blister pack or a Dosette™ (or similar package). Both are an at-a-glance way to see if you have taken a certain dose at a certain time.
I like blister packs better than Dosettes if you are not taking any "as needed" medication. You cannot accidently spill a blister pack, and you can fit a larger number of pills into one.
Most pharmacies will blister pack or fill a Dosette for free. If yours doesn't, threaten to take your business elsewhere. If they still don't budge (or say that they don't have the capabilities to blister pack), phone around and find a pharmacy that does.
Importantly, make sure that the pharmacy does not say that they have to fill a blister pack or Dosette a week at a time only. They sometimes say that this is store/company policy. That is BS. The reason that they only want to fill a week at a time is because thay will get dispensing fees for each medication every week, instead of every month (or every 3 months, depending upon how often you pick up refills).
Pharmacists (esp. owner/pharmacists) may claim that they blister pack/dosette is more work, therefore it can only be done on a weekly basis. What they are really saying is, "I am lazy and need incentive to fill compliance packaging; but my greed says that I will do it if you pay me dispensing fees every week, rather than every month." Trust me, it is not that hard to fill them, and really does not take that much extra time to fill blister pack or dosette; not enough work to justify weekly dispensing fees, anyway.
If you do find someone who will fill a blister pack dosette for a month (or more), be nice to them, since they were nice to you by filling and giving compliance packaging at no extra cost. Always give the pharmacist a few days to fill your prescriptions and refills. This way they can wait until there is a slow time in the store to fill your compliance packaging. Make sure that you tell them that you will be in to pick up the meds in a few days and you are doing this so that they won't feel rushed. This will decrease the risk of any mistakes being made in the filling of the prescriptions &/or compliance packaging, and will make you look like a nice guy in the eyes of the pharmacist (we tend to do the little extras for people who are nice to us).
Also make sure that the blister pack has "all" of the prescription labels adhered to it. This is important; it can literally be a matter of life and death. If you end up in the emergency room of a hospital and are comatose, most likely whomever brought you will not remember what medications you were taking, and when. Whether the blister pack is empty or not, it can be very time-consuming to find out vital information about what medications you are taking when there are no labels attached. Unlabeled blister packs also make it impossible to determine when you had your prescription filled last, by which pharmacy, if those filling it had made a dispensing error (dosage, drug, etc.), and if you are taking the medication properly. If a pharmacist says that he/she cannot fit all the labels onto a blister pack card, they just aren't being creative enough. On a Jones Packaging "Cold Seal™" blister pack, I can comfortably fit 14 labels with no information being covered up, nor labels being loose.
You may ask, what is "Cold Seal"? This type of newer blister packaging is relatively cheap and is a reliable (ie. does not fall apart like earlier models did) and has an adhesive covered by a protective backing on both sides. Just flip the back onto the front and press down. Voila! It's sealed! It does not use heat sealing machine, so that cost is saved. You can use an inexpensive template, that the bubbles (blisters) fix into, to ensure that the pharmacist is able to tightly seal each of the bubbles, with no pills falling out.
Also, Cold Seal (probably is known by other brand names as well) blister packs allow the pharmacist to adjust the size of the blisters. I recommend using the extra-large blisters (but not the extra-extra-large; they are too flimsy and are difficult to work with) for filling all prescriptions. The extra-large blisters are sturdy enough to offer protection to the meds contained therein (especially easily breakable capsules or gelcaps), and big enough to hold several medications.
Some pharmacies try to give blister packs with the drugs separated into their own cards. This may be convenient for some nursing home set-ups, but is almost as ineffective for compliance as vials are. Have the pharmacy package all of your medications together.
Dosettes (which also go by different names, depending upon the brands) are also available in a number of sizes, and the size that you need depends upon the number of medications one takes. Herein lies one of the problems with dosettes. On the whole, Dosettes cannot fit too many medications, especially if those medications are large. If one is taking 3 x 500mg Epival™/Depakote™ (divalproex) at bedtime, one would be hard-pressed to be able to fit anything else in the bedtime slot. It would require one to buy four of the extra-large dosettes, which are bulky and not very convenient to carry with you. The newer blister packs are able to fit several drugs in the extra-large, or if need be, the extra-extra-large. If the pills are still too bulky, there are tricks around this, as well.
Before we go any further, I would like to let you in on a little secret for opening blister packs. Never push the pills from the top and try to pop them out of the back. This is a good way to crush more delicate tablets and capsules, and to end up with small bruises on you fingers. Always scratch out the foil from the underside of the blister pack over an empty cup or your hand. In this way your pills don't get crushed, and are less likely to bounce all over the place (a sink is the worst place to pop out your pills, using either method.
Even if one is not taking many medications, the initial outlay is for 8 Dosettes. If you are not paying a weekly dispensing fee, do not expect the pharmacy to supply them for you. You need to have 4 Dossettes filled with the month of meds that you are using, plus 4 at the pharmacy to be filled. You could get away with having 5 or 6 Dossettes, if you don't mind an extra trip or two to the pharmacy.
Another beef that I have about Dosettes is that there is not enough room on them to attach more than 6 or so labels, so that they are easily readable. The little chart on the back usually lacks some vital information, such as the date of the last fill. Some pharmacies do have printers that are able to update the back chart, by printing out new ones every month. You can ask if their computer has this ability.
My biggest beef with Dosettes is the ease at which they seem to spill (especially when you turn them over to read the directions and they are still open). Doesettes also seem to break fairly easily when dropped.
