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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by BIGDaddyachmed69 on October 7, 2006, at 2:13:14
My cocktail is as follows
50 mg Paxil CR (depression, social anxiety)
1500 mg Depakote ER (anger)
40 mg Namenda (OCD)
600 mg Lyrica (generalized anxiety)
30 mg Amphetamine Salts (Adderall) (ADD)
10 mg Ambien (insomnia)
2 mg Alprazolam ER (panic)
Xanax IR as needed (a half a vile from before we made the switch)Feedback? I'm on this much medication and I still feel like crap. I'm popping Xanax two, three times a day and I'm going to run out. The same goes for the ambien, I've had to take two, three in order to get to sleep. I don't know what the deal is here...I feel horrible. My predicament is leading me to self medicate. Am I on too much medication? I'm afraid that if I come off of my meds I'll be worse off than I already am. This sucks.
Posted by HappyGirl on October 7, 2006, at 8:18:11
In reply to HELP, posted by BIGDaddyachmed69 on October 7, 2006, at 2:13:14
Hi:
I have Bipolar II with ultra rapid cycler.In my case, Zyprexa 5 mg. has been taking care all aspect of my problems, that is almost identical to your listed problems.
I agree with 'too many meds.' might not help much. Rather, the med.combo. makes your system confuse, even some of meds. does not go into your system appropriately.
Ask your pdoc. about one of APs at your next appt.
H.G.
Posted by laima on October 7, 2006, at 10:27:26
In reply to HELP, posted by BIGDaddyachmed69 on October 7, 2006, at 2:13:14
I've been in a similar situation before, before getting refered to a panel of "experts for tough and uncooperative cases"- and guess what- they were agast, utterly horrified at the number of drugs I was (supposed to be) using, saying things like, "After a certain point you don't know what is doing what, and you are inevitably treating many side effects. This is a mess. Don't EVER agree to take this many drugs ever again. How do you know what is going on? The brain is very delicate and poorly understood. 3, maybe even 4 drugs- is a lot. We need to wean you off." And they shook their heads and sputtered a lot in disbelief.Can you imagine-For example, I was given so many anxiety meds that in turn I was given some 90mg of ritalin per day, all at my disposal? And it didn't seem enough. Etc. Now, less than 7mg does the trick just as well- or better.
Withdrawal isn't fun- but I was counseled to not confuse withdrawal with the original problems. (It was explained, "If you use something like a benzo long term, suppressing your nervous system- and then suddenly stop- your nervous system will swing wildly in the opposite direction in response before it settles down. Many "withdrawal" symptoms work with this backlash premise. Cutting stimulants can make you tired, etc.") This is KEY to keep in mind. I am thankful I finally listened. (Just felt things couldn't be worse-so I thought I'd try)
Consider- tolerance to meds like benzos or hypnotics can arguably cause daily mini-withdrawals, you can develop a tolerance to stimulants- whatever-upping and upping your needs for more medication--which can also konk out at some point. (I'm not an expert, I only know from what I experienced and was told.)
Two years later, I am using only 3 medications, (as opposed to having my own personal home pharmacy) and feel far more stable, clear, and much, much better. Not perfect, but a night and day difference! I vote for second opinion with the best expert you can dig up.
Good luck.
> My cocktail is as follows
>
> 50 mg Paxil CR (depression, social anxiety)
> 1500 mg Depakote ER (anger)
> 40 mg Namenda (OCD)
> 600 mg Lyrica (generalized anxiety)
> 30 mg Amphetamine Salts (Adderall) (ADD)
> 10 mg Ambien (insomnia)
> 2 mg Alprazolam ER (panic)
> Xanax IR as needed (a half a vile from before we made the switch)
>
> Feedback? I'm on this much medication and I still feel like crap. I'm popping Xanax two, three times a day and I'm going to run out. The same goes for the ambien, I've had to take two, three in order to get to sleep. I don't know what the deal is here...I feel horrible. My predicament is leading me to self medicate. Am I on too much medication? I'm afraid that if I come off of my meds I'll be worse off than I already am. This sucks.
