Posted by bleauberry on June 26, 2009, at 20:34:26
In reply to new Mix of medications, posted by tonyz on June 26, 2009, at 12:33:29
> I went to a new doctor today. I told him about my history of current depression and relapses and expressed my fear about the neuroleptics.
At a reasonable dose and responsible food choices, the fears of Zyprexa should be near zero. It is a fabulous neuroleptic with qualities in depression far greater than any others. My opinion, experience, and observations. Mileage varies of course, but there is a pretty strong body of scientific and anecdotal evidence backing that opinion up. I have no idea why doctors use Seroquel so much. You would think there must be a lot of people doing well with it. Good luck finding them. They are rare. Zyprexa, different story. It works miracles quite often.
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> Prior to seeing him I was taking 75-100 mg seroquel, 16mg valium, 150mg Notriptyline.That valium is high. Valium even at low doses will eventually cause practically everyone to become very depressed. Valium is probably doing you more harm than your own disease is. If a benzo is absolutely needed, it should be switched to Xanax which at least has some antidepresant potential, and the goal should be to wean very slowly in very tiny steps off of benzos completely. For now, Valium is your worst enemy, despite whatever you think it might be doing for anxiety. Especially at that dose. No wonder you are so depressed.
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> He started me on Zoloft and lamictal and said I should leave the valium and Notriptyline at the same level and indicated I should take enough Seroquel so that I can sleep. Kind of left it from 50 - 200mg.I like the Zoloft idea. Zoloft and Nortriptyline go very well together. Unfortuneatly the other meds will blunt the goodness. Lamictal is not a bad choice, but I don't like changing more than one thing at a time. If you get worse, which drug did it, the Zoloft or the Lamictal? You won't know. If you don't get better, how would you know that just one or other would have worked by themselves, but the combination was bad? You won't know.
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> He gave me a starter pack for the lamictal. I mentioned lithium and said something about lamictal being better at preventing recurrent depressive episodes whereas lithium is better where mania is involved.That is generally true. It doesn't mean that will happen, and it doesn't mean lithium wouldn't have been a miracle, but what he said does have some general consensus to it. Lithium does by the way work best when it is combined with a noradrenergic med, as Nortriptyline is, versus a serotonergic med. I thought the starter pack was supposed to start at 12.5mg? You need to keep an eye out for a rash. That is a dangerous thing that can happen with Lamictal. You had fears about neuroletics. The fears of that rash are higher.
>He stated me with 50mg of Zoloft.
I am more conservative and probably would have started at 12.5mg or 25mg, but 50mg is a common starting dose and sometimes final dose. Zoloft is an excellent choice, especially with Nortriptyline.
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> I told him I was trying to avoid hospitalization. He expressed confidence that he could help me and the importance that given my history I will need to be on lamictal and Zoloft for maintenance.I like a doctor who expresses confidence. There are too many that seem too hurried to listen, too distant to listen, or just don't really love what they do.
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> I don't know how to find a doctor that you really feel comfortable with. I asked him about a problem taking trazodone and Nortriptyline together which had been prescribed for me at one time - I had heard this was not a good combination from another doctor. He didn't agree.Trazodone is a lousy drug and a lousy antidepressant. It works for practically no one and usually makes them feel worse. Even when used as just a sleep aid, it can commonly make one feel more depressed the next day.
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> So how do you find a doctor that you can really trust. This guy was willing to squeeze me in for two appointments next week, when I told him I was at the point of requiring to go in a hospital.That's a good sign. If he was uncaring or too busy, he wouldn't have done that. Finding a doctor you can really trust is something that takes time. Kind of like a girlfriend or boyfriend. Trusting relationships take time to be born and blossom.
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> I am trying to have faith that this is a good decision. I told him about the shakiness that I have been experiencing and he didn't have much to say about that.It's probably the seroquel, and it is probably a result of being on so many medications.
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> Last night in anticipation of this appointment or for whatever reason I didn't get any sleep. and I wound up taking another 4mg of valium.In my view seroquel is basically useless for depression, despite what others might debate about it. It is however one of the world's most powerful antihistamines, its primary mode of action, and is thus good for inducing sleep. But if it is not doing that, then I see no sense in staying on it. It could be immediately switched straight over to Zypexa which has some real antidepressant umph, especially combined with an ssri med like zoloft.
For sleep, I like Lunesta better, or for a good antihistamine sleep, a mere 7.5mg remeron will do the trick. Best yet, a low dose of Amitriptyline, which is Nortriptyline's parent.
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> So I've gone ahead and taken the Zoloft (50mg) and lamictal (starting dose).
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> I could use some positive feedback.
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> Just to summarize meds are
> 50 mg Zoloft
> 25mg lamictal (starting dose)
> 16mg valium
> 150mg Nortriptyline
> probably 100mg seroquel
>
>Keep in mind that if you play with the valium doses or seroquel doses, up or down, it will have an effect on you. For example, if I am correct in believing valium is causing a worse depression than you would have without it, if you were to lower the dose too much too fast, you would be even more depressed as part of the withdrawal effect. It would be short-lived, but you would still experience it. So it will be tricky to navigate your journey. If you change more than one thing at a time, you will not know what did what. Tiny steps is the way to go. I assume you are probably good with a knife or razor blade at customizing pill sizes. If not, you should learn and practice.
Worst case scenario you someday end up in the hospital...their job is not to get you better...their job is to stabilize you and get rid you of to make room for someone else. They will still let you out of the hospital in very bad shape as long as someone else needs your bed that is in worse shape than you are, as happened with me. If you ever do go to a hospital, the goal should be to use that as the place to get off of your meds and clean out so you can start Parnate. If you ever get to a place where this whole med merrigoround is just going downhill forever, then you are already long past the appropriate time to have been tried on the real powerhouse of antidepressants, Parnate.
Until then, and I don't think that will ever happen, definitely keep your eyes on Nortriptyline, Zoloft, and Zyprexa. I would get rid of Valium and Seroquel. Lamictal is a maybe, but I would keep its doses low for now. Zyprexa will keep you stable as well or better and probably a lot longer than Lamictal. Lamictal has only been clinical proven to provide protection from relapse for months, where Zyprexa has gone well past that.
I'm just somebody on an internet forum who you will never know and never meet. I hope my input will be helpful in guiding your journey, but your doctor is the one to discuss it with.
I think you are going to see better days in the not distant future. He sounds like a good doctor. I just want you to have some ideas to work with him.
ps...All Lyme disease patients have one thing in common...their stories are exactly like yours. The depression, the drugs not helping, the shakiness...ask your doctor if he has ever seen the pamphlet titled, "What Psychiatrists Need to Know About Lyme Disease", or the one, "Psychiatric Lyme Disease". Regardless whether he has or not, top priority for you is to have him find someone for you that is an expert on Lyme disease and have them give you a clinical exam and the Western Blot lab test from Igenex Lab specifically.
poster:bleauberry
thread:903309
URL: http://www.dr-bob.org/babble/alter/20090410/msgs/903368.html