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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by Racer on December 14, 2007, at 18:03:23
OK, a few of us have mentioned that we're having trouble Sticking It Out with new medications, and joked about starting a Sticking It Out Club. Instead of joking about it, let's just do it.
Today is roughly five weeks into the 9mg EMSAM patch for me. Sleep is a problem, although I kinda prefer getting up earlier, which is the result for me. I'm also experiencing GI problems, which I'm taking other drugs to try to mitigate, mostly bethanecol right now. Otherwise, I'm still experiencing depression, anhedonia, and a general lack of interest.
My pdoc says it is likely to take a full twelve weeks to see if this is going to work out for me. I'm reluctant to start augmenting it yet, because if it's not helping as much as my last cocktail -- Wellbutrin XL/Concerta -- did, I'd just as soon go back to that. But, I'm going to Stick It Out for another seven weeks unless my pdoc and therapist recommend giving up on it.
That's my Sticking It Out Club report for today. Would anyone else like to offer up their own report? I guess to make this more helpful, it might be useful to include requests for any sort of reassurance you might like, that you think would make it easier for you to Stick It Out on your medication trial.
I'll wish us all luck, in advance of any other postings to this thread.
Posted by bleauberry on December 14, 2007, at 19:19:13
In reply to Sticking It Out Club thread, posted by Racer on December 14, 2007, at 18:03:23
Yeah, I'll sign up for the Sticking It Out Club. My drug is DMSA, a mercury and lead chelator. This is not an easy protocol to follow. The only safe way to take it is every 4 hours around the clock in rounds, a few days on and a few days off. For me the first couple days are increased depression, fatigue and fogginess as the metals are moving out of tissues. The last couple days feel pretty darn good, like I'm 20 years younger before depression ever hit. Between rounds I relapse to my baseline dysthymia fatigue. It's like creating your own psychiatric roller coaster. But there is no other way to get those metals out. And it is the only thing that is eventually curative.
But when I started Lexapro with dysthymia, and 4 days later I was on my knees sobbing uncontrollably for no reason with a severely worsened depression, would I stick that out? No way. That's not curative. While we are all different, I know with my own body that when something shows a hint of goodness quickly, it ends up being pretty good for me longterm. When something shows worsening quickly, it just stays worse the whole time. I've tried sticking it out with those. Never again. There are various studies at pubmed on that very topic. Basically, an early response is predictive of a good response later, while the lack of an early response is predictive of a poor response later. These are general results, not all inclusive, but do seem to fit my own experience. Scott was an exception. He felt so bad for months it seemed like while titrating up on nardil. It finally kicked in after a long time and lots of suffering. I have to work every day and I have a family depending on me and bills to pay. I do not think I could have done all that in Scott's condition as he waited in deep pain.
But DMSA, the excruciating ride that it is for me, yeah, I'll stick it out.
Posted by maxime on December 14, 2007, at 19:31:32
In reply to Re: Sticking It Out Club thread, posted by bleauberry on December 14, 2007, at 19:19:13
Zoloft. I've been at 250 mg for 6 weeks. I still have depression, apathy, no motivation to do anything and anxiety. The anxiety is causing me to self harm. I will give it another 3-4 weeks and then I will add some Wellbutrin to it (already talked about it with my psychiatrist).
I have to return to work in January so this is going to be really hard. I really just want to try something else now to see if it will work. But I will give it more time.
I'll need someone to remind me to be patient.
Maxime
Posted by Phillipa on December 14, 2007, at 20:05:40
In reply to Re: Sticking It Out Club thread, posted by maxime on December 14, 2007, at 19:31:32
Still on luvox and sticking it out for the long term as it gives me no side effects can up and lower at will and sometimes a larger dose one day and smaller the next makes me feel much better. That's what my pdoc said to do. Phillipa
Posted by Racer on December 14, 2007, at 22:52:43
In reply to Re: Sticking It Out Club thread, posted by maxime on December 14, 2007, at 19:31:32
>
>
> I'll need someone to remind me to be patient.
