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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by g_g_g_unit on May 7, 2011, at 7:01:43
I complained to my psychiatrist that I've been feeling more restless, anxious and agitated on Zoloft, and have also been have some movement problems (leg twitching, etc.), all at a relatively low dose of 25mg, which I've been taking for almost 3 weeks now.
I have a referral to see a neurologist in 3 week's time due to the recurrence of movement problems I've been experiencing on ADs.
Anyway, my psychiatrist a little opaque, but he prescribed me Depakote for what he termed something along the lines of "excess excitatory activity" after I mentioned that combining even small amounts of caffeine with the Zoloft would result in panic-like anxiety. He also said it, if nothing else, my reaction might provide useful information for the neurologist.
Now, where I'm unclear is whether "excess excitatory activity" is code for some kind of potential mood instability. I know Zoloft has a reputation for causing anxiety, so found it weird I'd need to take a mood stabilizer just to tolerate it (as opposed to switching to a more sedating SSRI), but I also thought he might have a point - all my drug trials over the past year (Prozac, Clomipramine, Strattera, Dexedrine, etc.) have basically just resulted in increased agitation.
Unfortunately, the three months I spent on Neurontin last year were horrid. I basically slept 15 hours a day and could barely piece a thought together the entire time. It *did* kill my anxiety, though.
I was just beginning to feel a little smarter and more mentally energetic on the Zoloft, but now the Depakote has effectively nullified that. I've taken 100mg at night twice now and find that, strangely enough, it disturbs my sleep, resulting in more vivid dreaming and awakenings. So far, it does mute some of my anxiety, but at the expensive making me feel very .. stupid, and worsening my ADD.
Is there some kind of adjustment phase with Depakote? I know the dose I'm taking is small, but I seem to be especially sensitive to meds.
Posted by bleauberry on May 7, 2011, at 10:05:39
In reply to ughhh (Zoloft + Depakote), posted by g_g_g_unit on May 7, 2011, at 7:01:43
For excessive excitatory activity I would much prefer attempts at utilizing magnesium or low dose lithium. These are much more biologically harmonious and healthy overall, where depakote is not.
To me this is real simple. Stop zoloft and do something else. I mean, it's not as if the twitching and stuff is somehow going to "adjust" and go away the longer you stay on zoloft. If anything, the problems are likely to become more deeply embedded, longlasting, or permanent.
A neurologist will likely add on yet another med. Great. Take a med for one thing, another med to hopefully reduce the problems of the first med, and a third med to hopefully reduce the problems of both of them. I don't know. That's pretty common, happens every day with countless patients everywhere, but I personally do not agree with that. Except maybe in the rare case where the med is working like a miracle and makes it all worth it. I don't see that happen very often with zoloft by itself. Zoloft with nortriptyline could do that sometimes.
Excess serotonin can be excitatory. Restlessness, anxiety, nervousness, agitation....these are common effects that can occur when starting serotonin meds.
So maybe if some good signs from zoloft have started to show, keep it but do something else to help with the other symptoms. Begin some research to discover what else is available to you besides the very limited choices a psychiatrist has. All of our drugs unfortunately are really not very impressive. God knew what He was doing and created some of the most amazing medicines specifically for our healing. They are found in plants.
Personally I would attack this thing from a completely different angle. That is, "expel the evil and support the righteous". The drugs don't do either of those. That's what properly chosen plant medicines do. I have a completely different view than most people here, because I have been one of us for a long time, but now know I am a Lyme patient, not a psych patient. It just so happens the difficult psych symptoms I struggle with are actually just the toxins of undesired organisms living their normal lives. That includes a host of possibilities of which Lyme is just one.
Thankfully, the Lyme herbs cover pretty much the entire spectrum of possibilities....bacterial, fungal, viral, inflammation, immune disregulation, adrenals....all of which seriously mess with brain chemicals in a way that has equal or greater potency than any of our meds can counteract.
I know all the above is true, not just from the accounts of thousands of other people, but because my Doxycyline and plants have done a far better job on my depression, anxiety, and schizo-like weirdness than an entire backpack full of meds and ECT as well. Nothing I take is psychoactive or intended for psychiatry, and yet blows everything in the psych toolbox in the weeds.
I say all this merely to introduce to you there is another realm outside the psych office that has tremendous potential that you may not yet have embraced.
For immediate use:
Combination of any 2 or 3 of these with your zoloft, drop the depakote....
Lemon Balm, Passionflower, Skullcap, Valerian Root. These are for immediate relief within minutes or hours.As a base no matter what you do, there should be either Cordyceps or Eulethero (Siberian ginseng) onboard. or both. Siberian G is widely used, widely studied, and tolerated well by most people. Not me though. Cordyceps is my personal choice. These are for longer term rebalancing of internal biologies and fortifying the body against the devastation of stress and illness.
