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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jerrympls on March 20, 2006, at 2:01:59
Diagnosis: Major Depression, recurrent, treatment-resistnat w/GAD
Lexapro - 20mg
Adderall XR - 20mg 3xdaily
Klonopin - 1mg 4x daily
Hydocan (hydrocodone) - 5mg 4x daily
Seroquel - 100-300mg for INSOMNIA
Ambien CR - 12,5mgI feel relatively stable throughout the day, but as all of this wears off, by nighttime I'm depressed, lonley, anxious, ect.
I HATE the feeling that the bottom could drop out at any moment - and I don't know what could be added to staballize things? Lithium? Depakote? DA Agonists? Lamictal?
The Seroquel is the only thing that will GET me to sleep - but i tmakes me more depressed and makes me sleep for days - if I let it. It's a constant struggle just dealing with the Seroquel. Is there something that can smooth things out WITHOUT making me a zombie, fat, or apathetic?
Any help??
Thanks!
Jerry
P.S. See I told you that opiate therapy wasn't a miracle treatment. I think the biggest problem with my meds is that most of them WEAR OFF - the Adderall, Klonopin, Hycodan, etc. Lexapro helps to a bare minimum. Maybe increasing that?
Posted by SLS on March 20, 2006, at 6:35:20
In reply to I've got a good med combo, but still need advice.., posted by jerrympls on March 20, 2006, at 2:01:59
Hi.
I can think of a number of people here who would recommend that you try to substitute hydrocodone with buprenorphine. I believe it has a longer half-life and produces a more consistent improvement.
Have you already gone down the Nardil road with augmentation?
- Scott
> Diagnosis: Major Depression, recurrent, treatment-resistnat w/GAD
>
> Lexapro - 20mg
> Adderall XR - 20mg 3xdaily
> Klonopin - 1mg 4x daily
> Hydocan (hydrocodone) - 5mg 4x daily
> Seroquel - 100-300mg for INSOMNIA
> Ambien CR - 12,5mg
>
> I feel relatively stable throughout the day, but as all of this wears off, by nighttime I'm depressed, lonley, anxious, ect.
>
> I HATE the feeling that the bottom could drop out at any moment - and I don't know what could be added to staballize things? Lithium? Depakote? DA Agonists? Lamictal?
>
> The Seroquel is the only thing that will GET me to sleep - but i tmakes me more depressed and makes me sleep for days - if I let it. It's a constant struggle just dealing with the Seroquel. Is there something that can smooth things out WITHOUT making me a zombie, fat, or apathetic?
>
> Any help??
>
> Thanks!
>
> Jerry
>
> P.S. See I told you that opiate therapy wasn't a miracle treatment. I think the biggest problem with my meds is that most of them WEAR OFF - the Adderall, Klonopin, Hycodan, etc. Lexapro helps to a bare minimum. Maybe increasing that?
>
>
Posted by jerrympls on March 20, 2006, at 6:51:21
In reply to Re: I've got a good med combo, but still need advi, posted by SLS on March 20, 2006, at 6:35:20
> Hi.
>
> I can think of a number of people here who would recommend that you try to substitute hydrocodone with buprenorphine. I believe it has a longer half-life and produces a more consistent improvement.
>
> Have you already gone down the Nardil road with augmentation?
>
>
> - Scott
>Hey Scott! I was just going to Babblemail you and ask you to have a look at this post.
I've wondered about buprenorphine - my new pdoc seems to be somewhat open-minded so I amy bring that up to him.
As for Nardil - yep - been down that path. Wasn't good.
Anything else you can think of????
Thanks!!
Jerry
Posted by SLS on March 20, 2006, at 7:15:49
In reply to I've got a good med combo, but still need advice.., posted by jerrympls on March 20, 2006, at 2:01:59
> Diagnosis: Major Depression, recurrent, treatment-resistnat w/GAD
>
> Lexapro - 20mg
> Adderall XR - 20mg 3xdaily
> Klonopin - 1mg 4x daily
> Hydocan (hydrocodone) - 5mg 4x daily
> Seroquel - 100-300mg for INSOMNIA
> Ambien CR - 12,5mgSome doctors - probably a minority - see an episodic or recurrent depression as having a bipolar component. If you haven't evaluated the mood stabilizers yet, now might be a good time to consider investigating them.
I have a hard time imagining how a mood stabilizer would remedy the lability of mood that is produced by the daily fluctuations in the levels of hydrocodone.
Have you ever been evaluated for BPD? Do you have impulse control problems? Anger? BPD is more often seen (or at least diagnosed) in females. It does occur in males, but looks different in presentation. If you are BPD, I would recommend going with Trileptal and Zyprexa.