If you cannot find any pharmacy to blister pack your meds, you may have to use a Dosette. You would have to fill it yourself from the vials. It might be wise to get the pharmacist to show you how to do it properly the first couple of times. Also, it is wise to get someone else to check to see if you've filled it correctly every time. This may seem like a trivial thing, but in my pharmacy, where we do hundreds of Dosettes a week (I still don't like them), I have a second tech check the Dosettes filled by the first, then I check it from a master list. Anyone can, and will, make mistakes even if ultra-careful.
Be sure to save your labels from the vials (ask the pharmacist not to stick them on the vials) if filling your own Dosette. You can save these labels in your wallet (sort of a "poor-man's" Medic-Alert™ card) or tucked into the back of the Dosette. Be sure to keep the back card of the dosette updated with each change in medication. Fill out the card in pencil, as the White-Out™ can get very thick after a while.
Mark had mentioned daily pill packs. These are okay, but only if you are extremely comfortable with taking your meds. The daily packs are similar to a Dosette (ie. they are 1 out of the 7 days of the dosette). Daily packs are convenient if you need to take a regular dose of medication with you when you leave the house (eg. midday dose when going to work). The daily pill packs are also bulky, and are not that easy to conceal in jeans or a shirt pocket. I find the daily pill pack a pain-in-the-butt because it has to be filled everday. Others may find that this helps to job their memory to take the meds, but for me it doesn't.
Trouble, the reason I asked if there were any children in your household is because one of the memory jogging ideas I have involves leaving the blister pack on the bedside table or your pillow for the night time dose. Or you could leave it beside the sink where you brush your teeth, or you could put it in the drawer with the toothpaste.
Istead of guessing where and when you take your meds, I will let you anser my above questions, and I'll try to take it from there.
I hope that this seemingly endless monologue is of some help. - Cam
Posted by trouble on March 2, 2002, at 2:48:51
In reply to Re: medication compliance? » trouble, posted by Cam W. on March 2, 2002, at 1:15:06
Wow, Cam terrific, here we go:
e - It is not a good idea to double up meds. As Mark said, this can cause more harm than good in the long run. I am going to give you a partial (potential) answer to your problem, but I first need to know a bit more about all the meds that you are taking. I need to know:
>
> • the strengths of the medication that you are taking.Gabitril, mood stabilizer, still on a trial 4mg in am and 6mg in pm. I must admit I often get confused and take 6 PILLS instead of 3, since it doesn't register that the label refers to mg, not pills.
Provigil for narcolepsy, about a year
400 mg in amWellbutrin 200mg in am, 200 mg in pm
On and off over past few years, been on it steadily for about 6 months now
levoxyl 125mcg in am about 9 years
(does this really have to be on an empty stomach? I usually drink coffee and milk first, but I can stop if it's important)
> • the dosing instructions.
> • how often do you get refills (ie. how many days of medication does your doctor(s) normally write for)?
My insurance gives me 30 pills at a time> • how long you have been taking each medication.
> • any other medications (incl. herbals and non-prescription drugs) that you are taking..Butalbital 2 capsules at a time prn for migraines aboout 10 years (approx 6 pills per month, premenstrual)
Ambien 10mg 1-3 prn, haven't had one in 6 months
GABA CALM chinese medicine, prn
Ephedra for energy, 2 big pills, prn (this is the one that my pdoc got nasty about)
All kinds of vitamins gathering dust on my counter, taken randomly, but this week I bought a bottle from GNC called All-In-One Plus, vitamins and minerals and herbs and amino acids in liquid form, I take a swig from the bottle a couple times a day
Tums or Calcium tablets a few times a week
I just bought fish oil capsules and take 2 1000 mg softgels a day.
Bach Flower rescue remedy, take a sip prn
Echinachea when wheezing from too many cigarettes, 2 at a time, twice a day> • are all the medications that you are taking prescribed by one doctor?
NO, AD from pdoc, he will not prescribe sleeping pills and I see on ths board that other pdocs do! So I have to pay a sleep clinic to give me Ambien when my schedule goes awry.> • do you have young children at home?
I wish. But I have CTS and opening the bottles is getting real painful, esp in the mornings, so I might look into these bubble packs you mention.I was also on Trileptal for 6 weeks but it gave me nightmares so we switched to gabitril.
The problem w/ this background is that for the past 18 months I've been on 7 psychotropics, and the weaning is just now complete. But for a year and a half I was taking Paxil, BuSpar, Serzone, Wellbutrin, Provigil, Risperdol and one other I can't remember twice a day. Then a few months ago my pdoc said this is bu*lls*it, I don't know how it got to this point but YOU'RE ON 7 MEDS A DAY AND IT'S INAPPROPRIATE! And I'm like all right, I'm sorry, but was terrified of going off them and cracking up. But some of my current disorganization might be due in part to these changes.
To further exacerbate the circumstances in March 2001 I was diagnosed w/ADD, and my psychologicals indicate significant deficits in short-term memory retainment, high distractability, etc. Also a LD, in information processing (29 point spread btwn cognition and performance)
> Answering these questions will help me to figure out if your memory loss is medication-induced, or just old fashioned aging.
>
That would be a relief!!A few months ago I was setting aside one day a month and putting all my meds in old pill bottles which I taped numbers to, corresponding to the calendar days. It did not work out at all, so I'm going to try your advice. I'm on good terms w/ the pharmacist so we'll see how it goes over.
Here's one thing I didn't understand:
> Also make sure that the blister pack has "all" of the prescription labels adhered to it.
>Have pharmacy package all of your medications together.
>
Do you mean all of the different drugs to be taken at once in the same bubble? That does sound like a lot to ask!
>this seemingly endless monologue is of some help. - CamAbsolutely, thanks!
trouble
Posted by Dinah on March 2, 2002, at 9:00:32
In reply to Re: medication compliance? » trouble, posted by Cam W. on March 2, 2002, at 1:15:06
Posted by Sunnely on March 3, 2002, at 0:20:58
In reply to medication compliance?, posted by trouble on March 1, 2002, at 20:41:50
Cam's response to your question is excellent. Just want to add my 2 cents.
