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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Frustratedmama on July 6, 2009, at 20:35:30
Anyone ever feel like nothing is helping and it's time to ditch all the meds they are on and start all over...... I know this may backfire but.....I am a bit desparate....Trying one med at a time is also recommended but from what I read here it sounds like combinations can be the key so I am unsure what to do next.... Right now I am so depressed and so ready to throw in the towel! I know I will be worse off in the short term if I do this but I feel like crap anyways..... Need some advice from those of you that have been there.....
Posted by SLS on July 6, 2009, at 21:06:14
In reply to Time to ditch all the meds and start over?, posted by Frustratedmama on July 6, 2009, at 20:35:30
What has your doctor planned for you as alternative treatments?
- Scott
Posted by Lou Pilder on July 6, 2009, at 21:21:27
In reply to Time to ditch all the meds and start over?, posted by Frustratedmama on July 6, 2009, at 20:35:30
> Anyone ever feel like nothing is helping and it's time to ditch all the meds they are on and start all over...... I know this may backfire but.....I am a bit desparate....Trying one med at a time is also recommended but from what I read here it sounds like combinations can be the key so I am unsure what to do next.... Right now I am so depressed and so ready to throw in the towel! I know I will be worse off in the short term if I do this but I feel like crap anyways..... Need some advice from those of you that have been there.....
fm,
You wrote,[...ditch all..start all over...need some advice...].
I have found that there are crossroads in my life that I remember and one was what you are writing here about, the two roads you are faced with here.
One road you have tried and you have written,[...right now I am so depressed..ready to throw in the towel...]. This to me sounds like you are on the darkside of the road.
You wrote,[...start all over...]. You can sing a new song.
Lou
Posted by SLS on July 6, 2009, at 21:38:58
In reply to Lou's response-pneusawng » Frustratedmama, posted by Lou Pilder on July 6, 2009, at 21:21:27
> You wrote,[...start all over...]. You can sing a new song.
That's a great sentiment Lou. Now all we need to do is to help FM regain the breath of life to be able to sing that new song.
- Scott
Posted by Phillipa on July 6, 2009, at 22:09:07
In reply to Re: Lou's response-pneusawng, posted by SLS on July 6, 2009, at 21:38:58
Frustrated what's your plan any thoughts besides starting over. What meds worked in the past is a good starting place. Love Phillipa
Posted by floatingbridge on July 7, 2009, at 0:53:13
In reply to Re: Time to ditch all the meds and start over?, posted by SLS on July 6, 2009, at 21:06:14
HI FM,
When is the next time you see your pdoc? Do like/trust him/her?
Like Scott said, what did pdoc have in mind? And do you have anything you'd like to try?
So, (I'm guessing) that anger is down? If so, what helps that? How is emotional lability? Fatigue (and focus) are also issues if I recall correctly.
fb
Posted by floatingbridge on July 7, 2009, at 1:12:57
In reply to Time to ditch all the meds and start over?, posted by Frustratedmama on July 6, 2009, at 20:35:30
"If so then I would assume the missing links are NE and serotonin.... Thereofore, would parnate or pristiq be good choices???? "
Did you have trouble with wellbutrin? (NE--some find it irritating--)
Someone recently posted (Maybe Bleauberry?) That pristiq does not have very strong NE properties. This runs counter to what my pdoc said....so I don't know.
Have you tried parnate before? (I can't remember)
fb
Posted by bleauberry on July 7, 2009, at 8:42:10
In reply to Time to ditch all the meds and start over?, posted by Frustratedmama on July 6, 2009, at 20:35:30
So, after 8 years of doing pretty well on prozac+zyprexa+modafinil, things were going weird on me. Depression was coming back. New bizarre symptoms were popping up. A couple years of other med add-ons, substitutions, and desperate trials of just about everything, only seemed to fuel the slide into deeper darkness. They could not stop it, and in fact I believe were actually strengthening the slide down. The final hope, or at least I thought it was, was ECT. And that too was a disaster. But that true final hope was....wean off all meds, see what my true baseline is, and go from there. I was so disgusted with the failures of psychiatry I wanted out! I wanted a clean start. I had no idea where I was going or what my future was, only that it was absolutely NOT going to involve any of the meds I was currently on and it was NOT going to involve any of the same doctors I had seen.