Posted by Phillipa on May 7, 2011, at 11:19:52
In reply to Re: ughhh (Zoloft + Depakote), posted by bleauberry on May 7, 2011, at 10:05:39
Seriously how come doxy did nothing for me but give me sunburn with sunscreen? I stopped it after six weeks. Phillipa
Posted by mtdewcmu on May 7, 2011, at 12:07:31
In reply to ughhh (Zoloft + Depakote), posted by g_g_g_unit on May 7, 2011, at 7:01:43
> I complained to my psychiatrist that I've been feeling more restless, anxious and agitated on Zoloft, and have also been have some movement problems (leg twitching, etc.), all at a relatively low dose of 25mg, which I've been taking for almost 3 weeks now.
I felt restless and agitated on Zoloft and it never went away. I was on it for several months.
If Prozac made you feel the same way, I would not bother anymore with either of them. Any of the other SSRIs should be less agitating than those two. Celexa or Lexapro would be a good one to try next.
>
> I have a referral to see a neurologist in 3 week's time due to the recurrence of movement problems I've been experiencing on ADs.It seems kind of hasty to be sent to a neurologist for problems that only occur on medication. I would try at least one more AD before thinking of anything neurological, especially since Zoloft and Prozac are known to cause that sort of thing.
Unless your movement disorder is really stereotyped and indicative of some particular disease.
>
> Anyway, my psychiatrist a little opaque, but he prescribed me Depakote for what he termed something along the lines of "excess excitatory activity" after I mentioned that combining even small amounts of caffeine with the Zoloft would result in panic-like anxiety. He also said it, if nothing else, my reaction might provide useful information for the neurologist.I'm pretty sure "excess excitatory activity" is a way to say essentially nothing while sounding jargony and important.
>
> Now, where I'm unclear is whether "excess excitatory activity" is code for some kind of potential mood instability. I know Zoloft has a reputation for causing anxiety, so found it weird I'd need to take a mood stabilizer just to tolerate it (as opposed to switching to a more sedating SSRI), but I also thought he might have a point - all my drug trials over the past year (Prozac, Clomipramine, Strattera, Dexedrine, etc.) have basically just resulted in increased agitation.Going to a more sedating SSRI sounds like a perfectly logical thing to do. If you have not tried Lexapro, that would be my choice.
>
> Unfortunately, the three months I spent on Neurontin last year were horrid. I basically slept 15 hours a day and could barely piece a thought together the entire time. It *did* kill my anxiety, though.That's a remarkably strong reaction.
>
> I was just beginning to feel a little smarter and more mentally energetic on the Zoloft, but now the Depakote has effectively nullified that. I've taken 100mg at night twice now and find that, strangely enough, it disturbs my sleep, resulting in more vivid dreaming and awakenings. So far, it does mute some of my anxiety, but at the expensive making me feel very .. stupid, and worsening my ADD.I also started feeling better on Zoloft and it seemed promising, but the agitation made it impossible to continue. Celexa for me is almost like Zoloft without the agitation.
>
> Is there some kind of adjustment phase with Depakote? I know the dose I'm taking is small, but I seem to be especially sensitive to meds.You've had some sensitive reactions, but not all the meds you reported trying have been good ones.
Posted by morgan miller on May 7, 2011, at 22:22:47
In reply to Re: ughhh (Zoloft + Depakote), posted by bleauberry on May 7, 2011, at 10:05:39
The only problem with taking roots/herbs is you have to continually take them throughout the day and it is harder to maintain stable therapeutic efficacy.
I disagree with BB, I think the side effects with Zoloft could resolve and actually go away with higher doses. I was agitated and did not feel so great on 50 mg, but when I went up to 100 I felt pretty darn good. Zoloft and other SSRIs actually may help get the HPA axis working normally again after taking a hit from chronic stress and depression. Zoloft also has potential anti-inflammatory effects and may be beneficial for autoimmune issues through some mechanism that modulates the immune system. Zoloft inhibits mTOR and because of this, and a few other mechanismes, it may help prevent cancerous growths. I was on Zoloft for 8 years and the only reason why I'm not still doing well on it is because I stopped taking it.
BB is very biased. I actually totally agree with his natural approaches, I think they are great. But I do not agree with his biased opinion of how drugs like Zoloft will likely make things worse in the long run. When I stopped Zoloft I felt fine, unfortunately I was undiagnosed bipolar and five months later I had a major mixed episode(I had a fairly bad mixed episode before I ever took a medication at 22, so don't start thinking my issues were worsened by the drugs I've been on). Many people like BB are going off the experiences they read about on the internet and do not realize there are so so many people out there doing very well on drugs like SSRIs for many many years.
