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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Janelle on March 7, 2002, at 18:13:15
I'm in the process of switching meds due to a change in pdocs, but after reading the responses to my questions further above, I'm now having serious doubts about the switching ... what to do or not to do is now increasing my anxiety, giving me a headache (literally) ... I just don't know what to do ... any comments greatly appreciated.
1. Do I switch from Zyprexa to Seroquel - well, after a few days on Seroquel, it sure as heck gets me to sleep - I get very drowsy and woozy soon after taking it (50 mg). However, I'm feeling progressively worse each DAY that I'm on it - it seems to have a hangover effect that is troublesome.
Zyprexa not nearly as sedating as Seroquel. The Zyprexa 2.5mg did NOTHING for me, 5.0 was tolerable, but 7.5 was too much.
2. Do I switch to Serzone from EffexorXR - well, since the Seroquel is proving so sedating do I really want to add another sedating med - I hear that Serzone is quite sedating and I'm not convinced of its efficacy for depression. EffexorXR 150mg is helping me.
3. Do I start taking Lithium (Lithobid) as a mood stablizer (had previous success with Lamictal) - what I read in the responses to my first post about that have me VERY concerned about the safety (toxicity) of Lithium and how much help it would even be for depression which is more of a problem for me than hypomania.
I find myself in quite a quandry ... I'm so sick and tired of feeling sick and tired and now these med issues are really getting to me. Thanks to whoever can offer some support or suggestions.
Posted by JohnX2 on March 7, 2002, at 19:33:24
In reply to OH GOSH, I'm so upset, more confused than ever, posted by Janelle on March 7, 2002, at 18:13:15
Hi Janelle,Sorry you are so confused, that seems reasonable.
Is your new pdoc having you taper off these old medicines.
If I may ask what are you taking? What were you taking?Exactly in what order did you take Zyprexa,
Lamictal,Effexor and at what doses, and what
happened, and why were the changes made?Also, yesterday you seemed frustrated with your
old medicines, but today you feel maybe they
weren't so bad, is this just a relative perspective?Also, I wouldn't worry about Lithium toxicity.
Sorry for your dismay.
John
> I'm in the process of switching meds due to a change in pdocs, but after reading the responses to my questions further above, I'm now having serious doubts about the switching ... what to do or not to do is now increasing my anxiety, giving me a headache (literally) ... I just don't know what to do ... any comments greatly appreciated.
>
> 1. Do I switch from Zyprexa to Seroquel - well, after a few days on Seroquel, it sure as heck gets me to sleep - I get very drowsy and woozy soon after taking it (50 mg). However, I'm feeling progressively worse each DAY that I'm on it - it seems to have a hangover effect that is troublesome.
>
> Zyprexa not nearly as sedating as Seroquel. The Zyprexa 2.5mg did NOTHING for me, 5.0 was tolerable, but 7.5 was too much.
>
> 2. Do I switch to Serzone from EffexorXR - well, since the Seroquel is proving so sedating do I really want to add another sedating med - I hear that Serzone is quite sedating and I'm not convinced of its efficacy for depression. EffexorXR 150mg is helping me.
>
> 3. Do I start taking Lithium (Lithobid) as a mood stablizer (had previous success with Lamictal) - what I read in the responses to my first post about that have me VERY concerned about the safety (toxicity) of Lithium and how much help it would even be for depression which is more of a problem for me than hypomania.
>
> I find myself in quite a quandry ... I'm so sick and tired of feeling sick and tired and now these med issues are really getting to me. Thanks to whoever can offer some support or suggestions.
Posted by Sunnely on March 7, 2002, at 19:55:16
In reply to OH GOSH, I'm so upset, more confused than ever, posted by Janelle on March 7, 2002, at 18:13:15
1. Not sure why you have to change meds just because you changed psychiatrist. If the meds are working, I see no reason to change them.
2. What is the Zyprexa or Seroquel prescribed for? Although both are antipsychotics (Zyprexa is also approved for mania), doctors are using them for other reasons (off label) such as augmentation treatment for tx-resistant or partial response depression or bipolar disorder, anxiety, insomnia, dementia with agitation, parkinson's disease with psychosis, etc. In these situations, the dose of these medications are generally much lower than for treatment of psychosis such as schizophrenia. Zyprexa and Seroquel are both sedating so they are good choice in promoting sleep. However, one person's response and side effects may vary from another.
3. If Effexor 150 mg/day is helping you, why switch to Serzone? You are right that Serzone could be sedating and so combining it with Seroquel may compound this problem. This is not only due to pharmacodynamic drug interaction (additional effect on the site of action) but also pharmacokinetic drug interaction (Serzone potently inhibits the metabolism of Seroquel via CYP3A4 enzyme).
4. Although lithium is a good mood stabilizer, it is more effective in mania than depression. However, it is also effective as an augmentor to antidepressants in treatment-resistant or partial-response depression, and used a lot for this reason. Indeed Lithium has a narrow margin of safety, but with close monitoring clinically and of blood levels, this drug can be given safely.
