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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Tree on May 14, 2003, at 10:47:57
Hi, I am new here. I am experiencing depression and some anxiety following treatment (mastectomy) for breast cancer. My doctor prescribed Effexor, with Klonopin for sleep. I filled the prescription, then read the postings here about the horrible withdrawal, and became afraid to take it. I asked her for Wellbutrin instead and she thought it would be too strong, and would exacerbate my insomnia. I pushed and she gave it to me. I refuse to take anything that will make me gain weight, as that would defeat the purpose. (She thought Effexor would not make me gain). Anyway, I was all geared up to start the Wellbutrin today, and then my Chiropractor, who I saw yesterday, encouraged me to try 5htp first. She said it would only take about 5 days to work. This is my second day, and I don't feel anything yet. I took a Klonopin (sp?) last night, but only made it till 4:30am. I am looking for feedback on 5htp and the others. Also, do I jump right in with 300mg of Wellbutrin, if I decide to go that way, or do I build up. I am nervous about taking anything, but I need to do something soon.
Posted by Ron Hill on May 14, 2003, at 11:03:40
In reply to New and Nervous, posted by Tree on May 14, 2003, at 10:47:57
Hi Tree,
Welcome to pbabble. I'm glad you are here. I'm so sorry to hear of your difficult bout with cancer.
Before I respond to the issues you raise, may I ask a couple of questions? Is this the first instance of a major depressive episode in your life? If not, was the prior incident(s) precipitated by a major life event(s), or did it just come out of the blue? Is there a family history of depression and/or other mental health disorders?
-- Ron
-------------------------------------
> Hi, I am new here. I am experiencing depression and some anxiety following treatment (mastectomy) for breast cancer. My doctor prescribed Effexor, with Klonopin for sleep. I filled the prescription, then read the postings here about the horrible withdrawal, and became afraid to take it. I asked her for Wellbutrin instead and she thought it would be too strong, and would exacerbate my insomnia. I pushed and she gave it to me. I refuse to take anything that will make me gain weight, as that would defeat the purpose. (She thought Effexor would not make me gain). Anyway, I was all geared up to start the Wellbutrin today, and then my Chiropractor, who I saw yesterday, encouraged me to try 5htp first. She said it would only take about 5 days to work. This is my second day, and I don't feel anything yet. I took a Klonopin (sp?) last night, but only made it till 4:30am. I am looking for feedback on 5htp and the others. Also, do I jump right in with 300mg of Wellbutrin, if I decide to go that way, or do I build up. I am nervous about taking anything, but I need to do something soon.
Posted by Tree on May 14, 2003, at 13:23:34
In reply to Re: New and Nervous » Tree, posted by Ron Hill on May 14, 2003, at 11:03:40
Thanks, Ron. I guess I have been depressed for most of my life, though I didn't always know it. In my younger years, I medicated myself with drugs and alcohol, but when I became a professional, and then a parent, that wasn't an option any longer. My only safe addiction is food. I struggle with weight issues. I am not obese, but definitely overweight. About five years ago, a therapist diagnosed me with PTSD and Major Depressive Disorder. I was also going through a crisis in my marriage, which did make it unmanageable. I went on Zoloft. After a four week adjustment period during which I could not sleep, I started to feel better. But, two weeks later, I became pregnant, and went off it. Pregnancy, childbirth, and having a new baby (number3), really helped lift my depression. Also, I was able to take leave from my job in which I was miserable. Stress had been building again - 2 teenagers, a two-year-old, a difficult husband, depression creeping back in, and then the cancer trip has plunged me back down - deeper than I can remember. And, yes there is a family history of depression and manic-depression on my paternal side - grandfather, father, aunt, and also my brother(from a different father). I think I answered all your questions, and I look forward to any help you or anyone else has to offer.
Posted by Snoozy on May 14, 2003, at 15:44:59
In reply to New and Nervous, posted by Tree on May 14, 2003, at 10:47:57
Hi Tree -
Welcome. Is the doctor who prescribed Effexor for you a psychiatrist? Also, it sounds like you've been struggling with insomnia for a while?
I don't know anything about 5htp, but I have been on Effexor and am currently on Wellbutrin (400mg). It's been a while since I was on Effexor, but both of them can cause insomnia. If you decide to take Wellbutrin, it would probably be better not to start at 300. The SR tablets come in 100 and 150 mg strengths, so you could start with 100 or 150. In addition to the insomnia, it can cause some irritation in the beginning (both went away for me).
