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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by clipper40 on January 16, 2008, at 2:47:45
I have a friend who is on a 150 mg. of Effexor that he recently built up to. He's also in the process of withdrawing from a high daily dosage of a benzo. Between these two meds, he has A LOT of anxiety and is barely functioning. Is there any reason a doctor wouldn't or couldn't prescribe some Zyprexa, Remeron or doxepin etc. to help him out now?
Posted by Phoenix1 on January 16, 2008, at 2:47:46
In reply to Question about Combining Medications, posted by clipper40 on January 11, 2008, at 8:32:03
> I have a friend who is on a 150 mg. of Effexor that he recently built up to. He's also in the process of withdrawing from a high daily dosage of a benzo. Between these two meds, he has A LOT of anxiety and is barely functioning. Is there any reason a doctor wouldn't or couldn't prescribe some Zyprexa, Remeron or doxepin etc. to help him out now?
I worry about making too many changes at the same time. If it were me, I would rather stabilize on the Effexor before reducing the benzo. Effexor worsened my physical anxiety. Now, it is hard to know if your friend's anxiety is caused by the Effexor or by the reduced benzo dose, or a combination of both. If you are looking for something instead of a benzo, then the atypical AP's are not a great choice for anxiety unless the friend is Bipolar. Maybe he could try Gabapentin or Lyrica. My experience with these is that they do reduce anxiety but are as hard to quit as the benzos. Others feel differently on this.
Hope this helps,
Phoenix1
Posted by Phillipa on January 16, 2008, at 2:47:46
In reply to Re: Question about Combining Medications » clipper40, posted by Phoenix1 on January 11, 2008, at 8:59:21
Thanks for the info on the atypicals as a lot of docs I've talked to seem to favor them over benzos. Phillipa
Posted by Phoenix1 on January 16, 2008, at 2:47:46
In reply to Re: Question about Combining Medications » Phoenix1, posted by Phillipa on January 11, 2008, at 11:34:58
> Thanks for the info on the atypicals as a lot of docs I've talked to seem to favor them over benzos. Phillipa
I'm not saying atypical AP's have no place in the treatment of anxiety. I'm sure they do. But you have to look at the risk/benefit ratio. Those AP's can cause all sorts of nasty things that some of the other anti-anxiety meds don't. They're pretty powerful. I hate taking my Seroquel, but if I don't, I won't sleep. And it's just a low dose. That's how I justify it.
Phoenix1
Posted by clipper40 on January 16, 2008, at 2:47:46
In reply to Re: Question about Combining Medications » clipper40, posted by Phoenix1 on January 11, 2008, at 8:59:21
That was my concern about changing too many things at once but this guy is truly in hell right now. He needs something else to help him. I think he has been at 150 mg. for a week or two so he may be stabilized enough on the Effexor to add something else in.
I feel the same way about atypicals but I think Zyprexa may be different in terms of its effect on anxiety. (It still carries the risks of the other APs though.) I've read so many reports here about people who have been pulled out of the most horrible states in a very short time with Zyprexa.
I don't really want to recommend Neurontin or anything else that's got a bad withdrawal. He's already got the Effexor and benzo withdrawal to deal with. I'm pretty sure that Remeron and doxepin could help him a lot. The problem is that he may have a very conservative doctor who doesn't like to mix medications at all.
Anyway, thanks for your input.
Posted by bleauberry on January 16, 2008, at 2:47:46
In reply to Question about Combining Medications, posted by clipper40 on January 11, 2008, at 8:32:03
Zyprexa.
One word says it all.
Antipsychotics in general? No. Zyprexa? Yes. Zyprexa has for me and many other people shut down massive anxiety, panic attacks, outright paranoia, adverse drug reactions, fear, etc, in a mere 2 hours after dosing, landing on a peaceful soft cushion of relief.
The kind of anxiety your friend is having is not just way uncomfortable. It is outright dangerous and extremely damaging to the mind, the glandular systems, the immune system, the intestinal system, the whole body and spirit. Many cruel diseases come as a result of damage done from unchecked out of control anxiety. I do believe the doctor should do whatever it takes to shut this episode down pronto. I would normally suggest klonopin or xanax, but since a benzo is already in place, that means some other mechanism needs to be tweaked. That is where zyprexa comes in.
When things are back under control, then make whatever med changes are desired, except do it different this time...much smaller dose increments and much longer times at dose changes. Effexor can be customized by opening capsules and either dumping or counting the beads inside. Patients are not limited to taking whatever dose is available from the pharmacy. Many people have and do create their own custom size dose. In your friend's case, the dosage changes need to be real small steps, like perhaps 10mg at a time.
Posted by yxibow on January 16, 2008, at 2:47:47
In reply to Re: Question about Combining Medications, posted by bleauberry on January 11, 2008, at 19:10:37
I now sort of understand my doctor's approach to combining and introducing or removing medications even if it is a bit frustrating -- you don't do it all at once.
Why? Well for one it creates a vast unknown brew, but more importantly, one will never appreciate any changes if you don't give something a week or at least part of one to let things percolate. Psychiatric changes for the most part with complex agents other than say an IV injection of Haldol for a catatonic patient, occur on a longer term basis -- the neuroplasticity of the brain.
