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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 g_g_g_unit on August 3, 2011, at 10:06:57
I've been taking 10mg of Lexapro for close to six weeks now in combination with 500mg Depakote at night (I have ADHD and OCD). The pair have put a halt to the worst of my depression, anger and panic, but in turn have left me feeling lethargic, foggy, anhedonic and depersonalized. My OCD also hasn't really been touched.
I've also noticed that I've also been feeling quite restless and uncomfortable and will compulsively jump around from watching TV to checking my e-mail to cooking, etc. I'm not sure if this is increased hyperactivity or mild akathisia (which I'm prone to, it seems), but it's unpleasant.
I find coffee helps the anhedonia, amotivation etc. somewhat, but then completely eliminates any anti-anxiety benefits, so maybe my dose of Lexapro is too low and increasing it would allow me to tolerate a stimulant? I'm just worried about the akathisia and movement stuff (restless legs, muscle twitches, etc.)
I just can't seem to find a way to improve my anxiety/OCD without interfering with my cognition (or what little is left of it). Maybe spaciness is the trade-off I have to make, but I'd really rather not have to if possible.
For the record, here's what I've tried:
Luvox - foggy, anhedonic, more inattentive
Prozac - anxiety/agitation/akathisia at 20mg
Zoloft - anxiety/agitation/akathisia at 25mg
Remeron - severe anxiety at 30mg
Nortriptyline (for sleep) - helped attention, but
too stimulating to sleep, wasn't aware I had ADHD at the timeClomipramine - anxiety, agitation
Nardil - hypomanic, couldn't sleep, gave up after
12 weeksParnate - lower doses improved attention, worsened
anxiety, 30mg caused severe insomniaDexedrine - 2.5mg sorta helped; couldn't tolerate
higher doses due to anxiety/agitationStrattera - caused really bad anxiety and
moodiness, but felt 'smarter'Memantine - 10mg seemed to help anxiety; 20mg
(doctor's target dose) caused neg.
schizo-type symptoms
Posted by floatingbridge on August 3, 2011, at 17:36:04
In reply to humor me ..., posted by g_g_g_unit on August 3, 2011, at 10:06:57
Hi ggg, nice to see you.
Segeline? It has some efficacy for some for ADD.
Emsam? Easier to to take than segeline, though effect may be different. Also, one needs to be well-funded or have insurance, it seems to me, to pay for Emsam.
Posted by g_g_g_unit on August 5, 2011, at 5:57:02
In reply to Re: humor me ... » g_g_g_unit, posted by floatingbridge on August 3, 2011, at 17:36:04
> Hi ggg, nice to see you.
And you too :)
>
> Segeline? It has some efficacy for some for ADD.Hmm, I'd be a little worried about combining it with an SSRI.
>
> Emsam? Easier to to take than segeline, though effect may be different. Also, one needs to be well-funded or have insurance, it seems to me, to pay for Emsam.yeah, I'd love to try EMSAM, but it's not available on this side of the equator ..
*sigh*
so over it all ..
Posted by SLS on August 5, 2011, at 7:34:03
In reply to humor me ..., posted by g_g_g_unit on August 3, 2011, at 10:06:57
Wellbutrin + (methylphenidate or d-amphetamine) + guanfacine?
- Scott
Posted by floatingbridge on August 5, 2011, at 8:15:17
In reply to Re: humor me ... » floatingbridge, posted by g_g_g_unit on August 5, 2011, at 5:57:02
Oh. Doh! Sorry for the oversight.. Of course.
> > Hi ggg, nice to see you.
>
> And you too :)
>
> >
> > Segeline? It has some efficacy for some for ADD.
>
> Hmm, I'd be a little worried about combining it with an
SSRI.
>
> >
> > Emsam? Easier to to take than segeline, though effect may be different. Also, one needs to be well-funded or have insurance, it seems to me, to pay for
>
> yeah, I'd love to try EMSAM, but it's not available on this side of the equator ..
>
> *sigh*
>
> so over it all ..Let me look at your original list.
Posted by floatingbridge on August 5, 2011, at 8:28:34
In reply to humor me ..., posted by g_g_g_unit on August 3, 2011, at 10:06:57
Now humor me, okay? Effexor? I had a good run with it (not pristiq!).Stinulants cause some akathisa? What about something like a little Ritalin? I assume you have tried the progivil.
Straterra was good for your cognition? That is interesting to me. (I couldn't think on it.). Something in it's class?
Hmmmm. I like SLS's suggestion.