The general rules when it comes to taking psychotropic meds are:
1) Do not double the dose without your doctor's approval.
2) If you miss your dose and if its time to take the next dose, don't double the dose to make up for the missed dose.
Wellbutrin in particular may cause seizures if you double the dose. I understand you take 200 mg twice a day. Doubling the dose to 400 mg as a single dose may lead to this problem. In fact, the general recommendation as to Wellbutrin dosing to avoid risk of seizures are:
1) For depression, may start with 100 mg twice a day.
2) Give the doses at least 6-8 hours apart if the total daily dose is greater than 150 mg.
3) Each single dose should not exceed more than 150 mg.
4) The maximum daily dose should not exceed 450 mg.
5) Preferably, use the SR formulation.
6) Avoid use in patients with history of epileptic seizure and eating disorder.
7) Avoid use concomitantly with Zyban.
Gabitril (tiagabine), although use as an anti-epileptic, itself has been reported to cause seizures.
Modafinil (Provigil) induces the cytochrome enzyme P450 3A4 (CYP3A4). Gabitril is metabolized by this enzyme. So, there is the possibility that its blood level and therapeutic effect may be diminished when combined with Provigil.
BTW, I agree with the suggestion with the use of "pillminder" or "pillboxes" to avoid the chance of doubling the dose.
> I've never posted on this board b/c it hurts my pdoc's feelings when I go to the internet for answers. He doesn't even know about PSB yet, but that's another post.
>
> Anyway, my question is about compliance. Is it crucial to take the same number of meds every single day according to the label? My problem is in forgetting, which I do at least twice a week, only at night, and when I realize it I just double up on the next day. So, for example, instead of taking 2 Wellbutrins the next morning, I'll take 4, and then my regular 2 that night.
> I'm alot more on top of things than I was a few years ago, but still rarely manage a perfect medication week. I've been wondering if that's ok, or if I could be paying a price for it.
>
> I currently take Wellbrutin, Provigil and Gabitril.
>
> Thanks for your response!
> trouble
Posted by NikkiT2 on March 3, 2002, at 17:12:28
In reply to Re: medication compliance? » trouble, posted by Cam W. on March 2, 2002, at 1:15:06
I have this little box.. it is split into each day of the week, and then each day is split in four... each compartment holds my meds I have to take at each of these times.. I can easily check if I have taken a dose!!
It was fairly cheap, just from my local pharmacy. I refill it once a week and it is fab!!
I nevre double a dose I miss though... Always thought it was better not to!
nikki x
Posted by Chloe on March 4, 2002, at 18:39:52
In reply to Re: medication compliance?, posted by NikkiT2 on March 3, 2002, at 17:12:28
I never forget my meds. But I just want to never swallow the silly pills again because I get this awful "burning" scalp pain from the mood stabilizers. I take tiny amounts of many stabilizers to avoid bad effects.
112 Eskilith CR
500 neurontin (down from 600mgs..)
250 depakote
1.3 celexa
20 amitriptyline, for the neuropathic scalp pain.Well, after two weeks of great stability and productivity, I am ready to ditch the neurontin, then the Li again. Because I think those are the ones that make the "burning" the worst.
*I have a pattern, it seems. I get a good response to meds, then I feel good, then I am willing to risk my stability, to get rid of the damned side effects.* It always ends in pain and trouble.
BUT, somehow I must find a way to stay compliant...and not stop these stabilizers. I am BP 2 and if I drop out any of these meds, I spiral into depression or agitated mixed states.Any thoughts on how to stay med compliant, when I have such bad scalp pain? Should I just keep popping these pills and forget about constant sting? My pdoc is out of ideas. The TCA helped for a while, but now I have grown tolerant to it's effects, I guess...
Thanks so much
Chloe
Posted by Ritch on March 4, 2002, at 23:10:44
In reply to Re: medication compliance with painful S.E's?, posted by Chloe on March 4, 2002, at 18:39:52
> I never forget my meds. But I just want to never swallow the silly pills again because I get this awful "burning" scalp pain from the mood stabilizers. I take tiny amounts of many stabilizers to avoid bad effects.
>
> 112 Eskilith CR
> 500 neurontin (down from 600mgs..)
> 250 depakote
> 1.3 celexa
> 20 amitriptyline, for the neuropathic scalp pain.
>
> Well, after two weeks of great stability and productivity, I am ready to ditch the neurontin, then the Li again. Because I think those are the ones that make the "burning" the worst.
> *I have a pattern, it seems. I get a good response to meds, then I feel good, then I am willing to risk my stability, to get rid of the damned side effects.* It always ends in pain and trouble.
>
> BUT, somehow I must find a way to stay compliant...and not stop these stabilizers. I am BP 2 and if I drop out any of these meds, I spiral into depression or agitated mixed states.
>
> Any thoughts on how to stay med compliant, when I have such bad scalp pain? Should I just keep popping these pills and forget about constant sting? My pdoc is out of ideas. The TCA helped for a while, but now I have grown tolerant to it's effects, I guess...