My memory ain't so good, so I can't remember what things you have tried already. It might be interesting to see how you respond to Lamictal. It might not take you all the way to where you want to go, but it might produce enough of an improvement for you to continue to work while searching for a more effective treatment.
- Scott
Posted by jerrympls on March 20, 2006, at 7:23:34
In reply to Re: I've got a good med combo, but still need advi, posted by SLS on March 20, 2006, at 7:15:49
> > Diagnosis: Major Depression, recurrent, treatment-resistnat w/GAD
> >
> > Lexapro - 20mg
> > Adderall XR - 20mg 3xdaily
> > Klonopin - 1mg 4x daily
> > Hydocan (hydrocodone) - 5mg 4x daily
> > Seroquel - 100-300mg for INSOMNIA
> > Ambien CR - 12,5mg
>
> Some doctors - probably a minority - see an episodic or recurrent depression as having a bipolar component. If you haven't evaluated the mood stabilizers yet, now might be a good time to consider investigating them.
>
> I have a hard time imagining how a mood stabilizer would remedy the lability of mood that is produced by the daily fluctuations in the levels of hydrocodone.
>
> Have you ever been evaluated for BPD? Do you have impulse control problems? Anger? BPD is more often seen (or at least diagnosed) in females. It does occur in males, but looks different in presentation. If you are BPD, I would recommend going with Trileptal and Zyprexa.
>
> My memory ain't so good, so I can't remember what things you have tried already. It might be interesting to see how you respond to Lamictal. It might not take you all the way to where you want to go, but it might produce enough of an improvement for you to continue to work while searching for a more effective treatment.
>
>
> - Scott
>Yeah I've been studied to see if there is a BP element to my unipolar cycling - but the last team of psych docs I saw at the University of Minnesota couldn't find anything leading them to BPD. However, I have been on Tompomax, Lamicatal, Lithium, Depakote, etc in the past to see if anything would help. Nothing really worked. I've thought about perhaps trying Lamicatal again....I just don' tknow. I'm back in school and I desparately need some stabalizing med - but at the same time I don't want a new med to impair my concentration & memory - and for some reason I rememeber with Lamicatal (or Topomax?) that one side effect was being unable to vocalize words - meaning, I could see the word in my head, but couldn't say it. It was the wierdest thing.
Posted by SLS on March 20, 2006, at 7:32:48
In reply to Re: I've got a good med combo, but still need advi » SLS, posted by jerrympls on March 20, 2006, at 7:23:34
What about BPD (borderline personality disorder)?
It is unfortunate that this term has persisted, despite the fact that it does not lie on the border of psychosis. There is very likely a biological component to this disorder. Extreme mood lability is one of its major symptoms. Changes in mood can happen several times a day and occur over the course of minutes.
- Scott
Posted by jerrympls on March 20, 2006, at 8:27:33
In reply to Re: I've got a good med combo, but still need advi, posted by SLS on March 20, 2006, at 7:32:48
> What about BPD (borderline personality disorder)?
>
> It is unfortunate that this term has persisted, despite the fact that it does not lie on the border of psychosis. There is very likely a biological component to this disorder. Extreme mood lability is one of its major symptoms. Changes in mood can happen several times a day and occur over the course of minutes.
>
>Hmm I didn't think they used this diagnosis anymore. Interesting. However, I've never had a doctor bring it up....?
Posted by Racer on March 20, 2006, at 11:14:05
In reply to Re: I've got a good med combo, but still need advi » SLS, posted by jerrympls on March 20, 2006, at 8:27:33
> > What about BPD (borderline personality disorder)?
> >
> > It is unfortunate that this term has persisted, despite the fact that it does not lie on the border of psychosis. There is very likely a biological component to this disorder. Extreme mood lability is one of its major symptoms. Changes in mood can happen several times a day and occur over the course of minutes.
> >
> >
>
> Hmm I didn't think they used this diagnosis anymore. Interesting. However, I've never had a doctor bring it up....?
>I wouldn't expect a doctor to bring it up with a man, actually. It's a "woman's disorder" {rolls eyes}, except that it doesn't have to be. It's just like doctors don't think about breast cancer in men, you know? Also, a lot of doctors don't tell patients when they diagnose a personality disorder. At least, that's what I've been told.
Scott's got a good point, that there are some treatments that might be especially helpful for you if you are BPD, which makes it worth talking to your doctor about getting that checked out.
And I wonder if the Adderall could be contributing to this? I would think that 60mg Adderall would make sleep a difficulty, and I'm dropping my Adderall trial (immediate release version) because of irritability and increased depression. It didn't give me any of the benefits of Ritalin, and, although it didn't give me the rotten headaches I got on Ritalin, it gave me the other adverse effects which were just as bad. Maybe one of the other stimulants could give you a smoother ride?