Posted by g_g_g_unit on August 5, 2011, at 8:52:37
In reply to Re: humor me ... » g_g_g_unit, posted by SLS on August 5, 2011, at 7:34:03
> Wellbutrin + (methylphenidate or d-amphetamine) + guanfacine?
>
>
> - ScottHmm. I haven't tried Wellbutrin - I always suspected it would cause too much anxiety - but it might be worth considering, pending I can get my anxiety under control.
Sadly, I don't think guanfacine is available here either (only its sister drug, clonidine).
Posted by g_g_g_unit on August 5, 2011, at 8:56:35
In reply to Re: humor me ... » g_g_g_unit, posted by floatingbridge on August 5, 2011, at 8:28:34
>
> Now humor me, okay? Effexor? I had a good run with it (not pristiq!).Yeah, my psychiatrist said he likes to "keep Effexor up his sleeve". I'm sure that might be on the horizon if things continue this way with Lexapro.
>
> Stinulants cause some akathisa? What about something like a little Ritalin? I assume you have tried the progivil.Haven't tried Provigil. I'm not sure the stimulants are causing akathisia? I typically experience it on SSRIs. I tried Ritalin LA and didn't like it, but instant-release might be okay. I just wish I could help my anxiety by some means that wasn't really invasive (i.e. SSRIs, mood stabilizers etc.).
>
> Straterra was good for your cognition? That is interesting to me. (I couldn't think on it.). Something in it's class?I think so. The results were pretty erratic, but I remember moments of 'clarity'. Reboxetine's available here too..
>
> Hmmmm. I like SLS's suggestion.
Posted by floatingbridge on August 5, 2011, at 9:29:05
In reply to Re: humor me ... » floatingbridge, posted by g_g_g_unit on August 5, 2011, at 8:56:35
Did you like Dexedrine overall? Because I have heard some good reports re: tolerability and vvyanse (sp). Unless you do better with shorter acting agents.
Umm. Anxiety is a bear. I have taken Xanax xr for years. I wouldn't mind finding another agent. Too bad you did not tolerate Nardil well. I suppose that is up my sleeve, as you say.
I am tolerating Emsam fairly well (amazing) but it's early in
the trial, and was just bumped up. It somehow decreases anxiety overall, but by no means extinguishes it.You seem very med sensitive to me. I'm sorry this is so ongoing ggg. You able to do any writing these days?
Posted by g_g_g_unit on August 5, 2011, at 10:36:30
In reply to Re: humor me ... » g_g_g_unit, posted by floatingbridge on August 5, 2011, at 9:29:05
> Did you like Dexedrine overall? Because I have heard some good reports re: tolerability and vvyanse (sp). Unless you do better with shorter acting agents.
I'm beginning to sound like a broken record, but Vyvanse isn't available here either..
>
> Umm. Anxiety is a bear. I have taken Xanax xr for years. I wouldn't mind finding another agent. Too bad you did not tolerate Nardil well. I suppose that is up my sleeve, as you say.I like Xanax .. a little too much, maybe. Only IR is available here, though I'm pretty careful with my consumption, lest I let temptation get the best of me.
>
> I am tolerating Emsam fairly well (amazing) but it's early in
> the trial, and was just bumped up. It somehow decreases anxiety overall, but by no means extinguishes it.That's great to hear! I wish you the best of luck. It sounds like a good drug. I found it listed on a pharmaceutical company's site here, but I e-mailed them and never heard back.
>
> You seem very med sensitive to me. I'm sorry this is so ongoing ggg. You able to do any writing these days?Yeah. It's strange to think that there might just not be anything available to me that's tolerable. I just automatically assume that relief is out there if I want it, or look hard enough.
No, I haven't written in just over 2 years now. It's sad, and, at my lowest moments, saps me of the will to even bother with treatment. What's scarier though is when I ponder that I might not have been any good to begin with :-/ (Excuse for the little detour into self-pity).
Posted by morgan miller on August 5, 2011, at 12:17:32
In reply to humor me ..., posted by g_g_g_unit on August 3, 2011, at 10:06:57
If you don't give some drugs long enough, and don't try raising the dose after some time, despite experiencing side effects at lower doses, you may never know if that drug really would have worked for you. Believe or not, a drug like Zoloft(sertraline) can respond in a way where side effects subside and therapeutic effect increases at higher doses. So if you didn't feel well at 25 mg, it does not necessarily mean higher doses may have made you feel worse. I was always more agitated at 50 mg Zoloft, and found my sweet spot at 100mg, where the side effects disappeared and I felt so much better.