>
> Thanks so much
> ChloeHi Chloe,
I noticed that you have been relatively quiet lately (I figured that equated to "stable" :-)). My suggestion would be to jack up that darn amitripytline another notch! Since the 10mg generic amitrip. tabs are so cheap-just add a 3rd tablet and see what happens. I am probably going to have to revisit nortiptyline again. The Wellbutrin I am taking is making me agitated as hell. I almost couldn't go to work today I just felt so agitated and ILL. Of course it happens about 4-6 hours after my morning WB dose. It has been getting progressively worse the last week or two. I know I need more mood stabilizer, but I can't hack the Dep. weight gain, or the lithium GI distress. I knew the WB was making me a little more grouchy than I like, but it is going thermonuclear on me! No more. I quit taking it tomorrow. Nortripytline was a lot easier to tolerate and didn't make me anxious. I don't want to go back to a TCA, but I don't think I have any choice. I don't think my pdoc will write for methylphenidate or Provigil (and perhaps with good reason not to).
good luck with your situation,
Mitch
Posted by Chloe on March 5, 2002, at 17:23:36
In reply to Re: medication compliance with painful S.E's? » Chloe, posted by Ritch on March 4, 2002, at 23:10:44
Hey Mitch,
Yeah, I really have been feeling better and cycling so much less. Wow, you don't know how miserable you are, until you have a break from it!I probably should tweak the amitriptyline, rather than drop my MS doses. But I hate the anticholinergic effects of Ami. Yuck, like you hate gi distress from lithium, I hate dry mouth and constipation from ami. BUT, it sure has hell is better than being crazy. BTW, Depakote is very useful, but you are right about the weight gain stuff. I just always feel hungry. That is so unlike me. I am usually a very light, picky eater. But on dep, bring it on! It's not such a terrible thing for me. I have gotten rather unweight with all my cycling and depressions over the last few years.
Now, have you ever tried adding Metamucil, or any psyllium fiber to your diet? I have a friend with IBS who is "cured" since taking a tbs of the orange smooth texture stuff two or three times a day. Maybe with the addition of fiber, you could tolerate a little Extended release lithium? And if you had a little TCA on board too, you might really be ok, gi wise.
I remember reading a post you wrote about a month back where you said you took 150 mg of Li the night before and the next day you just felt very calm and undisturbed by things around you. Well, this is why I like Li. It might be the calming, stabilizing agent you need right now, since you feel like you are going to blow! The Eskilith CR can be broken into quarters, so you can take about 100 mgs/day. It is taking the edge off things for me and has helped with the psychotic symptoms some too.I hope you start to feel better as the WB leaves your body. I can really sympathize with your agitation. It's an awful place to be. I hope you and you pdoc can come up with a good plan for you. Though I think you are on the right track with Nort. and/or lithium or dep. I think Ritalin would send you into hypoland/crash or a rage without a major tranquilizer on board, and I don't think enough is known about Provigil for BP2's yet...
Thanks, and take care, Mitch
Chloe
Posted by Ritch on March 5, 2002, at 23:35:49
In reply to Re: medication compliance with painful S.E's? » Ritch, posted by Chloe on March 5, 2002, at 17:23:36
> I probably should tweak the amitriptyline, rather than drop my MS doses. But I hate the anticholinergic effects of Ami. Yuck, like you hate gi distress from lithium, I hate dry mouth and constipation from ami.
Hey, try some FLAX OIL, a dab will do ya! I just restarted it after having aggravated IBS/d symptoms from it. In all seriousness-try it to see if it helps and then maybe you can take a little more AMI.
>BUT, it sure has hell is better than being crazy.
Chloe, I am not sure what is worse-being chained to a toilet or being crazy. It was my number#1 compliance problem with lithium. The only thing that really worked was Lomotil twice a day to solve it. But docs didn't like the *opiates* in there... like I was going to become a diphenoxylate addict with the atropine as icing on the cake...
BTW, Depakote is very useful, but you are right about the weight gain stuff. I just always feel hungry. That is so unlike me. I am usually a very light, picky eater. But on dep, bring it on! It's not such a terrible thing for me. I have gotten rather unweight with all my cycling and depressions over the last few years.Yes, I took a 125mg tab of Depakote today before I went to work to keep me from throwing a coffee mug at my boss. It did help a lot I must admit, in preventing a politically incorrect hostile outburst. Unfortunately, I noticed that I was up and grazing the cafeteria an hour or two earlier than usual and returning an additional time after lunch. I am already 30 lb overweight with a family history of heart disease-I can't take this crap.
>
> Now, have you ever tried adding Metamucil, or any psyllium fiber to your diet? I have a friend with IBS who is "cured" since taking a tbs of the orange smooth texture stuff two or three times a day. Maybe with the addition of fiber, you could tolerate a little Extended release lithium? And if you had a little TCA on board too, you might really be ok, gi wise.Yes, I tried the so-called Metamucil "solution" to SSRI induced diarrhea/IBS and it failed big time. I also got some very weird perceptual scale distortions the last time I tried some Lithium(a week or so ago). I swear this whole thing is an ADHD thing coupled with temporal lobe instability. The IBS is the worst when I notice "photophobic" sensitivity, etc. almost like migraines. Strangely enough, when I was taking Adderall the IBS symptoms completely dissapeared.
> I remember reading a post you wrote about a month back where you said you took 150 mg of Li the night before and the next day you just felt very calm and undisturbed by things around you. Well, this is why I like Li. It might be the calming, stabilizing agent you need right now, since you feel like you are going to blow! The Eskilith CR can be broken into quarters, so you can take about 100 mgs/day. It is taking the edge off things for me and has helped with the psychotic symptoms some too.Yes, if it wasn't for the "spacey-scaley" feelings (everything seemed bigger than normal) from taking it-I wouldn't think twice about taking it to control things acutely for a few days at a time. However, it is a little easier to take a little Dep. here and there.
