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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by TomG on October 1, 2004, at 15:02:13
I'll try to keep this concise. I have psychotic depression. Two and a half months ago I was put on 20mg Geodon and it is the first medicine that has truly put an end to disorganized thought, paranoia, confusion, suicdal thought, and I think for the most part hopeless depression and anxiety. The only problem is that sedation set in about a month and a half into taking the Geodon. I have taken Zyprexa and Seroquel and it feels like a different kind of sedation than these medicines gave me. With these medicines I actually did sleep all day and take naps, but with the Geodon it is just a false sense of sleepiness with my natural underlying energy still intact, and I don't take naps.
I was recently taken off the 1200mg Neurontin that I was taking with the Geodon in the hopes this might be the culprit of the sleepiness. I tapered this down 300mg every 4 days. Unbelieveably I became more sleepy after stopping the Neurontin. I am also a little confused, because I seem to have lost drive, confidence, motivation and the focus that I had when I first started Geodon. I also don't get out of my house now not necessarily because of social anxiety but becuase of the loss of confidence and drive. The reason I am confused is becuase I don't know if the sedation is starting to affect my mood or if the Geodon is starting to fail me. I think more the sedation is starting to affect my mood.
This is the weird part. One week after I stopped the Neurontin I had something like euphoric hypomanic energy one evening that almost got rid of all my sedation. This only lasted one evening and the next day I started to have a headache and in the early evening I started to get waves of panic that came over me. I've had one panic attack before and it felt similar to the beginning of one, but it never fully formed. I started having little waves of loosing control of my mind, and I had that sinking feeling in my stomach like when you ask out a good looking girl or ride a roller coaster. I also felt like I was over salivating. Yesterday I had the same experience and it has lasted into today. I figured out what did it. The common thread in these experiences is that I had three or more cups of coffee before these mini panic attacks happened. Again I have only had one panic attack before and coffee was not the culprit. I also was drinking coffee while taking the Neurontin and even before Neurontin and Geodon with no problem. What are people's thoughts on what is going on here?
Also concearning the sedation I know that the antagonism of the histamine H1 receptor could be to blame for the sedation associatied with atypical antipsychotics, but what else could cause the sedation. Geodon also inhibits the reuptake of serotonin and norepinephrine. Could this be linked to sedation? Like I said before it feels like a different kind of sedation and the really weird thing is that it started over a month into dosing and not from the very beginning. I need some suggestions from others about some options here. I have tried 15mg Abilify and got akathesia. I tried Wellbutrin alone and it exacerbated paranoia and other psychotic symptoms. I also tried Provigil alone and I could see where this might be useful in this situation, but then I think back to the coffee and panic feelings and think maybe an SSRI might be useful. Thanks for reading this and I appreciate any input or similar experiences.
Tom
Posted by iris2 on October 2, 2004, at 21:26:44
In reply to I Need Some Help, posted by TomG on October 1, 2004, at 15:02:13
> Two and a half months ago I was put on 20mg Geodon and it is the first medicine that has truly put an end to disorganized thought, paranoia, confusion, suicdal thought, and I think for the most part hopeless depression and anxiety.
The only problem is that sedation set in about a month and a half into taking the Geodon. I have taken Zyprexa and Seroquel and it feels like a different kind of sedation than these medicines gave me. With these medicines I actually did sleep all day and take naps, but with the Geodon it is just a false sense of sleepiness with my natural underlying energy still intact, and I don't take naps.
>
> I was recently taken off the 1200mg Neurontin that I was taking with the Geodon in the hopes this might be the culprit of the sleepiness. I tapered this down 300mg every 4 days. Unbelieveably I became more sleepy after stopping the Neurontin. I am also a little confused, because I seem to have lost drive, confidence, motivation and the focus that I had when I first started Geodon. I also don't get out of my house now not necessarily because of social anxiety but becuase of the loss of confidence and drive. The reason I am confused is becuase I don't know if the sedation is starting to affect my mood or if the Geodon is starting to fail me. I think more the sedation is starting to affect my mood.
>
> This is the weird part. One week after I stopped the Neurontin I had something like euphoric hypomanic energy one evening that almost got rid of all my sedation. This only lasted one evening and the next day I started to have a headache and in the early evening I started to get waves of panic that came over me. I've had one panic attack before and it felt similar to the beginning of one, but it never fully formed. I started having little waves of loosing control of my mind, and I had that sinking feeling in my stomach like when you ask out a good looking girl or ride a roller coaster. I also felt like I was over salivating. Yesterday I had the same experience and it has lasted into today. I figured out what did it. The common thread in these experiences is that I had three or more cups of coffee before these mini panic attacks happened. Again I have only had one panic attack before and coffee was not the culprit. I also was drinking coffee while taking the Neurontin and even before Neurontin and Geodon with no problem. What are people's thoughts on what is going on here?