Posted by pseudoname on October 7, 2006, at 10:58:29
In reply to Re: HELP » BIGDaddyachmed69, posted by laima on October 7, 2006, at 10:27:26
Posted by laima on October 7, 2006, at 11:37:26
In reply to great post (nm) » laima, posted by pseudoname on October 7, 2006, at 10:58:29
I really appreciate your feedback.
Look- if I went through psychiatry-mess hell, the least I can attempt to do is hope I can tell someone about it and hope to spare them some of it?
You might be interested that my gut instincts (and bizarre side effects) got me to stop taking the ridiculous regimine of some 10plus meds ahead of time, which is how I got labelled as "uncooperative", "non-compliant", etc. Drugs like zyprexa and abilify (together, with a mess of others) started me off with mild hallucinations, shocks, and such- but all the doctor did was deduce I was turning psychotic, and she wanted to pile on more and more antipsychotics. I think she was also oblivious that swapping drugs like effexor in and out causes withdrawal- I had never heard of withdrawal, in fact and indeed feared I was losing my mind. Antipsychotics gone- "symptoms" vaporized. On and on like that. Later, the other doctors, at a med school, congratulated me and told me I did the right thing. That was nice to hear.
If I can remember back somewhat, I believe this woman simultaneously thought I should take:
prozac (depression-"just take it it must be doing something")
effexor (depression, see above)
neurontin ("restless legs"- diagnosis based on theory, not observation)
zyprexa (since I was obviously going nuts and paranoid)
abilify and/or seroquel (see above)
xanax XR (was gettting awfully anxious-)
klonopin (see above)
ritalin (too many benzos! exhausted all day, and diagnosed with add. 90mg! That I remember. And that didn't even include the XR or Concerta.)
ritalin XR (see above)
Concerta (see above)
desipramine (depression and sleep-since nothing else was working)
ironMore? I think if it has been manufactured, she prescribed it at some point. Pile it on! Something might work!
I finally just gave up and got into self medicating by abusing the never ending supplies of ritalin and klonopin until they konked out- even at such high doses. I crashed, got into a severe argument with her when she scolded, "Are you abusing drugs? i'm cutting you off 100% now." Great! I was using well over 90mg ritalin plus god knows how much klonopin. I ended up in a hospital to detox, and when I first arrived, she had called ahead to warn them about my explosive "temper". This was long ago enough it's almost laughable. I was the meekest and quietest person there, out in a couple days while they all scratched their heads.
Best doctors? This woman still listed in each year's "Guide to Best Doctors" in our city. I sense that per professional ethics, doctors don't criticize peers originating from their own institutions, though they'll make thinly veiled comments.
Posted by Phillipa on October 7, 2006, at 11:43:38
In reply to oh- thanks! » pseudoname, posted by laima on October 7, 2006, at 11:37:26
See that's why I refuse to take a lot of meds. Even the valium is letting me sleep to ll am from l-2am. Is that excessive? Love Phillipa
Posted by laima on October 7, 2006, at 12:17:16
In reply to Re: oh- thanks! » laima, posted by Phillipa on October 7, 2006, at 11:43:38
Oh I don't know- I think the problem in this case is piling on way too many types of meds all at once.Warmly,
Rita
> See that's why I refuse to take a lot of meds. Even the valium is letting me sleep to ll am from l-2am. Is that excessive? Love Phillipa
Posted by fca on October 7, 2006, at 13:17:53
In reply to HELP, posted by BIGDaddyachmed69 on October 7, 2006, at 2:13:14
IANAD or a psycopharmacologist but I cn tell you your chart would surely get flagged by our PI (performance Improvement team). I can not imagine how anyone, let alone you, knows what is going on and how it make make you feel. From a laymen's perspective I would cut the Paxil to 40, stay on the Namenda and wean your self from the rest. Stay on those two drugs for 14 days, increae Paxil to 50 if necessary, and gradually introduce the lyrica and add benzo's if necessary and PRN only. Try that for 4-8 weeks and see where you are. Get some CBT ASAP. This is only FWIW
Posted by pseudoname on October 7, 2006, at 14:53:25
In reply to oh- thanks! » pseudoname, posted by laima on October 7, 2006, at 11:37:26
I mean, WOW. What a history, laima! You seem to have survived your terrible experiences with your spirits intact: that says a lot about you & your continued capacity for recovery. I'm glad you posted about it.
