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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by MJK on September 20, 2000, at 0:27:52
Hello, everyone!
This is my first time posting and I am a little nervous. I tend to be very reserved with my feelings but was so impressed with the intellegent and sympothetic information passed between the members of this board, that I am more or less forcing myself to take a chance and open up a bit.
To give you a brief history, I've suffered from chronic depression since the age of 10 (for about 26 years) and, up until about two years ago, felt I had tried every combination of AD's possible, most with limited success. I also suffered from migraine headaches since childhood, which became unbareable 10 years ago after the birth of my first child. At that time, I was referred to a specialist, whose idea of pain management was a steady stream of prescription painkillers. After being hospitalized four separate times over the next three year period with multiple ulcers and severe colitis (caused by the vast amount of pain meds), I realized I was addicted and entered a drug rehab program. This coming January, I've been "painkiller free" for six years and, not surprisingly, have not had one migraine headache.
Now onto my current problem - after two more years of trying various treatmens for depression (including several additional docs and meds), I was finally referred to a doctor, who, after trying alot of "newer" meds (Celexa, Effexor, even Synthroid), started me on a regiment of Prozac (it was slowly increased up to 80 mgs. a day) plus 50 mgs. of Dexadrine (30 mgs. of sustained-release in the morning and 20 mgs. of fast-acting around 12:00 PM). This combo was prescribed, I think, out of desperation on my doc's part since the 80 mgs. of Prozac, which had been helping for several months, was no longer effective and I was starting to suffer from suicidal ideology.
Sorry to be going on for so long but I want to give you the full picture of my situation. This combination of Prozac and Dexadrine has been very successful, and for the past two years, I've lived the kind of peaceful, contented, NORMAL life I used to dream about (but never thought I'd have). About a year ago, I decided that I felt so good that "I must not need these meds any longer" and made the foolish mistake of trying to wean myself off. One month later (after a severe spiral downward), I went back to my doc (in shame) and she slowly started me back on the same combo. For the past 10 months or so, I have felt great!
Now comes the problem - although I have always had erratic sleep patterns, about six months ago, I stopped sleeping (if I was able to get more than two hours a night, I was happy) and I also started bruising very easily. Unfortunately, sleep deprevation comes with its own set of side-effects (as does walking around all bruised) and, at the urging of my spouse, I mentioned these problems to another doctor who has been treating my son for the past year for ODD/ADD/LD disorders (this doc is very well reputed and helped, immensely, with my son). He felt that my problems stemmed from the prolonged use of Prozac and that the Dexadrine was extremely dangerous and highly addictive. He and my husband made me so nervous about the Dexadrine (especially considering my history), that I stopped taking it about six weeks ago. Three weeks ago, I started feeling really bad again and last week, this new doctor started me on 20 mgs. of Adderal (which he says is less addictive than Dexadrine) with the intention of slowly weaning me off of the Prozac (I'm now down to 60 mgs. a day). Unfortunately, I've been on the new meds for five days now and today was my worst day yet - I didn't leave the house and stayed closed off in my bedroom crying most of the day. This evening, I've started thinking that I made a terrible mistake by altering my meds and
came upon this website while trying to research the prolonged use of Prozac and/or Dexadrine. Even though I found plenty of info on sleep disturbances relative to Prozac, I didn't find anything with mentioned bruising. I also realized that, for all of my fear about the addictive component of the Dexadrine, I had absolutely no withdrawal symptoms when I stopped cold-turkey six weeks ago (if you've ever been through drug withdrawal, you know that it is not the kind of thing you would overlook or not be aware of).So I;m hoping that you all can help me with this question - should I contine with the new med combo and hope that this doctor is right and that it kicks in at some point or should I go back to my other doctor (who, by the way knows about my decision to change and thought that it was a mistake) and restart the other combo which was so effective? I know most of you will say "talk about it with the new doc" but I feel that he is so steadfast in his beliefs about the Prozac/Dexadrine combo, that he won't be able to give an unbiased consideration of all choices.
Again, I'm so sorry to go on for so long but any feedback you can give me would be so appreciated! In some ways, I wish that none of the med's ever gave me the relief the Prozac/Dexadrine did - it was so much easier to deal with the reality of depression when I didn't know how it feels to be a functioning, normal-feeling human-being.
Anyway, thanks for taking the time and sticking through my story!
