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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by tonyz on June 26, 2009, at 12:33:29
I went to a new doctor today. I told him about my history of current depression and relapses and expressed my fear about the neuroleptics.
Prior to seeing him I was taking 75-100 mg seroquel, 16mg valium, 150mg Notriptyline.
He started me on Zoloft and lamictal and said I should leave the valium and Notriptyline at the same level and indicated I should take enough Seroquel so that I can sleep. Kind of left it from 50 - 200mg.
He gave me a starter pack for the lamictal. I mentioned lithium and said something about lamictal being better at preventing recurrent depressive episodes whereas lithium is better where mania is involved. He stated me with 50mg of Zoloft.
I told him I was trying to avoid hospitalization. He expressed confidence that he could help me and the importance that given my history I will need to be on lamictal and Zoloft for maintenance.
I don't know how to find a doctor that you really feel comfortable with. I asked him about a problem taking trazodone and Nortriptyline together which had been prescribed for me at one time - I had heard this was not a good combination from another doctor. He didn't agree.
So how do you find a doctor that you can really trust. This guy was willing to squeeze me in for two appointments next week, when I told him I was at the point of requiring to go in a hospital.
I am trying to have faith that this is a good decision. I told him about the shakiness that I have been experiencing and he didn't have much to say about that.
Last night in anticipation of this appointment or for whatever reason I didn't get any sleep. and I wound up taking another 4mg of valium.
So I've gone ahead and taken the Zoloft (50mg) and lamictal (starting dose).
I could use some positive feedback.
Just to summarize meds are
50 mg Zoloft
25mg lamictal (starting dose)
16mg valium
150mg Nortriptyline
probably 100mg seroquel
Posted by bleauberry on June 26, 2009, at 20:34:26
In reply to new Mix of medications, posted by tonyz on June 26, 2009, at 12:33:29
> I went to a new doctor today. I told him about my history of current depression and relapses and expressed my fear about the neuroleptics.
At a reasonable dose and responsible food choices, the fears of Zyprexa should be near zero. It is a fabulous neuroleptic with qualities in depression far greater than any others. My opinion, experience, and observations. Mileage varies of course, but there is a pretty strong body of scientific and anecdotal evidence backing that opinion up. I have no idea why doctors use Seroquel so much. You would think there must be a lot of people doing well with it. Good luck finding them. They are rare. Zyprexa, different story. It works miracles quite often.
>
> Prior to seeing him I was taking 75-100 mg seroquel, 16mg valium, 150mg Notriptyline.That valium is high. Valium even at low doses will eventually cause practically everyone to become very depressed. Valium is probably doing you more harm than your own disease is. If a benzo is absolutely needed, it should be switched to Xanax which at least has some antidepresant potential, and the goal should be to wean very slowly in very tiny steps off of benzos completely. For now, Valium is your worst enemy, despite whatever you think it might be doing for anxiety. Especially at that dose. No wonder you are so depressed.
>
> He started me on Zoloft and lamictal and said I should leave the valium and Notriptyline at the same level and indicated I should take enough Seroquel so that I can sleep. Kind of left it from 50 - 200mg.I like the Zoloft idea. Zoloft and Nortriptyline go very well together. Unfortuneatly the other meds will blunt the goodness. Lamictal is not a bad choice, but I don't like changing more than one thing at a time. If you get worse, which drug did it, the Zoloft or the Lamictal? You won't know. If you don't get better, how would you know that just one or other would have worked by themselves, but the combination was bad? You won't know.
>
> He gave me a starter pack for the lamictal. I mentioned lithium and said something about lamictal being better at preventing recurrent depressive episodes whereas lithium is better where mania is involved.That is generally true. It doesn't mean that will happen, and it doesn't mean lithium wouldn't have been a miracle, but what he said does have some general consensus to it. Lithium does by the way work best when it is combined with a noradrenergic med, as Nortriptyline is, versus a serotonergic med. I thought the starter pack was supposed to start at 12.5mg? You need to keep an eye out for a rash. That is a dangerous thing that can happen with Lamictal. You had fears about neuroletics. The fears of that rash are higher.
>He stated me with 50mg of Zoloft.
I am more conservative and probably would have started at 12.5mg or 25mg, but 50mg is a common starting dose and sometimes final dose. Zoloft is an excellent choice, especially with Nortriptyline.