While weaning all meds simultaneously, I did so in tiny steps over a 2 month period. I would focus on one med at a time for an aggressive wean, while doing a conservative wean on the others. Once the aggressive one was done and I was ok with it, I would turn to one of the conservative ones and make it aggressive.
There was a strange thing I noticed about 1 week after I had finally reached the end of my weaning journey. I had a great day! I hadn't felt one of those in years! I didn't even know my brain was capable. After that I fell back into my old illness, but it was different. It was milder. It was tolerable. It was manageable. It wasn't that deep dark hopeless place I was when I was on meds that didn't work. I now believe those meds were actually making it all worse, not better, even though they had at one time helped me. Somewhere along the line things changed and the meds became my enemies instead of my friends. Bottom line...I was much less ill off meds than on.
Even with a milder level of symptoms, you know it can wear anybody down over time. So treatment trials were started again. But this time things were different. One med at a time. Very low doses. Don't get in over my head. Stay out of deep water. Nothing fancy. Stick to basics.
I broke many of those rules and paid for it. SNRIs...bad idea. Meds from overseas...bad idea. Exotic combinations...bad idea. Not that these things aren't good for some people, just not for someone with my and your history.
Second only to the MAOIs I do not believe there is any strategy under the sun more effective than TCA+SSRI, both at low or ultra-low doses. My favorites are Lexpro+Nortriptyline, Zoloft+Nortriptyline. I am talking "supposedly" sub-therapeutic doses. My doctor is amazing. He has basically 3 antidepressants in his arsenal, extremely low doses, and quite literally "has never failed to fix a patient's depression" in 25 years and hundreds of patients. Seriously. Amazing strategies that defy the masses of psychiatry.
But a time of cleaning out to see what the baseline is will allow other things to work. Switching directly from one failure to something else, well, I don't know why, it just never worked for me. I see it here every day as well. I think sometimes the best road is to start over. Which means a drug holiday. Very often I have witnessed people feel temporarily better off their meds.
There is the depression of your illness. Then there is the depression from weaning. Say for example you are on a ssri but you feel real dark. You start weaning. Well, even though that ssri was doing you no good whatsoever, and maybe a lot of bad, the fact that there is now less serotonin at the synapse will create a short temporary new layer of depression on top of the true depression. Luckily it only lasts a few days. As the body adjusts, it is not unusual to experience a blip of surprising improvement as the brain overcompensates in the opposite direction. What I am saying is, if you wean off meds, do it slow, do it in tiny steps (custom microdose adjustments), and expect weird things...but know what they are...healing.
I dealt with the depression. Vigorous exercise such as chopping firewood helped. Staying off the couch helped. Doing anything helped. My biggest problem was the anxiety and nervousness. For that I sought the help of a few select herbs to get me through the worst moments. I avoided them unless it was desperate. Maybe once a twice a week that happened. They were Valerian and Passionflower. A supplement with GABA+Glycine was immediately helpful at times as well. And this will sound really weird, but a baked potato with its skin, at bedtime, every night, really took the edge off the next day and gave a better sleep. I think it has something to do with conversion of tryptophan to serotonin, in combination with other factors such as the daily body clock. The daily baked potato did not work any other time except bedtime. There is actually a whole book written on that.
There are a few times in everyone's life where I think we find ourselves stuck on a runaway train and nobody can do anything about it. We can ride it all the way to a crash, or we can jump off, take a few bruises and cuts, find outselves feeling somewhat relieved and better, and wait for the next train. Even though we got off a disasterous train, we still need a ride. I think the next train is going to be a lot friendlier ride.
Posted by psyclist123 on July 7, 2009, at 10:20:29
In reply to Re: Time to ditch all the meds and start over?, posted by bleauberry on July 7, 2009, at 8:42:10
If you, bleauberry, could write a novel along the lines of your above post I guess you might make a whole heap of money. I'll take my commission now. :)
Posted by chumbawumba on July 7, 2009, at 14:00:57
In reply to Re: Time to ditch all the meds and start over?, posted by bleauberry on July 7, 2009, at 8:42:10
Great post. I actually had a similar experience where I decided to get off the psych meds and start fresh.