>
> I hope you start to feel better as the WB leaves your body. I can really sympathize with your agitation. It's an awful place to be. I hope you and you pdoc can come up with a good plan for you. Though I think you are on the right track with Nort. and/or lithium or dep. I think Ritalin would send you into hypoland/crash or a rage without a major tranquilizer on board, and I don't think enough is known about Provigil for BP2's yet...You are probably right about the Ritalin. BUT, there are some people who feel uptight on Adderall, but feel calmed on Ritalin and vice versa. Interestingly, I *never* got hypomanic on the Adderall. I had some mild insomnia the first couple of nites, and then after that I just felt focused, alert, and my mood was kind of flat and "mechanical". Wellbutrin and SSRi's triggered far worse hypomania than the Adderall. Nortip. would be OK for anxiety/ADD sfx, but I don't want the cardiovascular crap with it. That is why I wonder if low-dose Duloxetine when it is avail. might be a good choice (with Neurontin+Klonopin).
Mitch
Posted by Zo on March 6, 2002, at 0:33:08
In reply to Re: medication compliance with painful S.E's?, posted by Chloe on March 4, 2002, at 18:39:52
All I can say is that I'm in Bipolar II Heaven after adding Lamictal to the mix.. .and it's lasting.
Zo
Posted by Chloe on March 6, 2002, at 19:00:25
In reply to Re: medication compliance with painful S.E's? » Chloe, posted by Ritch on March 5, 2002, at 23:35:49
Hey Mitch
I am sorry that there aren't more (good) meds available for BP, and depression for that matter...There sure alot of lousy choices if you are sensitive to the notorous side effects. I guess all we can hope for is that the more and better medications come down the line.I am really hoping that you come up with a good plan for your next "phase."
Hey, Zo made me think of it, have you tried Lamictal? Or do you have skin issues that made you reject a trial of that one? Lamictal, for me anyway, had profound AD affects, and was not sedating...In fact it was too activating for my tastes. :)Good luck Mitch
Chloe
Posted by Chloe on March 6, 2002, at 19:03:34
In reply to Re: medication compliance with painful S.E's? » Chloe, posted by Zo on March 6, 2002, at 0:33:08
> All I can say is that I'm in Bipolar II Heaven after adding Lamictal to the mix.. .and it's lasting.
Zo,
This is great news. Thanks for sharing :) And I hope to join you some day...Chloe
Posted by Ritch on March 6, 2002, at 23:41:17
In reply to Re: medication compliance with painful S.E's? » Ritch, posted by Chloe on March 6, 2002, at 19:00:25
> Hey Mitch
> I am sorry that there aren't more (good) meds available for BP, and depression for that matter...There sure alot of lousy choices if you are sensitive to the notorous side effects. I guess all we can hope for is that the more and better medications come down the line.
>
> I am really hoping that you come up with a good plan for your next "phase."
> Hey, Zo made me think of it, have you tried Lamictal? Or do you have skin issues that made you reject a trial of that one? Lamictal, for me anyway, had profound AD affects, and was not sedating...In fact it was too activating for my tastes. :)
>
> Good luck Mitch
> Chloe
Hi Chloe,I was thinking about that just about an hour ago. Well, to sum it up I was thinking about Geezer's potential trial with Zonegran (zonisamide-posts down below). I was concerned about the cognitive side effects/thinking disorder sfx with the Zon. since I am sensitive to "dumb drugs" (with comorbid ADHD). Well, I re-read the monograph on zonisamide to refresh my memory (no pun intended!), and I saw the SJS and TEN warnings that you see in a Lamictal monograph. Well, if I am going to pick a new mood stabilizer to add on to gabapentin and either one has similar potential for life-threatening rash but one has bad cognitive/irritability sfx compared to the other-I would choose the Lamictal. Glad you brought that up.
But, I am going to try to be patient instead and wait on pregabalin as a swap from gabapentin (maybe works better as an MS without cognitive sfx), escitalopram (maybe less dystonia/dyspepsia with the same positive effects), maybe a dab of Provigil would work better than WB or nortrip. for ADHD without causing any anx. or panic probs.?
Mitch
Posted by Chloe on March 7, 2002, at 22:15:38
In reply to Re: medication compliance with painful S.E's? » Chloe, posted by Ritch on March 6, 2002, at 23:41:17
> But, I am going to try to be patient instead and wait on pregabalin as a swap from gabapentin (maybe works better as an MS without cognitive sfx), escitalopram (maybe less dystonia/dyspepsia with the same positive effects), maybe a dab of Provigil would work better than WB or nortrip. for ADHD without causing any anx. or panic probs.?I admire you patience. And really hope some of the new stuff gives you better relief.
I am having a hell of a time with my scalp pain. I am using the awful scalp oil again. Hoping against hope that it will decrease the pain enough so I can stay on these mood stabilizers....Grrr
All the best
Chloe
Posted by Ritch on March 8, 2002, at 0:46:40
In reply to Re: medication compliance with painful S.E's? » Ritch, posted by Chloe on March 7, 2002, at 22:15:38
>
> > But, I am going to try to be patient instead and wait on pregabalin as a swap from gabapentin (maybe works better as an MS without cognitive sfx), escitalopram (maybe less dystonia/dyspepsia with the same positive effects), maybe a dab of Provigil would work better than WB or nortrip. for ADHD without causing any anx. or panic probs.?
>
> I admire you patience. And really hope some of the new stuff gives you better relief.
>
> I am having a hell of a time with my scalp pain. I am using the awful scalp oil again. Hoping against hope that it will decrease the pain enough so I can stay on these mood stabilizers....Grrr
>
> All the best
> Chloe
Hi Chloe,Did you notch up your amitripytline? Someone else posted here about Flax seeds helping with med-induced constipation. The Flax stuff also is supposed to help mood stabilization, too. Just an idea. I just wonder if the AMI is helping you sleep better (despite the pain), and that improved sleep makes for more natural defenses against the pain..and you have less cycling because you sleep better?? Well, the weirdest thing happened at my pdoc visit today. I mentioned having insomnia/dysphoria with the Wellbutrin I was taking and that I had to stop it. So guess what happened?, I get handed a script for Dexedrine. I was informed that the metabolites of the WB were indeed causing the insomnia and that the dex would leave my system quicker and metabolize more readily. I just took a dose today and barely noticed it. I did get quieter at work and wasn't as chatty and silly like I have been lately. Also, I seem to be thinking *less*. Very unusual and unexpected. Maybe it is the flax oil kicking in?
