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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by B2chica on February 15, 2016, at 17:50:13
my T and pdoc have been talking, it seems my T has more ideas for meds than pdoc... she is good and i like that she doenst have too big of an ego to say this but today she told me she just doesnt know where to go with me. i'm in mixed state. so suggested i get 2nd opinion.
my old pdoc (that worked So well with) i think is starting back to his practice a bit (left due to family issues). but i dont know if he is able to see me...
i have too long of a list to share the meds i've been on yet i want to ask for suggestions.
dx is mostly bipolar Mixed aka aggitated depression OR psychotic depression.
currently on pristiq 75 (she tried upping this because my depression was getting bad
adderall 20am, 10afternnon
gabapentin 300mg BID going to 3 or 4x daily
zyprexa 5mgi went up on zyprea to 10 and gave me flat affect.
tried upping pristiq to 75 but seems to be cycling me.
cant take me off adderall, only think keeping me from jumping.
gabapentin, honestly not sure what its doing if anything.any suggestions to augment?
i've never been on TCA.
i've been on enough SSRI's to know that either worsen depression or cycle me.******
i guess its pretty bad if your pdoc doenst know where to go next...
bad thing is, i'm not even in a competent state to suggest things. everytime i try to think of something, the birds fly in my head and take away my thoughts (only a visual...not real) see i can kinda joke.i'm safe...no suicidal ideation...yet. but i'm doing this picking thing that makes my hands bleed. infact i was doing it subconciously in pdoc office today and two fingers started bleeding enough i needed bandaids. luckly i carry them...
she stated that it was a very compulsive behavior...
still. she didnt change anything.****
SO... i'm calling out to all babble folks to cycle up some suggestions.if you want a list of meds ive been on, give me a while and i'll post them.
b2c
Posted by SLS on February 15, 2016, at 18:31:05
In reply to pdoc...hands in air. now what, posted by B2chica on February 15, 2016, at 17:50:13
I'm partial to Trileptal as a mood stabilizer that will help with mixed states, especially when anger and impulse control are problems. Lamictal can treat ultra-rapid cyclicity, but you have to take it religiously for no less than six months to see results. It can help with depression in the meantime. It might be a good drug to add to Trileptal or lithium.
What are your symptoms of psychosis?
Wellbutrin?
- Scott
Posted by B2chica on February 15, 2016, at 19:49:46
In reply to Re: pdoc...hands in air. now what » B2chica, posted by SLS on February 15, 2016, at 18:31:05
trileptal was the most dangerous med for me. i had a severe reaction, luckily while i was in the hospital. the result was me becoming Locked-In for about 10 hours.
lamictal i think actually would have worked but about 3 or 4 weeks in i started to develop breathing issues, like my throat was closing up. so i was taken off (within a day or 2 i was then fine).
symptoms of psychosis include: visual/audio illusions, audio hallucinations, at some point even hearing voices. feeling of thoughts being taken away from me, paranoia.
those were at my worst. does not always occur. also i have ptsd so i tend to start dissociating when my depression increases.wellbutrin was one of the best meds id been on but pooped out after a year or two. about 5 years after i tried again to no avail (including generic and branded).
maybe i should list the meds i've been on. would that help?
Posted by B2chica on February 15, 2016, at 19:57:27
In reply to Re: pdoc...hands in air. now what » B2chica, posted by SLS on February 15, 2016, at 18:31:05
everytime i see this list it quite frankly makes me very sad and hopeless. so i just copied and pasted it from my list. the meds either worked and pooped out, had no effect or had terrible side effects.
currently on pristiq, adderall, gabapentin and zyprexa.
i've been on pristiq for about 6-7 years mostly working except a few breakouts couple times a year. zyprexa has always been my 'GoTo' med, but it seems to only be keeping at bay the 'horribles'. not much else.currently symptoms Mixed state and what i see as cycling, but pdoc says IS the mixed state. Depression of the physical aspect, hypersomnia and insomnia, lethargy, life is very effortful, poor hygiene.