Do you think exercise and diet could help relieve some of the current troublesome symptoms/side effects you are currently experiencing?
You may want to consider lowering the Lexapro dose to 5 mg.
You may also want to consider adding Lithium at a low dose and lowering your Depakote dose.
Morgan
Posted by morgan miller on August 5, 2011, at 12:21:15
In reply to Re: humor me ... » floatingbridge, posted by g_g_g_unit on August 5, 2011, at 10:36:30
GGG, you know you can easily order medications through online pharacies. A whole lot of patients are doing this nowadays. My psychiatrist even admitted many of her patients do it and she's perfectly fine with it. Just a thought.
Posted by morgan miller on August 5, 2011, at 12:27:04
In reply to humor me ..., posted by g_g_g_unit on August 3, 2011, at 10:06:57
If 10 mg Memantine helped, why not try that again? How long were you on 10 mg? Maybe the relief you got was not significant enough to justify continuing taking it.
I say your best bet right now is not to drop your current cocktail, but to make adjustments, and maybe add something like a low dose of lithium. At least try this before making any drastic changes.
Are you taking any supportive supplements? Fish oil, magnesium, vitamin D3, l methylfolate(you should be if you are taking depakote), taurine, l theanine, or holy basil(new chapter supercritical)? You should also be taking l carnitine with depakote, it's stores are depleted along with folate when taking depakote. L carnitine supplementation may protect your liver from depakote's potentially harmful effects. There are many reasons to make sure l carnitine and folate levels are in a good range.
Posted by floatingbridge on August 5, 2011, at 13:24:22
In reply to Re: humor me ... » floatingbridge, posted by g_g_g_unit on August 5, 2011, at 10:36:30
>
> I like Xanax .. a little too much, maybe. Only IR is available here, though I'm pretty careful with my consumption, lest I let temptation get the best of me.It's difficult not to like Xanax :-/ once started. If you have the funds, the generic XR is avaiable. It wasn't wickedly expensive, and it cuts consumption because if taken like clockwork, there are way few pills to take, no withdrawal/rebound interdose issues. Just saying. I think the
regular release is problematic if taken regularly. And just saying since Morgan mentioned overseas orders.> >
> > You seem very med sensitive to me. I'm sorry this is so ongoing ggg. You able to do any writing?
>I found this info on the Emsam assistance program, FYI:
http://www.rxassist.org/Search/Prog_Details.cfm?program_Id=528&PD_Id=2640&Drug_Id=2959&Company_Id=245&search_type=2&CFID=7267046&CFTOKEN=65616120I like the idea of transdermals for a number of reasons. I think I tolerate them better. The only pain medication I take now is an NSAID transdermal. If I take the same NSAID internally it does zip for pain, but transdermally, wow. And it largely bypasses all the heptic/kidney stuff. Wish, and hope more transdermals are in the pipeline because of enhanced tolerability. (Emsam, I'm not pushing it. It could be too
agitating for you. Then there is your perfectly servicable Lexapro. It's just my own latest thing.)> No, I haven't written in just over 2 years now. It's sad, and, at my lowest moments, saps me of the will to even bother with treatment. What's scarier though is when I ponder that I might not have been any good to begin with :-/ (Excuse for
the little detour into self-pity).It's okay take a little wallow. I haven't written for years except chicken scratch. But I do journal, and have written a bit lately that will no doubt be found in unorganized piles upon my demise. I have a few good friends who encourage me to at least admit writing is important to me because it serves a sanity function even if there is no finished product or publication. So I encourage you. Besides, (no patronizing or dismissal here) you are young and many writers go years (sometimes painful years) between productive periods.
Besides. You might need certain circumstances, like quiet, in order to really function. Last we spoke, you were dealing with noise/sound issues.
fb
Posted by g_g_g_unit on August 6, 2011, at 8:05:15
In reply to Re: humor me ... » g_g_g_unit, posted by floatingbridge on August 5, 2011, at 13:24:22
> >
> > I like Xanax .. a little too much, maybe. Only IR is available here, though I'm pretty careful with my consumption, lest I let temptation get the best of me.
>
> It's difficult not to like Xanax :-/ once started. If you have the funds, the generic XR is avaiable. It wasn't wickedly expensive, and it cuts consumption because if taken like clockwork, there are way few pills to take, no withdrawal/rebound interdose issues. Just saying. I think the
> regular release is problematic if taken regularly. And just saying since Morgan mentioned overseas orders.>
> > >
> > > You seem very med sensitive to me. I'm sorry this is so ongoing ggg. You able to do any writing?
