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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by geno on March 22, 2002, at 20:08:31
3 beers or any others,
here is my med regiment. Note i still suffer from social phobia, alternating mood ups and downs.
Remeron 30mg bed
Paxil 10mg Bed
Desipramine 25mg bed
klonopin 1mg amThis combo is effective for sleep and anxiety. Very effective. Paxil and remeron work great for falling and staying asleep and i wake up rested. The desipramine gives me a lift from remeron sedation without axiety at this dose. BUT im still not social or outgoing.
I suspect if i swith to zoloft, which is more activating, would be better. esp at higher dosages. I could drop the remeron, but my sleep will go to heck. Id like to try dexadrine sap, but what do i tell my doc next week to get this. Maybe hell drop the desipramine and give me this med, telling him im too sedated, and paxil is making me too sedated, so swith me to zoloft. I also suspect if im on dexadrine/zoloft which both would be activating, the remeron/klonopin will counteract that, leaving me at a happy medium.what do you think?
geno
Posted by 3 Beer Effect on March 23, 2002, at 0:13:15
In reply to To 3 Beers, posted by geno on March 22, 2002, at 20:08:31
One problem is that at 50 mg, the starting dose of Zoloft, has not proven very effective & would probably make you sleepy- for me, 50 mg didn't have much of an AD effect. Zoloft 100 mg is approximately equivalent to Paxil 20 mg or Prozac 20 mg (Prozac is slightly more stimulating but causes more nervousness) & many people said the makers of Zoloft screwed up by making the starting dose too low. I found Zoloft 100 mg to be a very good & strong anti-depressant, the only trouble was I couldn't sleep at night. But if it was combined with Remeron at night, the Remeron blocks the bad serotonin receptors that cause sexual probs & insomnia that SSRIs like Zoloft or Paxil act on.
I think Zoloft 100 mg/morning and 15 to 30 mg of Remeron at night would be a good combination. Remeron when mixed when an SSRI does not usually cause serotonin syndrome, but if you combined Paxil & Zoloft it could so be careful. Combining 2 SSRIs is almost always a bad idea.
The Klonopin in the day will help offset the sometimes notable anxiety that occurs for about the first month with Zoloft- you probably won't need the dexedrine for the 1st month, in fact I think it might be better for you to avoid it b/c I think the combo would make you too nervous for the first month & you would end up quitting one or both. The first month on Zoloft can be rough because it causes anxiety and takes 3-4 weeks to start working well, but eventually your anxiety lessens (After 1-3 months). But if you do take Dexedrine for social phobia, it is best to take the low dose- 5 mg 2x per day (when you want to wake up & 6 hours later- but never later than 2-4 pm). You might tell him you'd like to switch to a Zoloft/Remeron combo because the Paxil is making you too sleepy and you'd like to quit the Desipramine b/c its an old tricyclic drug with "fill in the blank" whatever side effects its causing.
If the Zoloft and/or Dexedrine are overstimulating & cause insomnia you could reduce the Remeron from 30 mg to 15 mg since Remeron is most sedating at lower doses.
Its hard to tell how to get doctors to give you a prescription. If he knows anything about your GHB or drug use history I seriously doubt he would give you any dexedrine, but I guess it never hurts to ask. To ask, I would make an offhand comment about the dexedrine last, after he has written the Zoloft/Remeron/Klonopin prescriptions & say that you've read that it has helped people improve both their confidence, outgoingness, & that also you have trouble concentrating sometimes anyways. Don't request or tell him to prescribe it, it is better to turn it into a question in order to feed their monstrous Dr. ego. Like "Do you think maybe Dexedrine might be a good idea because I read blah, blah, blah?"
Its always hard to tell what your going to come out of there with. But anyways I would recommend the following for the 1st month- Zoloft 100 mg/morning; Klonopin 1 mg/morning; Remeron 30 mg/bedtime. If you wait to ask for the Dexedrine in the second month (return visit) you would probably have a much better chance of getting it- doctors don't like to make too many medication changes at once. Also, you might not even need the Dexedrine after a month on Zoloft 100 mg.
