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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 34. Go back in thread:
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
Posted by Chloe on March 11, 2002, at 19:02:26
In reply to Re: medication compliance with painful S.E's? » Chloe, posted by Ritch on March 10, 2002, at 21:59:53
> 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.Hey, Mitch,
I am so depressed today. The lack of 100 mgs of N makes a huge difference in my affect. I am also trying to get my 200 mg dose of neurontin in the evening (instead of the am), so I can sleep. I have lost the ability to sleep soundly without my 200 mgs at night :(.I do plan to bump up the li. I do think that will help with mood. But, I am having pretty bad scalp pain now, so I am reluctant to add some more li today...Any thought on if I can take all 225 in the am, or is it best to divide it?
>Wow, you are doing so well on such "Victrola" meds. It is really amazing.
I am not sure exactly what you mean by this...
But I can tell you that my mood is like a moving target. When I finally think I got it in my sights, something comes up, a side effect, a psychotic episode, whatever. So I have to constantly be titrating a tiny bit here and there to have *some* semblence of stability.
Oh, I had such a nice stretch. I hate it when I crash and burn. I made so many plans for this month (when I was feeling great!), that involve alot of responsibility and money. I really hope I can hold it together...
> 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...
When I was fourteen, after my first hospitalization, I was put on amitriptyline. I got up to 125 mgs for a couple of years. God did I feel *flat* too! I remember not caring about anything. Blah, blah, blah than I would have these wild rages. My mother was totally freaked by me!
150 mgs of Doxepin, Wow! How did you walk around? I heard that stuff is very sedating, but clearly less potent, I guess. It's interesting that your friends noticed that you didn't have a funny side anymore. How did you experience yourself? I get the impression you rather liked the feeling.
> It is doing OK, I think I could probably get by without the pstim until summer and do just fine otherwise.
Glad to hear you are doing ok...Is the pstim too stimulating? Maybe nortrip would feel better right now, pre summer?take care and thanks,
Chloe
Posted by Ritch on March 11, 2002, at 23:19:20
In reply to Re: medication compliance with painful S.E's? » Ritch, posted by Chloe on March 11, 2002, at 19:02:26
> Hey, Mitch,
> I am so depressed today. The lack of 100 mgs of N makes a huge difference in my affect. I am also trying to get my 200 mg dose of neurontin in the evening (instead of the am), so I can sleep. I have lost the ability to sleep soundly without my 200 mgs at night :(.Yes, I have to admit that Neurontin did the best for depression of any mood stabilizer (that I have tried). I wonder since it works on anxiety so well for most if that isn't the core of my depressions (ruminating during depressions). Depakote works good for hostility (so does Li), Lithium works #2 for depression as a mood stabilizer for me (but I do get the "spacey-scaley" stuff). BTW, I had to stop the dex. for a while. I took just 2.5mg yesterday and I had to go get copies of my taxes done. Well, it was just *too* intense. I went up to get a "store card" for the copy machines and I felt so amped. Kind of like the scene in "Fear and Loathing.." where Johnny Depp walks up to get a room at the beginning of the movie and the clerk has her scarf all up in the air flapping rapidly. Whew! Just too much. It just tends to set off panic. Nuff said. I will stash it for when I need it for real depressive stuff and tell my pdoc what happened.
>
> I do plan to bump up the li. I do think that will help with mood. But, I am having pretty bad scalp pain now, so I am reluctant to add some more li today...Any thought on if I can take all 225 in the am, or is it best to divide it?Since you were only on 112.5mg you might want to take it in smaller steps. The next logical small step would be to jump to 150mg instead of 225mg. You can do that with generic Li 300mg scored tabs.
>
> >Wow, you are doing so well on such "Victrola" meds. It is really amazing.
>
> I am not sure exactly what you mean by this...
> But I can tell you that my mood is like a moving target. When I finally think I got it in my sights, something comes up, a side effect, a psychotic episode, whatever. So I have to constantly be titrating a tiny bit here and there to have *some* semblence of stability.I just meant that you were using Li and Amitrip. and those have been around so long.
>
> Oh, I had such a nice stretch. I hate it when I crash and burn. I made so many plans for this month (when I was feeling great!), that involve alot of responsibility and money. I really hope I can hold it together...
>
>
> > 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...