> >
>
> I found this info on the Emsam assistance program, FYI:
> http://www.rxassist.org/Search/Prog_Details.cfm?program_Id=528&PD_Id=2640&Drug_Id=2959&Company_Id=245&search_type=2&CFID=7267046&CFTOKEN=65616120
>
> I like the idea of transdermals for a number of reasons. I think I tolerate them better. The only pain medication I take now is an NSAID transdermal. If I take the same NSAID internally it does zip for pain, but transdermally, wow. And it largely bypasses all the heptic/kidney stuff. Wish, and hope more transdermals are in the pipeline because of enhanced tolerability. (Emsam, I'm not pushing it. It could be too
> agitating for you. Then there is your perfectly servicable Lexapro. It's just my own latest thing.)Sorry, I meant that EMSAM was listed on some Australian pharmaceutical distribution site, but that I heard nothing back from them via e-mail. Maybe there were plans to release it here at one point, or they were importing it exclusively .. who knows.
Lexapro is okay, I suppose .. I mean, it's ultra-clean, but I feel like a zombie on the stuff.
>
> > No, I haven't written in just over 2 years now. It's sad, and, at my lowest moments, saps me of the will to even bother with treatment. What's scarier though is when I ponder that I might not have been any good to begin with :-/ (Excuse for
> the little detour into self-pity).
>
> It's okay take a little wallow. I haven't written for years except chicken scratch. But I do journal, and have written a bit lately that will no doubt be found in unorganized piles upon my demise. I have a few good friends who encourage me to at least admit writing is important to me because it serves a sanity function even if there is no finished product or publication. So I encourage you. Besides, (no patronizing or dismissal here) you are young and many writers go years (sometimes painful years) between productive periods.
>
> Besides. You might need certain circumstances, like quiet, in order to really function. Last we spoke, you were dealing with noise/sound issues.Well, I was mostly working on the journalism/criticism side-of-things, so I think a return to the field is unlikely - I've lost touch with what's going on in the world of the arts, and just never had a chance to develop properly, because I was always working around the OCD (which became harder and harder as time wore on). Medication (and anxiety and depression) also make it hard. I can't remember the last time I strung a worthwhile thought together (not that it wasn't always relatively difficult).
What about you? Were you more involved with fiction, poetry, etc.? Where have you published?
Posted by g_g_g_unit on August 6, 2011, at 8:08:38
In reply to Re: humor me ..., posted by morgan miller on August 5, 2011, at 12:17:32
> If you don't give some drugs long enough, and don't try raising the dose after some time, despite experiencing side effects at lower doses, you may never know if that drug really would have worked for you. Believe or not, a drug like Zoloft(sertraline) can respond in a way where side effects subside and therapeutic effect increases at higher doses. So if you didn't feel well at 25 mg, it does not necessarily mean higher doses may have made you feel worse. I was always more agitated at 50 mg Zoloft, and found my sweet spot at 100mg, where the side effects disappeared and I felt so much better.
Yeah, I was willing to continue with Zoloft, but I saw a neurologist who declared that the akathisia wouldn't subside and suggested I change SSRIs.
>
> Do you think exercise and diet could help relieve some of the current troublesome symptoms/side effects you are currently experiencing?Probably not.
> You may want to consider lowering the Lexapro dose to 5 mg.
>Hmm yeah, but 5mg wouldn't do anything for OCD. I raised my dose to 15mg today to try and get some benefit on that front.
Posted by g_g_g_unit on August 6, 2011, at 8:10:39
In reply to Re: humor me ..., posted by morgan miller on August 5, 2011, at 12:27:04
> If 10 mg Memantine helped, why not try that again? How long were you on 10 mg? Maybe the relief you got was not significant enough to justify continuing taking it.
I probably will try it again. I'm seeing the neurologist again soon.
>
> I say your best bet right now is not to drop your current cocktail, but to make adjustments, and maybe add something like a low dose of lithium. At least try this before making any drastic changes.
>
> Are you taking any supportive supplements? Fish oil, magnesium, vitamin D3, l methylfolate(you should be if you are taking depakote), taurine, l theanine, or holy basil(new chapter supercritical)? You should also be taking l carnitine with depakote, it's stores are depleted along with folate when taking depakote. L carnitine supplementation may protect your liver from depakote's potentially harmful effects. There are many reasons to make sure l carnitine and folate levels are in a good range.
>
>I have the basics covered - they're all I can afford right now. I'm not taking l-carnitine, no, but I'll look into it. thanks for the tip!
