Question:

I posted earlier that it’s starting to seem that albuterol is either not working, or, is actually starting to tighten me up, rather than loosen me up (paradoxical reaction?).  I seem to be tight all the time (have been checked for heart and other lung issues, but, nothing shows up). I finally convinced my doctor to try me on another MDI, so, he gave me Alupent.  I’ve tried it twice today (first time 2 puffs, second time, 8 hours later, three puffs, and don’t really see that it does anything–my pulse isn’t even going up, and, I don’t have any kind of nervous feeling. Any others have experiences with this? TIA!

Response:

Yep, I have asthma–all my life, and I’m 50.  I’m using Flovent and Serevent, too.  My doctor wanted to try me on MaxAir, rather than Alupent, but, the Pharmacy doesn’t stock it.  I’ve used the Alupent several times, and, it doesn’t really seem to do…anything–not even making my heart race. – Hide quoted text — Show quoted text – I posted earlier that it’s starting to seem that albuterol is either not working, or, is actually starting to tighten me up, rather than loosen me up (paradoxical reaction?).  I seem to be tight all the time (have been checked for heart and other lung issues, but, nothing shows up). I finally convinced my doctor to try me on another MDI, so, he gave me Alupent.  I’ve tried it twice today (first time 2 puffs, second time, 8 hours later, three puffs, and don’t really see that it does anything–my pulse isn’t even going up, and, I don’t have any kind of nervous feeling. Any others have experiences with this? TIA! Alupent is generaly not considered as good a beta2-agonist bronchodilator for asthma, as albuterol. Alupent is not listed as a preferred drug in the latest asthma guidelines. There are other beta2 agonists that are listed, like terbutaline & pirbuterol. It sounds like you may need a steroid inhaler for long term maintenance; like Pulmicort or Flovent. Have you had PFTs [pulmonary function tests] to demonstrate you have asthma? Ellis

Response:

Question:

My wife and I moved to Grande Prairie, Alberta, a year ago.  We came here from Prince Edward Island.  She is an American from Illinois. Since we got here, she has had increasing problems with her asthma, to the point that she is now being monitored and on a whole raft of medications, using sidestream, the whole nine yards.  My question is this; Is there any place in Alberta that is safe to live, or does the whole province pose a health risk to asthma sufferers.  If we can find relief further south, then we are willing to look at that option. Mike Nantau

Response:

Moving anywhere can usually be counted on to introduce the asthma sufferer to new triggers.  As usual it takes a while to get accustomed to them.  Hang in there. — Murray Stone phone:  (403) 486-5146  fax:  (403) 483-7791 snailmail:  616-21, 10405 Jasper Avenue Edmonton, AB, T5J 3S2 Canada

Response:

South is not good.  Here in Calgary asthma is pretty common.  Mine has gotten worse since moving here…but it is a beautiful city and I am not leaving.  I never had any problems in Grande Prairie with my asthma. – Hide quoted text — Show quoted text – My wife and I moved to Grande Prairie, Alberta, a year ago.  We came here from Prince Edward Island.  She is an American from Illinois. Since we got here, she has had increasing problems with her asthma, to the point that she is now being monitored and on a whole raft of medications, using sidestream, the whole nine yards.  My question is this; Is there any place in Alberta that is safe to live, or does the whole province pose a health risk to asthma sufferers.  If we can find relief further south, then we are willing to look at that option. Mike Nantau

Response:

South is not good.  Here in Calgary asthma is pretty common.  Mine has gotten worse since moving here…but it is a beautiful city and I am not leaving.  I never had any problems in Grande Prairie with my asthma.

Hi, My asthma also seems to be a lot worse since I moved here to Calgary from Ottawa 10 months ago. However, I also love it and am not planning on leaving. I thought that the dryness (Ottawa is VERY humid) would improve my allergies and asthma, but it seems to have made me more sensitive. I’ve been to emerg 5 times since I’ve been here, but 4 of those times were prolonged exposure to a cat and the last one was the result of what I *think* is bronchitis (I’ve been coughing for 2 weeks!) So, I guess these weren’t speciically due to living in Alberta. I have noticed that the respiratory therapists seem a bit behind here in terms of medication. Each time I have been to emerg (at 3 different hospitals) and they ask me what I’m taking I show them my Maxair which I take along with Beclefort. In each case they had never heard of Maxair before. I thought that was kind of strange because it came out in Ontario about 6 months ago. I find Maxair to be wonderful, literally instant relief. Any suggestions on how to cure this bronchitis? My gp put me on antibiotics 2 days ago but it doesn’t seem to be going away. I’m having trouble sleeping because whenever I lie down I have a huge coughing fit. The Maxair doesn’t stop the cough or the congested feeling. I took an expectorand cough syrup – but stopped when I started on the antibiotics. Should I go back on the cough syrup too? Everyone in my office is buying me halls and bringing me water – very embarassing. Thanks for any advice. Alyssa PS – I tried Flovent and it made me cough even harder.

Response:

Question:

i did literature search using Medline this afternoon, in between the patients ! But i did not find any article on "flovent and acne" or "flovent and rash" or "flovent and skin" good luck with aerobid. yatin j patel md http://md4lungs.com – Hide quoted text — Show quoted text – –WebTV-Mail-24826-3781 Content-Type: Text/Plain; Charset=US-ASCII Content-Transfer-Encoding: 7Bit Thanks for your response. My doctor put me on Aerobid about two weeks ago. So far I seem to be doing alright on it. Then again, I have been on an antibiotic, as well as O2. I finish it tonight. We shall see. However, I still have the red bumps. Perhaps they will clear up with time. I must tell you that I have COPD. Scaring on my left lung since childhood,bronchitis, and asthma. I became sick four years ago. Had to be hospitalized for a week, and was sent home with the O2. I was on it for about two months. Had to go back on two weeks ago. I checked out your website. I will be visiting often. We all use the same treatments and medications. –WebTV-Mail-24826-3781 Content-Description: signature Content-Disposition: Inline Content-Type: Text/HTML; Charset=US-ASCII Content-Transfer-Encoding: 7Bit <html<clock</clock</html –WebTV-Mail-24826-3781–

– Yatin J Patel MD http://md4lungs.com If you have asthma, this is your home. Join Dr. Patel every wednesday 7 PM Indiana Time for online chats. Before you buy.