Aggitation, anger, self loathing and disdain and contempt for the world around me. hopelessness, and prior bouts of crying.
there it is...my life layed out in 2 depressing paragraphs.AXIETY
xanax
sonata
klonipin
ambien
gabapentin
Inderol
Ativan (shots and tabs-.5-1mg)
Ativan (tabs .5-1mg
Buspar (gained 5lbs and attribute increased depression to it but not for sure, was only on it for about 2.5 weeks but depression got increasingly worse.
Prosazin (started to cry, 3 days Stopped)
DesyrelSSRI/SNRI other ADs
effexor
symbyax (Prozac)
wellbutrin (also XL, and two generics)
trazadone
remeron
zoloft
lexapro
pristiq
Fetzima (20,40, 60)AP
zyprexa (brand, generic: teva, aurobindo, Sun, Prasco 5mg tabs)
zyprexa zydis (brand, generic: Apotex, one other cant remember who)
seroquel
risperdal
geodon
abilify
perphenazine
Haloperidol (for anxiety) .5 to 1.mg PRN
Saphris Asenipine
Latuda 20, 40, 60mg.MOOD STAB
trileptal
topamax
lamictal possible SJSSTIMULANT
strattera
ritalin LA (and SA ritalin)
Adderall (corepharma, teva, barr, Sandoz)
Dexedrine ER (Barr)
Vyvanse
Desoxyn (Mylan?)OTHER
Omega-3
B-12
Folic acid
Centrum silver
Melatonin
Prenatal vitamin
B-100 complex vitamin
Deplin
Posted by baseball55 on February 15, 2016, at 21:14:36
In reply to pdoc...hands in air. now what, posted by B2chica on February 15, 2016, at 17:50:13
If your p-doc is suggesting a 2nd opinion, then you should do that. It's a consult for her as well as for you and allows her to get a fresh set of eyes on the problem. My p-doc felt stymied once and sent me to a (very expensive!) uber-psychopharmacologist who had some very good suggestions. It's no different from your primary care doc sending you to a specialist. It's a professional and ethical strength when a doctor can admit they are stymied and bring someone else on the case.
Posted by Horse on February 16, 2016, at 1:13:25
In reply to Re: pdoc...my list, posted by B2chica on February 15, 2016, at 19:57:27
lithium, depakote?
Posted by SLS on February 16, 2016, at 1:26:13
In reply to Re: pdoc...hands in air. now what, posted by B2chica on February 15, 2016, at 19:49:46
> trileptal was the most dangerous med for me.
Ouch. What kind of reaction did you have?
> lamictal i think actually would have worked but about 3 or 4 weeks in i started to develop breathing issues, like my throat was closing up. so i was taken off (within a day or 2 i was then fine).
Wow. You are certainly sensitive to some of these medications.
> symptoms of psychosis include: visual/audio illusions, audio hallucinations, at some point even hearing voices. feeling of thoughts being taken away from me, paranoia.
I admire your candor. I don't like to talk about the few psychotic manias that I've had. They were severe, but didn't include hallucinations. I guess I feel embarrassed that I lost control. You show a lot of courage.
> those were at my worst. does not always occur. also i have ptsd so i tend to start dissociating when my depression increases.
> wellbutrin was one of the best meds id been on but pooped out after a year or two. about 5 years after i tried again to no avail (including generic and branded).
>
> maybe i should list the meds i've been on. would that help?It would help a great deal.
This place is like a think tank. There are a lot of brains at work here and a lot of experiences to be shared. It is possible that an idea will emerge that your doctor may not have considered. It is good that most people here don't try to prescribe. Thoughts are more like suggestions to be considered by a doctor rather than a conclusion to be acted upon on your own.
Geodon (ziprasidone) is an antipsychotic that acts like a SNRI antidepressant at the same time. How did you react to it?
Last question: How did your doctors differentiate between schizoaffective disorder and psychotic depression?
- Scott
Posted by SLS on February 16, 2016, at 1:29:49
In reply to Re: pdoc...my list, posted by B2chica on February 15, 2016, at 19:57:27
Oops. Sorry.
I didn't see that you had already posted your list.