Mitch
Posted by Chloe on March 8, 2002, at 19:37:37
In reply to Re: medication compliance with painful S.E's? » Chloe, posted by Ritch on March 8, 2002, at 0:46:40
> Did you notch up your amitripytline? Someone else posted here about Flax seeds helping with med-induced constipation. The Flax stuff also is supposed to help mood stabilization, too. Just an idea. I just wonder if the AMI is helping you sleep better (despite the pain), and that improved sleep makes for more natural defenses against the pain..and you have less cycling because you sleep better??
I have switched my fish oil over to flax oil and I love it! I do think it has some "smoothing" properties. I am taking 5 G's of it already! But I called the local naturapathic/holistic lady from whom I buy all my supplements. She said for mood stabilization I would need to take 2-3 teaspoons of flax a day. Or about 10 grams. Wow! So I am thinking I should go up a little on the flax. It might help with the constipation, though it's hard to imagine I could be constipated on 5 grams! And then perhaps I could go up on the ami.
BUT my chief complaint is that I am so dried out. My scalp is so dry and painful, my hair brittle and dry (I always thought it was the lithium. But I don't see how 112 mg of li could be doing this...) and I have mouth sores from sleeping with my mouth open??? Who knows...I just know I am sleeping great! And I am pretty stable for me. But in all honesty, I think it's the neurontin that is doing the major drying. I increased to 500 mgs/day so I could get in an evening dose 2am/1evening/2hs. And the scalp pain that was relieved by the 20 mgs of ami came back with a vengence.
But now when I back off to 2/1/1 per day, I wake up in a foul mood that doesn't go away easily, and I am really snappy. But maybe with the added flax oil and decreasing the hs neurontin to 100 mgs things will get a bit better...N works so well, i just don't understand why I can't tolerate much of it...Maybe I need to get off it, it might be causing this awful pain, and then I could increase the Li a tad...who knows!!!
>Well, the weirdest thing happened at my pdoc visit today. I mentioned having insomnia/dysphoria with the Wellbutrin I was taking and that I had to stop it. So guess what happened?, I get handed a script for Dexedrine. I was informed that the metabolites of the WB were indeed causing the insomnia and that the dex would leave my system quicker and metabolize more readily. I just took a dose today and barely noticed it. I did get quieter at work and wasn't as chatty and silly like I have been lately. Also, I seem to be thinking *less*. Very unusual and unexpected. Maybe it is the flax oil kicking in?Wow, you got Dex! Sounds like that with the flax might be the ticket. I am glad you can pack up the WB til next dark/depression season!
In terms of flax oil, I say it's great. Very tolerable and no fish burps! Thanks for suggesting it a while back.
So glad you had a good day and that the "unusual and unexpected" turned out to be a nice thing!Chloe
Posted by Ritch on March 8, 2002, at 23:26:08
In reply to Re: medication compliance with painful S.E's? » Ritch, posted by Chloe on March 8, 2002, at 19:37:37
> > Did you notch up your amitripytline? Someone else posted here about Flax seeds helping with med-induced constipation. The Flax stuff also is supposed to help mood stabilization, too. Just an idea. I just wonder if the AMI is helping you sleep better (despite the pain), and that improved sleep makes for more natural defenses against the pain..and you have less cycling because you sleep better??
>
> I have switched my fish oil over to flax oil and I love it! I do think it has some "smoothing" properties. I am taking 5 G's of it already! But I called the local naturapathic/holistic lady from whom I buy all my supplements. She said for mood stabilization I would need to take 2-3 teaspoons of flax a day. Or about 10 grams. Wow! So I am thinking I should go up a little on the flax. It might help with the constipation, though it's hard to imagine I could be constipated on 5 grams! And then perhaps I could go up on the ami.Wow, you must have an iron gut! I just take 1G of flax oil and I get reflux from it (but no *fishy* reflux-which is OK). I got some Evening Primrose Oil, too, but I am going to wait and see how I react to the pstim over a week or so before I start adding it on-to make sure I don't confuse any adverse effects between the two.
>
> BUT my chief complaint is that I am so dried out. My scalp is so dry and painful, my hair brittle and dry (I always thought it was the lithium. But I don't see how 112 mg of li could be doing this...) and I have mouth sores from sleeping with my mouth open??? Who knows...I just know I am sleeping great! And I am pretty stable for me. But in all honesty, I think it's the neurontin that is doing the major drying. I increased to 500 mgs/day so I could get in an evening dose 2am/1evening/2hs. And the scalp pain that was relieved by the 20 mgs of ami came back with a vengence.
> But now when I back off to 2/1/1 per day, I wake up in a foul mood that doesn't go away easily, and I am really snappy. But maybe with the added flax oil and decreasing the hs neurontin to 100 mgs things will get a bit better...N works so well, i just don't understand why I can't tolerate much of it...Maybe I need to get off it, it might be causing this awful pain, and then I could increase the Li a tad...who knows!!!Well, I don't know if I mentioned it or not, but I am sort of "dose-limited" on Neurontin myself. I take 100mg tid, but if I try to increase it I get chondroital type pain in my ribs and get chest wall muscle spasms from it. What a drag-it works the best of *anything* for my head....