Response:

Thanks for your response. My doctor put me on Aerobid about two weeks ago. So far I seem to be doing alright on it. Then again, I have been on an antibiotic, as well as O2. I finish it tonight. We shall see. However, I  still have the red bumps. Perhaps they will clear up with time. I must tell you that I have COPD. Scaring on my left lung since childhood,bronchitis, and asthma. I became sick four years ago. Had to be hospitalized for a week, and was sent home with the O2. I was on it for about two months. Had to go back on two weeks ago. I checked out your website. I will be visiting often. We all use the same treatments and medications.

Response:

have you tried other steroid inhalers like aerobid or pulmicort? yatin j patel md – Hide quoted text — Show quoted text – –WebTV-Mail-14553-2611 Content-Type: Text/Plain; Charset=US-ASCII Content-Transfer-Encoding: 7Bit I do use a spacer. I do not have red bumps around my mouth, I have acne on my face, (not around my mouth) and red bumps on my arms and legs. When I am on this medication for very long periods my neck also turns red. When it first happened my pulmonary doctor sent me to a dermatologist, he said it was from sun and weather. When I went off it I cleared up. I know this is going to sound crazy, but when I first go off Flovent I can breathe better. Unfortunately I have to go back on it. I would like to know if any one using inhaled steroids has been diagnosed with hypohyroidism. I was diagnosed with it about six months after starting Flovent. It may or may not be a factor, but I can’t see inhaling anything can be good for my thyroid. My doc says no. After all they know best. If I sound fed up, it’s because I am. They just don’t listen. I’m scared. Any ideas? Thanks….. –WebTV-Mail-14553-2611 Content-Description: signature Content-Disposition: Inline Content-Type: Text/HTML; Charset=US-ASCII Content-Transfer-Encoding: 7Bit <html<clock</clock</html –WebTV-Mail-14553-2611–

– Yatin J Patel MD http://md4lungs.com If you have asthma, this is your home. Join Dr. Patel every wednesday 7 PM Indiana Time for online chats. Before you buy.

Response:

I’m also very, very fair-skinned. Blonde hair, lashes, brows. I have never had zits, but I did have "follicle infections" due to a hormone imbalance … but that was 25 years ago! My doctor at that time told me to wash my face, rubbing the sores til they bled, and then apply Polysporin ointment. Even with the ointment, it took a month or more for each sore to heal. Birth control pills helped the hormone problem and the sores (of course, if you’re male…. ignore this advice). This time it’s not hormones. I do use a spacer. I got desperate over the weekend and I used Victoria Principal’s blemish buster on each sore. They’re about 50% improved overnight. I’m also overweight, but I blame that on developing asthma 2 years ago and not being able to exercise as often as I want/need. I thought about seeing a dermatologist, but what’s the use of being on tetracycline when I’m still on Flovent? I’m on a 4-week tapering program. My allergist wants me off Servent BEFORE going off Flovent. So next week I stop the Serevent, and then 2 weeks later (if I survive), I try going off Flovent … no inhalers. But I’m on a double-dose of Claritin (2 a day). – Hide quoted text — Show quoted text – Hi, I have been lurking for months, afraid to post. Your post on Flovent prompted me to take the plunge. I have had the same problem. Was on Flovent for three years. Have had acne, and small red raised bumps on my legs and arms. Every time I go off the Flovent I clear up. My pulmonary doctor changed me to another steroid, Aerobid. However, I am afraid it is not any better. I hate the steroids. I am 40lbs. over my normal weight. I don’t even recognize myself. I was also told it was non-related. I have very fair skin, this may have something to do with it. I feel some doctors are not educated on the side affects of some of these drugs. That’s why we have to educate ourselves. Just wanted you to know you are not alone.

Response:

Hello, I am so glad you posted.  This is a support newsgroup…please don’t be afraid to be involved.  I will admit it gets pretty intense at times, but most folks here are in the same boat.  We have asthma and we use this newsgroup as a method to exchange information and to share experiences, plus gain some support if we happen to be having a hard time with our illness or meds.  There is no one person here that has all the answers, but all are willing to try and help.  Glad to see you here! I also gained weight after starting meds….I don’t know why.  I have always been a thin kind of girl, but not now.  :o(  I work out whenever I have the breath and do pretty well most times.  To me it’s a real battle and hits in the old self esteem area pretty hard.  I just keep doing the best I can. Take care, Patrice

Hi, I have been lurking for months, afraid to post. Your post on Flovent prompted me to take the plunge. I have had the same problem. Was on Flovent for three years. Have had acne, and small red raised bumps on my legs and arms. Every time I go off the Flovent I clear up. My pulmonary doctor changed me to another steroid, Aerobid. However, I am afraid it is not any better. I hate the steroids. I am 40lbs. over my normal weight. I don’t even recognize myself. I was also told it was non-related. I have very fair skin, this may have something to do with it. I feel some doctors are not educated on the side affects of some of these drugs. That’s why we have to educate ourselves. Just wanted you to know you are not alone.