I think there is definitely something to be said for the less is more approach.
Posted by Frustratedmama on July 7, 2009, at 16:38:55
In reply to Re: Time to ditch all the meds and start over?, posted by chumbawumba on July 7, 2009, at 14:00:57
Hey everyone,
Well, thanks for the responses!!!! Bleuberry you are really good at writing and I second the book idea.... Anyway, I did talk to pdoc and he is able to see my at the end of the week.....Til then we are upping the gabapentin to 300, 300, 400, to see if it helps and keeping the others the same....I am not sure this will work but will see him soon..... I am not sure what I want to do next but I do know that I need to change what i am doing.... I defnitely hate the fluctuations between the irrational, angry, irritable person I have become to the sad, depressed, can't go on person.... where did the real me go? Not sure how to find her anymore but I need her back (and so does my family)..... I am trying to read about neurotransmitters to see what is going on but it makes no sense to me..... ANyone have any ideas on how to wean or what to wean first if I do change this cycle....Current meds:
Adderall XR 10 mg in AM
Gabapentin 300 mg in AM 300 mg at noon and 400 mg at night
Lunesta 1-2 mg at night
Xyzal (antihistamine for allergies) 5 mg at nightWhat do you all think?
I think Parnate may be a good idea but what should I wean and what should I keep and all the other questions....in what order.....My thoughts..... aren't very helpful right now.....
Posted by Frustratedmama on July 7, 2009, at 17:10:27
In reply to Re: Time to ditch all the meds and start over?, posted by SLS on July 6, 2009, at 21:06:14
Hey Scott,
Pdoc doesn't really have a plan yet but said he will be thinking about it..... I know you have mentioned parnate and tegretol before....
I am thinking I probably need an antidepressant with a mood stabilizer.... Just my thoughts..... Not sure if he will go for this..... Lately the mood stabilizers depress me.... Topamax made me more depressed as is the gabapentin.... but the antidepressants seem to irritate me (not sure what doesn't irritate me at this point....). I am seeing him Friday and he is very open to suggestions.... what are yours? Just wondering. How are you doing? Is the lithium helping? I sure hope so....!
FM
Posted by Frustratedmama on July 7, 2009, at 17:12:51
In reply to Lou's response-pneusawng » Frustratedmama, posted by Lou Pilder on July 6, 2009, at 21:21:27
Lou, I don't understand your posts....not sure how to respond..... FM
Posted by Phillipa on July 7, 2009, at 19:43:28
In reply to Re: Lou's response-pneusawng » Lou Pilder, posted by Frustratedmama on July 7, 2009, at 17:12:51
I had a pdoc here basically try and get a baseline on me and since anxiety number one he took me off the tiny dose of luvox only 25mg then and upped benzos to high doses. Long story short didnt sleep for two weeks. Ended up in ER and they consulted with pdoc at big uptown hospital said go back on luvox and valium as the other doc had switched the benzo to long acting xanax first then ativan. Strangest thing I ever experienced. Once back on the valium and luvox slept again. Wierd Huh? Love Phillipa
Posted by Lou Pilder on July 8, 2009, at 12:26:42
In reply to Re: Lou's response-pneusawng » Lou Pilder, posted by Frustratedmama on July 7, 2009, at 17:12:51
> Lou, I don't understand your posts....not sure how to respond..... FM
You wrote,[...trying to ditch all meds...]
My response to your subject line of that you are trying to ditch all meds is a response from me thinking that what you could mean by that is that you would want to start a new life without taking psychotropic drugs prescribed to you.
Now I guess there could be another explanation to your statement like that you would want to stop the drugs you are taking, and then take a different drug, but I am unsure as if that is what you want to mean because you stated that you wanted to ditch {all} meds.
Now if you want to start a new life without drugs, then I could offer help to you from my perspective. But first, could you reply to me here with as to if you want to start a new life without any mind/mood-altering psychotropic drugs to clear up that ypou are or are not looking to replace the drugs you take with other drugs?