Have you considered joining a support group for breast cancer? Some of the depression and anxiety you're experiencing may be a natural response to cancer and the treatments. (I'm not saying it doesn't need to be treated though.)
I'd be happy to try and answer any questions about my Wellbutrin experience. Good luck to you and I hope you find something that works.
> Hi, I am new here. I am experiencing depression and some anxiety following treatment (mastectomy) for breast cancer. My doctor prescribed Effexor, with Klonopin for sleep. I filled the prescription, then read the postings here about the horrible withdrawal, and became afraid to take it. I asked her for Wellbutrin instead and she thought it would be too strong, and would exacerbate my insomnia. I pushed and she gave it to me. I refuse to take anything that will make me gain weight, as that would defeat the purpose. (She thought Effexor would not make me gain). Anyway, I was all geared up to start the Wellbutrin today, and then my Chiropractor, who I saw yesterday, encouraged me to try 5htp first. She said it would only take about 5 days to work. This is my second day, and I don't feel anything yet. I took a Klonopin (sp?) last night, but only made it till 4:30am. I am looking for feedback on 5htp and the others. Also, do I jump right in with 300mg of Wellbutrin, if I decide to go that way, or do I build up. I am nervous about taking anything, but I need to do something soon.
Posted by jerrympls on May 14, 2003, at 21:41:09
In reply to New and Nervous, posted by Tree on May 14, 2003, at 10:47:57
> Hi, I am new here. I am experiencing depression and some anxiety following treatment (mastectomy) for breast cancer. My doctor prescribed Effexor, with Klonopin for sleep. I filled the prescription, then read the postings here about the horrible withdrawal, and became afraid to take it. I asked her for Wellbutrin instead and she thought it would be too strong, and would exacerbate my insomnia. I pushed and she gave it to me. I refuse to take anything that will make me gain weight, as that would defeat the purpose. (She thought Effexor would not make me gain). Anyway, I was all geared up to start the Wellbutrin today, and then my Chiropractor, who I saw yesterday, encouraged me to try 5htp first. She said it would only take about 5 days to work. This is my second day, and I don't feel anything yet. I took a Klonopin (sp?) last night, but only made it till 4:30am. I am looking for feedback on 5htp and the others. Also, do I jump right in with 300mg of Wellbutrin, if I decide to go that way, or do I build up. I am nervous about taking anything, but I need to do something soon.
Hello! and welcome to the board. I just wanted to comment on the withdrawl of Klonopin - I've been taking benzos like Klonopin, Xanax, Ativan, etc. for the past 11 years of my depression/anxiety treatments (I didn't ever take them all at the same time). *I* have never, ever had terrible withdrawl from going off of any of them. The worst it ever got was some anxiety rebound - but other than that no problems. I even have alcoholic parents - so one might assume I'd have the "addict" gene - but I have never had a problem with addiction of any kind (except for Dominos pizza and the new DOTS they have...hehe). I guess I'm lucky because there are many who suffer through terrible withdrawl from medications like Klonopin. Just keep in mind that there are an equal number who don't have problems with withdrawl. they key is to go off it (if/when you go off of it) VERY slowly - stopping any med for that matter will cause some shock to your system.
So, I wouldn't worry about addiction and/or withdrawl - just take care of yourself right now - sounds like you have enough to worry about as it is.
IN fact - now that I think of it - the only terrible withdrawl I've had is when I've gone off of SSRIs like Paxil, Celexa, Prozac, Zoloft, and Luvox - UGH - terrible "brain shocks" and dizziness- the worst. However, I've been slowly going off of Lexapro and have not had any problems.
So, hang in there and I hope this helps some.
Jerry
Posted by bookgurl99 on May 14, 2003, at 23:52:12
In reply to New and Nervous, posted by Tree on May 14, 2003, at 10:47:57
Hey Tree,
Just wanted to say 'hi.' Sorry you're going through a hard time right now. Hopefully you can turn this low spot into an opportunity to get the treatment that can make your life better.
I completely agree with the suggestion to get into a support group. A mastectomy is a really big deal. On one level, radical changes in our bodies really shakes our sense of who we are. But, once again, that can be a chance to change and grow. (Or just accept what's going on.)