Posted by laima on October 7, 2006, at 17:32:46
In reply to Wow. » laima, posted by pseudoname on October 7, 2006, at 14:53:25
> I mean, WOW. What a history, laima! You seem to have survived your terrible experiences with your spirits intact: that says a lot about you & your continued capacity for recovery. I'm glad you posted about it.
Thanks- I'm actually kind of embarressed I didn't dump her sooner- but I was trying to finish grad school and just resorted to self-medicating. That of course, basically meant I was something like a drug addict- way up, then take something to go way down. I didn't really care any more. Not exactly a recommended course! I was feeling pretty hopeless- this was supposed to be a very good doctor per all the reports. (So much for that method of finding a doctor!) I'm sure the emotional rollercoaster (most notably from overdoing ritalin, interpreting the crash as recurring depression, and numbing it out with klonopin, running out of stuff, and being oblivious to the phenomena of 'withdrawal" didn't exactly enhance my good judgement. Oh well. Time makes painful memories much less so. And the silver lining is I ended up in very good and knowledgeable hands at the med school- they don't even usually take "new patients", I was told. I won't blame or denounce any single medication, but hearing of polypharmacy to that extreme makes me cringe, because of how harmful it was for me, and because the arguments I heard against such practice made so much sense. Yes, I was very surprised to find how much clearer and better I felt as the excess meds were chipped away.
I was impressed and encouraged by how thoughtfully and strategically they did it. Ie- WAY too many stimulants, not even safe for a fairly young and fit person like me. Way too many antidepressents that obviously were not working. So they chopped out all the antidepressents in one go, slashed the excess stimulants in one go- which allowed them to slash the klonopin, and they added wellbutrin- an "activating" antidepressent which also helps with add. They also seemed to think it would be much less likely to mess with sleep than ssris.
They also cut out all zyprexa and antipsychotics, scoffing I wasn't psychotic at all- but rather suffering from side effects. That was a rather ROUGH and sudden switch- I think they were a bit swift, but the end results put me on a better path.No, still not perfect, by any means, but by comparison, lightyears better off now. I hope that if anyone's doctor gives them a twinge of doubt, they are more assertive in questioning or seeking an alternative opinion than I was. Don't simply fall for a "highly recommended expert"!
Posted by laima on October 7, 2006, at 17:39:57
In reply to Re: Wow. » pseudoname, posted by laima on October 7, 2006, at 17:32:46
Oh- I should clarify- while most of that year I self-medicated almost exclusively with ritalin and klonopin (and alcohol), every once in awhile, out of desperation, I would give all or part of the ridiculous program a brief try, and then re-quit after about a week of feeling...psycho. I'm sure that means I was constantly getting myself into situations like effexor withdrawal, clueless all the while that such a thing even exists.
Posted by SLS on October 7, 2006, at 21:32:05
In reply to Re: HELP, posted by fca on October 7, 2006, at 13:17:53
> stay on the Namenda
You feel Namenda 40mg is effective for OCD? I have heard of people trying it for this and that some clinical trials were underway, but I was not aware that there was much evidence for it yet. Results from the NIH clinical trial for depression were disappointing. Maybe this will be different. I found 40mg to be a bit intoxicating after my first few doses upon dosage increase from 20mg, so I decreased back to 20mg. I felt pretty wierd. I probably should have pushed it. The Stanford study is using 20mg.
http://www.clinicaltrials.gov/ct/gui/show/NCT00264238
Actually, with the exception of Depakote, I don't think the cocktail looks that bad except that it is obviously not the right one for BIGDaddy. I don't think you can convict a medication regime based upon whether its number of drugs exceeds 3 or 4.
If one judges BIGDaddy's treatment to be a complete failure with no historical information to indicate the efficacy of any of the drugs currently being administered, then I guess it makes sense to dismantle the regime - perhaps completely. If Paxil at 50mg ain't doing it now, why would it do it later? How about Effexor maybe? Of course, if Effexor has already proven unacceptable, then maybe take a look at others. Nardil would cover a lot of angles if other drugs have already been tried.