Morgan
Posted by morgan miller on May 7, 2011, at 22:25:30
In reply to Re: ughhh (Zoloft + Depakote) » g_g_g_unit, posted by mtdewcmu on May 7, 2011, at 12:07:31
What was the highest dose you got up to? Did you ever try tweaking the dose? Or did you just get up to 50 and stop there? Zoloft's effects can be highly dose dependent, this may be due to it's mild DRI properties and potent sigma 1 antagonism.
Posted by Phillipa on May 7, 2011, at 23:28:51
In reply to Re: ughhh (Zoloft + Depakote) » mtdewcmu, posted by morgan miller on May 7, 2011, at 22:25:30
Morgan missed you and totally forgot about the anti-inflammatory properties of zoloft. Thanks for mentioning it again. 50 really is a small dose with 200mg the max? Phillipa
Posted by creepy on May 8, 2011, at 0:49:17
In reply to ughhh (Zoloft + Depakote), posted by g_g_g_unit on May 7, 2011, at 7:01:43
Do you think youre being pushed into a mild mixed state? Irritability? Feeling hurried? Thats what Id expect depakote for.
zoloft supposedly does a little dopamine RI at higher doses but Im not sure where and how much that takes place. A lot of folks say theyve had akathisia on it. It has probably the worst reputation of all the SSRIs for causing mixed state stuff, but its the one SSRI that hasnt done that to me so far. Go figure!
a doc could misinterpret akathisia as anxiety or agitation. Do you have a therapist as well, that you could bounce that off of? Someone that has a history of observing you?
Posted by g_g_g_unit on May 8, 2011, at 4:25:52
In reply to Re: ughhh (Zoloft + Depakote) » g_g_g_unit, posted by mtdewcmu on May 7, 2011, at 12:07:31
> I felt restless and agitated on Zoloft and it never went away. I was on it for several months.
That's a pity.
>
> If Prozac made you feel the same way, I would not bother anymore with either of them. Any of the other SSRIs should be less agitating than those two. Celexa or Lexapro would be a good one to try next.I've tried Lexapro before. It turned me into a zombie (to use a familiar descriptor amongst psych patients). My psychiatrist was thinking about prescribing an MAOI, given that I reacted well to Nardil in the past, but the problem is that I then have no chance of treating my attention issues.
>
> >
> > I have a referral to see a neurologist in 3 week's time due to the recurrence of movement problems I've been experiencing on ADs.
>
> It seems kind of hasty to be sent to a neurologist for problems that only occur on medication. I would try at least one more AD before thinking of anything neurological, especially since Zoloft and Prozac are known to cause that sort of thing.I'm not seeing a neurologist for the general restlessness. It's to treat the restless leg syndrome, which I've had on every single AD I've tried, and which destroys my sleep quality, making taking an AD otherwise kinda pointless.
Posted by g_g_g_unit on May 8, 2011, at 4:42:24
In reply to Re: ughhh (Zoloft + Depakote), posted by creepy on May 8, 2011, at 0:49:17
> Do you think youre being pushed into a mild mixed state? Irritability? Feeling hurried? Thats what Id expect depakote for.
> zoloft supposedly does a little dopamine RI at higher doses but Im not sure where and how much that takes place. A lot of folks say theyve had akathisia on it. It has probably the worst reputation of all the SSRIs for causing mixed state stuff, but its the one SSRI that hasnt done that to me so far. Go figure!
> a doc could misinterpret akathisia as anxiety or agitation. Do you have a therapist as well, that you could bounce that off of? Someone that has a history of observing you?I'm starting to wonder if it may be some kind of mixed state, though I'm not certain. I've had full-blown akathisia on Prozac, but I explained to my doctor that the restlessness on Zoloft is a little milder (though I was taking 20mg Prozac vs. 25mg Zoloft). I'm still also unclear as to whether what I experienced on clomipramine was akathisia or something else, but like I say, I do seem prone to overstimulation - reacting strongly to even tiny stimulant doses.
I do find myself feeling hurried, yeah. Like when I'm walking, I find I walk a lot faster and more urgently for some reason. I'll also feel like I constantly need to be doing something throughout the day and almost overschedule, though I'm not sure if that's an OCD thing because my OCD/obsessiveness has been a lot worse as well. And yeah, I am more irritable and quite depressed overall, despite being more productive during the day.
I don't believe Zoloft only affects dopamine at higher doses. Even if the DRI is weaker at this dose, sigma antagonism will increase dopamine, which might explain the increase in OCD.
I'm in CBT, but we mostly deal with OCD.