As for meds and Effexor, I wouldn't be completely fearful of withdrawal. Remember that people who post usually have the most positive or negative to say about a particular medication; people rarely post to say that they feel 'o.k.'
I think it's more important to focus on your quality of life right now, than an eventual withdrawal in a year or so. If you want to beat depression and still lose weight, most people suggest combining a dopaminergic drug (like wellbutrin or maybe even Strattera) with an SSRI. That way you have enough dopamine to not eat a whole pizza, and enough serotonin to stay smiley.
I think it does make sense to take things slow for now. A good psychiatrist is really a help at these times; regular doctors just do not know as much about interactions between natural and prescribed medications.
If you want to try 5-HTP, double check with a psych. or pharmacist that it doesn't conflict with the wellbutrin. (there's a list of possible interactions at "http://www.healthandage.com/html/res/com/ConsSupplements/Interactions/5Hydroxytryptophan5HTPcs.html";).
Let us know what you try and how it's going. :D
books
Posted by bookgurl99 on May 15, 2003, at 3:52:55
In reply to Re: New and Nervous » Tree, posted by bookgurl99 on May 14, 2003, at 23:52:12
5-HTP ineractions list at : http://www.healthandage.com/html/res/com/ConsSupplements/Interactions/5Hydroxytryptophan5HTPcs.html
Posted by jemma on May 15, 2003, at 13:13:14
In reply to New and Nervous, posted by Tree on May 14, 2003, at 10:47:57
I would definitely start wellbutrin at a low dose - 150 mg max - for at least 5 days, then increase to 300. Wellbutrin may well make your insomnia worse, and cause irritability. Is your depression the anxious, agitated, insomniac kind, or the low-energy, anhedonic, eat-and-sleep-too-much kind? Wellbutrin helps the latter, but might make the former worse.
As for the effexor, different people react differently to different meds. Effexor and paxil, because of their short half-lives, cause terrible withdrawal problems in people who are poor metabolizers of ssri's - about 10% of the population. But for others, the problems don't seem to be nearly so severe. I had a very easy time stopping effexor, as have many others. But my friend had bad dreams for months. On the other hand, I once became addicted to ativan because I couldn't handle the rebound anxiety and insomnia that resulted every time I tried to stop. So I avoid benzos, though I know they've helped a lot of people.
As for 5HT, I had a bad experience with it. I found myself losing my temper easily, had hot flashes, and had trouble sleeping. It may have been interacting with my selegiline, and causing mild seratonin syndrome.
You might consider combining wellbutrin with a "cleaner" ssri, like celexa. The wellbutrin should prevent weight gain, and combine with the celexa to boost dopamine, norepinephrine, and seratonin in your brain.
Good luck with all this. I'm sorry you've had such a rough time. I hope that, after all your hardship, you'll find relief from the depression that has plagued you for so long.
- Jemma
Posted by Ron Hill on May 15, 2003, at 19:12:50
In reply to Re: New and Nervous, posted by Tree on May 14, 2003, at 13:23:34
Tree,
I think you are wise to weigh the costs and benefits of psychotropic medications before jumping in with both feet. Sometimes the "cure" can be worse than the disease.
If you decide to take medication, please rule out bipolar II as a dx prior to taking antidepressants. If you are bipolar (like I am), a moodstabilizer is the first medication to bring on board.
-- Ron
Posted by Tree on May 16, 2003, at 8:28:58
In reply to Re: New and Nervous, posted by jemma on May 15, 2003, at 13:13:14
Thank you for all the warmth and information. This is my fourth day on the 5htp and so far, nothing, but it's supposed to take about 5 days. I am skeptical. I do have a breast cancer support group, on-line and once a month in-person, and it is helpful - but just while I'm with them. I see a therapist every other week, but not a psychiatrist. My primary physician prescribed the meds.
Jemma, I seem to have the low-energy, sleepy, eat-to-much symptoms in the daytime, and the anxiety, insomnia at night. Is that odd? Tuesday night, I took a Clonopin and only slept for a few hours, Wed. I took an Ambien and slept all night, and last night, I did pretty well with nothing at all. Who knows what that means. Today, I am exhausted.