Getting a second opinion is a good idea.
- Scott
Posted by SLS on February 16, 2016, at 2:04:13
In reply to Re: pdoc...my list, posted by B2chica on February 15, 2016, at 19:57:27
I see that you have already tried propranolol - presumably for PTSD and anxiety. I'm sorry the prazosin didn't work out for you. You might want to revisit prazosin at some point. It works for PTSD, developmental PTSD (chronic trauma disorder), along with anxiety and depression. I took 30 mg/day (10 mg t.i.d.). I don't know what your crying was all about. Did you feel worse in any other way? Maybe the crying was a startup side effect that would have disappeared quickly. How strongly did your doctor feel about prazosin?
Just curious: Did Latuda and Remeron make your depression worse in the same way that Buspar did?
A few people have had luck with Keppra (levetiracetam) when other mood stabilizers failed.
Horse's ideas are better than mine. If you haven't tried lithium or Depakote (valproate), these drugs can help work on the manic component of your mixed state. Lithium can also help with the depressive aspect.
For what it's worth, if you do have schizoaffective disorder, it has been my observation that if you can prevent the mania, you can prevent the psychosis. What I have seen in a friend of mine is: normal -> mania -> schizoid psychosis -> depression. Her psychosis was almost exactly like yours, although she was not agitated. She did not suffer from mixed states.
You have been severely ill for a long time. It may take months of continuous treatment with the same drugs at the same dosages to break through the wall and get the healing process started. Arriving at a homeostasis is usually the goal. You can't do this by making changes in treatment every few weeks. It would be interesting to make a list of those drugs that you find tolerable, and begin to consider building a core treatment around which to try new things. For instance, it might make sense to bring lithium on board and keep taking it if you tolerate it, even if you don't feel an immediate therapeutic effect.
You'll get there. One step at a time.
- Scott
Posted by SLS on February 16, 2016, at 6:16:26
In reply to Re: pdoc...hands in air. now what » B2chica, posted by SLS on February 16, 2016, at 1:26:13
I forgot to add anxiety in the schizoaffective mood progression.
normal -> anxiety -> mania with or without mixed-state -> schizoid psychosis -> depression -> normal
How does this compare to your cycle? You might not have periods of feeling normal. I hope you do. You could use periodic sanctuary.
- Scott
Posted by B2chica on February 16, 2016, at 18:36:12
In reply to Re: pdoc...hands in air. now what » B2chica, posted by SLS on February 16, 2016, at 1:26:13
to this day they never really told me exactly what happened. but i had just started the med that morning, our group was allowed outside for 15min (this was over 10 years ago we'd go out to smoke). then right when we came in i think 9am we had a group session. i was sitting at the table when everything started buzzing i was looking at a gal across from me trying to get her attention, i realized i coudlnt talk, i tried to move my left arm and it started to posture i let out a sort of gutteral sound (as i was trying to scream). the nurse finally came over and helped me up i took about three dragged steps and lost the ability to walk so another nurse came and the two of them carried me to my bed (i remember tyring to tell them my head felt like it was on fire, i tried like hell to say the one word 'hot' but couldnt get it out)
They put me in the bed and raised the foot of it. Later the nurse said something about blood pressure plummeting. but i also remember the nurses and doctors talking while i was in the room, she kept asking why my eyes were 'doing that'... but i dont know what she meant.
anyway, the whole while i am totally competent mentally but couldnt move and couldnt utter a single word. that lasted until about 7 or 8 that night, maybe later im not really sure.
After all that, i did stay on the med as i figured i made it thoughtthat ordeal and it ended up cycling me about every two-three days.
Yes, it sucks. Generics and i dont play well together. i think i would be willing to try another generic of it though beacuse i do respond differently to differnt generics.
Candor, well...i'm over 40 and feel quite comfortable laying it all out here. one advantage of getting older.
Geodon, i started at 80 and it didht do much for my depression or anxiety, went up to 160 (double the dose) and within 3 days i was severely suicidal, more than i had been in a while.
i dont think any have ever mentioned schizoaffective. i think mostly for two reasons, i dont tend to have hallucinations so much as illusions. and either halluc or illusion i am aware that they are such, so part of me stays in 'realiy' .