>
> Also concearning the sedation I know that the antagonism of the histamine H1 receptor could be to blame for the sedation associatied with atypical antipsychotics, but what else could cause the sedation. Geodon also inhibits the reuptake of serotonin and norepinephrine. Could this be linked to sedation? Like I said before it feels like a different kind of sedation and the really weird thing is that it started over a month into dosing and not from the very beginning. I need some suggestions from others about some options here. I have tried 15mg Abilify and got akathesia. I tried Wellbutrin alone and it exacerbated paranoia and other psychotic symptoms. I also tried Provigil alone and I could see where this might be useful in this situation, but then I think back to the coffee and panic feelings and think maybe an SSRI might be useful. Thanks for reading this and I appreciate any input or similar experiences.
>
> TomTom,
Sounds like you understand and know much more than I about the mechanisms of how these meds work. But I'll give you my two cents worth at least until you hear from someone more well informed. Sometimes it helps to get an objective point of view. Just remember mine might not be the best.
It sounds like the Geodon is doing a good job on the psychotic part of your dx.
The sleepiness I am not sure why it is different with Geodon. It could be the particular medication or it could be that because it is working and the others did not you are not as depressed your tendency would not be to go and nap. For myself regardless whether a med is making me tired if I am more depressed and tired too I will tend to sleep. If I am not so depressed I might still have energy especially if it is chemically induced tiredness and I will not opt to sleep. It does sound like the medication is giving you a feeling of being tired. Let me ask is it a kind of heavy feeling? It definitely sounds like the kind of feeling an antipsychotic could give you. It might have taken a while to build up in your blood stream and for your body to adjust to and that is why it took time for you to feel tired like this.
You probably slept more on these other meds because they did not alleviate your symptoms and if they made you feel tired you were probably quite fine with sleeping to escape.It definitely sounds like the sedation is affecting your mood. It also sounds like perhaps you might want to decrease the Geodon. I do not know what kind of dose 20mg is? But if you need this dose to alleviate the negative symptoms I think there are ways to work around the tiredness.
Antipsychotics could definitely have an effect on drive. I don't know if the lack of confidence is just a symptom of your depression or just because you feel tired and not so motivated your confidence level is lower. You are a better judge than I could be!
It definitely sounds like the coffee is exasperating anxiety. Why not just not drink it or any caffeine for a few days. That would be simple enough and you would be able to tell if that was causing problems. It also sounds like you had some withdrawal from the neurontin that caused a lot of different stuff from panic to salivation to headache and more. Is that over?
Have you noticed any change since decreasing the Neurontin? Do you think you need it? I do not know why your tiredness got worse except perhaps it had nothing to do with the Neurontin.
From what you have said about your symptoms it does sound like you need something for depression. Some medication that would improve concentration, focus, drive, motivation. I am not so sure about the SSRI's but again you know more than I. From what I do know I would suggest something along the lines of Adderal or Strattera. Considering the panic I would not go the Provigil route.
I hope things keep getting better for you:)
irene
Posted by TomG on October 3, 2004, at 22:46:37
In reply to Re: I Need Some Help » TomG, posted by iris2 on October 2, 2004, at 21:26:44
Thanks for your reply. I think you are right that because I am not depressed I am not taking naps. You asked me about the "heaviness". I can't say that this applies to me. All I can say is that it is just a false sense of sleepiness. My eyes feel dry and tired, but for some reason I just don't want to go and sleep. If you have ever taken Benadryl this is the closest thing I can relate it to, but it is 24/7. I also think you are right that the sleepiness is so prolonged now that it is starting to affect my mood. 20mgs is the absolute lowest dose that I can take. Pfizer doesn't make a lower dose. Thats why I think this is all weird, because I am so tired on such a low dose. I did stop the caffeine for a week before I tried it again and it gave me the same panic feelings the second time. So, I have narrowed it down that it is the coffee that is causing the problem. I have never had this problem before with coffee. Another weird thing is that when I first had the hypomania and the panic I had allergies that popped up almost simultaneously, and I usually never have allergies. Possibly I have also developed a coffee allergy. Also the benefit from Neurontin was negligable. It is easy enough to try it again at 1200mgs. I'm tending to think that Adderall or Strattera would possibly aggrevate psychotic symptoms or panic rather than Provigil. I have taken Provigil a long time ago pre-Geodon and it didn't seem to give me problems in the increased anxiety or panic department. We'll see on Oct. 18 when I see my pdoc. I am just thankful that I have found the main drug in what I am sure will be a cocktail of medicines. Hopefully just two. Thanks
Tom
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