>
> I told him I was trying to avoid hospitalization. He expressed confidence that he could help me and the importance that given my history I will need to be on lamictal and Zoloft for maintenance.I like a doctor who expresses confidence. There are too many that seem too hurried to listen, too distant to listen, or just don't really love what they do.
>
> I don't know how to find a doctor that you really feel comfortable with. I asked him about a problem taking trazodone and Nortriptyline together which had been prescribed for me at one time - I had heard this was not a good combination from another doctor. He didn't agree.Trazodone is a lousy drug and a lousy antidepressant. It works for practically no one and usually makes them feel worse. Even when used as just a sleep aid, it can commonly make one feel more depressed the next day.
>
> So how do you find a doctor that you can really trust. This guy was willing to squeeze me in for two appointments next week, when I told him I was at the point of requiring to go in a hospital.That's a good sign. If he was uncaring or too busy, he wouldn't have done that. Finding a doctor you can really trust is something that takes time. Kind of like a girlfriend or boyfriend. Trusting relationships take time to be born and blossom.
>
> I am trying to have faith that this is a good decision. I told him about the shakiness that I have been experiencing and he didn't have much to say about that.It's probably the seroquel, and it is probably a result of being on so many medications.
>
> Last night in anticipation of this appointment or for whatever reason I didn't get any sleep. and I wound up taking another 4mg of valium.In my view seroquel is basically useless for depression, despite what others might debate about it. It is however one of the world's most powerful antihistamines, its primary mode of action, and is thus good for inducing sleep. But if it is not doing that, then I see no sense in staying on it. It could be immediately switched straight over to Zypexa which has some real antidepressant umph, especially combined with an ssri med like zoloft.
For sleep, I like Lunesta better, or for a good antihistamine sleep, a mere 7.5mg remeron will do the trick. Best yet, a low dose of Amitriptyline, which is Nortriptyline's parent.
>
> So I've gone ahead and taken the Zoloft (50mg) and lamictal (starting dose).
>
> I could use some positive feedback.
>
> Just to summarize meds are
> 50 mg Zoloft
> 25mg lamictal (starting dose)
> 16mg valium
> 150mg Nortriptyline
> probably 100mg seroquel
>
>Keep in mind that if you play with the valium doses or seroquel doses, up or down, it will have an effect on you. For example, if I am correct in believing valium is causing a worse depression than you would have without it, if you were to lower the dose too much too fast, you would be even more depressed as part of the withdrawal effect. It would be short-lived, but you would still experience it. So it will be tricky to navigate your journey. If you change more than one thing at a time, you will not know what did what. Tiny steps is the way to go. I assume you are probably good with a knife or razor blade at customizing pill sizes. If not, you should learn and practice.
Worst case scenario you someday end up in the hospital...their job is not to get you better...their job is to stabilize you and get rid you of to make room for someone else. They will still let you out of the hospital in very bad shape as long as someone else needs your bed that is in worse shape than you are, as happened with me. If you ever do go to a hospital, the goal should be to use that as the place to get off of your meds and clean out so you can start Parnate. If you ever get to a place where this whole med merrigoround is just going downhill forever, then you are already long past the appropriate time to have been tried on the real powerhouse of antidepressants, Parnate.
Until then, and I don't think that will ever happen, definitely keep your eyes on Nortriptyline, Zoloft, and Zyprexa. I would get rid of Valium and Seroquel. Lamictal is a maybe, but I would keep its doses low for now. Zyprexa will keep you stable as well or better and probably a lot longer than Lamictal. Lamictal has only been clinical proven to provide protection from relapse for months, where Zyprexa has gone well past that.
I'm just somebody on an internet forum who you will never know and never meet. I hope my input will be helpful in guiding your journey, but your doctor is the one to discuss it with.
I think you are going to see better days in the not distant future. He sounds like a good doctor. I just want you to have some ideas to work with him.
ps...All Lyme disease patients have one thing in common...their stories are exactly like yours. The depression, the drugs not helping, the shakiness...ask your doctor if he has ever seen the pamphlet titled, "What Psychiatrists Need to Know About Lyme Disease", or the one, "Psychiatric Lyme Disease". Regardless whether he has or not, top priority for you is to have him find someone for you that is an expert on Lyme disease and have them give you a clinical exam and the Western Blot lab test from Igenex Lab specifically.