>
> When I was fourteen, after my first hospitalization, I was put on amitriptyline. I got up to 125 mgs for a couple of years. God did I feel *flat* too! I remember not caring about anything. Blah, blah, blah than I would have these wild rages. My mother was totally freaked by me!
> 150 mgs of Doxepin, Wow! How did you walk around? I heard that stuff is very sedating, but clearly less potent, I guess. It's interesting that your friends noticed that you didn't have a funny side anymore. How did you experience yourself? I get the impression you rather liked the feeling.Yep, doxepin is the *most* sedative TCA. I was just very depressed and taking 75mg/day... and nothing was getting any better. So, they told me to double it (that was back in '83). When I was trying the Amitrip. it wasn't during the middle of a depressive episode-more of an "in-between" period. But, I must say that 20mg day-and I was more energized. That is the nice thing about low-dose amitrip. or nortrip. you get lowered anxiety and more energy at the same time. I will probably be back on nortrip. soon. It would be kind of nice if I could ditch TCA's and Celexa and just take duloxetine. It is supposed to be like Effexor with much less cardiovascular sfx. Well, effex. made me want to puke and gave me weird dreams and hypomania... The proof will be in the pudding.
>
>
> > It is doing OK, I think I could probably get by without the pstim until summer and do just fine otherwise.
>
> Glad to hear you are doing ok...Is the pstim too stimulating? Maybe nortrip would feel better right now, pre summer?
>You hit the nail on the head I think.
Mitch
Posted by Chloe on March 12, 2002, at 19:57:30
In reply to Re: medication compliance with painful S.E's? » Chloe, posted by Ritch on March 11, 2002, at 23:19:20
Hey Mitch
Can bearly type. I am so agitated. I really thought going down on Neurontin and going up on Ami would help with my scalp. But it's the same. The burning is so persisent.So now I have gone down to 300 mgs on the Neurontin, (that was helping with anxiety/depression/stabilizaation) and have no relief from scalp pain, but have terrible emotional pain. God, I really blew it this time. I should just rideout the neuropathic pain. But when it really burns, I just can't swallow my meds. This is a miserable cycle.
How I am going to stop going off my meds if I keep getting unbearable side effects? I can't relate to anyone or anything. My dog is driving me nuts, and I am so itchy, my ezcema is awful(strress?). And I want to up the lithium! Wow, that will really help my skin, NOT.
I want to call my pdoc, but she said that I should have stayed at 500 Neurontin and increased the amitriptyline to 30 mgs and the Li to 225 mgs if I got destabilized. But she is always trying to overmedicate me on my meds in my opinion. I am not a huge person, and I have sensitive neurons.
I guess I will up the Li in the am...But a part of me thinks I should just go with the devil l know and up the N back to 500, not fooling with the li. I am so confused and uncomfortable. And perdictable. 2 or 3 days after I decrease my doses of a stabilizer, I head into major depression/what to end it, mode. Why can't I learn??? ANd just deal with the scalp pain??? I wish I knew! And what would make me feel stabile again...
Thanks for listening.
Your Dex and taxes story sounded like no fun. That supercharged feeling is really awful. Glad you survived.
Chloe
Posted by Ritch on March 12, 2002, at 21:35:37
In reply to Re: medication compliance-the cycle con'ts » Ritch, posted by Chloe on March 12, 2002, at 19:57:30
> Hey Mitch
> Can bearly type. I am so agitated. I really thought going down on Neurontin and going up on Ami would help with my scalp. But it's the same. The burning is so persisent.
>
> So now I have gone down to 300 mgs on the Neurontin, (that was helping with anxiety/depression/stabilizaation) and have no relief from scalp pain, but have terrible emotional pain. God, I really blew it this time. I should just rideout the neuropathic pain. But when it really burns, I just can't swallow my meds. This is a miserable cycle.
>
> How I am going to stop going off my meds if I keep getting unbearable side effects? I can't relate to anyone or anything. My dog is driving me nuts, and I am so itchy, my ezcema is awful(strress?). And I want to up the lithium! Wow, that will really help my skin, NOT.
>
> I want to call my pdoc, but she said that I should have stayed at 500 Neurontin and increased the amitriptyline to 30 mgs and the Li to 225 mgs if I got destabilized. But she is always trying to overmedicate me on my meds in my opinion. I am not a huge person, and I have sensitive neurons.
