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Online 2sungo

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back and forth
« on: August 21, 2014, 02:35:45 PM »
So I had another week or more of good days, where I was able to drink green tea, which seems to make me happier and gives me more energy, and then once again in the last couple of days, crash, not feeling so great.  I had been slowly lowering my klonopin back to 1 mg, thinking that might be making me more depressed during a few days before I felt better again, but last night I took 1 mg and took .5 this morning, but still feel anxious and depressed.  Am still on 50 mg pristiq, half a 15 mg remeron at night, and 5 mg Lexapro.  Will see pdoc on Friday, and of course that always makes me anxious.  My pulse has been running fast even though I have managed for quite some time not to use the bp monitor, my bp is almost always fine, its my pulse that gets high when I am uncomfortable, and maybe even when I am okay.  I can remember a few days ago not having any anxiety whatsoever then it comes back along with depression.  It seems I just cant seem to beat it once and for all this time, I have periods of improvement then relapse, before it would just go away after a while.  There are times I can accept it and not worry too much, and other times where it gets to be too much.  I probably didn't help myself yesterday when I was reading a very long thread about Brintillex, one of the newer drugs, seems like everything else it works for some and not at all for others.  I want something that is going to work for years like before.  Zoloft did work for me twice but made me tired and caused a hand tremor the second time and anorgasmia, so I switched to other drugs that also worked but with less side effects--but they pooped out after several years (serzone first time then Lexapro second time).  Still, I would do it again if it would give me stable improvement like before, I will talk to my pdoc about it.  However its also a bad time to change much with work about to begin again in about a week.  I find it weird that I can feel so good on some days, and then back to square one, complete with stomach rumbles, fatigue, agoraphobia, lethargy, dry mouth, pit in stomach, and sometimes that horrible arm skin burning feeling.   Sometimes I get really hopeful that the periods of good days signal that I am getting better but then I have a downturn and it feels so bad then.  Its like I am almost there, but I can't make it stick.  Is this normal for a lot of us, maybe it is the darkness before the dawn kind of thing? 






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Re: back and forth
« Reply #1 on: August 21, 2014, 06:13:18 PM »
Its like I am almost there, but I can't make it stick.  Is this normal for a lot of us, maybe it is the darkness before the dawn kind of thing?

Maybe. Frankly, if it was in my power, I'd stick you into a hospital bed, take you off all your meds and then get you onto one antidepressant at a significant dose and keep you on it until it fully kicked-in coupled with daily therapy. But this probably isn't possible in your hospital system. :(  However, I think a single antidepressant would be a better way to go that taking a collection of meds at barely therapeutic doses and below.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Online 2sungo

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Re: back and forth
« Reply #2 on: August 21, 2014, 07:50:05 PM »
Yeah, Ian I can see where that might be a good idea, but you are right, our hospital system doesn't work like that and isn't well designed for our kind of folk, they segregate the "mental" patients from the rest as though the brain was an organ different than a liver.  Plus they put all kinds of different "mental" conditions together which must be depressing and/or anxiety provoking in itself.  If I had a million dollars to spare I am sure I could arrange something like you suggest, but I don't.   I am doing therapy, and I try my best to replace my distorted negative thinking with better ways of looking at things, but on a bad day, which today was, not much helps.  I kept trying to read the book Feeling Good by Dr Burns, going over how to recognize and change depressive thinking but I kept falling asleep.  I felt a bit better speaking with my therapist, who does understand this stuff from a personal as well as professional perspective.  I wrote down stuff in my journal, including her suggestions which I mostly already know, but on a day like today the best I can do is let it pass and hope for better.  Tomorrow is pdoc appointment, that's where meds need to be discussed, I just wish she hadn't gone on a three week vacation (plus I had to wait another week from when she got back for my apt) so its a bad time to redo meds with work fast approaching.   I did have recent blood work which showed I had very low serum serotonin, its not a usual test and I don't think I had it before, but it was below 25 and the normal range I think starts at 50 or so.  At least it wasn't too high, that is serious, but I cant find much about the significance of it being too low and at this point I don't care, just want to feel better. 
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Re: back and forth
« Reply #3 on: August 21, 2014, 08:26:51 PM »
I did have recent blood work which showed I had very low serum serotonin, its not a usual test and I don't think I had it before, but it was below 25 and the normal range I think starts at 50 or so.  At least it wasn't too high, that is serious, but I cant find much about the significance of it being too low and at this point I don't care, just want to feel better.

Two things to keep in mind are that the brain is only a minor user of serotonin, less than 2% of the amount made and used by the body, the gut accounts for 95%, plus the brain is separated from the rest of the body by the blood-brain-barrier, so IMHO, serum levels tell you very little about the relationship of serotonin with what is going on in the brain (there is as much serotonin stored in platelets as used in the brain). And secondly, antidepressants actually reduce serotonin synthesis and expression after a few weeks.