>
> MaximeI'll help remind you. That's what the club is for -- reminding one another to be patient, while we Stick It Out starting a new drug. You've promised yourself four weeks, I've got about seven. I guess we can hold cyber-hands, and make it through.
xoxo
Posted by yxibow on December 15, 2007, at 2:51:18
In reply to Re: Sticking It Out Club thread, posted by Phillipa on December 14, 2007, at 20:05:40
> Still on luvox and sticking it out for the long term as it gives me no side effects can up and lower at will and sometimes a larger dose one day and smaller the next makes me feel much better. That's what my pdoc said to do. Phillipa
"sticking out" with the Luvox I think could do what you have described in the long run, as a direct plasma level builds up, but going up and down just moves this plasma level all over the place as it is a twice a day drug. Fortunately not with the harsh withdrawal effects of dumping Paxil which is at least 2x a day.
Its something to raise cautiously to percolate the plasma level and its effect on your neurotransmitters, that much I agree with, and that is sticking out.
Posted by Jay_Bravest_Face on December 15, 2007, at 5:16:39
In reply to Sticking It Out Club thread, posted by Racer on December 14, 2007, at 18:03:23
Good thread...btw..:-) I just wanted to comment on your 'cocktail'. You may have heard this a million times before...if so..just ignore me...most women do. ;-) Have you thought of adding just a 'pinch' (a micro-dose) of say a serotogenic and/or benzo or the like, med? Also, there is melatonin to consider, as it soothes the hyper-anxiety in the evening, at least, that can cause
anhedonia. I found a timed-release helps a bit during the day. (Not falling asleep during the day...just 'soothed'.)Yes, I am positive anhedonia is also connected strongly with anxiety as well as depression. Different heads of same coin. I experienced my worst ever anhedonia on high doses of Wellbutrin, as well as nortriptyline, and desipramine. My belief is the 'background noise' of hyper-anxiety can appear all calm and such, and that we detach ourselves from pretty much everything going on as a result to keep things 'appearing' calm. That jolt of norepinephrine (and even dopamine) from the meds also seems to have a 'numbing' effect on the CNS after awhile. BUT....I do take Dexedrine with my Prozac (heavy dose of Prozac, though, 80mg, plus 5mg Zyprexa, 4mg Clonazepam, 200mg Topamax...but I see it as...well...balance..lol) I think we are going through this love-in with dopamine these days, like we did with serotonin. As Peter Kramer once said, we aren't exactly "..having dopamine appreciation days around here yet." lol. There is also an opiate as well.
So, I hope I didn't ruin your thread. If you would prefer to correspond off-list, or in a new thread, that is fine by me too! I've kept my mouth closed on many medication issues in here because I think I was always afraid of a "bad" consequence on somebody's med regime. Sorta like the dogma bit my karma..lol. But, I realized maybe I could offer some "alternative"...as I have responded at the Doc's office to some comments made on here. No harm done.
Anyhow...thank-you....there is free beer in the back fridge....goodnight. :-)
Jay
Posted by bleauberry on December 15, 2007, at 6:01:16
In reply to Re: Sticking It Out Club thread, posted by Phillipa on December 14, 2007, at 20:05:40
> Still on luvox and sticking it out for the long term as it gives me no side effects can up and lower at will and sometimes a larger dose one day and smaller the next makes me feel much better. That's what my pdoc said to do. Phillipa
That is an interesting phenomenon. I have noticed it myself over the years. I feel best starting a drug or a new dose, and again when decreasing the dose, but worse at a steady dose. The timeline to hit the feeling worse part is almost always 3 to 4 days.
