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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Zana on April 20, 2009, at 16:11:45
So, I am working with a new pdoc, first one I've seen since my old one dumped in frustration after 15 years. Bear with me; I know a lot of you have read this stuff before.
Am feeling a fair amount of confidence in her but she's a little what? loose, breezy, casual? She makes me feel a little nervous about my meds for reasons I can't quite put my finger on. And I am taking a lot of meds: 50mg Pristiq; 100mgs Provigil; 900mg gabapentin; 45mg Remeron; 300mgs Seroquel; 3mg Klonopin.
My diagnosis is major depression- has been for a long time. I became profoundly depressed about a year and a half ago when it became clear that my husband was about to lose his 4th job in 9 years. I have not been able to work for 5 years. I was bearly able to leave my bedroom or the house for about 9 months.
Since starting the Pristiq, I have been feeling better. But, you know how it goes, they never stop a med before adding a new one and before you know it you are taking a stew of pharmaceuticals and have no idea what any one of them is doing good, bad or indifferent.
It bugs me. It distresses me. I have no idea what is going on under all these meds. I have no idea which of them is helping and which are hurting. But I am feeling better. Maybe it's not important to know if I really need 300 mgs of Seroquel. Maybe it's OK to take 45 mgs of Remeron even though 15 would put me to sleep and it didn't seem to have any AD effect for me. But maybe the 45mgs of Remeron is keeping me from becoming agitated on the Pristiq, which has been a common result for me on SSRIs and SNRIs.
My old pdoc dumped me because she had run out of ideas. I went to a highly touted pdoc for a consult and he didn't have any new ideas except to try Pristiq and to add risperidone or substitute it for Seroquel.
So I should be happy, right? I am not terribly depressed right now, dispite the fact that my husband is out of work and we may lose our home. I guess we could say the meds are working.
But I feel very unsettled. Maybe it's the Provigil. Maybe it's me. I feel like I never know anymore what's me and what's the meds. I don't think I could live without them and I hate that!
I hate being dependent on this pdoc, on the meds, on my husband. My whole life feels dependent on external forces. It s*cks.
Posted by sowhysosad on April 20, 2009, at 16:43:28
In reply to If it ain't broke don't fix it?, posted by Zana on April 20, 2009, at 16:11:45
I'm in a really similar position to you at the moment so I sympathise 100%! Also share your concern about taking multiple meds.
I don't know a great deal about med combos, but I did read with interest that over here (the UK) most combos aren't approved for major depression because they just don't think the scientific evidence for their effectiveness is convincing enough.
A guy in the US with BP disorder I met in a chatroom had switched to a "minimalist" pdoc, who believed in using a bare minimum number of meds and only treating symptoms as they surfaced. He was only taking lithium, after years on 4-5 meds, and felt better than he had in some time.
Perhaps - under a doc's supervision - you could try withdrawing some of the meds one by one to see how you react.
Posted by Zana on April 20, 2009, at 17:00:44
In reply to Re: If it ain't broke don't fix it? » Zana, posted by sowhysosad on April 20, 2009, at 16:43:28
Thank you for your thoughts. I have had the same idea: maybe I could start reducing one med at a time and see what happens... get down to the least I need. I just don't know if I'm already at the least or not. I guess there's only one way to find out.
I too have seen studies that say people don't do any better on combos than on fewer meds.
Well, thanks again. It's nice to have a sympathetic ear.Zana
Posted by sowhysosad on April 20, 2009, at 17:30:16
In reply to Re: If it ain't broke don't fix it?, posted by Zana on April 20, 2009, at 17:00:44
Pleasure Zana!
Unless you have BP I, manic episodes or psychotic depression I'd guess the Seroquel is largely acting as a sedative and serotonin/adrenaline receptor blocker.
But Klonopin and Remeron are sedatives too, and Remeron blocks some of the same receptors (the Remeron may, as you say, be preventing you getting agitated on the Pristiq by blocking the relevant serotonin receptors).
Perhaps Seroquel would be the med you'd miss the least?
There's a lot of controversy about Gabapentin's use in psychiatry too, and apparently not much convincing evidence that it actually achieves anything.
And maybe if you lowered your intake of sedative meds you wouldn't need a stimulant like Provigil?
Can any of our psychopharmacological experts advise?
Posted by Zana on April 20, 2009, at 18:21:59
In reply to Re: If it ain't broke don't fix it? » Zana, posted by sowhysosad on April 20, 2009, at 17:30:16
Yes, I'd love to hear from some of resident experts.
Thanks again.
Zana
Posted by raisinb on April 20, 2009, at 21:18:43
In reply to If it ain't broke don't fix it?, posted by Zana on April 20, 2009, at 16:11:45
Hi Zana--
Do you have a therapist you can work with, too? Some of the stuff you expressed--like hating your dependence--are more than med-related and maybe you could work with a therapist about them.
Posted by Phillipa on April 20, 2009, at 23:59:07
In reply to Re: If it ain't broke don't fix it?, posted by Zana on April 20, 2009, at 18:21:59
Zana since kind of in same position of fear and lack of money and the job I feel some is just plain fear. I know mine is. As when I can forget feel better. It is a lot of meds. What did the new pdoc say? Stay on them all? I think I might try cutting down on either seroquel or remeron. But you know your body best. Love Phillipa
Posted by jedi on April 21, 2009, at 3:18:24
In reply to If it ain't broke don't fix it?, posted by Zana on April 20, 2009, at 16:11:45
Hi Zana,
With your current financial and security challenges, I would suggest not doing a lot of experimenting right now. If the major depression is under control, look at the title of the thread. It is perfectly normal to feel some stress when faced with the challenges you are facing right now. The main thing is keeping the major depression under control. I fear that if you start changing things while in the middle of this stressful financial situation, the major depression could return.When your husband is working again and the stresses of life are not so great, that is the time to work on decreasing the meds. I am probably not the one to give this advice, since my life is always stressful, and I am constantly challenging myself to get on as few meds as possible. But I do know from experience, when your life is hectic and stressful, it is not the best time to adjust a working cocktail.
Be Well,
Jedi
Posted by Zana on April 21, 2009, at 16:53:22
In reply to Re: If it ain't broke don't fix it? » Zana, posted by raisinb on April 20, 2009, at 21:18:43
Thanks for asking. Yeah, I do have a therapist and the issue of trusting my "helpers" is a big issue. I keep looking for the perfect med or combo. Therapy takes so long... But my therapist is very committed and sure that he can help me and that therapy will work. I'm less sure.
Thanks again.
Zana
Posted by raisinb on April 22, 2009, at 14:46:41
In reply to Re: If it ain't broke don't fix it?, posted by Zana on April 21, 2009, at 16:53:22
Good. He sounds like a good one. Keep working--the answers are out there.
Posted by desolationrower on April 24, 2009, at 16:49:56
In reply to Re: If it ain't broke don't fix it? » Zana, posted by raisinb on April 22, 2009, at 14:46:41
zana, if i didn't post about your drug combo, make a post directed at me, although i agree with jedi
but i think you might benefit a lot from mindfulness meditation.
-d/r
This is the end of the thread.
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