So, Scott asked you about BPD features, here's a quote:
>Do you have impulse control problems? Anger? BPD is more often seen (or at least diagnosed) in females. It does occur in males, but looks different in presentation.
Anything in there fit you? Easily aroused to anger? Slow to return to baseline? Impulsivity? Reckless behavior?
Normally, I get my back up about diagnoses, but when they provide clues towards effective treatment, it's worth looking into a bit more.
Good luck. And wear your sweater, it's cold out there.
Posted by jerrympls on March 21, 2006, at 1:46:30
In reply to Re: I've got a good med combo, but still need advi » jerrympls, posted by Racer on March 20, 2006, at 11:14:05
> > > What about BPD (borderline personality disorder)?
> Scott's got a good point, that there are some treatments that might be especially helpful for you if you are BPD, which makes it worth talking to your doctor about getting that checked out.
>
> And I wonder if the Adderall could be contributing to this? I would think that 60mg Adderall would make sleep a difficulty, and I'm dropping my Adderall trial (immediate release version) because of irritability and increased depression. It didn't give me any of the benefits of Ritalin, and, although it didn't give me the rotten headaches I got on Ritalin, it gave me the other adverse effects which were just as bad. Maybe one of the other stimulants could give you a smoother ride?
>
> So, Scott asked you about BPD features, here's a quote:
>
> >Do you have impulse control problems? Anger? BPD is more often seen (or at least diagnosed) in females. It does occur in males, but looks different in presentation.
>
> Anything in there fit you? Easily aroused to anger? Slow to return to baseline? Impulsivity? Reckless behavior?
>
> Normally, I get my back up about diagnoses, but when they provide clues towards effective treatment, it's worth looking into a bit more.
>
> Good luck. And wear your sweater, it's cold out there.Oh I forgtot to answer his questions - well, I'm not easily aroused to anger - I'm barely arousable to anything. Not much impulsivity either or reckless behavior.
I'm sure that the Adderall does effect my sleep - but it's a double edged sword - without it I cannot get out of bed. I learned that lesson the hard way - I satyed in bed for almost 2 years after graduating college. I did nothing but stay in bed.
I'm just frustrated......ya know?
Jerry
Posted by Racer on March 21, 2006, at 10:49:21
In reply to Re: I've got a good med combo, but still need advi » Racer, posted by jerrympls on March 21, 2006, at 1:46:30
> > > >>
> I'm just frustrated......ya know?
>
> Jerry
>You betcha. I do know.
Got a quick question for you, though: I just stopped Adderall, because it made me so irritable, but I'm wondering if Adderall XR might be more tolerable? Have you tried both versions? (I remember when you first came here -- I think you've tried much more than I have...)
(Speaking of which, you do seem in a much better place now than you were then. I'm glad to see it. I think you had a lot of people worried for you back then.)
Posted by jerrympls on March 21, 2006, at 11:08:26
In reply to Re: I've got a good med combo, but still need advi » jerrympls, posted by Racer on March 21, 2006, at 10:49:21
> > > > >>
> > I'm just frustrated......ya know?
> >
> > Jerry
> >
>
> You betcha. I do know.
>
> Got a quick question for you, though: I just stopped Adderall, because it made me so irritable, but I'm wondering if Adderall XR might be more tolerable? Have you tried both versions? (I remember when you first came here -- I think you've tried much more than I have...)
>
> (Speaking of which, you do seem in a much better place now than you were then. I'm glad to see it. I think you had a lot of people worried for you back then.)Hey Racer-
yeah - I was in a BAD place this past summer - among other times. But I've been relatively stable recently after returning to school.
As for Adderall - I certainly do notice a difference between the immediate release and the XR version. The big difference is the immediate release hits you quickly and quite hard - whereas the XR is VERY smooth. I've been on Ritalin, Concerta, Dexedrine and Adderall and I have to say the Adderall XR has helped me the most. But I don't seem to get increased anxiety or irritability from stimulants - only from being sleep deprived. IF I had to choose a #2 stim, it would be Dexedrine for sure - the extended release form.
I've just started taking a B-complex vitamin supplement to see if it helps with my overall reaction to stressors. I'm also trying a sublingual form of B-12. Ever tried those?
Hope you're hanging in there!
Jerry
Posted by djmmm on March 21, 2006, at 12:32:20
In reply to Re: I've got a good med combo, but still need advi » Racer, posted by jerrympls on March 21, 2006, at 11:08:26
> > > > > >>
> > > I'm just frustrated......ya know?
> > >
> > > Jerry
> > >
> >
> > You betcha. I do know.