I have my own personal theory on what is happening. I believe the feedback mechanisms are messed up. As the dose is increased, the extra serotonin immediately provides benefits. The feedback receptors do not respond right away. But after 3 days, they do finally "get it" and say "hey there is more serotonin here than is supposed to be according to our genetic instructions", and then pretty much tell the receptors to re-regulate themselves so as not to respond to the extra serotonin, and they tell the serotonin manufacturing processes to slow down production.
When decreasing a dose, at about 3 days the feedback mechanism says "hey we have a shortage of serotonin here, so you receptors step up your sensitivity and you manufacturers bring in the overtime crew and get this serotonin pumping". And that feels good. But then after 3 days of that, once again the feedback mechanism reaches a status quo plateau and everything settles back to where genetics wants it to be, which unfortunately is also what is making us feel bad. Genetics always revert back to default, even when they are wrong, and they always find a way to undo whatever a drug is manipulating.
My theory anyway. All I know is, at 3 days I got problems. They do not resolve at 3 weeks, 6 weeks, or 6 months. But if I start moving the dose around and keep the feedback mechanism in confusion so it doesn't have time to find its wrong place, it feels better.
Weird I know. But for me it is as predictable as a clock.
Posted by llurpsienoodle on December 15, 2007, at 7:00:26
In reply to Re: I hate to offer advise....but... » Racer, posted by Jay_Bravest_Face on December 15, 2007, at 5:16:39
Hi all,
I'm trying SO hard not to gain weight. I've given up on losing weight. I want to call pdoc and get off of some of the culprit drugs. Maybe I can reduce my AP (abilify) and just keep the zyprexa prn, as it seems to work in a hurry. Maybe I can reduce the dose of zoloft, as that's when this problem started.BUT! in the meanwhile I'm going abroad for 3 weeks.
so I have to stick it out while sticking out (tall white girl in Asia... haha)
-Ll
Posted by linkadge on December 15, 2007, at 10:27:07
In reply to sticking out lol, posted by llurpsienoodle on December 15, 2007, at 7:00:26
Posted by linkadge on December 15, 2007, at 10:28:38
In reply to Re: Well,... I won't start a club for quitters (nm), posted by linkadge on December 15, 2007, at 10:27:07
Posted by Jamal Spelling on December 15, 2007, at 11:44:29
In reply to Re: Cause nobody would stay in it.... (nm), posted by linkadge on December 15, 2007, at 10:28:38
Posted by linkadge on December 15, 2007, at 11:46:14
In reply to Re: Us quitters are a persecuted minority (nm) » linkadge, posted by Jamal Spelling on December 15, 2007, at 11:44:29
"I was born to quit"
George Castanza.
Linkadge
Posted by Phillipa on December 15, 2007, at 13:39:09
In reply to sticking out lol, posted by llurpsienoodle on December 15, 2007, at 7:00:26
Lurpsie have a wonderful time. Phillipa ps that butt pic you were skinny on social that time.
Posted by llurpsienoodle on December 15, 2007, at 15:28:24
In reply to Re: sticking out lol » llurpsienoodle, posted by Phillipa on December 15, 2007, at 13:39:09
I have never posted a pic on this forum. you must have confused me with someone else.
ll
Posted by Phillipa on December 15, 2007, at 18:27:39
In reply to Re: Sticking It Out Club thread » Phillipa, posted by yxibow on December 15, 2007, at 2:51:18
Was always told take largest dose of day at night. And preferable at l00mg then anything over that should be in the am. Phillipa
Posted by Phillipa on December 15, 2007, at 18:35:40
In reply to Re: sticking out lol » Phillipa, posted by llurpsienoodle on December 15, 2007, at 15:28:24
Lurpsie maybe you were the pic taker with kk and another babbler a long time ago. Phillipa
Posted by yxibow on December 15, 2007, at 22:09:51
In reply to Re: Sticking It Out Club thread » yxibow, posted by Phillipa on December 15, 2007, at 18:27:39
> Was always told take largest dose of day at night. And preferable at l00mg then anything over that should be in the am. Phillipa
That is correct. It is generally more sleep inducing for someone so taking 250, you would take 100 in the morning and 150 at night. But taking 50 in the morning and 100 one day and 100 in the morning and nothing the next night and the third day taking 150 in the morning and 75 at night is going to lead to a load of troubles of inconsistent plasma levels
Forget the half life, the plasma level is what you're aiming for and that can only happen when you take a dose consistently like you say 50 and 100 or 100 and 100 every single day for some weeks.