Lou
Posted by Frustratedmama on July 8, 2009, at 16:15:32
In reply to Lou's reply- » Frustratedmama, posted by Lou Pilder on July 8, 2009, at 12:26:42
Hi Lou,
I am not sure what I want to do anyomore...that's kind of the problem....I want to do whatever I need to do to feel better..... if that means new meds, no meds, or whatever.... I just want to try and feel better.... When I wrote the post I think I was thinking I wanted to ditch current cocktail of meds and start over with either new meds or new plan.... but I am not sure what to do now.... I just raised one of the meds I am on and seem to be a little better today.....
FM
Posted by SLS on July 8, 2009, at 16:29:48
In reply to Time to ditch all the meds and start over?, posted by Frustratedmama on July 6, 2009, at 20:35:30
FM, it might take some time before you feel wonderful again. Please be patient and tolerant of the pain and frustration. It won't last forever. In the meantime, continue to educate yourself so that you can help your doctor choose what directions to explore.
You might need to do something like combine a mood stabilizer with a couple of antidepressants. I wouldn't know what to suggest because I don't know what your treatment history looks like. How do you experience your condition (eg. anxiety, depression, racing thoughts, etc.)? Which drugs made you feel better? Which drugs made you feel worse?
- Scott
Posted by Frustratedmama on July 8, 2009, at 16:46:51
In reply to Re: Time to ditch all the meds and start over? » Frustratedmama, posted by SLS on July 8, 2009, at 16:29:48
> Hi Scott,
Thanks for the encouragement.... I need reminders to be patient cause it's so hard feeling like this..... but I know nothing changes overnight (although the first couple doses of gabapentin were kind of nice).... Anyway, I am trying to educate myself and am thinking it might be time to retry parnate again and to ditch the adderall.... Does parnate hit dopamine? If so, it seems this might make the most sense as I would be covered in all areas (at least I think I would)..... Right now I experience depression with irritability (some times of day are worse than others..... and racing thoughts..... difficulty sleeping but tired (not manic thats for sure- never had any euphoria but maybe dysphoria....Drugs that made me feel better:
All ssri's (all pooped out and none have helped in the last few years),
Effexor (eventually pooped out and haven't retried due to withdrawal effects)
Lamictal (side effects were lousy - wont go into detail)
Neurontin (currently taking)
Valium and Librium
Adderall (all stimulants helped some- this one was least offensive and I am currently on 10 mg XR)
Trazadone (difficulty keeping level consistent during the day)
Lithium (side effects were intolerable)The rest of the meds (which cover just about everything) were either stopped or didn't work...Lots of times I stopped due to side effects.... This was what happened with Parnate.... But I was taking with a stimulant and without anything to stabilize mood....
One annoying thing about the meds is the rebound effect..... I hate that! I experience it with the gabapentin and the adderall.....
argh!I would gladly switch to anything that doesnt have this effect.....
FM
Posted by SLS on July 8, 2009, at 17:10:46
In reply to Re: Time to ditch all the meds and start over? » SLS, posted by Frustratedmama on July 8, 2009, at 16:46:51
For me, I have found that adding nortriptyline to Effexor was more efficacious than either drug alone. As Steven Stahl has come to recommend, combining a SRI with a TCA is often successful. The two TCAs that I think are worth exploring are desipramine and nortriptyline. A combination of Lexapro with either of these two TCAs is probably a good choice.
What happens when you take Wellbutrin?
What is your current sleep pattern?
Parnate is a drug worth giving trying, I believe. The thing is, some people need to go as high as 80mg. Of course, the titration of this drug might take several months. If you are lucky, 40mg might very well be enough. You cannot judge this drug by what you experience during the first few weeks. You might very well get a stimulant-type "kick" from Parnate over the first week. However, it will take a good 2-3 weeks at the right dosage to experience a significant improvement. If it takes 4 weeks to reach 60mg, then you might have to wait another 2-3 weeks to respond. I would recommend that you start at 10mg and move up 10mg every week until you get to 40mg. You can remain at this dosage for a few weeks before increasing the dosage again. I was able to tolerate increasing the dosage of Parnate to 60mg by the end of week two. However, I did experience low blood pressure for having increased so quickly. Now that I have been at 80mg for a number of months, I hardly know that I am even taking the drug.