Response:

I do use a spacer. I do not have red bumps around my mouth, I have acne on my face, (not around my mouth) and red bumps on my arms and legs. When I am on this medication for very long periods my neck also turns red. When it first happened my pulmonary doctor sent me to a dermatologist, he said it was from sun and weather. When I went off it I cleared up. I know this is going to sound crazy, but when I first go off Flovent I can breathe better. Unfortunately I have to go back on it. I would like to know if any one using inhaled steroids has been diagnosed with hypohyroidism. I was diagnosed with it about six months after starting Flovent. It may or may not be a factor, but I can’t see inhaling anything can be good for my thyroid. My doc says no. After all they know best. If I sound fed up, it’s because I am. They just don’t listen. I’m scared. Any ideas? Thanks…..

Response:

Hi, I have been lurking for months, afraid to post. Your post on Flovent prompted me to take the plunge. I have had the same problem. Was on Flovent for three years. Have had acne, and small red raised bumps on my legs and arms. Every time I go off the Flovent I clear up. My pulmonary doctor changed me to another steroid, Aerobid. However, I am afraid it is not any better. I hate the steroids. I am 40lbs. over my normal weight. I don’t even recognize myself. I was also told it was non-related. I have very fair skin, this may have something to do with it. I feel some doctors are not educated on the side affects of some of these drugs. That’s why we have to educate ourselves. Just wanted you to know you are not alone.

Response:

Using flovent inhaler without a spacer would increase the oral deposition of the medicine. This may predispose one to those bumps on the skin around the lips. In article Nope, not on prednisone, and I don’t have a history of acne. In fact, I’ve always been complimented on my porcelain skin. That’s why this is a horrific experience for me. are you on prednisone also? because i take flovent and serevent, and only get the redness and welts when i’m on the prednisone also…

– Hide quoted text — Show quoted text – Do you have a history of acne? PErhaps you have developed it and it is totally unrelated to the asthma. Two doctors tell me that the dozens of pimples/sores on my face are not related to Flovent, yet the Flovent insert mentions follicle infections as a rare side effect. It cleared up when I was on antibiotics for a sinus infection but it came right back. I went off Flovent for 2 weeks and saw minor improvement, but my asthma doc said I could not be on Serevent without being on Flovent, so I had to go back on Flovent. He wants me to wean off both eventually, if possible. In the meantime, I’m using an antibiotic ointment called MetroGel on my face, but it only controls the severity of the welts; it doesn’t make it go away. Anybody have a similar experience? Any hope?

– Yatin J Patel MD http://md4lungs.com If you have asthma, this is your home. Join Dr. Patel every wednesday 7 PM Indiana Time for online chats. Before you buy.

Response:

are you on prednisone also? because i take flovent and serevent, and only get the redness and welts when i’m on the prednisone also…

Response:

Nope, not on prednisone, and I don’t have a history of acne. In fact, I’ve always been complimented on my porcelain skin. That’s why this is a horrific experience for me. are you on prednisone also? because i take flovent and serevent, and only get the redness and welts when i’m on the prednisone also… – Hide quoted text — Show quoted text -Do you have a history of acne?  PErhaps you have developed it and it is totally unrelated to the asthma. Two doctors tell me that the dozens of pimples/sores on my face are not related to Flovent, yet the Flovent insert mentions follicle infections as a rare side effect. It cleared up when I was on antibiotics for a sinus infection but it came right back. I went off Flovent for 2 weeks and saw minor improvement, but my asthma doc said I could not be on Serevent without being on Flovent, so I had to go back on Flovent. He wants me to wean off both eventually, if possible. In the meantime, I’m using an antibiotic ointment called MetroGel on my face, but it only controls the severity of the welts; it doesn’t make it go away. Anybody have a similar experience? Any hope?

Response:

Do you have a history of acne?  PErhaps you have developed it and it is totally unrelated to the asthma. – Hide quoted text — Show quoted text – Two doctors tell me that the dozens of pimples/sores on my face are not related to Flovent, yet the Flovent insert mentions follicle infections as a rare side effect. It cleared up when I was on antibiotics for a sinus infection but it came right back. I went off Flovent for 2 weeks and saw minor improvement, but my asthma doc said I could not be on Serevent without being on Flovent, so I had to go back on Flovent. He wants me to wean off both eventually, if possible. In the meantime, I’m using an antibiotic ointment called MetroGel on my face, but it only controls the severity of the welts; it doesn’t make it go away. Anybody have a similar experience? Any hope?

Response:

Two doctors tell me that the dozens of pimples/sores on my face are not related to Flovent, yet the Flovent insert mentions follicle infections as a rare side effect. It cleared up when I was on antibiotics for a sinus infection but it came right back. I went off Flovent for 2 weeks and saw minor improvement, but my asthma doc said I could not be on Serevent without being on Flovent, so I had to go back on Flovent. He wants me to wean off both eventually, if possible. In the meantime, I’m using an antibiotic ointment called MetroGel on my face, but it only controls the severity of the welts; it doesn’t make it go away. Anybody have a similar experience? Any hope?

Response:

Question:

Hi:   I use 2 puffs of flovent and 2 puffs of servent daily to control my exercise induced asthma.  However, I am experiencing a major drawback:  my voice is continuously hoarce.  The doctor told me just to lower my medication to the amounts shown above.  I do use one of those extended tubes when taking in the flovent.   Anyone else had this side effect — and were you able to find some way to be able to take the meds and be able to talk.

Gargle with a teaspoon of salt in 8 oz of very warm water after taking your meds.  Also, increase your fluid intake. Chris Owens

Response:

Hi:  I use 2 puffs of flovent and 2 puffs of servent daily to control my exercise induced asthma.  However, I am experiencing a major drawback:  my voice is continuously hoarce.  The doctor told me just to lower my medication to the amounts shown above.  I do use one of those extended tubes when taking in the flovent.  Anyone else had this side effect — and were you able to find some way to be able to take the meds and be able to talk.

