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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Patient on February 15, 2003, at 15:52:30
Hi,
I'm new here.
This past week my psychiatrist gave me samples of Lexapro and Carbatrol ER(carbamazepine extended release).
Previously I was taking 20 mg Celexa daily for the past 4 months, augmented with 10 mg BuSpar (to help counteract sexual dysfunction as well as help boost Celexa), as well as .5 mg lorazepam (Ativan) taken during week prior to start of period (higher irritability time). I was doing so-so: feeling like a zombie during morning hours, then highly energetic by late afternoon/evening, which at times I would experience irritability. I began to take .5 mg Ativan at bedtime to help me sleep. Prior to this, I was awakening at 3-4 in the morning unable to fall back asleep. I think my worst complaint after first being put on Zoloft a couple of years ago for PMS, then switched to Prozac, and then to Celexa, is apathy. This part of drug treatment is even worse for me than the sexual dysfunction caused by these drugs. I have not had the weight gain that others complain about. I also do not like the lack of short-term memory, and having word-finding difficulties.
My doctor hasn't outright diagnosed me as yet. I have been seeing him since 2001. He thinks I have either Borderline Personality Disorder, or Bi-polar depression. I have suffered from bulimia nervosa for many years in the past. I have had big problems with spending too much money, do not make long-lasting friendships, and do not work outside the home. Throughout my life I have suffered from depression and extreme anxiety. I also self-mutilate, but not in the strict sense of the word-i.e. I don't cut my wrists-I hit myself with my fists very hard, usually the forward sides of my head. I also hit my legs and stomach, but more so my head. This occurs during a rage attack. I have a very big problem with rage outbursts, as does my entire family. I cry and feel drained after hitting myself, and I no longer feel rage, but just want to nap. I am married but have no children (by choice).
I have started taking 5 mg. of escitalopram (Lexapro) in the morning, and 200 mg capsule of Carbatrol ER with evening meal. My doctor is hoping the carbamazepine (anticonvulsant) will help smooth out my ups and downs, as well as help with my anger problem. This is an off-label use for carbamazepine. My doctor ordered blood tests for platelets, white blood cell and red blood cell count prior to start of Carbatrol, since Carbatrol has been known to reduce these in some individuals. I requested a T3 and T4 thyroid test, as well as cholesterol test, since this drug can also affect these. My doctor did not request tests for liver enzymes. He mentioned he may later try lithium, but that's if carbamazepine doesn't help.
So far, I have noticed lethargy or sleepiness an hour after taking Lexapro (stronger than after taking 20 mg Celexa), but it only lasts for about 2 hours or so. When I first took Carbatrol, I noticed a bit of a druggy or spacy feeling, like one would experience after taking an antihistamine, but the next two days upon taking it I did not notice this as much.
I am happy to submit this information and will submit more as I go along with my current treatment. I am doing quite well, considering what I was experiencing just a month ago.
Posted by judy1 on February 16, 2003, at 11:49:52
In reply to BPD patient on Lexapro carbamazepine, posted by Patient on February 15, 2003, at 15:52:30
I'm glad you are doing better, it sounds as if you and your pdoc have found a good med combo. I just wanted to make sure you are in therapy also (especially for the SI) and if so- how is that going? take care and welcome to the board- judy
Posted by Patient on February 17, 2003, at 12:28:00
In reply to Re: BPD patient on Lexapro carbamazepine » Patient, posted by judy1 on February 16, 2003, at 11:49:52
Hi Judy,
I'm sorry, but I do know what SI is. Oh wait, I just got it, it is self-injury. No, I'm not in therapy for that. We are on a strict budget and my psychiatrist is the least expensive in town. He used to be a general practitioner years ago and isn't that great with therapy. We do enjoy talking, though, and this is in some ways how he gets me to feel like opening up to him.
Instead, I go to my library and read books on depression, anxiety, OCD, etc. One very good book I am reading is "Feeling Good" by David Burns, M.D. It contains common sense cognitive therapy helps. I find it very helpful. Anger outbursts is one of those things that is difficult for me to control. Once it hits me, it's too late. I'm instead working on what causes me to lose my temper so easily; I have a very low frustration threshhold, as does most of my family. I also self-hate, which only makes it easier to hit myself. Once I used the fireplace poker on my head and did a bit of wounding.
Yes, the med. combo is very good I think, from reading about it in Dr. Bob's Tips section for BPD rage outbursts.