Posted by B2chica on February 16, 2016, at 19:06:14
In reply to Re: pdoc...hands in air. now what » SLS, posted by SLS on February 16, 2016, at 6:16:26
i didnt even know why i was crying, i wasnt sad, it was a very physical reaction. and my pdoc? i called him from a park where i was going to kill myself. he heard me not able to stop crying, said it was the med, to get off med immedaitely and go straight home and call him the next day. i did and was better in acouple days.
Remeron i was only on for a few days in the hospital, it did do anything for me so the day before i left the doc took me off it (probabloy put me on something else but cant remember).
Latuda...um yes, i think that one did. although i wasnt sure if it wasnt doing anything and i was just getting worse, or if my getting worse was med induced.
i have only heard of Keppra and am VERY willing to try it. i will keep that name in my back pocket when i see pdoc next.
and oddly enough (just call me mrs. paradox) i actually start to have the psychosis when my depression gets severe. although they say its a mixed state but im not so sure thats always true.i also tend to have my depressions first, then 'bing' straight up into anxiety ridden depressive mania.
You know its good to hear that. you are absolutely right about the time thing. this bout has lasted longer (partly pdoc issue but i digress). and it will take a longer time to heal up.i do feel periods of normalcy. usually good bit of time. but every year right around halloween-ish, november-ish i start having trouble sleeping, then that usually goes to aggitation (which could be considered mania side) but then soon depression and sometimes i dont have the aggitation, sometimes it goes straight to depression, than usually if depression gets severe (its like my body reacts to the severe depression and i bounce straight in to high energy with a positive emotion but only for about a day, quickly the thoughts turn negative, so think about having nothing but disdain and contempt for yourself and life in general, now add manic energy behind that and there i am. trying to control myself to not move. headphones here i come.
honestly its the fact that i DO have a nice long normal bout that allows me to really withstand the severist of either side... i think that;s why i feel blessed in a way to have a bipolar aspect as i know there are two sideds, and just when i dont think i can stand the depression any longer, here comes the manicy side. and when i cant stand that whoop theres me lying in bed for a week.
i cant thank you enough. mostly for the encouraging words, and well making me not feel completly alone... you have no idea...(scratch that you do) how alone i've been feeling lately. it seems like when i need people the most (which isnt all that often) there is no one around.
exhibit A- saw pdoc yesterday, she is supposed to get back to me to let me know what is up with my med regime, i hear nothing. i call to get 2nd opinion doc and cant get in till march 10th. asked T for sooner appt. and she's booked, no space at all....
my (1) work friend i almost never see now because im only part time and hours only overlap a little.BUT... as i say this despite my little personal pity party, i am dedicating to my writing. infact i'm writing now between psychobabble notes. i'm working on YA novel, but also writing a few short stories in between...
today i am not really writing, but trying to edit... its tough though. but at least i have enough energy to sit upright in my chair (Ha).
thanks Scott.
b2
Posted by Zyprexa on February 19, 2016, at 3:57:44
In reply to pdoc...hands in air. now what, posted by B2chica on February 15, 2016, at 17:50:13
B2
What about 7.5mg z? Are you still taking the generic, the one that is most like z?
Have you tried taking the z severl times a day? I take 3 doses every day, 6 hours apart. I find that it make the ups and downs much less. You get a beter effect from the med, and the eating is not so bad.
Also I wanted to suggest a small amount of cannabidiol. Which I've been taking for 6 months now. It makes the z work better with less. Also has a kind of smothing out effect. Calms anxiety. You only have to take it once or twice a day. I take 2 doses of 6mg avg in evening. It has realy helped to calm my anxietys around people. And I feel more whole as a person. Might sound crazy, but deffinely works. I buy it from Luckyvitamin.com , chepest place around, I take cannavest. Might be worth a try for you. I felt like I was just going in circles till I started it. I saw on you tube a woman who takes it for anxiety and it got her off benzos, with a better effect.
This is the end of the thread.
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