I use a Volumatic for my Becotide to keep my voice from getting hoarse. I found that I had to use it for the Serevent too, because that was begining to have the same effect. I also find eating (bio) youghurt sooths my throat when it does get hoarse, perhaps it keeps any sub-clinical oral thrush at bay. Pete

Response:

This may sound like a stupid answer, but….are you rinsing your mouth out after every puff of Flovent?  You should still gargle with water etc., even if you are using a spacer. My apologies if you are already aware. Kelly – Hide quoted text — Show quoted text – Hi:  I use 2 puffs of flovent and 2 puffs of servent daily to control my exercise induced asthma.  However, I am experiencing a major drawback:  my voice is continuously hoarce.  The doctor told me just to lower my medication to the amounts shown above.  I do use one of those extended tubes when taking in the flovent.  Anyone else had this side effect — and were you able to find some way to be able to take the meds and be able to talk.

Response:

Hi:   I use 2 puffs of flovent and 2 puffs of servent daily to control my exercise induced asthma.  However, I am experiencing a major drawback:  my voice is continuously hoarce.  The doctor told me just to lower my medication to the amounts shown above.  I do use one of those extended tubes when taking in the flovent.   Anyone else had this side effect — and were you able to find some way to be able to take the meds and be able to talk.

Response:

Do you rinse your mouth out after using the flovent? – Hide quoted text — Show quoted text – Hi:   I use 2 puffs of flovent and 2 puffs of servent daily to control my exercise induced asthma.  However, I am experiencing a major drawback:  my voice is continuously hoarce.  The doctor told me just to lower my medication to the amounts shown above.  I do use one of those extended tubes when taking in the flovent.   Anyone else had this side effect — and were you able to find some way to be able to take the meds and be able to talk.

Response:

I had this problem when I first started on Flovent. It went away after a couple of weeks. I also use an aerochamber and always rinse my mouth with mouthwash and drink some water after use. I also recently stopped Flovent by using Accolate which works great for excercise induced asthma.

Response:

Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit doug, try using a spacer unit, it will help, and also wash your mouth out with water, and gargle with water or a mouth wash if needed.  this will definitely help with the hoarse voice.  The spacer unit is expensive, but it works.  good luck. Allen Hi:   I use 2 puffs of flovent and 2 puffs of servent daily to control my exercise induced asthma.  However, I am experiencing a major drawback:  my voice is continuously hoarce.  The doctor told me just to lower my medication to the amounts shown above.  I do use one of those extended tubes when taking in the flovent.   Anyone else had this side effect — and were you able to find some way to be able to take the meds and be able to talk.

Content-Type: text/html; charset=us-ascii Content-Transfer-Encoding: 7bit <HTML <FONT COLOR="#CC33CC"<FONT SIZE=+1doug,</FONT</FONT <BR<FONT COLOR="#CC33CC"<FONT SIZE=+1try using a spacer unit, it will help, and also wash your mouth out with water, and gargle with water or a mouth wash if needed.&nbsp; this will definitely help with the hoarse voice.&nbsp; The spacer unit is expensive, but it works.&nbsp; good luck.</FONT</FONT <BR<FONT COLOR="#CC33CC"<FONT SIZE=+1Allen</FONT</FONT

<BLOCKQUOTE TYPE=CITEHi: <P&nbsp; I use 2 puffs of flovent and 2 puffs of servent daily to control <BRmy exercise induced asthma.&nbsp; However, I am experiencing a major <BRdrawback:&nbsp; my voice is continuously hoarce.&nbsp; The doctor told me <BRjust to lower my medication to the amounts shown above.&nbsp; I do <BRuse one of those extended tubes when taking in the flovent. <P&nbsp; Anyone else had this side effect — and were you able to find <BRsome way to be able to take the meds and be able to talk. Search, Read, Post to Usenet</BLOCKQUOTE &nbsp;</HTML

Response:

Question:

White Knight — I am similar to you in a lot of ways  (top education, unable to work, worried about going bankrupt and losing my home, etc.) and would really like to hear your wisdom.  But it’s just impossible for me to read what you have to say through all the ranting and shouting. I hope you will get some relief and be able to have the career that seems important to you.  I am having trouble not giving up, but I am getting really bored with daytime t.v. and internet stuff. "If this is coffee, please bring me some tea.  If this is tea, please bring me some coffee."                                                            - Abraham Lincoln

Response:

I am sick and tired about all these posts trying to scare people away from trying xanax.  As someone who has suffered from bipolar disorder(type 2) for 15 years, tried all the antidepressants, now on a cocktail of meds, including xanax and paxil, my experience is that PAXIL has many more adverse effects versus the marginal benefit of some anxiety relief.  I took Paxil for 5 months and was not taking any xanax, and I got some anticapation anxiety relief at the cost of NO LIBIDO, sleeping 12 hours a day, having no motivation, just didn’t give a shit, already gained 10 pounds in 5 months with the carbo craving…..And people want to talk about xanax dependency and problems with withdrawl.  I am not trying to minimize people’s experience or their pain, but with anxiety or other mental health issues, the word is YOUR MILEAGE MAY VARY(YMMY).  I am a college graduate in electrical engineering from a top 5 engineering college, and now have not worked for over two years mostly because of anxiety and some depression yearly.  After working for 11 years struggling with depression and anxiety, I now have a hard time stepping outside my home.  I have considered suicide 1000’s of times over the last 15 years, actually researched and made the plans and was about to end it, and then I started on the Paxil…….Yeah, my suicidal obsessions went away, but now I was content to veg out all day watching TY or on the Net, my desire to GET A JOB disappeared.  Go research web sites and you will see how many people have problems with SSRI’s, yeah they are alive and taking that $3 pill two times a day or many $3 pills for me, but now I am NUMB and just there.  Prior to Paxil I use to be a emotional person, felt the pain of others and would cry when touched by something, but now I am a Paxil-zombie, yeah some anxiety relief but a LOT OF ME is also gone.  So all those xanax phobics, please allow people to fail with their options without scaring them.  What are people’s choices when it comes to anxiety or panic, yes paxil, yes benzo’s, yes MAIO’s, yes CBT(Cognitive Behavior Therapy).  My experience is PAXIL SUCKS and THE WITHDRAWAL IS HORRIBLE BASED ON MUCH FEEDBACK I HAVE READ ON THE NET, MAIO’S like parnate have some studies that back them up but the food restrictions are VERY DIFFICULT(no cheese, wine, beer, chocolate, many OTC meds, etc.), CBT might work for some but the feedback I have heard is that CBT plus meds work the best and I HAVE DONE THE THERAPY ROUTE and it was a waste of money. As one doctor told me, people who suffer from PANIC and think they are dieing have never been told that "your not going to die, it is all in your head"…Well that was my last session with him.  Just to repeat, this is MY EXPERIENCE and YOUR MILEAGE MAY VARY.  Now I could continue to HIBERNATE IN MY HOUSE, NOT WORK, RUN OUT OF MONEY AND THEN BE HOMELESS…..Or I can be proactive and continue to experiment and try to find some solution that will allow me to work and have a life.  I have taken xanax in the past, just started it one month ago, still taking a low dose of paxil, and I am MUCH MUCH BETTER at dealing with day to day life, interacting with people, giving my shit done, etc. Yeah, maybe I will be taking xanax for the rest of my life but the only side effect I have had is some sleepiness.  And to those who talk about TOLERANCE BUILDUP, that is a CROCK, yes you might have to increase your xanax from .25mg 3 times a day to .50mg 3 times a day, there are people who have taken xanax for 5 to 15 years and most leveled out after 1 year at a dose and have no desire to increase. People need to do some research and FIND OUT THE REAL TRUTH, not what BIG PHARMA and BIG BUSINESS OWNED MEDIA OUTLETS want us to believe. Not to be cynical, but $3 no generic available paxil is much better for DRUG COMPANIES, then CHEAP GENERIC XANAX which might be more effective with less side-effects.  Why are benzo’s so hard to get, cause drug lobbiest have access to CONGRESS and made sure that THE NO-PROFIT SOLUTIONS(IE LIKE BENZO’S) are not readily available. Let me make THE NEWCOMERS TO MENTAL ILLNESS aware that HYPE ABOUT THE LATEST ANTIDEPRESSANT HAS EVERYTHING TO DO WITH THE BILLIONS OF DOLLARS THAT WILL BE MADE ON THE DRUG, and the only time you will hear about THE NEGATIVES about that drug will be when it comes off-patent. Now that we have generic prozac, we will hear more about side effects like NO LIBIDO, WEIGHT GAIN, SUICIDE, AND OTHER  EFEECTS.  Of course, as long as Paxil and Zoloft have no generics, MEDIA HYPE will be still muted, but give it time.  Just as all the SSRI’s go generic, we will hear about ALL THE NEGATIVES and out will come the new batch of 8 TO 12 WEEK STUDIED ANTIDEPRESSANTS to start the new profit cycle.  People with mental illness are just pawns, half ass useless meds are approved based on 8 week studies, NO REASON FOR A LONG TERM STUDY, we really don’t want to KNOW THE TRUTH, and as soon as the generics start rolling out, OUT COMES THE DIRTY LAUNDRY, not to HELP US, NO, ONLY SO THAT WE GO ON THE LATEST $5 PILL THAT HAS A 80% SUCCESS RATE AND EVEN LESS SIDE EFFECTS.  Hell as long as everyone is making money, who cares about THE CRAZIES that take the product, we just need them alive and taking their meds.  Now I forget, was I taking about the cigarette industry or drug companies, HELL WHAT IS THE DIFFERENCE.  This of course is just the opinion of a mentally ill patient with 15 years of experience popping pills, all of which have a 70% effective rate, but I guess I am the exception, "ALIVE" AND NOT SUICIDAL, AND NOT HAPPY ABOUT IT. White Knight

Response:

Question:

My experience is that, despite the oft insurer referenced literature saying that post people can step down to H2 blockers, very few of my patients successfully make the transition.

I was put on Biaxin-Prisolic and Pepto Bismal for a thirty day treatment to cure my H-Pylori and reduce my acid reflux with success. I was and am still on 800mg daily of Tagamet daily which so far has kept me under control.

Response:

Can I ask a sort of follow up question? I have asthma and reflux problems treated by prilosec. The question I have is "What is the long term effects of taking prilosec for a long time ( at least a year with no end in sight)?"

When Prilosec first came out there was a concern that long term administration may lead to B12 deficiency and possibly gastric cancer. Fortunately, after 20 or so years of use this seems to not be the case. It appears to be safe for long term use. — CBI, MD

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My experience is that, despite the oft insurer referenced literature saying that post people can step down to H2 blockers, very few of my patients successfully make the transition. I was put on Biaxin-Prisolic and Pepto Bismal for a thirty day treatment to cure my H-Pylori and reduce my acid reflux with success. I was and am still on 800mg daily of Tagamet daily which so far has kept me under control.