Posted by morgan miller on August 6, 2011, at 10:05:37
In reply to Re: humor me ... » morgan miller, posted by g_g_g_unit on August 6, 2011, at 8:08:38
> Yeah, I was willing to continue with Zoloft, but I saw a neurologist who declared that the akathisia wouldn't subside and suggested I change SSRIs.
Doctors don't always know everything. Getting to a point where we can do our own thing, as long as we educate ourselves properly, seems to be ideal in today's state of psychiatry. Finding a psychiatrist, or a neurologist, that will work with you is best.
> > Do you think exercise and diet could help relieve some of the current troublesome symptoms/side effects you are currently experiencing?
>
> Probably not.
>
> > You may want to consider lowering the Lexapro dose to 5 mg.
> >
>
> Hmm yeah, but 5mg wouldn't do anything for OCD. I raised my dose to 15mg today to try and get some benefit on that front.Who says 15 mg will do anything for OCD? I'm not sure if Lexapro will work this way. If you are already experiencing side effects from Lexapro, it's one of those SSRIs that might be more likely to give an increase in side effects with increased dose. I think it's probably worth going up in dose, just give it a few weeks at least before deciding to go up again or back down. Who knows, maybe you will do much better on 20 mg, without the severity of side effects, anything is possible with these drugs.
How long were you on Zoloft? I almost feel like Zoloft might be worth another try at some point.
I think you should try to keep things as simple as possible at this time, staying on medications with the least risk for intrusive side effects.
I do think you should consider a low dose of lithium. Lithium is not the bad guy drug so many people think it is. Heck, it's not even a drug that was synthesized in a lab, it naturally occurs. Plus, your brain's health may benefit in ways from taking low dose lithium long term.
Morgan
Posted by morgan miller on August 6, 2011, at 10:07:58
In reply to Re: humor me ... » morgan miller, posted by g_g_g_unit on August 6, 2011, at 8:10:39
GGG, how do you know if regular exercise and meditative stretching will not help if you do not try them? Exercise and stretching may not give you close to 100 percent relief, but they may give you some relief, which is worth it.
Posted by Chris O on August 6, 2011, at 10:35:17
In reply to humor me ..., posted by g_g_g_unit on August 3, 2011, at 10:06:57
GGG Unit:
I'm pretty certain the highest doses of SSRIs are recommended for OCD symptoms. I have GAD with OCD symptoms. When I took Lexapro, I did 40mg a day (didn't work though). Prozac was 80-100mg a day. Luvox 300-450mg a day, I think. Paxil was 75mg and Serzone 1200mg. Unfortunately, for me, even at at these higher doses, I still had symptoms. Perhaps they will work for you, though. I think it's worth a try.
Chris
Posted by floatingbridge on August 6, 2011, at 12:11:31
In reply to Re: humor me ... » floatingbridge, posted by g_g_g_unit on August 6, 2011, at 8:05:15
Poetry. A chapbook. A few online, then, crash boom.
Poetry is hard. I kinda' suck, but not quite bad enough. Sometimes I think about short fiction. Have you tried fiction? Less rules, more freedom. Have you heard of 'sudden fiction'? It's like a paragraph or a page.
I never had the head for journalism. I admire it, though, very much.
Writers can really pressure themselves. I don't know what that's about, but it can be painful. But I believe in reinvention. Language is plastic.
Posted by floatingbridge on August 6, 2011, at 12:15:54
In reply to Re: humor me ..., posted by Chris O on August 6, 2011, at 10:35:17
> GGG Unit:
>
> I'm pretty certain the highest doses of SSRIs are recommended for OCD symptoms. I have GAD with OCD symptoms. When I took Lexapro, I did 40mg a day (didn't work though). Prozac was 80-100mg a day. Luvox 300-450mg a day, I think. Paxil was 75mg and Serzone 1200mg. Unfortunately, for me, even at at these higher doses, I still had symptoms. Perhaps they will work for you, though. I think it's worth a try.
>
> ChrisMaybe you have written about this elsewhere. If so, my apologies. May I ask how you are treating the OCD symptoms now? It is not one of my own issuses, but I have friends that contend with it.
fb
Posted by morgan miller on August 6, 2011, at 22:24:07
In reply to Re: humor me ..., posted by Chris O on August 6, 2011, at 10:35:17
Chris, have you done years of hard work in therapy to try to get to the bottom of and work out what might be driving your OCD?
Also, have you tried Memantine? How about NAC?
This is the end of the thread.
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