>
> I guess I will up the Li in the am...But a part of me thinks I should just go with the devil l know and up the N back to 500, not fooling with the li. I am so confused and uncomfortable. And perdictable. 2 or 3 days after I decrease my doses of a stabilizer, I head into major depression/what to end it, mode. Why can't I learn??? ANd just deal with the scalp pain??? I wish I knew! And what would make me feel stabile again...
>
> Thanks for listening.
> Your Dex and taxes story sounded like no fun. That supercharged feeling is really awful. Glad you survived.
> ChloeChloe,
Yikes! Sounds like a Neurontin withdrawal. I would bring the Neurontin back up to where it was first thing, then make a decision about upping the Li next (give it 3-4 days before you bump up the Li). I have had some destablization issues lately. It is all related to anxiety/panic issues. When I am out of major seasonal depressions I am hypersenstive to stimulants and antidepressants. They tend to hose up my sleep and cause intrusive thoughts and/or music-which can wind up with panic. I think it is all a neuroendocrine thing. The stims or AD's cause a "cascade" of sorts that wind up resulting in crappy sleep patterns, ruminations, and then hostility or panic. (aka "mixed state" crap). I have had to add 125mg of Depakote at bedtime the last couple of nites so I don't get an early morning awakening. I will continue to add Dep. on until my appetite starts to ramp up-then I will drop it (I think that will *signal* the return to relative normal neuroendocrine functioning).
Your pdoc might be right-it sounds like a lot of meds, but it may be where you need to be (?). You may just need to find the stabilization dose that keeps your "toes out of your nose", and then deal with the neuropathic pain trips.
I liked that.. "Dex and taxes", that is awfully close to "Death and Taxes"! It really wasn't that awful-I just knew better that it was going to get worse if I continued the pstim..
Mitch
Posted by Chloe on March 13, 2002, at 19:06:53
In reply to Re: medication compliance-the cycle con'ts » Chloe, posted by Ritch on March 12, 2002, at 21:35:37
> Yikes! Sounds like a Neurontin withdrawal. I would bring the Neurontin back up to where it was first thing, then make a decision about upping the Li next (give it 3-4 days before you bump up the Li). I have had some destablization issues lately. It is all related to anxiety/panic issues. When I am out of major seasonal depressions I am hypersenstive to stimulants and antidepressants. They tend to hose up my sleep and cause intrusive thoughts and/or music-which can wind up with panic. I think it is all a neuroendocrine thing. The stims or AD's cause a "cascade" of sorts that wind up resulting in crappy sleep patterns, ruminations, and then hostility or panic. (aka "mixed state" crap). I have had to add 125mg of Depakote at bedtime the last couple of nites so I don't get an early morning awakening. I will continue to add Dep. on until my appetite starts to ramp up-then I will drop it (I think that will *signal* the return to relative normal neuroendocrine functioning).
Hi Mitch,
I think March is a very difficult month for folks with mood disorders...The days are rapidly getting longer, hence more activating light. But the temperature is more like winter/hyberation mode, at least where I am. Maybe it's just me, but early spring through the end of april can be really bumpy.I am glad the depakote is shutting some of the noise down at night. Hopefully at that low dose you won't get the munchies. I find it very dose related and don't notice appetite changes until above 250 mgs.
Last night I was feeling really obsessive and crazy about what to do about my meds (as you well know). And felt shockingly like I was heading into the badlands. So I though Li would be more "potent" than an increase of 100 mgs of Neurontin.
I think Li could be an AD prn for me, have you heard of Li used like that? I felt energetic within an hour and happy that I had gone with the li not the Neurontin. But now 18 hours later, I think i should still go back up on the N. I am not crazy about Li's AD effect without the calming of N. I still think I am in N withdrawal. So I guess I will just have the Li increase as a one time thing, and try to resume my 400-500 of N over several days.
I really hate the short fuse I have on 300 on N. Boy I will lash out at anything. AND if I don't have a dose every six hours I am sweating, snapping and shaking.OH, and I think the increased ami has also made me more bitchy. I have lots of energy, but it's an agrevated energy. Boy, what a mess I am with all these meds. I wonder if I dare drop the ami back to 20, increase the N to 400 and drop out my eve dose of li that I started last night. Humm, alot of changes...And scalp pain is probably a given, but I got to get to some emotional balance here. What, so I can start this whole process over again? I sure as hell hope not...
