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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Phillipa on February 9, 2005, at 21:26:03
Sorry to bother you all again, but after a visit to the neurologist today he confirmed what you all have said "You're in W/D". He also told me to change pdocs again until I found one who understood. So I switched to an older woman whom my daughter-in-law and son see. I see her on Monday. In the meantime, I still have muscle twitching or nerves {not sure which}, and feel all dried up hair, eyes, etc. Also muscle aches and pains. I was also started on 50mg of zoloft and l5mg of remeron at the same time. I took benadryl once for bee stings and felt tired but at the same time wound up. Since remeron has anti-histamine properties, do you think I should cut it down? I'm not sleeping any better, and depression is not helped. Also since zoloft is activating should I cut it down? I don't want to make too many changes, but I have the okay to go back on l0cc chloral hydrate, and am adding back the l.5mg total of xanax each night. I know this is confusing, that's why I need some help. Thanks, Phillipa
Posted by SLS on February 9, 2005, at 22:25:10
In reply to Need Your Help So Agitated, posted by Phillipa on February 9, 2005, at 21:26:03
Hi Phillipa.
What exactly are you being treated for?
How would you be if you were to stop taking antidepressants?
- Scott
Posted by Phillipa on February 9, 2005, at 23:30:21
In reply to Re: Need Your Help So Agitated, posted by SLS on February 9, 2005, at 22:25:10
Hi Scott! Good to hear from you. I'm asuming I'm still dx'd with anxiety/depression. I have been given small doses of Paxil 5-l0mg for years, until I was put on Cymbalta about the same time as you were. I went up to 60mg for about l l/2 months after starting at 30mg. Then I took the advice of other "Posters" and since I felt no different at all, I began decreasing the dose till at the beginning of January I stopped. To tell you the truth, I don't know how I am without them, especially since there are so many anxiety provoking situations occuring in my life now. Fondly, Phillipa
Posted by Cecilia on February 10, 2005, at 3:45:02
In reply to Need Your Help So Agitated, posted by Phillipa on February 9, 2005, at 21:26:03
Remeron is supposed to be sedating but definitely also gave me that horrible tired but wired feeling. Zoloft is also very activating. If you`re just taking the Xanax once a day you`re going to be in withdrawal most of the day because of its short half-life. If you can first convince your doctor to get the anxiety a little more under control with a long acting benzo like clonazepam, and then add one antidepressant at a time you might be better off. Personally I think doctors who start more than one med at the same time, except in emergency situations, are not too bright, you never know what drug is causing what effects. Cecilia
Posted by SLS on February 10, 2005, at 6:43:13
In reply to Re: Need Your Help So Agitated » SLS, posted by Phillipa on February 9, 2005, at 23:30:21
> I'm asuming I'm still dx'd with anxiety/depression. I have been given small doses of Paxil 5-l0mg for years,
What motivated you to try other medications?
What happened with the Paxil?
Recently, there has been renewed interest in the use of tricyclic antidepressants (TCA) here on Psycho-Babble. Very often, the anxiety and depression are inseparable, with anxiety being a symptom of a depressive disorder rather than it being a disorder of its own. If you alleviate the depression, you also alleviate the anxiety. If find your treatments unsatisfactory, you might want to try taking a TCA like nortriptyline or desipramine. If you sleep rather poorly, you can instead use a more sedating drug like doxepin or amitriptyline. Nortriptyine is probably the mildest of these drugs. If you use it, though, you must pay attention to blood levels to help determine dosage. Most people do well at a dosage of 75mg. However, these same people can actually experience a return of depression if they go much higher. For me, it seems that 100mg it right. People will usually respond with blood levels that lie between 50-150 ng/ml. I am somewhere around 120ng/ml.
Of course, there are other alternatives that you haven't explored yet.