Posted by geno on March 23, 2002, at 17:44:25
In reply to Re: To 3 Beers, posted by 3 Beer Effect on March 23, 2002, at 0:13:15
Thanx 3 beers,
Ya that sounds like a plan. ALthough my sex drive initially from remeron went down, at 30mg. Paxil killed it more. So im taking some testosterone cream for sexual aid and muscle building. I like the dexadrine mixined with the klonopin.2 questions. How does dexadrine differ from desipramine. I know desipramine hits norepinephrine. Second, will the dexadrine work like welbutrin, because welburtin was a nightmare panic attack for me! Sometimes even a cup of coffee will make me edgy, even on 1mg of klonopin, but sometimes it will make me talkative. Desipramine side effect are increased heart rate. I also feel a body and head tingle from it, which actually is pleasant, but nothing to do with social interactions.
If dexadrine is a disinhibitor and causes some euphoria, ill do good on it, in combo with klonopin, then use remeron for sleep and zoloft for depression/mood. But ill start with telling the doc to switch me to zoloft. then next visit mention dexadrine.
ps. He knows about me history of ghb abuse. But dexadrine is an upper. GHB alcohol are downers, which i like so he may take that into consideration. He wont pescribe me more than 2mg of klonopin or 1mg of xanax a day.
geno
Posted by 3 Beer Effect on March 24, 2002, at 0:34:34
In reply to Re: To 3 Beers, posted by geno on March 23, 2002, at 17:44:25
Don't take Dexedrine while you are taking Desipramine. Desipramine & the other tricyclics don't affect dopamine but they mainly work by increasing norephedrine. Dexedrine increases both norepinephrine & dopamine. If you take Desipramine with Dexedrine you will probably become a nervous/insomniac wreck & it could be a dangerous drug interaction.
Dexedrine differs from Wellbutrin since Dexedrine causes a euphoric "on top of the world" feeling without much nervousness. I would guess from reading your posts for a while that the normal ADD dose of 10 mg 2x a day would make you too nervous & you'd be better off with 5 mg 2x a day (the best social phobia dose). For me, caffeine (1 No-Doz causes more anxiety than low dose dexedrine). Caffeine is an anxiogenic with minimal euphoric properties= not a very good social phobia medicine. Don't drink caffeine while taking Dexedrine.
I tried a friend's Wellbutrin SR for a week when I ran out of Ritalin & couldn't find any Adderall to buy off anyone during finals week. Wellbutrin SR 300-450 mg day made me feel like a dog took a cr*p on my head & made me want to throw up.
Posted by Bekka H. on March 24, 2002, at 1:18:00
In reply to Re: the Wellbutrin dogturd effect, posted by 3 Beer Effect on March 24, 2002, at 0:34:34
Wellbutrin SR 300-450 mg day made me feel like a dog took a cr*p on my head & made me want to throw up.
***********************************************
Well, those aren't the exact words I would have used, but I think Wellbutrin is highly overrated. I do not understand why Wellbutrin isn't a restricted drug. I function so much better on a low dose of Dexedrine than I ever did on Wellbutrin. I know a few people who do well on it, but the majority of people I know on Wellbutrin become hypomanic and/or manic and develop all sorts of grandiose ideas about themselves. I've also seen Wellbutrin unearth a lot of rage in a number of people.
Now, 3 Beers, as much as I am amused by your uninhibited, colorful language, I do hope you will be careful. We don't want you to get blocked because we enjoy having you here!
Posted by Zo on March 25, 2002, at 17:18:55
In reply to Re: the Wellbutrin dogturd effect, posted by 3 Beer Effect on March 24, 2002, at 0:34:34
Didn't I get on your case before about these one-week speed-trials of meds? I mean--in the nicest possible way--if you're going to post negative subject lines on a med, it would be cool if you had also used it within any known protocol on this planet.
Or make that very clear in your post. Here's an example: I went hog wild crazy bejesus with Wellbutrin for a week, and boy did I feel like crap.
And then we get to say, Oooookay.
Ah, youth. Fondly,
Zo
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