If you had previous success with Lamictal, is it possible to try it again? Lamictal appears to be more effective in bipolar depression (depression with history of hypomania) than in acute mania.
> I'm in the process of switching meds due to a change in pdocs, but after reading the responses to my questions further above, I'm now having serious doubts about the switching ... what to do or not to do is now increasing my anxiety, giving me a headache (literally) ... I just don't know what to do ... any comments greatly appreciated.
>
> 1. Do I switch from Zyprexa to Seroquel - well, after a few days on Seroquel, it sure as heck gets me to sleep - I get very drowsy and woozy soon after taking it (50 mg). However, I'm feeling progressively worse each DAY that I'm on it - it seems to have a hangover effect that is troublesome.
>
> Zyprexa not nearly as sedating as Seroquel. The Zyprexa 2.5mg did NOTHING for me, 5.0 was tolerable, but 7.5 was too much.
>
> 2. Do I switch to Serzone from EffexorXR - well, since the Seroquel is proving so sedating do I really want to add another sedating med - I hear that Serzone is quite sedating and I'm not convinced of its efficacy for depression. EffexorXR 150mg is helping me.
>
> 3. Do I start taking Lithium (Lithobid) as a mood stablizer (had previous success with Lamictal) - what I read in the responses to my first post about that have me VERY concerned about the safety (toxicity) of Lithium and how much help it would even be for depression which is more of a problem for me than hypomania.
>
> I find myself in quite a quandry ... I'm so sick and tired of feeling sick and tired and now these med issues are really getting to me. Thanks to whoever can offer some support or suggestions.
Posted by Janelle on March 7, 2002, at 22:04:18
In reply to Re: OH GOSH, I'm so upset, more confused than ever » Janelle, posted by JohnX2 on March 7, 2002, at 19:33:24
Hi John,
I appreciate your kindness in responding to my posts. I'm really in quite a state of confusion and feel torn between the "old" pdoc and those meds and the "new" one with the switch in meds.
Okay, to answer your questions ...
One thing that really bothered me about the new pdoc is NO, he is NOT having me taper off the old meds ... which in the case of Zyprexa I hear it is okay to just stop that one, but EffexorXR I point blank asked him if I could just stop taking it and he said YES. However, I've read up on it and even in the package insert, it clearly and emphatically states that this med one MUST taper off on.
So, new pdoc is WRONG or MISINFORMED about how a patient should go off EffexorXR. Thus, I begin to lose "faith" in him. If I hadn't taken it upon myself to wonder and read up on just stopping EffexorXR cold turkey and had done it as he said, I shudder to think what I would have gone through (last year I went through AWFUL withdrawal from not tapering off Paxil slowly enough - I was sooo sick).
I am currently taking: EffexorXR 150 mg, Klonopin 1mg and Seroquel 50 mg (I have only been on the Seroquel for 2 days, having switched to it from Zyprexa 2.5mg).
If I remember correctly I began taking EffexorXR and Zyprexa at the same time about a year ago, and then a few months later the Lamictal was added in. I have been on Klonopin for many years.
You are right on target - yesterday I did feel frustrated with the old meds, but today, I am indeed feeling that they may not have been so bad, especially after reading the messages on here about Lithium (the question about it being a "natural salt" and the comparison to mercury, which is also natural but is bad news REALLY made me start to ponder the Lithium).
Also, new pdoc is having me take 100mg of Lithobid, which I am begininng to think is so low a dose it might not even make a difference in how I feel or my cycling.
Thinking back, the combo of EffexorXR, Zyprexa, Lamictal and Klonopin had me on my feet and functioning again. It was when the old pdoc felt that I might be able to get by with just the Lamictal without the AD (EffexorXR) and I tapered off the EffexorXR back then that I soon crashed.
This now leads me to wonder if I should just get back to that original "cocktail" rather than switching so many meds. ACCKKKKKKK ...!
Hope this clarifies??!
Posted by Janelle on March 7, 2002, at 22:15:31
In reply to Re: OH GOSH, I'm so upset, more confused than ever » Janelle, posted by Sunnely on March 7, 2002, at 19:55:16
1. New psychiatrist has a very different background and perspective than old one, they disagree on choices of meds. For example, new pdoc is gung-ho on Lithium; old pdoc said for me to AVOID it.
The "old" meds don't seem to be doing the trick ... they're not getting me stabilized - I keep cycling - but it could be because of the absence of Lamictal.
2. The Zyprexa or Seroquel is prescribed for severe anxiety, insomnia and possible hypomania and in the case of Zyprexa to help somewhat with depression.
3. Since Effexor 150 mg/day is helping me, I've decided for the time being NOT to switch to Serzone.
4. I've read elsewhere what you said about how Lithium is more effective in mania than in depression, and I am FAR more plagued by depression than by mania. So, this makes me wonder just how effective Lithium would be for me. Yet, I've also read elsewhere what you said about Lithium being effective as an augmentor to antidepressants in treatment-resistant or partial-response depression, and used a lot for this reason. I seem to have partial-response depression.