Yes. Monotherapy is a neat package to build a life around if you need to be on drugs at all. Try a few. If it becomes evident that you are not a remitter to the first 3-4 drugs, take note of which of them you responded best to. You might have to return to it and use it as a base to build on. So, adding augmenting drugs is a likely scenario here. It may be that comorbid conditions exist that need treatment using different medications. I'm not saying that some psychiatrists don't make a mess of people's brains. However, what I am saying is that in difficult cases, the best psychiatrists have no better choice than to use one or two handfuls of drugs to treat a single patient.
- Scott
Posted by Phillipa on October 7, 2006, at 21:55:43
In reply to Re: HELP, posted by SLS on October 7, 2006, at 21:32:05
Scott how are you? You're my concern. I care so much about you. Love Jan
Posted by SLS on October 7, 2006, at 21:59:47
In reply to oh- thanks! » pseudoname, posted by laima on October 7, 2006, at 11:37:26
Now, that's a mess.
- Scott
> prozac (depression-"just take it it must be doing something")
> effexor (depression, see above)
> neurontin ("restless legs"- diagnosis based on theory, not observation)
> zyprexa (since I was obviously going nuts and paranoid)
> abilify and/or seroquel (see above)
> xanax XR (was gettting awfully anxious-)
> klonopin (see above)
> ritalin (too many benzos! exhausted all day, and diagnosed with add. 90mg! That I remember. And that didn't even include the XR or Concerta.)
> ritalin XR (see above)
> Concerta (see above)
> desipramine (depression and sleep-since nothing else was working)
> iron
Posted by SLS on October 7, 2006, at 22:04:41
In reply to Re: HELP » SLS, posted by Phillipa on October 7, 2006, at 21:55:43
> Scott how are you? You're my concern. I care so much about you. Love Jan
I am ok.
Existing.
Not too painful.
Barely worth my time.
Not rewarding.
Lonely.
Soon to be stressed.
Listening to Yes.
Was listening to Tull.
We'll see.
- Scott
Posted by Racer on October 8, 2006, at 1:41:03
In reply to Re: HELP » Phillipa, posted by SLS on October 7, 2006, at 22:04:41
> >
> Listening to Yes.
>
> Was listening to Tull.
>
Scott, you know I love you, man, but we gotta do something about that! Break out the Pentangle, or maybe some Who. If you gotta have musicianship and melody and things like that -- and Pentangle doesn't do it for you -- try Cat Stevens, or even Jim Croce...But Scott? All teasing aside, you know how I feel, right?
Posted by fca on October 8, 2006, at 12:01:18
In reply to Re: HELP, posted by SLS on October 7, 2006, at 21:32:05
Two of the leading pdocs on OCD in the country are using Namenda for TX resistant OCD and report (online) good anecdotal results. Besides it is relatively benign as far as psychotherapeutics go. If his is using Namenda I assume the OCD is a significant problem--Namenda targets the obsessive thoughts which can really be debilitating if you also have anxiety and depression. I suggested staying on the Paxil because it is plain and reliable. Some augmentation might be beneficial. I do not believe effexor or any of the other SNRIs are particularly helpful with OCD.
Personally I would attack the OCD as a primary target because it really can exaccerbate the other problems (once again assuming it is the obsessional component that we really want to get under control).. After that I am out of my league. Thanks fca
Posted by SLS on October 8, 2006, at 15:22:07
In reply to Re: HELP, posted by fca on October 8, 2006, at 12:01:18
Hi.
> Two of the leading pdocs on OCD in the country are using Namenda for TX resistant OCD and report (online) good anecdotal results.
Not meaning to be challenging, but I wouldn't mind reading some of their work. Would you mind naming them?
> Besides it is relatively benign as far as psychotherapeutics go.
I had no side effects at all except for that feeling of intoxication when I tried to increase to 40mg. Perhaps that would have dissipated had I continued with it.
> I do not believe effexor or any of the other SNRIs are particularly helpful with OCD.
There is clomipramine (Anafranil). That's an SNRI, and is probably the most effective drug currently available for OCD. Is there any reason to make a generalization like that? Do you feel NE reuptake inhibition is counterproductive?
The only other two SNRIs are Effexor and Cymbalta. The other tricyclics really don't qualify I don't think.
Not too many studies have been conducted with Effexor in the treatment of OCD from what I could find. Most have been favorable. One placebo controlled study was not. One found Effexor to be helpful to treat SSRI non-responders. However, there was one VERY good study that compared Paxil to Effexor in which Paxil was shown to be superior. I thought the study was of an impressive design and used the right dosages and an adequate treatment duration.