Treating H. pylori in duodenal and many peptic ulcers seems to be beneficial. It is questionable whether it is worthwhile in gastritis. The current thinking is that treating it makes reflux worse as often as better. The theory is that the chronic inflammation of the stomach may cause lower acid secretion, thus helping the reflux. Unfortunately, it also slightly increases the risk of gastric cancer. I’m glad you got better. I would guess that either the stomach inflammation was causing as much of your symptoms as the GERD, that the acid blockade alone helped the reflux, or that you are one of the lucky ones who’s reflux was actually helped and not worsened by eradicating the H. pylori. — CBI, MD

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- Hide quoted text — Show quoted text – Since we’ve recently moved, I had to get a new PCP.  Yesterday he told me  that since I’d been taking Prilosec for three months, my reflux should be cured  and there would be no need to continue taking it.  The doctor did, BTW, also  add Singular to try to improve the control of my asthma. I’m wondering if it’s typical for others to only have to take Prilosec for three months No. There is some literature that the pharmacy plans love to quote when telling the docs to try to lower the intensity of acid suppression by switching to the cheaper H2 blockers like Zantac, Tagamet, or Pepcid after 8 weeks on a proton pump inhibitor (Prilosec). I have not heard anyone advocate just stopping the meds altogether. Even the insurers who pay for the meds do not suggest this. My experience is that, despite the oft insurer referenced literature saying that post people can step down to H2 blockers, very few of my patients successfully make the transition. or if stopping it is likely to cause me more problems with asthma than I have now. Yes. Should I get another opinion? You could either try it and go back and say "I told you so" if and when the symptoms worsen or you can get a second opinion. A third option would be to ask if you can just step down to a med like Zantac instead and then stop it if you continue to do well. I would be a little concerned that your new doc seems to be getting his continuing medical education from the drug rep and insurer literature and then getting it wrong at that.

Can I ask a sort of follow up question? I have asthma and reflux problems treated by prilosec. The question I have is "What is the long term effects of taking prilosec for a long time ( at least a year with no end in sight)?" J. Freedman,Jr

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– Hide quoted text — Show quoted text – I was diagnosed with asthma about a year ago, though I’ve likely had it for several years at least.  After a couple of pretty severe asthma attacks, I was put on Albuterol inhaler and Flovent.  I did pretty well for a few months, but started having increased problems in the past three months with constant wheezing, especially at night, requiring almost daily night-time use of my rescue inhaler. During that time, I was diagnosed via upper endoscopy as having reflux. Apparently I’ve actually had it for a long time because there was a lot of scarring at the junction between the esophagus and stomach.  I was put on Prilosec which did not only help the epigastric pain I’d been having, but seemed to help the shortness of breath I’d been having at night (though it hasn’t made it completely go away either). Since we’ve recently moved, I had to get a new PCP.  Yesterday he told me that since I’d been taking Prilosec for three months, my reflux should be cured and there would be no need to continue taking it.  The doctor did, BTW, also add Singular to try to improve the control of my asthma. I’m wondering if it’s typical for others to only have to take Prilosec for three months or if stopping it is likely to cause me more problems with asthma than I have now. Should I get another opinion? Sandra

I’ve been using prilosec for about three years now.  This year my insurance company (a colorful one) informed me that they would only allow me three months of prilosec and a non-sedating antihistamine.  The prilosec worked wonderfully, even a late-night pizza caused no discomfort.  However, my reflux hasn’t been cured.  This last winter, being out of work for four weeks after foot surgery, I discovered that my reflux had disappeared, I even ate a late-night pizza to test it and had no problems.  About four days before going back to work the reflux reappeared!  My conclusion was that it was stress related.  I’m also taking singulair and I believe it has been helpful also.  Although I’ve been getting allergy shots for three years now and feel they have helped as well.  It’s hard to put my finger on the exact cause for the reduction of my asthma.  I’ve weaned myself down to two puffs of serevent at night, the singulair, allergy shots and only rarely a puff or two of albuterol.  I have been trying to wean myself off of the prilosec, taking it only every second or third night.  I notice a bit of reflux but can control that fairly well with only an antacid.

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I was diagnosed with asthma about a year ago, though I’ve likely had it for several years at least.  After a couple of pretty severe asthma attacks, I was put on Albuterol inhaler and Flovent.  I did pretty well for a few months, but started having increased problems in the past three months with constant wheezing, especially at night, requiring almost daily night-time use of my rescue inhaler.   During that time, I was diagnosed via upper endoscopy as having reflux. Apparently I’ve actually had it for a long time because there was a lot of scarring at the junction between the esophagus and stomach.  I was put on Prilosec which did not only help the epigastric pain I’d been having, but seemed to help the shortness of breath I’d been having at night (though it hasn’t made it completely go away either).   Since we’ve recently moved, I had to get a new PCP.  Yesterday he told me that since I’d been taking Prilosec for three months, my reflux should be cured and there would be no need to continue taking it.  The doctor did, BTW, also add Singular to try to improve the control of my asthma. I’m wondering if it’s typical for others to only have to take Prilosec for three months or if stopping it is likely to cause me more problems with asthma than I have now. Should I get another opinion? Sandra

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Since we’ve recently moved, I had to get a new PCP.  Yesterday he told me that since I’d been taking Prilosec for three months, my reflux should be cured and there would be no need to continue taking it.  The doctor did, BTW, also add Singular to try to improve the control of my asthma. I’m wondering if it’s typical for others to only have to take Prilosec for three months

No. There is some literature that the pharmacy plans love to quote when telling the docs to try to lower the intensity of acid suppression by switching to the cheaper H2 blockers like Zantac, Tagamet, or Pepcid after 8 weeks on a proton pump inhibitor (Prilosec). I have not heard anyone advocate just stopping the meds altogether. Even the insurers who pay for the meds do not suggest this. My experience is that, despite the oft insurer referenced literature saying that post people can step down to H2 blockers, very few of my patients successfully make the transition. or if stopping it is likely to cause me more problems with asthma than I have now.