> I liked that.. "Dex and taxes", that is awfully close to "Death and Taxes"!Sometimes I even have a sense of humor when I feel the worst. Ironic huh?
Thanks for listening, Mitch. :)
Chloe
Posted by Ritch on March 13, 2002, at 23:36:42
In reply to Re: medication compliance-the cycle con'ts » Ritch, posted by Chloe on March 13, 2002, at 19:06:53
> Hi Mitch,
> I think March is a very difficult month for folks with mood disorders...The days are rapidly getting longer, hence more activating light. But the temperature is more like winter/hyberation mode, at least where I am. Maybe it's just me, but early spring through the end of april can be really bumpy.Well....I have noticed the increased light intensity since early February... There IS a connection. What do I do- wear special contacts or something-wear a special temperature controlled suit?? Live in a deep cave?? All I can say is that I can't wait for April and May. That is when all of this uneven mixed crap settles out to just nice pure giggly-fun hypomania. It is really weird. It is like you are stuck in a glacier and then stuff starts to melt-and *really* quick. Then you find yourself on a canoe heading through the rapids where all the melt-off is going (watch out for the boulders!). Then you hit the main river and it is just a fast moving (but very smooth) very cold current. Ahhh. No paddling-just high speed smooth sailing. That's what I want (I will get that-it is just that I will have to *wait* a little bit). :-)
>
> I am glad the depakote is shutting some of the noise down at night. Hopefully at that low dose you won't get the munchies. I find it very dose related and don't notice appetite changes until above 250 mgs.Yeah, it is also helping with impulsivity at work, too. Everybody else I am working with was grouchy all day-almost bipolar dysphoria I swear! I just didn't give a dang. It was like getting a job assignment to defuse a bomb on the bomb squad and just lightly offering to get pizza after we got the defusing over with-no biggie-what's next?? :-) I don't know whether that is unnatural apathy or not.
>
> Last night I was feeling really obsessive and crazy about what to do about my meds (as you well know). And felt shockingly like I was heading into the badlands. So I though Li would be more "potent" than an increase of 100 mgs of Neurontin.
>
> I think Li could be an AD prn for me, have you heard of Li used like that? I felt energetic within an hour and happy that I had gone with the li not the Neurontin. But now 18 hours later, I think i should still go back up on the N. I am not crazy about Li's AD effect without the calming of N. I still think I am in N withdrawal. So I guess I will just have the Li increase as a one time thing, and try to resume my 400-500 of N over several days.
> I really hate the short fuse I have on 300 on N. Boy I will lash out at anything. AND if I don't have a dose every six hours I am sweating, snapping and shaking.
You just be eliminating it rapidly. As you know you are looking at a peak 1.5 hrs postdose and a 5 hour half-life. Do the math and to keep a relatively stable level you are going to have to do at least 100mg 4x daily.>
> OH, and I think the increased ami has also made me more bitchy. I have lots of energy, but it's an agrevated energy. Boy, what a mess I am with all these meds. I wonder if I dare drop the ami back to 20, increase the N to 400 and drop out my eve dose of li that I started last night. Humm, alot of changes...And scalp pain is probably a given, but I got to get to some emotional balance here. What, so I can start this whole process over again? I sure as hell hope not...
TCA's *can* make me grouchier, but not as grouchy as Remeron, Buspar, Wellbutrin, Effexor, pstims (drat).>
>
> > I liked that.. "Dex and taxes", that is awfully close to "Death and Taxes"!
>
> Sometimes I even have a sense of humor when I feel the worst. Ironic huh?
>
> Thanks for listening, Mitch. :)
> Chloe
No problema,Mitch
Posted by Chloe on March 14, 2002, at 22:01:35
In reply to Re: medication compliance-the cycle con'ts » Chloe, posted by Ritch on March 13, 2002, at 23:36:42
Hey Mitch
Well, I am thrilled to say I dropped the ami to 20 mgs and upped the neurontin to 400 and no scalp pain! Whew!I just can't take too much TCA. I get into to these arguements where I am sure I am right and I get into a rage if I don't get understood. And I am told later, that I was being understood. I was just so hot headed, I able to hear reason! Thank god going down on the TCA made me much cooler today, but I am also dragging. I guess I can't have the energy boost without the rage. Oh well. Rage is the pits!