Posted by morganpmiller on June 26, 2009, at 20:41:01
In reply to new Mix of medications, posted by tonyz on June 26, 2009, at 12:33:29
doesn't look too bad..I personally don't like seroquel but if your feeling good on it and don't notice anything bad from it then there is no reason to stop.
I love zoloft, it's a very effective antidepressant that should eventually relieve anxiety as well. If you get up to 100mgs or more you may have the added benefit of some dopamine reuptake inhibition. Zoloft is the least toxic of all the SSRIs and is recommended as the safest SSRI for pregnant women.
I wonder if you would be able to lower the valium dose and maybe use it on an as needed basis if Zoloft really works well for you. I always feel like if the right antidepressants and mood stabillizers give us what we need and work they way they are supposed to, there are other things we can do to manage whatever anxiety is left, like bikram yoga/regular yoga or intense exercise/stretching(stretching increases GABA levels) or meditation. That's just me. If some things were preventing me from being able to workout or do yoga, like if I were crippled in some way, I may be popping my benzos regularly.
I think you might be headed down the right path as far as medications go. I hope you start seeing results-zoloft and lamictal will take a while.
Just curious, why did you make a post on the alternative page?
Posted by tonyz on June 26, 2009, at 21:39:08
In reply to Re: new Mix of medications » tonyz, posted by bleauberry on June 26, 2009, at 20:34:26
bleuberry,
I am overwhelmed with the amount of time you have taken to craft a very detailed and helpful response. I can't thank you enough.Being a bit apprehensive about medications I did drop the Nortriptyline to 125 just to mitigate the risk of serotonin syndrome even though it is very rare with Notrtriptyline.I thought about lyme disease as well several years ago I don't believe I had the test you specifically mentioned. It is relatively rare in NC although it does happen. My neighbor had the misfortune of contracting lyme and rocky mountain spotted fever. The tet my GP gave me was negative but she put me on a course of antibiotics just to be on the safe side. I did have a red spot on my arm maybe similar to errthrya migranis (I know that is not the correct spelling). She dismissed that, but I will mention to the doctor. Other than cognitive issues which has happened in the past with my depression I have not had any other impairments generally associated with lyme, joint pain etc. But it is worth ruling out. You have accumulated a lot of knowledge concerning drugs, receptors and their interactions and I applaud you for sharing. Thanks again.
Posted by tonyz on June 26, 2009, at 21:58:16
In reply to Re: new Mix of medications, posted by morganpmiller on June 26, 2009, at 20:41:01
Thanks Morgan for your input, if it winded up on the alternate page it was just an error on my part. I also do yoga, about 5 classes a week - I thought it was actually helping in the beginning it seemed the depression was not advancing as rapidly. Somehow with self talk and yogic principles I felt I was beginning to control it, I got better tapered of the meds and relapsed quickly (never happened that quickly before), started back on the meds and got better had tapered the valium down to 2.5mg and the Notrtriptyline lowered and eliminatedd the seroquel and then I tried remeron for sleep then trazadone and then relapsed miserably. I want to taper the valium and the seroquel but I need sleep so I'm taking it slower maybe 1 mg a week on the valium a little faster than the Ashton schedule but much slower than I've done before. I will ask my dock about possibly swithching to a different benzo - I don't like the benzos and the neuroleptics so those I will try to eliminate first. But thanks for taking the time to respond, I hope I can be of some help to you someday
I think you may have mentioned Parnate in another posting. Many years ago I took Nardil. The diet was a pain, there were a list of foods you couldn't eat - I don't specifically remember yogart but any pickled or fermented items, red wine I believe and cheeses (may not have been all cheeses). I think Milk was ok. I'll see if I can find the list and will make a posting. I like to eat a lot of ethnic foods so Nardil was a real drag for me. I was hospitalized at the time and was primarily treated with sinequan. I never got an explanation as to why I should be taking Nardil. I think some doctors just get attached to a certain drug or they see some characteristics in a patient that responed well and they make their choice that way. I didn't care for this doctor. I felt no better on the Nardil than than the Sinequan but that was me. My understanding at the time was MAOIs were used when people didn't respond well to the tricyclics.