Posted by Cherrie on September 20, 2000, at 6:53:06
In reply to ADVICE BADLY NEEDED!, posted by MJK on September 20, 2000, at 0:27:52
I think you should be proud of yourself for all you have gone through and survived, it may have been difficult but the important thing is you are still here and making a sincere effort to get to the bottom of things. You can never ask too many questions, and if you don't feel like you are getting anywhere with a doctor then go and find someone else ultimately who you feel comfortable with, remember they are not infallable (being a nurse I know that first hand!) I also think that conflicts make you a stronger person. I'm sorry that I can't help you with the long term effects of Prozac etc but I too have gone through some pretty big traumas and mental illness and I just wanted to encourage you to keep going.
Cherrie
Posted by MJK on September 20, 2000, at 10:17:15
In reply to Re: ADVICE BADLY NEEDED!, posted by Cherrie on September 20, 2000, at 6:53:06
> I think you should be proud of yourself for all you have gone through and survived, it may have been difficult but the important thing is you are still here and making a sincere effort to get to the bottom of things. You can never ask too many questions, and if you don't feel like you are getting anywhere with a doctor then go and find someone else ultimately who you feel comfortable with, remember they are not infallable (being a nurse I know that first hand!) I also think that conflicts make you a stronger person. I'm sorry that I can't help you with the long term effects of Prozac etc but I too have gone through some pretty big traumas and mental illness and I just wanted to encourage you to keep going.
> CherrieThank you so much, Cherrie. For my first try at this, it is extremely reassuring to have this kind of initial response.
MJK
Posted by shellie on September 20, 2000, at 10:34:09
In reply to Re: ADVICE BADLY NEEDED!, posted by MJK on September 20, 2000, at 10:17:15
MJK. Sorry you are having such a horrible time of it. I have no imput into which doctor is correct (maybe you need a third consult), but there is information about easy brusing while taking ssris in Psychopharmocology Tips by Dr. Bob (http://www.dr-bob.org/tips). Under search put in the words brusing and ssri and you'll get some information. Wish I could be of further help. Shellie
Posted by Racer on September 20, 2000, at 14:09:42
In reply to ADVICE BADLY NEEDED!, posted by MJK on September 20, 2000, at 0:27:52
Oh, my! That doesn't sound good at all!
As someone who used to self-medicate with speed (meth), I'll mention that what you're describing sounds a LOT like speed withdrawal. Sitting in a dark room, sobbing, feeling suicidal? No energy, no motivation, no sunshine? Yeah, that sounds about right... Don't discount the emotional expression of a physical symptom.
Now then, on to the other questions:
I lean towards the doc telling you to drop the dex. The bruising, in my experience, is more likely to be related to that than the prozac. (I have a connective tissue disorder that makes me bruise easily: I take Prozac, and bruise LESS easily than before.)
How's this scenario sound:
The Prozac just isn't working, but it counteracts some of the side effects of the speed (what do you think Dex is?), so the two together get you through life.
Possible? Maybe trying to find a new drug, one which actually works on your depression, is a better answer? Believe me, I went through hell trying to find a combo that works, and it has worked consistently for over a year -- despite major stressors! Maybe it's a combination of ADs, rather than just one.
If you have good communication with the second doctor, maybe this will start a dialog about possibilities there? I hope so.
Remember, of course: your mileage will vary! This is just to offer a few things to think about and talk to your doctor about!
Good luck, though. We're the same age, about, and both female, so I can't help but feel a sense of identification with you. Go forth and cure us! ;-P
Posted by Sunnely on September 20, 2000, at 19:47:08
In reply to ADVICE BADLY NEEDED!, posted by MJK on September 20, 2000, at 0:27:52
> Now comes the problem - although I have always had erratic sleep patterns, about six months ago, I stopped sleeping (if I was able to get more than two hours a night, I was happy) and I also started bruising very easily. Unfortunately, sleep deprevation comes with its own set of side-effects (as does walking around all bruised) and, at the urging of my spouse, I mentioned these problems to another doctor who has been treating my son for the past year for ODD/ADD/LD disorders (this doc is very well reputed and helped, immensely, with my son). He felt that my problems stemmed from the prolonged use of Prozac and that the Dexadrine was extremely dangerous and highly addictive. He and my husband made me so nervous about the Dexadrine (especially considering my history), that I stopped taking it about six weeks ago
================================
Hello MJK,
I can't tell you for sure what you should do about your meds as only you and your doctor can decide on this matter. But I thought I would post a response to help you with your decision.