Your office does *not* sound like a barrel of laughs. Does anyone there have a sense of humor? That must be a challenging place to work. It's admirable you can get yourself there everyday. I guess you will jsut have to count the days until the "giggly-fun hypomania"! I loved your "canoe" discription.
Hey, do you think a different TCA would cause less rage and a pressured feeling? You mentioned how doxepin did little for you at high doses. Does doxepin have a reputation for being less "potent" in the AD department? So I could use a higher dose to help pain, but get less AD agitation? Any thoughts?
Well hang in there. I am glad you got the depakote for now. Seems like a necessary element for this volatile season, spring!
Chloe
Posted by Ritch on March 14, 2002, at 22:23:43
In reply to Re: medication compliance-TCA Q » Ritch, posted by Chloe on March 14, 2002, at 22:01:35
> Hey Mitch
> Well, I am thrilled to say I dropped the ami to 20 mgs and upped the neurontin to 400 and no scalp pain! Whew!
>
> I just can't take too much TCA. I get into to these arguements where I am sure I am right and I get into a rage if I don't get understood. And I am told later, that I was being understood. I was just so hot headed, I able to hear reason! Thank god going down on the TCA made me much cooler today, but I am also dragging. I guess I can't have the energy boost without the rage. Oh well. Rage is the pits!
>
> Hey, do you think a different TCA would cause less rage and a pressured feeling? You mentioned how doxepin did little for you at high doses. Does doxepin have a reputation for being less "potent" in the AD department? So I could use a higher dose to help pain, but get less AD agitation? Any thoughts?
Sounds like 400mg/day Neurontin may be the dose for you. It is tough to figure out what is causing weird troubles when you are on polypharmacy. TCA's have made me argumentative in the past. I would stick with your latest change to 20mg AMI and the Neurontin at 400mg/day and keep everything else the same, and see how that pans out over a week or two-so you can see how your natural cycling pattern goes with the same meds. A switch to a different TCA? Gee, I think the AMI is *the* best for neuropathic pain. You might try nortripytline (same dosage), but you will find it much less sedative and you probably won't sleep as soundly as you do with amitrip. The doxepin.. well, it is *more* sedative than the amitriptyline. But it has little serotonergic effect at all-which might end up causing *more* grouchiness. I would stick with the ami. Just an opinion. Also, increasing the Neurontin might have accounted for less grouchiness by itself (whether you reduced the ami. or not). I accidentally skipped my second dose of N. today and got a little amped at work.
>
> Your office does *not* sound like a barrel of laughs. Does anyone there have a sense of humor? That must be a challenging place to work. It's admirable you can get yourself there everyday. I guess you will jsut have to count the days until the "giggly-fun hypomania"! I loved your "canoe" discription.Oh, everyone there *has* a sense of humor-it just gets clouded over by stress, dysphoria. Everybody gripes about the same crap. If my only contact with management was a single email when I came in everyday I would probably be quite happy-and they would be quite happy with my work. It really isn't admirable that I can get there everyday-it would be more accurate to say miraculous.
>
> Well hang in there. I am glad you got the depakote for now. Seems like a necessary element for this volatile season, spring!
>
> ChloeActually, the Depakote is unfortunately more of a necessary element to remain plugged in to the economy via the current workplace situation I am stuck in.
Mitch
Posted by Chloe on March 16, 2002, at 11:01:41
In reply to Re: medication compliance-TCA Q » Chloe, posted by Ritch on March 14, 2002, at 22:23:43
Thanks Mitch,
I did hear the doxepin can be good for neuropathic pain only because it has more antihistimine, and can decrease some itching. But with less seranergic effect, I might really be in trouble with my temper. So thanks for pointing that out. My pdoc is never keen on switching things too much any way. Dosages yes, but different drugs in teh same class no...Well, I pulled a Rumplestilskin, and have slept over 18 hours, and now I am going to be late for work. I haven't been so tired in years. I have no idea what happened. Just needed to being lying down, and I just couldn't get up until the darn alarm clock this morning. Ugh...
Hope you have a good weekend
Chloe
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