The danger is a reaction that will cause very high blood pressure.
Posted by morganpmiller on June 26, 2009, at 22:10:57
In reply to Re: new Mix of medications » tonyz, posted by bleauberry on June 26, 2009, at 20:34:26
>I like the Zoloft idea. Zoloft and Nortriptyline go very well together. Unfortuneatly the other >meds will blunt the goodness. Lamictal is not a bad choice, but I don't like changing more than >one thing at a time. If you get worse, which drug did it, the Zoloft or the Lamictal? You >won't know. If you don't get better, how would you know that just one or other would have worked >by themselves, but the combination was bad? You won't know.
I agree completely..too many meds..some good meds..and some bad ones. Taking some that may give you a much needed boost, and some that will dope you up so much you may never feel good. I don't know why psychiatrist insist on doing this.
I will add..it may be worth it in the long run to try to take a little pain and tolerate some things until the "good" medications are able to give you what you really need. Basically, start weening off the bad sh*t, seroquel and valium. And, maybe add a low dose of zyprexa as suggested.
Good advice and assessment beauberry
Posted by morganpmiller on June 26, 2009, at 22:16:00
In reply to Re: new Mix of medications, posted by tonyz on June 26, 2009, at 21:58:16
> Thanks Morgan for your input, if it winded up on the alternate page it was just an error on my part. I also do yoga, about 5 classes a week - I thought it was actually helping in the beginning it seemed the depression was not advancing as rapidly. Somehow with self talk and yogic principles I felt I was beginning to control it, I got better tapered of the meds and relapsed quickly (never happened that quickly before), started back on the meds and got better had tapered the valium down to 2.5mg and the Notrtriptyline lowered and eliminatedd the seroquel and then I tried remeron for sleep then trazadone and then relapsed miserably. I want to taper the valium and the seroquel but I need sleep so I'm taking it slower maybe 1 mg a week on the valium a little faster than the Ashton schedule but much slower than I've done before. I will ask my dock about possibly swithching to a different benzo - I don't like the benzos and the neuroleptics so those I will try to eliminate first. But thanks for taking the time to respond, I hope I can be of some help to you someday
>
> I think you may have mentioned Parnate in another posting. Many years ago I took Nardil. The diet was a pain, there were a list of foods you couldn't eat - I don't specifically remember yogart but any pickled or fermented items, red wine I believe and cheeses (may not have been all cheeses). I think Milk was ok. I'll see if I can find the list and will make a posting. I like to eat a lot of ethnic foods so Nardil was a real drag for me. I was hospitalized at the time and was primarily treated with sinequan. I never got an explanation as to why I should be taking Nardil. I think some doctors just get attached to a certain drug or they see some characteristics in a patient that responed well and they make their choice that way. I didn't care for this doctor. I felt no better on the Nardil than than the Sinequan but that was me. My understanding at the time was MAOIs were used when people didn't respond well to the tricyclics.
>
> The danger is a reaction that will cause very high blood pressure.No worries Tony..good post by beauberry huh..very helpful and informative. It's sad that our doctors are not able to see things this way.
Thanks for sharing your experience. You don't have to help me in any way, but if you did one day that would be nice of course.
Hope you get to feeling better on the right meds in the next month or two..Goodluck
Posted by Lao Tzu on July 5, 2009, at 8:54:32
In reply to new Mix of medications, posted by tonyz on June 26, 2009, at 12:33:29
Hello. I am on both zoloft and lamictal. It's been about 3 years to date. Both of these medications are helpful. For me, zoloft works well for my anxiety issues and lamictal helps with depression. I don't really have anything bad to say about these drugs. They have a solid track record in psychiatry and will probably be quite helpful to you. You just need to be patient as it may take some time for your body to get used to them.
Posted by elanor roosevelt on August 9, 2009, at 16:19:53
In reply to Re: new Mix of medications » tonyz, posted by bleauberry on June 26, 2009, at 20:34:26
Lamictal, I am sure, is going to end up as one of those meds that doctors believe in more than their patients do.
the titration causes great instability. I am surprised that your doctor suggested it
there are times in life when you just don't have the time to mess with a long transition into stability
i hope the lamictal works for you but just know that if you start to wonder if it is more of a problem than a solution--pay attention
good luck to you
be kind and gentle with yourself
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