I guess your recommendation of trying the Namenda makes sense. Did those doctors give any indication as to how long to allow Namenda to work?
When thinking of Effexor, my focus was on the depression, the two anxiety disorders, and the lack of treatment response to Paxil. I guess the OCD didn't jump out at me as a prominent feature of the overall situation.
BIGDaddy:
How does your OCD present itself?
- Scott
Posted by Phillipa on October 8, 2006, at 18:40:33
In reply to Re: HELP, posted by fca on October 8, 2006, at 12:01:18
Typo? Anafranil is an SNRI? Thought it was a TCA? Love Phillipa
Posted by fca on October 8, 2006, at 20:08:38
In reply to Re: HELP, posted by SLS on October 8, 2006, at 15:22:07
Sorry but the two pdocs I mentioned both participate on a subscription only forum and I am reluctant to mention them since they are both involved in research but use Memantine (Namenda) off label. There has been a past reference to one of them on Psychobabble. I appreciate your support for this.
You are right about Anafranil but if I am not mistaken it was the effect on the serotonin system that is believed to account for the responses. I think there is general consensus that the only drug to significantly and consistently benefit persons with OCD play with serotonin.
Because of the Paxil and Namenda and the extent it can seriously exacerbate all of the other crummy thoughts and self destructive behaviors
he OCD jumped out at me.
Posted by fca on October 8, 2006, at 20:54:09
In reply to Re: HELP, posted by fca on October 8, 2006, at 20:08:38
Last Sentence should read:
Because of the Paxil and Namenda and the extent OCD can seriously exacerbate all of the other crummy thoughts and self destructive behavior the OCD jumped out at me as something to aggressively control.
Posted by SLS on October 9, 2006, at 4:53:52
In reply to Re: HELP » fca, posted by Phillipa on October 8, 2006, at 18:40:33
> Typo? Anafranil is an SNRI? Thought it was a TCA? Love Phillipa
TCA = Tricyclic Antidepressant
SNRI = Serotonin Norepinephrine Reuptake Inhibitor
At some point, these labels become overlapping. The chemical structure is TCA, but, the biological properties are SNRI. It is such an old and dirty drug, that it is rarely ever given that designation, though. Effexor and Cymbalta, although given the designation SNRI, are such potent serotonin reuptake inhibitors, that they are collectively called SRI drugs when it is that property that is the focus of attention. Despite their perhaps inferior performance to Anafranil, and the SSRIs, they still possess anti-obsessional properties.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed
- Scott
Posted by SLS on October 9, 2006, at 5:01:15
In reply to HELP, posted by BIGDaddyachmed69 on October 7, 2006, at 2:13:14
> Feedback? I'm on this much medication and I still feel like crap.
How does your OCD present itself?
Have you tried Nardil?
- Scott
Posted by BIGDaddyachmed69 on October 13, 2006, at 7:52:23
In reply to Re: HELP » BIGDaddyachmed69, posted by HappyGirl on October 7, 2006, at 8:18:11
> Hi:
> I have Bipolar II with ultra rapid cycler.
>
> In my case, Zyprexa 5 mg. has been taking care all aspect of my problems, that is almost identical to your listed problems.
>
> I agree with 'too many meds.' might not help much. Rather, the med.combo. makes your system confuse, even some of meds. does not go into your system appropriately.
>
> Ask your pdoc. about one of APs at your next appt.
> H.G.I would consider low-dose Zyprexa as a last resort, I've been on it before and it's the only AP that didn't have any noticeable side-effects. It did seem to help...perhaps it is worth another shot. I'm not entirely comfortable with the idea of being on an AP, I have to admit.
Posted by BIGDaddyachmed69 on October 13, 2006, at 7:54:48
In reply to Re: HELP » BIGDaddyachmed69, posted by laima on October 7, 2006, at 10:27:26
By the way, thanks for the feedback all of you...I've read all of your posts and really appreciate it. I had forgotten I'd posted this...I must have been on a lot of Xanax at the time. The next time I see my doctor I'm going to have to have a serious talk with him about all these meds...
This is the end of the thread.
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