- Scott
Posted by Frustratedmama on July 8, 2009, at 17:30:29
In reply to Re: Time to ditch all the meds and start over?, posted by SLS on July 8, 2009, at 17:10:46
Scott,
can you explain the difference between desipramine and nortriptyline? I tried nortriptyline once but the dry mouth was hard for me to deal with so I was wondering what the differences are and if desipramine might be worth a try.... Also, would prozac or zoloft work instead of lexapro? Just wondering as lexapro wasnt that great for me.... but could've been due to the lack of TCA or lack of mood stabilizer> What happens when you take Wellbutrin? Worked for me years ago...cant remember why I stopped.....
>
> What is your current sleep pattern? I go to bed too late (between 11 and 12) and wake up at 6:30 (not by choice- only cause I HAVE to) Sleep is hard for me but I take lunesta which helps.....Another question for you scott, How does parnate work? does it help with dompamine, NE, and serotonin? I am thinking if it did it might be worth it.... If not, then maybe the combination theory might be better (but then I would need to keep the adderall on board probably to get the dopmaine effect).....
Thanks Scott
FM
Posted by Tony P on July 10, 2009, at 22:34:20
In reply to Time to ditch all the meds and start over?, posted by Frustratedmama on July 6, 2009, at 20:35:30
> Anyone ever feel like nothing is helping and it's time to ditch all the meds they are on and start all over...... I know this may backfire but.....I am a bit desparate....Trying one med at a time is also recommended but from what I read here it sounds like combinations can be the key so I am unsure what to do next.... Right now I am so depressed and so ready to throw in the towel! I know I will be worse off in the short term if I do this but I feel like crap anyways..... Need some advice from those of you that have been there.....
========================================
I truly empathize. I've been feeling exactly that way lately -- borderline suicidal and nothing seems to be helping, sick of taking so many expensive pills, so why not chuck the lot? My pdoc persuaded me that feeling that way can actually be a symptom of my disease in itself (I am mildly bipolar, so I do tend to go to extremes). I agree that combinations are the way to go for most of us atypical or treatment resistant or mixed BP II/III types, but it's hard after a while to know what's helping & what isn't.He did mention the old TCA's and MAOI's, but we agreed that that they might not be right for me. So, frustrating though it is, we're changing/dropping/adding one thing at a time -- otherwise you're left not knowing which were the important meds. I was on Cymbalta, Remeron & 3 or 4 other meds. We dropped the Remeron, which was making me sleep all day, then added Lamictal (mood stabilizer); that left me feeling stable but depressed, so now I'm trying 90 mg/day Cymbalta instead of 60, and after a week am getting some benefit. I'm not sure I can handle the Lamictal: after 3 months at 200 mg/day I am still getting severe tremors and anxiety attacks from it.
Other meds that have helped me:
- Clonazepam in moderate doses (2-3 mg), as I easily get over-stimulated & anxious, sometimes hypomanic, on most A-D's;
- Requip (ropinirole), which is a dopamine enhancer that mostly acts on receptors that don't affect mood, but which has a small but significant effect on the "good mood" D-receptors;
- Modafinil, which is a stimulant & dopamine enhancer but milder than Adderall (no insomnia and very little tolerance buildup);
- and good old coffee -- a quadruple latte first thing and I'm good for the day, so long as I stay active, which it's pretty hard not to after that much coffee!Tony P
Posted by Frustratedmama on July 11, 2009, at 10:24:09
In reply to Re: Time to ditch all the meds and start over? » Frustratedmama, posted by Tony P on July 10, 2009, at 22:34:20
Thanks Tony P - It's comforting to know I am not alone....wish i was in some ways cause I dont wish this upon anyone
Posted by floatingbridge on July 11, 2009, at 11:52:43
In reply to Re: Time to ditch all the meds and start over?, posted by Frustratedmama on July 11, 2009, at 10:24:09
This is the end of the thread.
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