> >
> > Got a quick question for you, though: I just stopped Adderall, because it made me so irritable, but I'm wondering if Adderall XR might be more tolerable? Have you tried both versions? (I remember when you first came here -- I think you've tried much more than I have...)
> >
> > (Speaking of which, you do seem in a much better place now than you were then. I'm glad to see it. I think you had a lot of people worried for you back then.)
>
> Hey Racer-
>
> yeah - I was in a BAD place this past summer - among other times. But I've been relatively stable recently after returning to school.
>
> As for Adderall - I certainly do notice a difference between the immediate release and the XR version. The big difference is the immediate release hits you quickly and quite hard - whereas the XR is VERY smooth. I've been on Ritalin, Concerta, Dexedrine and Adderall and I have to say the Adderall XR has helped me the most. But I don't seem to get increased anxiety or irritability from stimulants - only from being sleep deprived. IF I had to choose a #2 stim, it would be Dexedrine for sure - the extended release form.
>
> I've just started taking a B-complex vitamin supplement to see if it helps with my overall reaction to stressors. I'm also trying a sublingual form of B-12. Ever tried those?
>
> Hope you're hanging in there!
>
> JerryHey Jerry...
Im guessing the adderall is keeping you awake...try taking the last (3rd dose) earlier if you can, or eliminate the 3rd dose.....for example, if I take my 2nd dose of parnate anytime after 12 noon, I cant sleep at night, but before 12, Im fine. Also, B vitamins are VERY stimulating for many, try taking it in the morning ONLY. I have had success with Melatonin (9 mgs) and 50-75mg of benadryl knocked me out better than ambien/sonata, etc <---- worked well, but caused rebound insomnia the next night!
Some other "alternative" sleep aids.. you could try an evening yoga class, it has helped me in the past, avoiding caffeine, try some of the teas that promote sleep (like sleepy time tea, or bedtime tea-- both contain relaxing herbs like hops, passionflower, kava, etc). Aerobic exercise can help release the excess adrenaline.
good luck!
Posted by jerrympls on March 21, 2006, at 12:54:06
In reply to Re: I've got a good med combo, but still need advi, posted by djmmm on March 21, 2006, at 12:32:20
> > > > > > >>
> > > > I'm just frustrated......ya know?
> > > >
> > > > Jerry
> > > >
> > >
> > > You betcha. I do know.
> > >
> > > Got a quick question for you, though: I just stopped Adderall, because it made me so irritable, but I'm wondering if Adderall XR might be more tolerable? Have you tried both versions? (I remember when you first came here -- I think you've tried much more than I have...)
> > >
> > > (Speaking of which, you do seem in a much better place now than you were then. I'm glad to see it. I think you had a lot of people worried for you back then.)
> >
> > Hey Racer-
> >
> > yeah - I was in a BAD place this past summer - among other times. But I've been relatively stable recently after returning to school.
> >
> > As for Adderall - I certainly do notice a difference between the immediate release and the XR version. The big difference is the immediate release hits you quickly and quite hard - whereas the XR is VERY smooth. I've been on Ritalin, Concerta, Dexedrine and Adderall and I have to say the Adderall XR has helped me the most. But I don't seem to get increased anxiety or irritability from stimulants - only from being sleep deprived. IF I had to choose a #2 stim, it would be Dexedrine for sure - the extended release form.
> >
> > I've just started taking a B-complex vitamin supplement to see if it helps with my overall reaction to stressors. I'm also trying a sublingual form of B-12. Ever tried those?
> >
> > Hope you're hanging in there!
> >
> > Jerry
>
> Hey Jerry...
>
> Im guessing the adderall is keeping you awake...try taking the last (3rd dose) earlier if you can, or eliminate the 3rd dose.....for example, if I take my 2nd dose of parnate anytime after 12 noon, I cant sleep at night, but before 12, Im fine. Also, B vitamins are VERY stimulating for many, try taking it in the morning ONLY. I have had success with Melatonin (9 mgs) and 50-75mg of benadryl knocked me out better than ambien/sonata, etc <---- worked well, but caused rebound insomnia the next night!
>
> Some other "alternative" sleep aids.. you could try an evening yoga class, it has helped me in the past, avoiding caffeine, try some of the teas that promote sleep (like sleepy time tea, or bedtime tea-- both contain relaxing herbs like hops, passionflower, kava, etc). Aerobic exercise can help release the excess adrenaline.
>
> good luck!Perhaps that's why I got really irritable this morning - I took a B complex vitamin and B-12. I noticed effects rather quickly - irrritated at everything and now I feel "dissatisfied" and depressed - even though I've already taken the Adderall. I didn't think the B vitamins woul dhave such an effect.
UGH I hate this feeling - I just want everything to go away! It's so wierd - I haven't felt like this in a long time. Odd.
This is the end of the thread.
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