It just takes time and that's the "sticking it out" part because changes do occur over time, OC thoughts become less troublesome over time although you don't notice it.
That's the one thing about SSRIs, is that you'll never know how you got along with out one unless you drop it like a log (please don't do that).
Posted by yxibow on December 15, 2007, at 22:14:31
In reply to Re: I come from a long line of quitters, posted by linkadge on December 15, 2007, at 11:46:14
> "I was born to quit"
>
> George Castanza.
>
>
>
> Linkadge
>Its not quitting, its disillusionment or an alternative view of looking at things. Sometimes it takes the longest time to find something right, but I do believe that, and I'm not referring to you at all, there are some people who have a string of medicine bottles stretching across the room after dropping it after a week for things that... I don't know how to say it, some things that really are endurable because they eventually settle out. Because the reward may be more than the "minor discomfort". (See next paragraph for my caveat)
Now I'm not saying if something is giving you an instant rash or vomiting (non anxiety driven) uncontrollably that one shouldn't discontinue -- that's not "quitting."
Posted by linkadge on December 15, 2007, at 23:29:33
In reply to Re: I come from a long line of quitters » linkadge, posted by yxibow on December 15, 2007, at 22:14:31
I do recomend discontinuing medications prematurely for certain reasons.For instance, I had taken zoloft for a few months while feeling significantly worse than before taking it. Such feelings did not improve over the two months, and didn't abate untill after I stopped the medication.
When a different doctor initiated the same drug on a different ocasion, the exact same feelings returned, so I trusted myself and stopped the drug. I didn't expect anything magical to happen the second time around.
In some cases its not really a matter of blindly following the doctors orders, or getting over a start up phase. Its a matter of, I know where this trial is going, and this isn't a matter of toughing it out.
Somtimes I think that this is the clinical effect, ie inducing some sort of hellish drug reaction that takes your mind off your real problems. You know, how when you go to a horror movie you leave feeling glad to be alive, even though you are no more alive then when you went into the theatre.
Linkadge
Posted by sunnydays on December 15, 2007, at 23:33:51
In reply to Re: I come from a long line of quitters, posted by linkadge on December 15, 2007, at 23:29:33
I'm sorry you had that happen. I do agree there are situations where stopping a drug early is appropriate, as you described. I quit Wellbutrin after 3 days because I couldn't move my head without feeling like I was going to pass out and I looked like I was slightly drunk when walking.
However, I think ideally drugs will work without side effects. It's not just about taking your mind off the original suffering with new suffering, or it shouldn't be. I've been lucky in that Effexor and Lexapro had no side effects and worked quite well for me (although the Lexapro pooped out and it took a full twelve weeks for the Effexor to take effect).
If only it was easier to do the kind of research that needs to be done to figure out how these drugs work (I'm a science major, and it's just so incredibly complicated that I'm kind of amazed they even found the drugs in the first place). *sigh*
sunnydays
Posted by Racer on December 16, 2007, at 0:03:44
In reply to Re: I come from a long line of quitters » linkadge, posted by yxibow on December 15, 2007, at 22:14:31
> >
>
> Sometimes it takes the longest time to find something right, but I do believe that, and I'm not referring to you at all, there are some people who have a string of medicine bottles stretching across the room after dropping it after a week for things that... I don't know how to say it, some things that really are endurable because they eventually settle out. Because the reward may be more than the "minor discomfort".Thank you for making that point. I've dropped drugs very shortly after starting them, for good reasons and not-so-good reasons, and I've also stuck with a couple that caused problems I should have recognized as deal-killers much sooner. And I've stuck with medications that caused problems at the start, and found that they were effective enough to make any discomfort worthwhile.
