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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by Lynn on October 14, 1998, at 9:11:41
Toby,
Have to ask you once again for some advice. As I stated in my last post, I decided to drop my meds (Neurontin 1400 mg/day, Effexor 125/day and Wellbutrin SR 300/day) because I was just as depressed as I was when I first started this cycle. But more importantly I just felt tired all of the time AND VERY UNMOVTIVATED. Couldn't seem to find the motivation to return to work.
Since dropping the meds (or reducing) my depression seems abated but my anxiety is more acute, but I don't seem to hyperfocus anymore (obssevively worry )
Made an appointment with a new Doc who specialized in ADD as I suspected this too was a possibility given the many symptoms and recent diagnosis of neice and brother.
As you wisely stated, dropping all of them at the same time was not a good idea. The first 2 days I felt great!! Energy and a return of "good feelings". Started noticing the 3rd night very bad nightmares, intense sweating and insomnia. During the day I was very tired because I wasn't sleeping. Tried to endure this for about 5 days when I got terrible stomach pains which landed me in med all day. Not sure if this too was a symptom of withdrawl, but decided to alter my plan.
I started back on the wellbutrin 150 per day and neurontin 800 per day. Have alternately stopped the wellbutin and reduced the neurontin. Noticed that days I did not take neurontin had return of insomnia and night sweats and dreams, with no symptom return of not taking Wellbutrin.
Meanwhile, saw the new doc who agrees that I probably do have ADD and depression. She has had success with Wellbutin for ADD and depression. As I had been taking Wellbutin for about 6 months alone last year, I don't think that this alone will help with the ADD. Also, I'm not sure if my depression totally stopped, or maybe continued on this because ADD wasn't diagnosed and treated properly?
We are "playing" with Ritalin right now. She said I probably won't see a lot of difference as long as I am on Neurontin. I take one Ritalin in the am and feel calmer and a little more focused. When I tried to take 2 because I didn't notice much difference, it was too much (jittery). Also, the Ritalin doesn't seem to last very long (2 hours). I am taking Wellbutrin SR 150 mg am and am still feeling tired.
My main concerns are
1) How can I get off this neorontin, how long will it take before I stop the "night" stuff. Is this interfering with the Ritaling and Wellbutrin? and why am I reacting so bad to this particular drug?2) I have always been an insomniac, and I didn't realize until now that for the last year I for the first time in my life I have not had sleep problems (with the start of Neorontin and Trazadone). I am still taking 1/2 Trazadone at night, not helping with sleep, only sleeping 5 hours even with Ambien. Tried taking 1 full Trazadon, but made me feel like a Zombie the next day and didn't help with sleep.
3) What medications would be best to treat depression and ADD without making me feel tired from either lack fo sleep or "hangover" the next day? I have alwasy reacted very badly to any meds that have drowsiness effect. Make me too tired to function, but have always had sleep problems, both waking up early and getting to sleep.
Finally, am only taking the Ritalin 2 times per day (not after noon), don't feel jittery or anything so I don't think this is interfering with my sleep. Also, the wellbutin seems to make me tired, but side effects seem to indicate the opposite, so don't know whether I should take am or pm.
I have never been bothered by caffeine, but am very careful not to drink too much.
I see the new Doc again on Tuesday and my general Doc tomorrow and would love some insight.
Thanks for all your advice, it has definately led me down the right roads and new doctors.
Lynn
Posted by Toby on October 14, 1998, at 14:53:22
In reply to Need advice - Toby, posted by Lynn on October 14, 1998, at 9:11:41
1) The PDR cautions "Do not stop Neurontin abruptly." Now, whether that's because there is a withdrawal syndrome or because it's approved for seizures and the seizures might return if the Neurontin is stopped suddenly, I don't know. I have not known anyone to have withdrawal from it. However, when in doubt, taper slowly. If you are taking 800 mg per day now with 400 mg tablets, you should probably go to 400 mg at bedtime for about a week and then discontinue it. If you have tablets that come in 300 mg size, go to 600 mg per day for 3-4 days, then 400 mg per day for 3-4 days, then 300 mg per day for 3-4 days, then stop it. However you can decrease it in the smallest increments in 3-4 day blocks.
2) If true Neurontin withdrawal, nightmares, etc, no wonder trazodone not helping. Perhaps the taper will resolve that. Plus, your body will have to get used to not having the sedating effect of Neurontin around.
3) Certainly if the ADD responds to a stimulant (which are used sometimes for depression) that may be all you need. Cylert is a nonaddictive, long acting ADD medication that you only have to take once a day and is sometimes used to augment antidepressants. You said that you never got any real relief with the antidepressants but that your depression seemed to have lifted when you stopped all the meds. The anxiety got worse, but I wonder if that was really just the ADD rearing its head?
4) If the Wellbutrin is making you tired, take it at lunchtime and if it still makes you tired in the afternoon, take it at bedtime. But why does the doc want you take Wellbutrin AND Ritalin since the Wellbutrin didn't do anything before? Also, the Ritalin is quite short acting but if you find the right daily dose, you can use the Sustained Release form to keep from having to dose yourself constantly through the day. If you can't get the dose up any higher due to jitteriness (in other words, say you are taking 5 mg at 7am and 12 noon but it wears off at 9am so you go up to 10 mg at 7am and get jittery, but 5 mg at 7am and 9am does fine but you don't want to be worrying with a pill every couple of hours) she'll probably switch you to Dexedrine or Adderall to see if you get a better response. Also, make sure you eat (take the medication on an empty stomach, but be sure to eat something within an hour or so). That sometimes cuts down on the jitteriness that comes with an increased dose.
This is the end of the thread.
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