I'm still not sure if the Depakote is supposed to be an antidote to the agitation/mood symptoms or 'akathisia' and insomnia. Either way, it's still disrupting my sleep. I suppose my original post was also meant as an inquiry into whether the sx. are transient. I tried taking it with Xanax last night and slept better - and felt more stable today - but mood stabilizers do quite a number on my cognition. The plus is that I could freely ingest nicotine/caffeine today without panicky/overstimulated.
Posted by g_g_g_unit on May 8, 2011, at 4:47:58
In reply to Re: ughhh (Zoloft + Depakote), posted by bleauberry on May 7, 2011, at 10:05:39
Thanks, I appreciate your suggestions bleauberry.
The Zoloft had yielded some improvements - namely, with respect to physical energy and alertness - which is why my psychiatrist has decided to stick with it for the time being.
As tempting as it would be to ditch the Depakote, I just don't want to violate my psychiatrist's instructions at this point and gamble on herbs. Maybe once I'm more stable, but my condition is pretty bad at the moment.
> For excessive excitatory activity I would much prefer attempts at utilizing magnesium or low dose lithium. These are much more biologically harmonious and healthy overall, where depakote is not.
>
> To me this is real simple. Stop zoloft and do something else. I mean, it's not as if the twitching and stuff is somehow going to "adjust" and go away the longer you stay on zoloft. If anything, the problems are likely to become more deeply embedded, longlasting, or permanent.
>
> A neurologist will likely add on yet another med. Great. Take a med for one thing, another med to hopefully reduce the problems of the first med, and a third med to hopefully reduce the problems of both of them. I don't know. That's pretty common, happens every day with countless patients everywhere, but I personally do not agree with that. Except maybe in the rare case where the med is working like a miracle and makes it all worth it. I don't see that happen very often with zoloft by itself. Zoloft with nortriptyline could do that sometimes.
>
> Excess serotonin can be excitatory. Restlessness, anxiety, nervousness, agitation....these are common effects that can occur when starting serotonin meds.
>
> So maybe if some good signs from zoloft have started to show, keep it but do something else to help with the other symptoms. Begin some research to discover what else is available to you besides the very limited choices a psychiatrist has. All of our drugs unfortunately are really not very impressive. God knew what He was doing and created some of the most amazing medicines specifically for our healing. They are found in plants.
>
> Personally I would attack this thing from a completely different angle. That is, "expel the evil and support the righteous". The drugs don't do either of those. That's what properly chosen plant medicines do. I have a completely different view than most people here, because I have been one of us for a long time, but now know I am a Lyme patient, not a psych patient. It just so happens the difficult psych symptoms I struggle with are actually just the toxins of undesired organisms living their normal lives. That includes a host of possibilities of which Lyme is just one.
>
> Thankfully, the Lyme herbs cover pretty much the entire spectrum of possibilities....bacterial, fungal, viral, inflammation, immune disregulation, adrenals....all of which seriously mess with brain chemicals in a way that has equal or greater potency than any of our meds can counteract.
>
> I know all the above is true, not just from the accounts of thousands of other people, but because my Doxycyline and plants have done a far better job on my depression, anxiety, and schizo-like weirdness than an entire backpack full of meds and ECT as well. Nothing I take is psychoactive or intended for psychiatry, and yet blows everything in the psych toolbox in the weeds.
>
> I say all this merely to introduce to you there is another realm outside the psych office that has tremendous potential that you may not yet have embraced.
>
> For immediate use:
> Combination of any 2 or 3 of these with your zoloft, drop the depakote....
> Lemon Balm, Passionflower, Skullcap, Valerian Root. These are for immediate relief within minutes or hours.
>
> As a base no matter what you do, there should be either Cordyceps or Eulethero (Siberian ginseng) onboard. or both. Siberian G is widely used, widely studied, and tolerated well by most people. Not me though. Cordyceps is my personal choice. These are for longer term rebalancing of internal biologies and fortifying the body against the devastation of stress and illness.
>
Posted by mtdewcmu on May 8, 2011, at 16:33:58
In reply to Re: ughhh (Zoloft + Depakote) » mtdewcmu, posted by morgan miller on May 7, 2011, at 22:25:30
> What was the highest dose you got up to? Did you ever try tweaking the dose? Or did you just get up to 50 and stop there? Zoloft's effects can be highly dose dependent, this may be due to it's mild DRI properties and potent sigma 1 antagonism.
I gave it the full trial. I started at 50mg, then 100mg, then 150mg. I could tolerate 100mg, but it didn't seem to be enough. I could not tolerate 150mg. I'm not sure if I tried half-steps like 125mg. I gave it a lot of chances.
This is the end of the thread.
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