Yes. Should I get another opinion?

You could either try it and go back and say "I told you so" if and when the symptoms worsen or you can get a second opinion. A third option would be to ask if you can just step down to a med like Zantac instead and then stop it if you continue to do well. I would be a little concerned that your new doc seems to be getting his continuing medical education from the drug rep and insurer literature and then getting it wrong at that. — CBI, MD

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I am 26 and have had asthma since I was a child.  Today I consider my asthma to be well controlled.  I use my bronchodilator two puffs twice a day (sometimes 3 if I exercise or otherwise trigger an attack), take singulair once a day, and am getting allergy shots which seem to be reducing my asthmatic reactions to allergens. However, I still have occasional mild attacks when I go out in the wind and cold or when I exercise.  I use my inhaler (third time for the day) and it goes away.  To me, this is much better than my asthma has ever been and I’m satisfied, but my doctor says having any asthma symptoms at all can cause airways remodeling.  He wants me to take inhaled steroids (flovent) as well. I am worried about the flovent because I am at an extremely high risk for osteoporisis (my grandmother got it despite consuming 200% RDA calcium every day of her life and taking hormonal supplements after menopause–everything you’re supposed to do). Can an occasional mild, easily treatable attack really cause airways remodeling?  (Also, consider that when I was young my asthma was not controlled well at all–I had frequent moderate attacks, a couple of severe ones, and had to use my bronchodilator 6 times a day, so I’m sure some remodeling has already occurred–I don’t know if that’s relevant). Also, how long does Serevent take to start working?  I tried that once briefly and it didn’t seem to help, so I stopped, but am considering trying that again instead of the steroids. Thanks, Karen

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Is trying a weaker inhaled steroid (such as Vanceril or even Azmacort) an option?  The side effects of steroids are more severe the stronger the steroid is, as I understand it, and Flovent is one of the stronger ones.

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- Hide quoted text — Show quoted text – I am 26 and have had asthma since I was a child.  Today I consider my asthma to be well controlled.  I use my bronchodilator two puffs twice a day (sometimes 3 if I exercise or otherwise trigger an attack), take singulair once a day, and am getting allergy shots which seem to be reducing my asthmatic reactions to allergens. However, I still have occasional mild attacks when I go out in the wind and cold or when I exercise.  I use my inhaler (third time for the day) and it goes away.  To me, this is much better than my asthma has ever been and I’m satisfied, but my doctor says having any asthma symptoms at all can cause airways remodeling.  He wants me to take inhaled steroids (flovent) as well. I am worried about the flovent because I am at an extremely high risk for osteoporisis (my grandmother got it despite consuming 200% RDA calcium every day of her life and taking hormonal supplements after menopause–everything you’re supposed to do). Can an occasional mild, easily treatable attack really cause airways remodeling?  (Also, consider that when I was young my asthma was not controlled well at all–I had frequent moderate attacks, a couple of severe ones, and had to use my bronchodilator 6 times a day, so I’m sure some remodeling has already occurred–I don’t know if that’s relevant). Also, how long does Serevent take to start working?  I tried that once briefly and it didn’t seem to help, so I stopped, but am considering trying that again instead of the steroids. Thanks,  Karen

I would recommend consider going on low dose beclomethasone; say 2 pf Vancenase or Beclovent twice a day. Beclomethasone is the steroid inhaler with the longest history of safety and is the one recommended in pregnancy. The dose is 42 ug beclomethasone per puff, so 4 puffs is only 168 ug/day. This should help prevent remodeling. There are some concerns that some other steroid inhalers like Azmacort, maybe even Flovent, have more severe side effects; certainly their record is much shorter. Serevent is a long-acting bronchodilator. It should start working within 15 minutes and peaks out at about 4 hours later. Regarding calcium, note that vitamin D is also needed to enable absorption; this can come from milk, vitamin pills or sunshine. Ellis

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Thanks, but I do take it at bedtime…. do I need another med?

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I catnap for about 2-3 hours and then I get going..

Hi Lisa, I used to have the same problem so now I take it at bedtime and I don’t have that problem anymore. Priscilla Remove NOSPAM when replying

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I was curious just how much sleep a 34 year old woman needs, I started taking Zoloft in Jan., and want to sleep all morning…which is not good when you have preschoolers at home.  I work 2nd shift, so I do not get home from work and into bed until midnight.. and then I get up at 6:30 with the daughter who goes to school.  After she leaves, I turn on the tv on PBS for the 4 yr old and I catnap for about 2-3 hours and then I get going.. the good news is that I can finally sleep at night when I want to, however I am still needing more sleep than I can get at night.  My Zoloft dose is 100mg… my next appointment is March 24, any suggestions? Thanks }i{ Lisa

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I don’t take Zoloft but the meds I am on tend to make me sleep lots and lots. I guess our best course of action is to complain to the doc about sleeping so much. I don’t mind the sleeping so much as being tired all the time. I guess we need a med adjustment. – Hide quoted text — Show quoted text -I was curious just how much sleep a 34 year old woman needs, I started taking Zoloft in Jan., and want to sleep all morning…which is not good when you have preschoolers at home.  I work 2nd shift, so I do not get home from work and into bed until midnight.. and then I get up at 6:30 with the daughter who goes to school.  After she leaves, I turn on the tv on PBS for the 4 yr old and I catnap for about 2-3 hours and then I get going.. the good news is that I can finally sleep at night when I want to, however I am still needing more sleep than I can get at night.  My Zoloft dose is 100mg… my next appointment is March 24, any suggestions? Thanks }i{ Lisa

Web Page at: http://www.robertpo.com

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It’s KOOL how people let their inners talk here.  I like to read these posts, even though my own inners shall not come out much anymore.