Here's something I know about myself now: I panic about starting a new medication. I've had some bad experiences, and I'm frightened by trying new medications. So, before starting my current medication trial, I talked about that fear, and about my previous experience with stopping medications prematurely, and my therapist, my psychopharmacologist, and I came up with a potential solution to it. I would update my pdoc twice weekly via email, letting him know what was going on; and my therapist and I would discuss the problems I might run into and ways to cope with them. Turns out, having that in place has made even the worst periods of this current medication trial much easier than any others I've been through. Instead of having the panic build and build, I can communicate a problem to my treatment team, get a response that might reassure me -- and often get a solution to the problem. It's worth learning to communicate those fears to one's doctors, because it makes it possible to find solutions to the stresses of medication trials.
Most of the pattern I developed of stopping medications prematurely stemmed from a bad situation with a doctor. Often, his choice of medication left me feeling as though he was punishing me rather than treating me. (I'm anorexic and internet savvy -- tell me Remeron is the only thing out there to try? Um...) Not having a doctor I trusted made a huge difference in my ability to tolerate start up effects. I've had to work very hard to learn to trust my current doctor, and it's been worth the effort I've been making. (Although it's still a struggle to trust him, even though he's proved himself every time I've risked it so far.)
I started this thread in hope that we could support one another in a similar sort of manner. Reminding one another that the potential rewards -- relief from depressive symptoms -- outweigh most of the problems we start out with, and letting one another know there's a hand to hold as we struggle with those problems during this time of uncertainty. (I have a fairly low tolerance for uncertainty, which I think is not uncommon amongst people with anxiety disorders.)
Sorry for going on and on. Thanks again for your post. I really enjoy your posts, they're often so sensible, so kind. Thank you for being here.
Posted by Justherself54 on December 16, 2007, at 10:44:27
In reply to You make some good points » yxibow, posted by Racer on December 16, 2007, at 0:03:44
I too suffer terrible anxiety when starting a new med..I always stare at it for about 3 days, then with shaking hands take the first dose..I've had some awful experiences with starting meds so I work closely with my pdoc (by phone as it's an hour drive) usually 2-3 times a week. He's pulled me off some quickly (trazadone was one) and some he's been able to calm me (sometimes with extra clonazapam) to try to get through the first couple of weeks..
It's hard to take a new med when you're hanging on by your toenails..knowing that a new med is quite possibly going to make you feel worse for a couple of weeks..
Kudos to all us babblers who keep getting back on the med roller coaster!!
Posted by linkadge on December 16, 2007, at 15:25:28
In reply to You make some good points » yxibow, posted by Racer on December 16, 2007, at 0:03:44
>relief from depressive symptoms -- outweigh most >of the problems we start out with
Perhaps, that is, if the drug ends up working for you. Its not just a matter of enduring side effects for a guarenteed result. For people such as myself, many side effects many side effects don't improve, nor does the drug do anything meaningful.
Many of the side effects are not begign, and ignoring certain side effects may not be healthy.
Extreme akathesia may be accompanied by cholinergic dammage. Insomnia, high blood pressure or weight loss can sometimes worsen the clinical condition. Treatment emergent suicidiality (IMHO) should always indicate drug discontinuation. Paranoia, or psychotic thinking can happen with MAOI's, Wellbutrin, which can also worsen the clinical condition.
Posted by Phillipa on December 16, 2007, at 18:25:41
In reply to Re: You make some good points, posted by linkadge on December 16, 2007, at 15:25:28
Wellbutrin after one week made me manicy and I had an appointment with the pdoc who saw the condition I was in and sent me to the hospital for a week to get me off of it. Phillipa
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