About 4 years ago I got up the nerve to tell my gyn. doc about my temper problems that worsen before my period starts. He gave me a prescription for Zoloft 50mg. I didn't stick with the medicine, for I have always been one that is suspicious of mood-altering drugs and after a month I stopped taking it. This was the first time I have every sought help for my emotional problems, in my 30's. Anyway, we relocated, and two years later I went to a new gyn, and she said what I was experiencing was Pre-Menstrual Syndrome, so she put me on Zoloft. I only took 25 mg. which worked very well. A few months later Wellbutrin was added to it to help with libido problems from the Zoloft, for me and my husband found the sexual dysfunction a big problem. It didn't help. Then I finally went to see a psychiatrist-boy was I nervous! The Zoloft dose was increased to 50 mg and I got shaky hands and became agitated, so I was switched to Prozac 20 mg. That worked great at the beginning (as did the Zoloft), but then after 3 or so months I began to experience agitation, irritability, and negative thoughts came back. So then I went to another psychiatrist in town (boy, was he expensive!) and he switched me to Wellbutrin ER. I could only handle it for about a month and a half. I was relaxed and felt euphoric, but at the same time I was irritable, but in a relaxed way-if that makes any sense. Then I went back to my original psychiatrist and he switched me to Celexa 20 mg. That worked well at the beginning, though didn't work well during the week or so prior to my period. I actually liked the sleepy feeling it caused after an hour or so upon taking it, for I have always been a bit on the hyper, unrelaxed side. He added 10 mg BuSpar to help boost Celexa. I didn't notice any difference. Celexa, too, wasn't working after a few months, as well as it did at the beginning, but it was the least agitation producing SSRI I have tried.
As for the Lexapro; so far it is working very well, but it has only been a week now. But I notice that I feel euphoric after the lethargy wears off. I am only taking 5 mg., but for me, I'd rather start out low and increase if needed. I do know that most of the SSRI's can cause a blood level increase in carbamazepine, so I'm going to assume that Lexapro can cause the same, so I'd rather take a smaller dose for that reason. I started this combination on the day I started my period, and instead of my usual 6 or 7 day length period, it was only 4 to 5 days. I'm as regular as clockwork in length and time of starting, so I'll assume this is because of the meds.
I can be long winded, so I hope I didn't "talk" your ears off. I just wanted to add more background information. I've had problems with depression, anxiety, bulimia, and SI since I was in my mid-teens.
Thanks for asking!
I can check your previous posts, but I was wondering if you have tried carbamazepine? I know each of us reacts differently to meds. as we all have a unique brain. This is my first time to try a mood stabilizer.
Regards,
Patient
Posted by Dr. Bob on February 17, 2003, at 16:43:57
In reply to Re: BPD patient on Lexapro carbamazepine » judy1, posted by Patient on February 17, 2003, at 12:28:00
> One very good book I am reading is "Feeling Good" by David Burns, M.D.
I'd just like to plug the double double quotes feature:
http://www.dr-bob.org/babble/faq.html#amazon
But I don't mean to be pushy. Did you deliberately not use it to link to Amazon? If so, I'd be interested in why, over at Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
Posted by Patient on July 25, 2003, at 15:34:59
In reply to Re: BPD patient on Lexapro carbamazepine » judy1, posted by Patient on February 17, 2003, at 12:28:00
It's been a while since I posted an update. I can say I haven't had a rage attack since writing this letter. I was taking the 5mg Lexapro and 200mg carbamazepine daily for a bit over a month, then I got so sick of being a zombie during the day that I quit both meds. I was fine for a few days until my husband mentioned my over-spending and I went downhill. I went back on the Lexapro, taking 5mg daily, and began taking carbamazepine on an as-needed basis, which is usually about a week or more before my period starts when I become more irritable. The carbamazepine does make me sleepy the next day, so the less I have to take it, the better if I don't want to be a zombie.
In the past two weeks I started taking 10mg of Lexapro in the early evening. So far, I am doing well. Ativan sits on the shelf most of the time. I think the situation at home has started getting to me with our rainy-day funds being used to pay health insurance, and our very low income not meeting our needs, and the job outlook for my engineer husband not going well (we think he's over-qualified). It puts pressure on me to find a job, but I just can't do it-I have too many fears and hang ups about working outside the home. He'll probably have to get a contract job which means I'll be by myself. This is what I want for he currently works at home, and it seems I can't get anything done with him around (retired couple syndrome? ;). I do much better by myself. My dad was the same way.