The only real concern with low serotonin levels might be that it is involved in blood coagulation and wound repair so low platelet levels may cause bleeding and/or slow wound healing. If you're not having any problems with either then there is no cause for alarm. Also, as per above, the gut is the major user so low levels may cause either diarrhea or constipation. Again, if you're not having problems then the low serum level probably doesn't matter.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Online 2sungo

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Re: back and forth
« Reply #4 on: August 22, 2014, 05:38:13 PM »
Ian, the pdoc told me the serum serotonin level didn't matter, as you pretty much said, she said its what's in the brain that counts.  I was in a state when I was in her office at least in the beginning, just so frustrated by all of this, but she wants to proceed cautiously, so she wanted me to increase the lex to 10 mg from 5, and klonopin to 1.5, 1 at night, .5 in the morning and more if anxious.   She mentioned possibly using mood stabilizers at some point but not now, she doesn't want to add any more meds, she wants me to feel better first and then reduce one of the meds at least.  She also emphasized doing daily guided meditation practice to stabilize the nervous system, by strengthening the parasympathetic part.  She thinks situational stuff has a lot to do with it, b/c sometimes I am good, and then crash.   Before I had more of a support system in that I was never alone at home, nowadays that is often the case until evening.  I can only hope that the extra serotonin boost from a bit more lex does something, and the klonopin calms me, I am worried about it making me depressed but I cant seem to do without it yet either.  Plus when all this began I was both anxious and depressed, and my uncle who is going thru something similar describes symptoms like mine in the beginning--losing weight, loss of interest in things, afraid to go anywhere, nervous, fatigue, morning dread etc., I have done better relatively speaking in the similar time frame we have been sick, which was just before my mom died for me and right after she died (his sister) for him.  He doesn't take any benzo (was on Ativan and just stopped, says he can sleep okay though) and is on 10 mg of lex, I suggested he may need to up that.  Where he is there aren't many good docs around and he is not willing to see a pdoc so his anxious depression has been the worst for him so far too. 
I did come across some studies on the net mentioning statins and low cholesterol being a possible cause of anxiety/depression and I did mention that to my pdoc.  She asked me if I was on one, and I told her yes (I know I must have told her this before) but didn't follow up on that line of thought.  She does want me to increase my fish oil pills from 2 to 3 then maybe 4 a day, says that should also help anxiety. 
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Re: back and forth
« Reply #5 on: August 22, 2014, 06:11:52 PM »
I can only hope that the extra serotonin boost from a bit more lex does something

if it does the most likely reaction will be heightened anxiety and other side-effects for a while. Fortunately, after a week or two serotonin levels in the brain should drop back to the previous baseline in most brain regions and often well below it in areas associated with anxiety and depression. Antidepressants reduce brain serotonin levels, they don't increase them as the popular mythology maintains.

Quote
I did come across some studies on the net mentioning statins and low cholesterol being a possible cause of anxiety/depression and I did mention that to my pdoc.

Low cholesterol can affect the brain which is made up mostly of fats including a high percentage of cholesterol. There have been a couple of studies showing that those with low cholesterol levels don't live longer than those with high levels because they are more likely to have violent deaths through accidents, etc. So it may be important for the med dose taken to be only just enough to bring levels into the normal range. Unfortunately, I'm one that has naturally low cholesterol levels so will probably end up running amok on my 100th birthday and meet an unfortunate end. That's the plan anyway. :winking0008:

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Online 2sungo

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Re: back and forth
« Reply #6 on: August 22, 2014, 09:54:49 PM »
I think I did feel a bit more anxious, but not in a really bad way, after I upped the lex dose this evening, but it was not long lived and could be placebo effect for all I know.  This should be similar to when I was tapering the lex and going onto Pristiq last spring, for a while I was on both and as we know Pristiq comes in a 50 mg pill so its all or nothing.   I didn't have much trouble with the transition (other than some anxiety and mostly minor stuff) until after I went off the lex totally, then I remember crashing a week later.  Then we tried to raise the Pristiq to 100, no go, then add the remeron (okay at half a pill but not at 15 mg and still not doing the job) then added back lex at 5 mg with mixed results.  I also think the klonopin at 1.5 mg should quell most anxiety, and I can take more if it gets too bad.  I just hope it doesn't add to the depression that seems to be strong with this anxiety spell.  I need to be able to function as school starts soon, and that itself can be a stressful thought.  I really think, though, that afterwards I'd rather go back on lex or some SSRI (not Prozac, that gave me akithisia or however its spelled many decades ago) than mess with mood stabilizers other than klonopin, if it can be called that.  I guess a lot of people take Seroquel but its in the same class I think as sapphris, which made me black out and go to the er with the one and only dose I took (my wife has never recovered from the sight of me on the bathroom floor that night, lucky I didn't hurt myself falling, I don't even remember blacking out--and I never have on any other medication in my life) and while it seems to be good at stopping anxiety it also seems to mess with ones metabolic profile and is another thing that doesn't sound like fun to go off of.  Lamactil sounds great for those for whom it works, but again has issues that would be deal killers for me. 
As for cholesterol, its not that mine was ridiculously high, but my HDL was low, so I needed to get it down from about 210 or so, and I must say Lipitor did the job, it usually hovers around 130 or 140ish or so, and my HDL has gone up significantly as I have lost weight and/or because of the fish oil pills.  Since I've been tested for most things under the sun like most anxiety folks, I already know I have some mild plaque in my carotid arteries, so hopefully this slows down its buildup.   Of course, if Lipitor was what made me have this current round of anxiety/depression I would go off it immediately, but I've been on it for years without problems before.  I am sure my mind issues are not that simple anyway, if they were then the fish oil would have fixed it, let alone the meds.   I wasn't gifted with genes for low cholesterol anyway, so I don't expect to make it to 100, but I would like to live the rest of my life without anxiety and depression, I feel like its wasted time that instead could be enjoyed like before.  I have to admit, though,  there have been some good days even during this year and a half long hell where I have glimpsed my former life, and that gives me hope.
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