![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by tina on May 7, 2000, at 23:59:46
Got another question(really not sleepy) anyway---My doc just upped my celexa dose but it feels like I am getting more depressed now. Is it possible that TOO much can be LESS effective than a lower dose? I am so NOT sleepy. I took two Xanax two hours ago and I feel like I have enough energy to clean out the garage(not that i'll do it). What's with that. I have been an insomiac for a while now but I'm usually tired and can't sleep not wired and restless. Does that have anything to do with the extra celexa and how long does it take according to Dr Jensen to know if celexa IS the right AD for me??? Lots a questions, sorry, just up and no one else to talk to. Thanks for listenin'---Tina
Posted by afatchic on May 8, 2000, at 0:29:48
In reply to to Cam/Anyone?????, posted by tina on May 7, 2000, at 23:59:46
Tina, have ever tried Trazadone? I took it for years at bedtime and it always nocked me out, it also happened to be a great AD for me. The only reason I went off it was that I thought it was responsible for my weight gain. Other than that, for me, it was a great medication.
> Got another question(really not sleepy) anyway---My doc just upped my celexa dose but it feels like I am getting more depressed now. Is it possible that TOO much can be LESS effective than a lower dose? I am so NOT sleepy. I took two Xanax two hours ago and I feel like I have enough energy to clean out the garage(not that i'll do it). What's with that. I have been an insomiac for a while now but I'm usually tired and can't sleep not wired and restless. Does that have anything to do with the extra celexa and how long does it take according to Dr Jensen to know if celexa IS the right AD for me??? Lots a questions, sorry, just up and no one else to talk to. Thanks for listenin'---Tina
Posted by JohnL on May 8, 2000, at 3:28:08
In reply to to Cam/Anyone?????, posted by tina on May 7, 2000, at 23:59:46
> Got another question(really not sleepy) anyway---My doc just upped my celexa dose but it feels like I am getting more depressed now. Is it possible that TOO much can be LESS effective than a lower dose? I am so NOT sleepy. I took two Xanax two hours ago and I feel like I have enough energy to clean out the garage(not that i'll do it). What's with that. I have been an insomiac for a while now but I'm usually tired and can't sleep not wired and restless. Does that have anything to do with the extra celexa and how long does it take according to Dr Jensen to know if celexa IS the right AD for me??? Lots a questions, sorry, just up and no one else to talk to. Thanks for listenin'---Tina
Tina,
In my experience it has definitely been a real phenomenon to get worse instead of better at a higher dose, sometimes. Though most of these meds don't have established therapeutic windows (except for a few, like Nortriptyline for example), I do believe each drug does have a particular therapeutic window which varies from person to person, depending on what amount it takes to correct the chemistry at fault. Below that window or above that window only makes things worse. That's just my experience anyway.It's not uncommon for the SSRIs to destroy sleep structure. I'm sorry you have to deal with that. Not only do we sleep poorly or not at all sometimes, but then we are totally exhausted during the day as a result of it. And sometimes a drug we expect to be sedating--like Xanax--can mysteriously do just the opposite. On the flip side, there are people who fall asleep on stimulants.
Dr Jensen usually has patients try a med for 5 days to a week. Then there's a one day washout before the next trial. Usually three different drugs from the same class are tried in this manner before the next consultation. That short trial though--contrary to misconception--doesn't necessarily prove the right drug. It is instead searching for the superior drug match. Six week trials can be avoided about 90% of the time when the superior match is identified. But even then, sometimes things go wrong. I mean, psychiatry is tricky and full of unknowns, no matter who the physician is. A med can provide good initial response and then deteriorate after that. That provides clues of other brain chemistries involved that weren't at first suspected.
Sometimes a patient won't respond to any med rapidly. In Jensen's practice, that is rare. That's because several drugs from several classes are sampled. Usually one of them is an 'accidental-yet-on-purpose' pleasing discovery. But sometimes not. In those cases, the patient can then choose which of the meds they liked the best in short trials for longer traditional trials. For example, ones that caused worsening could be weeded out. Ones with the best overall initial side effects might be favored. But sometimes there's no way to avoid the longer trials. Is that the case with you? I don't know. I don't know what drugs from what various classes you have tried. Until then, I hope your chemistry will adjust enough to let you get a good night's sleep! :-)
Since you've already been on Celexa for a while, I think it makes sense to stay with a solid 6 weeks to see how it progresses. And I would personally stay at a comfortable dose. Not a dose that makes me feel worse quickly. I think it becomes too confusing and perhaps counterproductive to mix different strategies mid-stream. Best to finish out what you're already doing before making any other modifications, I think.
Anyway, I hope things go better for you. Maybe the Celexa just needs more time for the trickle down effect to take place. Maybe it's not the right drug at all. At this point we probably can't know for sure. But after 6 to 8 weeks, we should be able to make a better judgement. And then decide what to do next, if anything else is needed.
JohnL
Posted by Cam W. on May 8, 2000, at 6:46:54
In reply to to Cam/Anyone?????, posted by tina on May 7, 2000, at 23:59:46
Tina - It could be some of those nasty SSRI start-up side effects. Maybe try upping the dose by 1/2 a table insted of a whole one, for a few days to a week, then adding the other 1/2 tablet into the regimen. Tell the doctor about this reaction, it will help him/her to guide future decisions about you med doses. And do clean out the garage now, this energy won't last (except the neighbors may think you are a little crazy/eccentric. I know my neighbor wonders when I do an all-nighter every now and then - cleaning the yard and garage at 5 am on a weekend).Hope this helps - Cam W.