Case reports suggest that serotonergic antidepressants such as the SSRIs (Prozac, Paxil, Zoloft, Luvox, Celexa) and others (e.g., Effexor) can lead to increased bleeding, such as ecchymoses (spontaneous bruising), epistaxis (spontaneous nose bleeding), and prolonged or heavy menstrual bleeding. Rarely, they have caused gastrointestinal, genitourinary, or intracranial bleeding.
Among the SSRIs, more cases have been reported with fluoxetine (Prozac) than others. The adverse reactions frequently reported include ecchymoses (bruising), epistaxis (nose bleeding), bleeding internal hemorrhoids, menorrhagia (heavy menstrual flow), gastrointestinal ulcerations with hemorrhage, petechiae (reddish small skin spots), and melena (blackish stool).
The mechanism as to how these reactions occur seems to be related to the effect of the SSRIs on serotonin. Under normal circumstances, platelets (blood particles responsible for clotting) release serotonin at the site of vascular tears, leading to further platelet aggregation and vasodilation (blood vessels enlarge). This permits sealing of the tear stopping the bleeding. It appears that the SSRIs block the reuptake of serotonin into the platelets which lead to decreased serotonin to be released by the platelets into the site of bleeding, impairing the clotting effect. Most oftentimes, dose reduction or discontinuation of the SSRI resolves this problem.
If you are on SSRI, you should also avoid the use of aspirin or NSAIDs (e.g., Motrin, Advil, etc.) as the concurrent use of these meds can produce a sharp increase in the risk for bleeding. You should also be aware that certain herbal preparations may interfere with clotting mechanism and may increase risk of bleeding especially if combined with the serotonin-boosting drugs, aspirin, NSAIDs, and warfarin (Coumadin). These herbs include chamomile, feverfew, garlic, ginger, gingko, and ginseng.
The following case reports exemplify bleeding tendencies from use of serotonin-boosting antidepressants.
1] A 19-year-old woman developed spontaneous bruising and 3 ecchymoses on her arms a week after beginning Effexor, 50 mg twice a day. She had no personal or family history of any bleeding disorder nor any other medical condition. Her clotting factors and platelet counts were noted to be within normal limits. Once Effexor was stopped, her ecchymoses and easy bruising resolved over 10 days.
2] Abnormal bleeding occurred in 5 patients, aged 8-15 years, within 1 week to 3 months after starting on 25-100 mg per day of sertraline (Zoloft). Four patients experienced frequent episodes of nosebleed, and another had bruising on the lower legs. The complications resolved after discontinuation or dosage reduction of sertraline; in 1 patient, bleeding reappeared 2 weeks after sertraline was reintroduced. Another patient was treated with an alternative SSRI, with no recurrence of bleeding. In 3 patients, bleeding parameters assessed during treatment were normal.
References:
1. Antidepressants and Bleeding. In: Biological Therapies in Psychiatry Newsletter, AJ Gelenberg, MD (editor), April 1998.
2. Do Antidepressants Increase Upper GI Bleeding? In: Biological Therapies in Psychiatry, AJ Gelenberg MD (editor), July 2000.
3. Potential Bleeding and SSRIs. In: Psychiatry Drug Alerts, May 2000.
4. Miller LG: Herbal Medicinals: Selected clinical considerations focusing on known or potential drug-herb interactions. Archives of Internal Medicine, November 9, 1998.
5. Wong AC, Smith M, Boon HS: Herbal remedies in psychiatric practice. Archives of General Psychiatry 1998;55:1033-1044.
Posted by JohnL on September 22, 2000, at 5:34:17
In reply to ADVICE BADLY NEEDED!, posted by MJK on September 20, 2000, at 0:27:52
MJK,
You might ask your doctor to substitue Provigil in place of other stimulants. I suspect most of the good effects your medications had were due mostly to the stimulant, somewhat to the synergy of the Prozac+stimulant combo, and least to Prozac alone. As a safer less addictive and much smoother stimulant, you might want to take a look at Provigil. It has recently been documented as a good augmentation for antidepressants. I can confirm that from personal experience.
I can't help but be a little biased, because while Ritalin or Adderall worked fairly well for me, Provigil blows them away bigtime. I can't say enough good about Provigil.
John
This is the end of the thread.
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