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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Wildman on October 17, 2004, at 8:14:53
I've been on a combo of 10mg Lex and 25mg Seroquel for the last 9 months now. My symptoms have gotten much better and my sleep is so much deeper. I don't have _that_ much to complain about.
I have noticed, as we get into Fall here that I am starting to get so tired during the day usually around dinner time. This is the first Fall that I have been on this combo and have always been very sensitive to the amount of daylight (winter is hell for me).
I am wondering if I may need a med change in that I am so tired by the end of the day that the Seroquel almost seems like overkill - I could fall asleep right after dinner and feel like I could sleep through the night.
I'm wondering that as the days get shorter, if I should increase my Lexapro to say 20mg? I have always thought I suffered from seasonal affective disorder and was wondering if more Lex would help.
What about Provigil? Any suggestions?
Thanks in advance.
Wildman
Posted by Ritch on October 17, 2004, at 11:14:17
In reply to Lexapro/Seroquel: After 9 months, posted by Wildman on October 17, 2004, at 8:14:53
> I've been on a combo of 10mg Lex and 25mg Seroquel for the last 9 months now. My symptoms have gotten much better and my sleep is so much deeper. I don't have _that_ much to complain about.
>
> I have noticed, as we get into Fall here that I am starting to get so tired during the day usually around dinner time. This is the first Fall that I have been on this combo and have always been very sensitive to the amount of daylight (winter is hell for me).
>
> I am wondering if I may need a med change in that I am so tired by the end of the day that the Seroquel almost seems like overkill - I could fall asleep right after dinner and feel like I could sleep through the night.
>
> I'm wondering that as the days get shorter, if I should increase my Lexapro to say 20mg? I have always thought I suffered from seasonal affective disorder and was wondering if more Lex would help.
>
> What about Provigil? Any suggestions?
>
> Thanks in advance.
>
> WildmanI have seasonal bipolar depressions (esp. winter) and I have to boost the noradrenergic system to keep my head above water and my energy level from falling to zero. I've never tried Provigil, but adding in some Wellbutrin (bupropion) might be a good low-cost add-on for winter. Nortiptyline might help, too. I've found Stratterra to help with this as well (and it curbs appetite really well, too). SSRI's haven't helped me much in the past for winter depression.
Posted by HappyGirl on October 19, 2004, at 0:31:55
In reply to Lexapro/Seroquel: After 9 months, posted by Wildman on October 17, 2004, at 8:14:53
Hi:
Some of M.I.s have so to speak, 'seasonal symtoms' that need MORE med. dosage. If you'd think 'tiredness' around the dinner time, try to increase Lexapro a bit to see if this can help.Wellbutrin is one of the best meds. for 'energy,' 'wakefullness,' and all other good components, ... I, too agree with. Also, sometime, your symptoms change with time, even the exact same dx (but not everyone, just some of folks). For that reason, your system/brain may need more med. effect.
H.G.
Posted by Wildman on October 19, 2004, at 13:15:34
In reply to Re: Lexapro/Seroquel: After 9 months, posted by HappyGirl on October 19, 2004, at 0:31:55
HappyGirl,
Thanks for responding. I decided to bump my Lexapro to 15mg/day from 10mg and this is now day #2. I am finding that, so far, this seems to be a move in the right direction (very mild hypomania with an energy that lasts all day).
I know it will take a week or so to really get the full impact of this change but it's been positive so far.
I did have to double up my nightly Seroquel last night to 50mg, but I've had to do that before when I've had a very busy day combined with random mild hypomania.
Not sure if my pdoc would be up for adding Wellbutrin, he may be more inclined to support keeping the Lex at 15 and using 25-50mg Seroquel as needed.
I appreciate your insight into the seasonal components of my situation. While I have been battling this stuff for the last 20 years, I've only seen a pdoc and been on meds for the last 9-10 months now, so I haven't had a chance to see what a full year cycle is like. I was starting to really dread the cooler temps, cloudiness and short days, but I can almost now see myself getting through this winter with a minimum of issues.
If I have the right tools (and I think Lex/Seroquel have been great for me so far) then I can handle tweaking the dosages depending on the seasons. The alternative is not pretty - slogging my way though winter, cabin fever, short temper and grumpiness, lethargy, anhedonia, the list goes on.
I'm not scheduled to see my pdoc for about another month and am debating about whether to inform him of my little experiment right now. I'm sure he'll want me to come in right away to discuss it, but it's too expensive to see him for something like this, and think I may wait for our regular time.
Wildman
Posted by HappyGirl on October 20, 2004, at 0:23:37
In reply to Re: Lexapro/Seroquel: After 9 months, posted by Wildman on October 19, 2004, at 13:15:34
Hi Wildman:
I'm glad to know your med. increase, both Lex. and Seroquel working on you good.
Normally, ... although this is to be my personal experience, there needs to increase med. dosage after 9-12 months when your system started to adjust the med. combo. COMPLETELY. Then, I didn't surprise to see your problem as to med. adjustment/increase.In my guess, ... if this med. adjustment does NOT offer enough relief, then your pdoc. most likely adds one more med. which may NOT be another SSRI, rather other class of A.D. which may give you 'wakefullness.'
As to Wellbutrin, ... it's one of best meds. which has stimulating effect. For that reason, some of folks taking WB for concentration and energy. Also, there is NO weight gain, rather losing some weight and PLUS for good relationship. Then, in this regard, WB is one of most unique A.D.s. However, some saying S.E.s from WB is intolerable. Then, it's tough to say whether this med. is for you. At least, in my case WB has been helping me GREAT deal.
That being said, ... some saying, if you experience hypomanic from any of SSRIs, then just take it as needed whenever your depressive episode starts hitting you hard. Otherwise, take it as rxed due to inducing hypomanic from any of SSRIs. Also, stress triggered by working hard or any hectic events could exasperate depression. Then, I'm guessing you may need some rest on both physical and mental aspects as much as possible during weekends.In regard to appt. with the pdoc., ... normally most of pdocs. do NOT mind his/her patients making med. dosage adjustment without visiting/asking the pdoc. unless you started taking more than 'recommended/standard dosage.'
However, if your symptoms for some reason change, you may need to call the pdoc. before your regular visit next month.
H.G.
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