Anyhow, I've learned a lot from your messages. Mainly, that different meds work differently on different people. I guess I will just have to do trials and see what works best for me. I feel like I very much want to try the Wellbutrin, and hope I can find a way to sleep with it. If the 5htp doesn't kick in, I will start on Monday.Be well.
Posted by bookgurl99 on May 16, 2003, at 9:00:19
In reply to Re: New and Nervous, posted by Tree on May 16, 2003, at 8:28:58
> Jemma, I seem to have the low-energy, sleepy, eat-to-much symptoms in the daytime, and the anxiety, insomnia at night.
Tree,
Hi, actually, these symptoms are not that unusual, especially after an ordeal. In a simplified way, if your body is healing, you may not have enough energy to make melatonin to help you sleep at night, nor enough of happy-brain chemicals to keep you truly energized during the day.
I once saw a naturopath who treated these symptoms as adrenal exhaustion. (I cut out stimulants, rested more, and took a few safe supplements.)
Anyways, the body can really be a mystery at times, but at least you're getting a lot of clues. :D
Good luck,
books
Posted by johnj on May 16, 2003, at 11:37:26
In reply to Re: New and Nervous » Tree, posted by bookgurl99 on May 16, 2003, at 9:00:19
bookgurl99
Hi,
I have the same symptoms, tired, insomnia, and anxiety towards sleep. Can I ask what the Naturopath suggested? Thank you
Posted by Bill L on May 16, 2003, at 11:39:15
In reply to Re: New and Nervous, posted by Tree on May 16, 2003, at 8:28:58
Hi- drugs like 5-HTP generally give only minor effects. I wouldn't worry too much about Effexor withdrawal. People who take Prozac while weaning off of Effexor usually have an easy time with it.
Posted by bookgurl99 on May 17, 2003, at 10:38:40
In reply to Re: New and Nervous » bookgurl99, posted by johnj on May 16, 2003, at 11:37:26
> Hi,
>
> I have the same symptoms, tired, insomnia, and anxiety towards sleep. Can I ask what the Naturopath suggested? Thank youhi,
it was actually quite a few things.
first, i took some homeopathic remedies from europe. i think you'd have to actually see a homeopath for those.
next, i did a 'cleansing fast.' i ate steamed vegetables for 3 days, drank juiced carrots, beets, and apples for 2 days (i did this at my parent's house where i have no responsibilities;they were supportive), and went back to 3 days of steamed veggies. i don't know how helpful this step was, but it's commonly used to 'heal' the body.
next, i gave up _all_ processed foods for a while. i also cut out wheat, tomatoes, citrus, dairy, and eggs. (it was hard, but not impossible.) after a few weeks, i added things back in slowly. this helped me discover that i have a sensitivity to wheat and tomatoes. pizza gives me a migraine!
i also gave up coffee for a time -- that was the hardest.
as i wasn't on any AD's at the time, i took an anti-anxiety supplement that i think had calcium and valerian in it before bedtime. (i think it may be possible to do this _on_ an AD, too.)
this is a _lot_ to do, and i had very few responsibilities at the time, which enabled me to make these changes. i think they make sense like this.1)the "cleansing fast" eliminated those cravings for processed foods.
2)cutting back on processed foods reduced the strain on the body/adrenals to sort out what it's eating.
3)"eliminating" things and then adding them back let me find some food sensitivities. this allowed me to further reduce the stress on the adrenals.
4)reducing coffee _also_ reduced the anxiety/stress level, in theory. :D
5)the valerian/stress combo helped me sleep while i was freaking out over all this! :D
Posted by Snoozy on May 17, 2003, at 11:13:33
In reply to Re: New and Nervous » johnj, posted by bookgurl99 on May 17, 2003, at 10:38:40
>this helped me discover that i have a sensitivity to wheat and tomatoes. pizza gives me a migraine!
>I learned this from a headache clinic I went to: There are at least 3 migraine trigger foods in pizza, 4 or more depending on toppings. The cheese, of course. I was surprised to learn tomatoes can be too (the deadly nightshade family!), and the really new one to me was that there's something in fresh baked dough that can trigger a migraine. I can't remember exactly what it is, but they said it was ok to eat stuff that was maybe a day old. Yum. The various meats like pepperoni are also bad triggers.
But pizza - come on, it's nature's most perfect food :) I can't stop eating pizza! I find I do have to watch my spaghetti sauce intake - tomatoes.
This is the end of the thread.
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