Posted by Greg on May 8, 2000, at 7:13:18
In reply to to Cam/Anyone?????, posted by tina on May 7, 2000, at 23:59:46
Tina,
Good Morning! There are several sleep aids available, Ambien is the one I use. I've heard that Trazadone helps a lot of people but I 've never personally tried it. Don't know much other than what I've read here about Celexa.You took 2 Xanax and have the energy to clean out the garage?? Lions and Tigers and Bears, oh my! I take a 1/2mg and relax comfortably, a full mg puts me to sleep and I wake up groggy in the am. I think 2 of them would make me sleep for a week... hmmm, I DO have a vacation coming up....
I hope the Xanax is working for the panic attacks.
Hugs,
Greg> Got another question(really not sleepy) anyway---My doc just upped my celexa dose but it feels like I am getting more depressed now. Is it possible that TOO much can be LESS effective than a lower dose? I am so NOT sleepy. I took two Xanax two hours ago and I feel like I have enough energy to clean out the garage(not that i'll do it). What's with that. I have been an insomiac for a while now but I'm usually tired and can't sleep not wired and restless. Does that have anything to do with the extra celexa and how long does it take according to Dr Jensen to know if celexa IS the right AD for me??? Lots a questions, sorry, just up and no one else to talk to. Thanks for listenin'---Tina
Posted by tina on May 8, 2000, at 7:54:56
In reply to Re: to Cam/Anyone?????, posted by JohnL on May 8, 2000, at 3:28:08
> >Thanks guys, it's nice to know there are people who'll listen no matter what the hour. I do feel like I'm being a bit of a pain sometimes with all these questions but you're right John I don't have much experience when it comes to the meds, I'm just beginning to educate myself. With you guys in my corner I'm sure I'll come out fine. Thanks--Tina
Got another question(really not sleepy) anyway---My doc just upped my celexa dose but it feels like I am getting more depressed now. Is it possible that TOO much can be LESS effective than a lower dose? I am so NOT sleepy. I took two Xanax two hours ago and I feel like I have enough energy to clean out the garage(not that i'll do it). What's with that. I have been an insomiac for a while now but I'm usually tired and can't sleep not wired and restless. Does that have anything to do with the extra celexa and how long does it take according to Dr Jensen to know if celexa IS the right AD for me??? Lots a questions, sorry, just up and no one else to talk to. Thanks for listenin'---Tina
>
> Tina,
> In my experience it has definitely been a real phenomenon to get worse instead of better at a higher dose, sometimes. Though most of these meds don't have established therapeutic windows (except for a few, like Nortriptyline for example), I do believe each drug does have a particular therapeutic window which varies from person to person, depending on what amount it takes to correct the chemistry at fault. Below that window or above that window only makes things worse. That's just my experience anyway.
>
> It's not uncommon for the SSRIs to destroy sleep structure. I'm sorry you have to deal with that. Not only do we sleep poorly or not at all sometimes, but then we are totally exhausted during the day as a result of it. And sometimes a drug we expect to be sedating--like Xanax--can mysteriously do just the opposite. On the flip side, there are people who fall asleep on stimulants.
>
> Dr Jensen usually has patients try a med for 5 days to a week. Then there's a one day washout before the next trial. Usually three different drugs from the same class are tried in this manner before the next consultation. That short trial though--contrary to misconception--doesn't necessarily prove the right drug. It is instead searching for the superior drug match. Six week trials can be avoided about 90% of the time when the superior match is identified. But even then, sometimes things go wrong. I mean, psychiatry is tricky and full of unknowns, no matter who the physician is. A med can provide good initial response and then deteriorate after that. That provides clues of other brain chemistries involved that weren't at first suspected.
>
> Sometimes a patient won't respond to any med rapidly. In Jensen's practice, that is rare. That's because several drugs from several classes are sampled. Usually one of them is an 'accidental-yet-on-purpose' pleasing discovery. But sometimes not. In those cases, the patient can then choose which of the meds they liked the best in short trials for longer traditional trials. For example, ones that caused worsening could be weeded out. Ones with the best overall initial side effects might be favored. But sometimes there's no way to avoid the longer trials. Is that the case with you? I don't know. I don't know what drugs from what various classes you have tried. Until then, I hope your chemistry will adjust enough to let you get a good night's sleep! :-)
>
> Since you've already been on Celexa for a while, I think it makes sense to stay with a solid 6 weeks to see how it progresses. And I would personally stay at a comfortable dose. Not a dose that makes me feel worse quickly. I think it becomes too confusing and perhaps counterproductive to mix different strategies mid-stream. Best to finish out what you're already doing before making any other modifications, I think.
>
> Anyway, I hope things go better for you. Maybe the Celexa just needs more time for the trickle down effect to take place. Maybe it's not the right drug at all. At this point we probably can't know for sure. But after 6 to 8 weeks, we should be able to make a better judgement. And then decide what to do next, if anything else is needed.
> JohnL
Posted by harry b. on May 8, 2000, at 8:40:58
In reply to Re: to Cam/Anyone?????, posted by Cam W. on May 8, 2000, at 6:46:54
>
> I know my neighbor wonders when I do an all-nighter every now and then - cleaning the yard and garage at 5 am on a weekend).
>
> Hope this helps - Cam W.We all do some of this. Several years ago I bought
a DirecTV satellite dish. The box sat in my house
for a month or so, just couldn't find the time or
energy to install it.One night, sleepless, I got my ladder, a few drop
lights and my tools, and was on my roof from
around 1am to 4am. Mission completed. And my neighbors
never said a word.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.