- Scott
Posted by Bill LL on February 10, 2005, at 8:04:11
In reply to Need Your Help So Agitated, posted by Phillipa on February 9, 2005, at 21:26:03
I can speak about one of the issues that you posed. Remeron is an unusual drug in the sense that a lower dose will cause more tiredness than a larger dose.
Other than that, I know that Remeron and Zoloft are both great drugs. I think that most docs like to start patients on one drug a a time in order to see which drug has what effects. But I guess your doc must have had some reason to do 2 at a time.
I think that all of the SSRI's have some degree of antihistamine effect. Lexapro makes me feel more dry. But the good thing is that while being on Lexapro, I have not needed my allergy medication.
> Sorry to bother you all again, but after a visit to the neurologist today he confirmed what you all have said "You're in W/D". He also told me to change pdocs again until I found one who understood. So I switched to an older woman whom my daughter-in-law and son see. I see her on Monday. In the meantime, I still have muscle twitching or nerves {not sure which}, and feel all dried up hair, eyes, etc. Also muscle aches and pains. I was also started on 50mg of zoloft and l5mg of remeron at the same time. I took benadryl once for bee stings and felt tired but at the same time wound up. Since remeron has anti-histamine properties, do you think I should cut it down? I'm not sleeping any better, and depression is not helped. Also since zoloft is activating should I cut it down? I don't want to make too many changes, but I have the okay to go back on l0cc chloral hydrate, and am adding back the l.5mg total of xanax each night. I know this is confusing, that's why I need some help. Thanks, Phillipa
Posted by Phillipa on February 10, 2005, at 10:10:00
In reply to Re: Need Your Help So Agitated » Phillipa, posted by SLS on February 10, 2005, at 6:43:13
Scott: It was a new pdoc when the other left and of course he had his own ideas of what to do. What other options do you refer to? Fondly, Phillipa
Posted by SLS on February 10, 2005, at 10:32:46
In reply to Re: Need Your Help So Agitated, posted by Phillipa on February 10, 2005, at 10:10:00
> Scott: It was a new pdoc when the other left and of course he had his own ideas of what to do. What other options do you refer to? Fondly, Phillipa
I'll give it some thought. I like Bill's suggestion to look at Remeron. Initially, I wasn't going to suggest it because it migh aggravate agitation at the higher dosages necessary to evoke a robust antidepressant effect. However, if the drug is a good match for your brain chemistry, it will probably remain anxiolytic through the entire dose range.
SSRI + Remeron, and especially Effexor + Remeron can be a powerful combination and is extolled by some very influential pdocs. I guess it makes sense to begin at the beginning with a new pdoc. One step at a time. Unless you have had success previously with a particular combination, I guess your doctor can't help but want to keep it simple in the beginning and add one thing at a time. However, if he is unwilling or reluctant to use combinations of antidepressants to treat difficult cases, I would seriously look for a doctor who will. Perhaps you can ask him under what circumstances he favors combining drugs. You might feel more confident in him if you like his answers.
- Scott
Posted by Phillipa on February 10, 2005, at 16:34:12
In reply to Re: Need Your Help So Agitated » SLS, posted by Phillipa on February 9, 2005, at 23:30:21
Ran a search on the new pdoc Judith S. Yongue today. Apparently she has published quite a few papers, and one of them is on addiction. She is also a reviewer for the American Psychiatric Association. If you want to see the long list of her contributions simply do a search using her name. You'd be amazed at what pops up. I hope this means she knows something. Let me know what you think if you get a chance to search. Fondly, Phillipa
Posted by banga on February 11, 2005, at 7:26:42
In reply to Re: Need Your Help So Agitated » Phillipa, posted by Phillipa on February 10, 2005, at 16:34:12
Phillipa,
What about Luvox? I know the brand name is off the market but the generic is around,right? As it is supposed to help OCD (and anxiety) too. Or had you already tried it?
It is on that ever-changing "meds worth trying" list for me, as I too have anxious depression.
This is the end of the thread.
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