By the way, new pdoc prescribed 100 mg/day of Lithobid, which from what I read is starting to sound like virtually nothing. Argh ...!
YES, since I had previous success with Lamictal, it is possible to try it again.
Hope this clarifies things.
Posted by Ron Hill on March 8, 2002, at 1:58:18
In reply to OH GOSH, I'm so upset, more confused than ever, posted by Janelle on March 7, 2002, at 18:13:15
Janelle,
I am sorry you don't feel very well. Remember, it will get better. This is not going to last forever. You have triumphed in prior trials and you will win this battle as well!
My Silly Question: Why did you switch pdocs?
-- Ron
-----------------------> I'm in the process of switching meds due to a change in pdocs, but after reading the responses to my questions further above, I'm now having serious doubts about the switching ... what to do or not to do is now increasing my anxiety, giving me a headache (literally) ... I just don't know what to do ... any comments greatly appreciated.
>
> 1. Do I switch from Zyprexa to Seroquel - well, after a few days on Seroquel, it sure as heck gets me to sleep - I get very drowsy and woozy soon after taking it (50 mg). However, I'm feeling progressively worse each DAY that I'm on it - it seems to have a hangover effect that is troublesome.
>
> Zyprexa not nearly as sedating as Seroquel. The Zyprexa 2.5mg did NOTHING for me, 5.0 was tolerable, but 7.5 was too much.
>
> 2. Do I switch to Serzone from EffexorXR - well, since the Seroquel is proving so sedating do I really want to add another sedating med - I hear that Serzone is quite sedating and I'm not convinced of its efficacy for depression. EffexorXR 150mg is helping me.
>
> 3. Do I start taking Lithium (Lithobid) as a mood stablizer (had previous success with Lamictal) - what I read in the responses to my first post about that have me VERY concerned about the safety (toxicity) of Lithium and how much help it would even be for depression which is more of a problem for me than hypomania.
>
> I find myself in quite a quandry ... I'm so sick and tired of feeling sick and tired and now these med issues are really getting to me. Thanks to whoever can offer some support or suggestions.
Posted by Chloe on March 8, 2002, at 19:05:53
In reply to Answers to SUNNELLY: » Sunnely, posted by Janelle on March 7, 2002, at 22:15:31
> 4. I've read elsewhere what you said about how Lithium is more effective in mania than in depression, and I am FAR more plagued by depression than by mania. So, this makes me wonder just how effective Lithium would be for me. Yet, I've also read elsewhere what you said about Lithium being effective as an augmentor to antidepressants in treatment-resistant or partial-response depression, and used a lot for this reason. I seem to have partial-response depression.
>
> By the way, new pdoc prescribed 100 mg/day of Lithobid, which from what I read is starting to sound like virtually nothing. Argh ...!
>
Hi Janelle,
I am so sorry you are so confused and have a pdoc that wants to turn your life upside down with med changes. IMHO, if something is working, even a little, it's best to add something, or subtract something from the mix. Not throw out the whole mix without taper and start over.I just want to clarify about lithium...I don't think you will be taking the high doses that people with BP 1 need to take. So you will rarely need blood tests after you are stabilized in a very low range, usually around or below 0.6 This is the range where AD augmention is the best. And tends to help those who have a partial response to their given antidepressant.
I don't even want to address the thing about Li being a natural salt like mercury...Since, i don't recall the FDA approving mercury as a treatment for depression/mania recently. LOL
Lastly, I don't think lithobid comes in a 100 mg size. (It would be great if the sustained release came in 100mgs size since I am into taking teeny doses at the moment.) Soo, if your pdoc were to start you on Lithobid, I think the lowest starting dose is 300 mgs. And you could quickly go to 600 mgs which some people find more than enough.
BUT, the above may be totally moot, as you have had some success with Lamictal...I would certainly want to go with something that I have tolerate ok and liked ok in the past. Rather than introducing a whole new chemical...BTW, I have tried lamictal myself, and I find it nothing like Li. For me, it was extremely activating. At first it spun me off into hypomania and insomnia. And then after a time, I just remember having a headache and feeling awful all the time. So everyone reacts differently to meds. I wish your new pdoc knew this and would let you have some say in what works for you and what you "like" to take. That will make you more compliant and happy as a patient and person :)
Best wishes to you
Chloe
Oh, one more thing, Li also is good for psychotic symptoms. I can't take any AP's though I desperately need them at times. Li is the only meds that seems to control distorted thinking, paranoia, etc. that is not an AP. Though I see you are taking AP's for sleep problems, so again, this may be another moot point. Take care. :)
Posted by JohnX2 on March 8, 2002, at 20:34:28
In reply to Re: For Janelle/Li , posted by Chloe on March 8, 2002, at 19:05:53
> I don't even want to address the thing about Li being a natural salt like mercury...Since, i don't recall the FDA approving mercury as a treatment for depression/mania recently. LOL
>This was a joke I made arguing Lamictal not being
potentially more toxic than Li because Li is a more
"naturally occuring substance". ;)-John
This is the end of the thread.
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