Posted by clipper40 on January 16, 2008, at 2:47:47
In reply to Re: Question about Combining Medications, posted by bleauberry on January 11, 2008, at 19:10:37
I agree completely but I also think that there are other medications that can do the same thing. Doxepin has done this for me when I was in really bad shape. The problem here is that my friend is in the U.K. and doesn't have access to a good psychiatrist, only a GP, who may or may not know much about psychotropic meds. Meanwhile my friend is in such bad shape. It's so frustrating knowing that he doesn't need to suffer like this. He sees the GP on Tuesday so hopefully this doctor will agree to prescribe something like Zyprexa for him. In the meantime, I'm trying to give him information on things to ask for.
I think I'm going to recommend that he take vitamin B3 (niacinamide,which has helped me in the past with anxiety) to tide him over until Tuesday. So infuriating that in this day and age someone has to go through this. GRRRRRR!
Posted by clipper40 on January 16, 2008, at 2:47:47
In reply to Re: Question about Combining Medications, posted by yxibow on January 11, 2008, at 21:05:21
I also understand the reasoning behind not adding in too many medications at once but this guy has been at the same dosage of Effexor for more than a week. Also, I feel that the very extreme discomfort he's in is justification for an exception to that reasoning anyway.
Posted by Phoenix1 on January 16, 2008, at 2:47:47
In reply to Re: Question about Combining Medications, posted by bleauberry on January 11, 2008, at 19:10:37
> Zyprexa.
>
> One word says it all.
>
> Antipsychotics in general? No. Zyprexa? Yes. Zyprexa has for me and many other people shut down massive anxiety, panic attacks, outright paranoia, adverse drug reactions, fear, etc, in a mere 2 hours after dosing, landing on a peaceful soft cushion of relief.
>
> The kind of anxiety your friend is having is not just way uncomfortable. It is outright dangerous and extremely damaging to the mind, the glandular systems, the immune system, the intestinal system, the whole body and spirit. Many cruel diseases come as a result of damage done from unchecked out of control anxiety. I do believe the doctor should do whatever it takes to shut this episode down pronto. I would normally suggest klonopin or xanax, but since a benzo is already in place, that means some other mechanism needs to be tweaked. That is where zyprexa comes in.
>
> When things are back under control, then make whatever med changes are desired, except do it different this time...much smaller dose increments and much longer times at dose changes. Effexor can be customized by opening capsules and either dumping or counting the beads inside. Patients are not limited to taking whatever dose is available from the pharmacy. Many people have and do create their own custom size dose. In your friend's case, the dosage changes need to be real small steps, like perhaps 10mg at a time.
>
>Why do people here like Zyprexa SO much? (I'm not trying to make a generalization or offend anyone, and I'm not intentionally being uncivil, but Zyprexa is popular among PB'ers, and I'm just trying to figure out why.) How is it significantly different than any of the other atypical APs? The risks are still there, but if there is more benefit, then maybe it's a good idea. How is it different? I take small doses of Seroquel for sleep which I hate because I feel like it is way too powerful of a drug just for sleep, but on the other hand, without it I would be wide awake (crickets chirping) at 3AM, even with the zopiclone OR a powerful benzo. Some psych nurse suggested I try chloral hydrate. Yuck....
Posted by Phillipa on January 16, 2008, at 2:47:47
In reply to Re: Question about Combining Medications » bleauberry, posted by Phoenix1 on January 12, 2008, at 10:50:40
Phoenix yes I like to know too also guess who took chloral hydrate for years me and it works very well very strong and from the l800's I think. Yes some of the pbabblers say it the zyprexa is also good for suicical ideation. Phillipa
Posted by yxibow on January 16, 2008, at 2:47:48
In reply to Re: Question about Combining Medications » Phoenix1, posted by Phillipa on January 12, 2008, at 19:13:58
> Phoenix yes I like to know too also guess who took chloral hydrate for years me and it works very well very strong and from the l800's I think. Yes some of the pbabblers say it the zyprexa is also good for suicical ideation. Phillipa
The fastest drug for suicidal ideation is lithium, among others (Haldol probably). I can't vouch for Zyprexa because unfortunately it created mild Tardive Dystonia in my legs and arms -- which may be gone now that Seroquel has covered it up (its a palleative for it). When I first took it a long time ago I took a small dose and slept like a baby, my depression was gone.
So, don't take my situation as what is a typical experience, its quite rare and still now unclear since I resumed Seroquel.
Posted by stargazer2 on January 16, 2008, at 9:38:53
In reply to Question about Combining Medications, posted by clipper40 on January 16, 2008, at 2:47:45
What benzo is he tapering off of, at what dosage and why? I would think if reducing the dosage of the benzo for whatever reason and if Effexor isn't controlling his anxiety, another medication would be added to control the anxiety.
At least that is the approach I would expect from my pdoc.
Maybe Effexor is not the right AD to use for him. Does he have a good relationship with his pdoc or is this a relatively new doc he saw to wean him off the benzo?
My pdoc would never let me suffer like that and if he were not comfortable with benzo withdrawls, he would or should refer me to someone that has experience in this, it is not a routine procedure and mnay pdocs do not do it correctly.
Stargazer
Posted by Phillipa on January 16, 2008, at 12:44:10
In reply to Re: Question about Combining Medications, posted by stargazer2 on January 16, 2008, at 9:38:53
Agree and since on the thread wanted to continue to be on it thanks Phillipa
This is the end of the thread.
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