You (since you have the iron gut), seem to tolerate Lithium a lot better than I do. Maybe it would be a good idea to increment the Lithium a notch and decrement the Neurontin a notch and see how that goes for a few days?
>
>
> >Well, the weirdest thing happened at my pdoc visit today. I mentioned having insomnia/dysphoria with the Wellbutrin I was taking and that I had to stop it. So guess what happened?, I get handed a script for Dexedrine. I was informed that the metabolites of the WB were indeed causing the insomnia and that the dex would leave my system quicker and metabolize more readily. I just took a dose today and barely noticed it. I did get quieter at work and wasn't as chatty and silly like I have been lately. Also, I seem to be thinking *less*. Very unusual and unexpected. Maybe it is the flax oil kicking in?
>
> Wow, you got Dex! Sounds like that with the flax might be the ticket. I am glad you can pack up the WB til next dark/depression season!
> In terms of flax oil, I say it's great. Very tolerable and no fish burps! Thanks for suggesting it a while back.
> So glad you had a good day and that the "unusual and unexpected" turned out to be a nice thing!
>
> Chloe
Well, so far it doesn't seem to be retriggering any dysphoria or insomnia that the Wellbutrin obviously was doing. One nice thing I noticed today-I wasn't in a hurry... about anything. Very odd-I just flowed from one task to another and didn't have this feeling of pressure that I had to get everything done all at *once*. I didn't necessarily feel all that *focused*-I just felt that everything had a priority or queue of sorts that could be patiently followed with a *plan*. I spent a lot more time sitting doing things instead of pacing around thinking *about* doing them. Almost an anxiolytic like feeling.Mitch
Posted by Chloe on March 9, 2002, at 17:13:14
In reply to Re: medication compliance with painful S.E's? » Chloe, posted by Ritch on March 8, 2002, at 23:26:08
> Well, I don't know if I mentioned it or not, but I am sort of "dose-limited" on Neurontin myself. I take 100mg tid, but if I try to increase it I get chondroital type pain in my ribs and get chest wall muscle spasms from it. What a drag-it works the best of *anything* for my head....I am glad I am not alone in that there is a good med, but the dose can't be pushed too high. Though, I decreased the N by 100 mgs last night, and I had a horrible day today. About 5 hours after my morning dose of N, I got the shakes and felt so irritable and panicky (I don't usually have "panic" type issues). So I took a 2.5 valium and tried to proceed with my job at the store. As the slow hours passed, I felt worse and more shaky, sweaty and teary.
All the while my scalp is burning like crazy cause I gave that scalp oil another two day trial. And I think the steriod makes my head burn worse. Not to mention the massive hair loss I had over the last two morning in the shower when I washed it out. God, i couldn't be more depressed and agitated. I can't relax, I feel lilke I am on speed. And I only went down only 100 mgs on the N. I wish I could just take my damn meds and not worry about side effects. Today I would swear I am in hell. I apologize for the desperateness of my post. I guess I need more valium if I am going to survive the night. I feel awful. And I wish I had some solution to my mystery scalp pain...I don't have dry skin, but I have desperately dry scalp/hair with pain that no NSAID will touch. How does this make sense??? Would a "pain specialist" think I am nuts if I made an appointment? I just don't know how to address the pain, so I can stay on my meds...> You (since you have the iron gut), seem to tolerate Lithium a lot better than I do. Maybe it would be a good idea to increment the Lithium a notch and decrement the Neurontin a notch and see how that goes for a few days?
I am scared the li will dry my burning scalp too...but it might be the way to go. Though I don't know if li will quiet this shaky/panicky feeling I have. Do li and N work on the same receptors? My mind can't think that clearly now...Would li help with N withdrawal?
> Well, so far it doesn't seem to be retriggering any dysphoria or insomnia that the Wellbutrin obviously was doing. One nice thing I noticed today-I wasn't in a hurry... about anything. Very odd-I just flowed from one task to another and didn't have this feeling of pressure that I had to get everything done all at *once*. I didn't necessarily feel all that *focused*-I just felt that everything had a priority or queue of sorts that could be patiently followed with a *plan*. I spent a lot more time sitting doing things instead of pacing around thinking *about* doing them. Almost an anxiolytic like feeling.I know that "rushed" feeling and I hate it. I am glad you had a day without it! I get that pressured feeling from too much ssri(or not enough MOOD STABILIZER!). I feel like I have to do fifty things at once, and I literally get out of breath trying to get everything done. Which of course I don't...Not rushed but a little unfocused sounds ok for now. You can work on honing your attention to detail as the days pass...I would just try to enjoy the anxiolytic feeling while it lasts :)
Thanks for listening, I apologize for my desperation.
Chloe
Posted by Ritch on March 9, 2002, at 23:04:00
In reply to Re: medication compliance with painful S.E's? » Ritch, posted by Chloe on March 9, 2002, at 17:13:14
>
> > Well, I don't know if I mentioned it or not, but I am sort of "dose-limited" on Neurontin myself. I take 100mg tid, but if I try to increase it I get chondroital type pain in my ribs and get chest wall muscle spasms from it. What a drag-it works the best of *anything* for my head....
>
> I am glad I am not alone in that there is a good med, but the dose can't be pushed too high. Though, I decreased the N by 100 mgs last night, and I had a horrible day today. About 5 hours after my morning dose of N, I got the shakes and felt so irritable and panicky (I don't usually have "panic" type issues). So I took a 2.5 valium and tried to proceed with my job at the store. As the slow hours passed, I felt worse and more shaky, sweaty and teary.