How true that antidepressants don't help a person get better, unless they are also getting good psychotherapy treatment. My affordable doctor just is not good at psychotherapy, and so I am not getting better as I would hope to. Instead of seeing him monthly, his ineffectiveness and our bugdet now allows for every 3 month appointments; could be pushing it to 6 mo. So, up to 10mg it is.
In the past I have fiddled with my dosage and gone off the medicines too often to prove to me that I do terrible without them. I think the anger is my worst problem. It's enough to keep me on these medicines for life. I would much rather suffer from panic attacks or severe depression, both of which I have suffered from, or accept the drug-induced apathy, than to have this temper problem that is like having a murderer live inside me. I was really hoping I would make the miraculous change like the patients in "Listening to Prozac", by Kramer.
I am thankful for the drug Lexapro, and for carbamazepine for when I do need to take it. Out of all that I've tried Lexapro is the one I'm staying with. I only wish I could have started on it in my teens, when all my problems started to show themselves. I can also understand why my brother with schizophrenia went off medicines so often-the side effects made him a walking tree.
This is my original post:
"Posted by Patient on February 15, 2003, at 15:52:30Hi,
I'm new here.
This past week my psychiatrist gave me samples of Lexapro and Carbatrol ER, also known as Tegretol XR(carbamazepine extended release).
Previously I was taking 20 mg Celexa daily for the past 4 months, augmented with 10 mg BuSpar (to help counteract sexual dysfunction as well as help boost Celexa), and .5 mg lorazepam (Ativan) taken during week prior to start of period (higher irritability time). I was doing so-so: feeling like a zombie during morning hours, then highly energetic by late afternoon/evening, which at times I would experience irritability. I began to take .5 mg Ativan at bedtime to help me sleep. Prior to this, I was awakening at 3-4 in the morning unable to fall back asleep. I think my worst complaint after first being put on Zoloft a couple of years ago for PMS, then switched to Prozac, and then Celexa, is apathy with each SSRI. This part of drug treatment is even worse for me than the drug-induced anorgasmia. I have not had the weight gain that others complain about. I do not like the lack of short-term memory, and having word-finding difficulties. It's enough to keep from from working outside the home for fear of screwing upsomething important (I would be working as vet tech).
As for what is wrong with me; my doctor hasn't outright diagnosed me as yet. I have been seeing him since 2001. He thinks I have Borderline Personality Disorder, or Bi-polar depression. I have suffered from bulimia nervosa for many years in the past. I have had big problems with spending too much money, impulsiveness, do not make long-lasting friendships, and do not work outside the home. Throughout my life I have suffered from depression and extreme anxiety with a very short temper. I also self-mutilate, but not in the strict sense of the word-i.e. I don't cut my wrists like I've heard some do for the adrenaline rush-I hit myself with my fists very hard, usually the forward sides of my head. I also hit my legs and stomach, but more so my head. This occurs during a rage attack and it's as if I wanted to beat myself up for I have so much hate towards me (must be what a spouse or child abuser feels when they are beating up on them). I have a very big problem with rage outbursts, as does my entire family. I cry and feel drained after hitting myself, and I no longer feel rage, but sleepy.
I am married but have no children (thank God, by choice), in my late 30's. This week I have started taking 5 mg. of escitalopram (Lexapro) in the morning, and 200 mg capsule of Carbatrol ER with evening meal. My doctor is hoping the carbamazepine (anticonvulsant) will help smooth out my ups and downs, as well as help with my anger problem. This is an off-label use for carbamazepine. My doctor ordered blood tests for platelets, white blood cell and red blood cell count prior to start of Carbatrol, since carbamazepine has been known to reduce white blood cell and platelets in some individuals. I requested a T3 and T4 thyroid test, as well as cholesterol test, since this drug can also affect these. My doctor did not request tests for liver enzymes. He mentioned he may later try lithium, but that's if carbamazepine helps.
So far I have noticed lethargy or sleepiness an hour after taking Lexapro (stronger than after taking 20 mg Celexa), but it only lasts for about 2 hours or so. When I first took Carbatrol, I noticed a bit of a druggy or spacy feeling, like one would experience after taking an antihistamine, but the next two days upon taking it I did not notice this as much.
I am happy to submit this information and will submit more as I go along with my current treatment. I am doing quite well, considering what I was experiencing just a month ago." next post was reply to judy.
This is the end of the thread.
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