> All the while my scalp is burning like crazy cause I gave that scalp oil another two day trial. And I think the steriod makes my head burn worse. Not to mention the massive hair loss I had over the last two morning in the shower when I washed it out. God, i couldn't be more depressed and agitated. I can't relax, I feel lilke I am on speed. And I only went down only 100 mgs on the N. I wish I could just take my damn meds and not worry about side effects. Today I would swear I am in hell. I apologize for the desperateness of my post. I guess I need more valium if I am going to survive the night. I feel awful. And I wish I had some solution to my mystery scalp pain...I don't have dry skin, but I have desperately dry scalp/hair with pain that no NSAID will touch. How does this make sense??? Would a "pain specialist" think I am nuts if I made an appointment? I just don't know how to address the pain, so I can stay on my meds...
Wow, Chloe-you are definitely a Neurontin responder then. Hopefully pregabalin will be as or more effective with less sfx. I am really hoping about this one. I would really like to be able to tolerate about 600-900mg/day.
>
> > You (since you have the iron gut), seem to tolerate Lithium a lot better than I do. Maybe it would be a good idea to increment the Lithium a notch and decrement the Neurontin a notch and see how that goes for a few days?
>
> I am scared the li will dry my burning scalp too...but it might be the way to go. Though I don't know if li will quiet this shaky/panicky feeling I have. Do li and N work on the same receptors? My mind can't think that clearly now...Would li help with N withdrawal?From my own personal experience Li and N. are the only two MS that I have tried that have true antidepressant qualities. (Haven't tried Lamictal)
You have been on higher Li doses before, I kinda of think that is probably where you need to head to (say 300mg/day).>
>
> > Well, so far it doesn't seem to be retriggering any dysphoria or insomnia that the Wellbutrin obviously was doing. One nice thing I noticed today-I wasn't in a hurry... about anything. Very odd-I just flowed from one task to another and didn't have this feeling of pressure that I had to get everything done all at *once*. I didn't necessarily feel all that *focused*-I just felt that everything had a priority or queue of sorts that could be patiently followed with a *plan*. I spent a lot more time sitting doing things instead of pacing around thinking *about* doing them. Almost an anxiolytic like feeling.
>
> I know that "rushed" feeling and I hate it. I am glad you had a day without it! I get that pressured feeling from too much ssri(or not enough MOOD STABILIZER!). I feel like I have to do fifty things at once, and I literally get out of breath trying to get everything done. Which of course I don't...Not rushed but a little unfocused sounds ok for now. You can work on honing your attention to detail as the days pass...I would just try to enjoy the anxiolytic feeling while it lasts :)
>
> Thanks for listening, I apologize for my desperation.
> Chloe
Desperation *is* the situation,Mitch
Posted by Chloe on March 10, 2002, at 19:18:41
In reply to Re: medication compliance with painful S.E's? » Chloe, posted by Ritch on March 9, 2002, at 23:04:00
> Desperation *is* the situation
How true, Mitch. You have been such a great provider of information and source of support to me in these "desperate" times. I appreciate it so much.I talked to the pdoc today. She said I should go back up to 500 of Neurontin and go up to 30 mgs of Ami. Didn't you tell me to do that a while back??? I should have listened and avoided all this!!! She added if I get "unstable" from too much AD, I should add a little more Li.
But I looked back in my notes, and I have *always* had dry skin issues with N above 400 mgs. And I guess 300 mgs is best skin/hair wise, but definitely not mood wise. So I was thinking I should add in another 112 eskilith in the evening to total 225mgs lithium per day and and keep the N in the 300-400 range.
I am really not crazy about increasing the ami...But perhaps it wouldn't be as bad as I invision. How high have you gone on ami? What is a typical "small" dose anyway for pain or sleep, do you know off the top of your head?Gee, any word on the pregabilin trials? Now I am interested, since I have such a love/hate relationship with N!
How is the Dex/Neurotin/Celexa/klon going? Do you still have an absence of feeling rushed? I do hope so!
Take care
Chloe
Posted by Ritch on March 10, 2002, at 21:59:53
In reply to Re: medication compliance with painful S.E's? » Ritch, posted by Chloe on March 10, 2002, at 19:18:41
> I talked to the pdoc today. She said I should go back up to 500 of Neurontin and go up to 30 mgs of Ami. Didn't you tell me to do that a while back??? I should have listened and avoided all this!!! She added if I get "unstable" from too much AD, I should add a little more Li.
>
> But I looked back in my notes, and I have *always* had dry skin issues with N above 400 mgs. And I guess 300 mgs is best skin/hair wise, but definitely not mood wise. So I was thinking I should add in another 112 eskilith in the evening to total 225mgs lithium per day and and keep the N in the 300-400 range.Hi Chloe,
I would try the bump in Li to 225mg/day, and keep everything else the same. Do that for a week, and then consider the bump of AMI to 30mg/day. Wow, you are doing so well on such "Victrola" meds. It is really amazing.
> I am really not crazy about increasing the ami...But perhaps it wouldn't be as bad as I invision. How high have you gone on ami? What is a typical "small" dose anyway for pain or sleep, do you know off the top of your head?
Just an FYI, but doxepin was the first AD I was on and that got pushed all the way to 150mg/day during a bipolar depressive summer episode and it did... diddly squat. Amitriptyline has much more potent AD activity. I was on 20mg/day for a while, but it made me *too* flat, and my friends complained that I wasn't fun to be around anymore so I stopped taking it. Maybe I shouldn't have in retrospect...>
> Gee, any word on the pregabilin trials? Now I am interested, since I have such a love/hate relationship with N!
>
> How is the Dex/Neurotin/Celexa/klon going? Do you still have an absence of feeling rushed? I do hope so!It is doing OK, I think I could probably get by without the pstim until summer and do just fine otherwise.
Mitch
>
> Take care
> Chloe
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