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No, Dante, I don’t think your raggin on me.  I really appreciate how you’ve explained things to me.  I think your really kool.  Don’t worry about the spelling, I understand what you’re trying to get across. Hope your 4th went well. eterniti

cool you aint p*ssed. an cool you can get what Im sayin even if I dont spell so hot. seem like virtual mode is okay with ya. cool she talked with ya an your gettin along. dont know if what I had to say did any thing. but okay. Im cool.   later Dante

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Okay, I see where the whole miscommunication started.  Using exclamation points to me isn’t like I’m yelling.  I use ‘em a lot, random-like.  Like this! doesn’t mean I’m yelling and I am truly truly sorry that he thought that.  I honestly didn’t mean to be seeming like I was yelling.  People can live how they like, I have no place to dictate anything like that.  Thank you very much for explaining it to me, Dante.  I should watch my typing and be more careful because I honestly honestly didn’t mean it that way.

its cool. cool with me any way. gess I see it like this if folks are sayin stuf thats like not raggin those ! dont mean yellin. but if folks are like riled up an upset or somethin an use em like you did its like yellin. gess its a mater of what your talkin bout. like you used em here an it dont look like yellin cuz your not bein sereus an kritikle. did I spell that right? me I dont spell so hot. I dont much care but may be folks dont get what Im sayin. VM:  I don’t think you should stay inside, I think you should come out more often.  I am truly sorry you thought I was yelling at you.  I didn’t mean it to seem that way.  Is there anything I can do to make it up to you? ~a very sorry eterniti

very cool eterniti. hope you dont think Im raggin on you.     Dante – Hide quoted text — Show quoted text – Be the change you want to see in the world.           -Ghandi

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Okay, I see where the whole miscommunication started.  Using exclamation points to me isn’t like I’m yelling.  I use ‘em a lot, random-like.  Like this! doesn’t mean I’m yelling and I am truly truly sorry that he thought that.  I honestly didn’t mean to be seeming like I was yelling.  People can live how they like, I have no place to dictate anything like that.  Thank you very much for explaining it to me, Dante.  I should watch my typing and be more careful because I honestly honestly didn’t mean it that way.   VM:  I don’t think you should stay inside, I think you should come out more often.  I am truly sorry you thought I was yelling at you.  I didn’t mean it to seem that way.  Is there anything I can do to make it up to you? ~a very sorry eterniti Be the change you want to see in the world.           -Ghandi

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Well, I’m glad I didn’t come off as rude…. If it’s any consollation, I think you are real.  I will listen to you.  I understand your anger.  It just hurts me to hear you say such negative things about someone.

this dont make no sense to me. isnt a consollation some stars in the sky that make a picture? any way its cool you think virtual mode is real an that you will listen. why it hurt you its not bout you? Bunch a z*n freaks. Hey, I’m a Z*n "freak" too thank you.  :)

no ofense spose to spat those words words that gotta do with r*lgions. But if you get sick and tired of seeing her like that, why don’t you do something about it?  cursing and complaining and insulting won’t do a d*mn thing to change anything.

sure it does. it makes folks know they dont like some thing. And no matter what you say, I still think of her as a wonderful peson.

dont think what virtual mode said was bout the person but the body. it you dont like the body you dont like the body. kinda simple like that. But you are as well, in your own rights.  Your emotions are justified!

thats right! Maybe I had no right to say anything to start, but hearing insults is one of my defensive  trigger buttons.

is that how you got hurt? I knew I should have stayed inside.  Now my negatory vibes are gonna make people not like me No, it’s okay to come out.  You can’t keep this tension and anger locked up inside for ever!  I don’t think any less of you, I just think there are other ways than insults.

well may be he dont know any other way to say how p*ssed off he feels an then when he does he gets jumped on for it! dont blame him at all for wantin to shut up now an not be round for folks to know hes round. not cool to open your mouth an then get told you did it it wrong. real drag. this is probly why I aint seen teens round here so much bc they say stuf an then get jumped on. real cr*p thing to do to some body who dont talk very much. get that same sh*t round here to an Im sick of it! Hoping to hear from you, tierra

thatd be a meericle. Dante

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Hey, I like you. Opinions are like ’ssholes everyone’s got one. You certainly have a right to yours. To everything else you said I say "’men sister!" Boy how I can relate! Veronica – Hide quoted text — Show quoted text – x-no-archive: yes virtual mode Hey, I know this is gonna sound rude most likely, but why don’t you be a little nicer to her! Well, by my standards, you don’t sound rude at all.  By my standards, I’M the rude one.  I’m rude for a reason.  Because I have very little say so and no one listens to me, why should I be miss nicey nice?  Being ‘nice’ to other people who treat me like I’m not real and having not a sould listen to me is too humilitating.  At least my anger and rudeness allow me to retain my dignity and pride.  Dignity and pride are all I have.  If those two things change, I become, like nothing but dirt under their fingernails.   If she has a weight problem, talking like that will do nothing. If anything, it could make it worse by causing negative feelings. She has enought negative feelings for the whole continuum here.  I dont’ ’cause’ negative feelings, I was CREATED by negative feelings.  And in trying to break away from the mould I was made from, I find that my rebellion is negative.  Everything I touch is somehow connected to something negative. Terra would tell me, ‘don’t say negative, say receptive’.  But that’s a bunch of hokey New Age bullsh*t.  Bunch a zen freaks.  Be supportive.  Encourage her to do healthy things.  But nicely!  It can’t be as bad as you make it sound, and even if it is, what doesitmatter? Because I got to live here too.  I get sick and tired of seeing that big fat gut protruding out in front of me and that big fat *ss sticking out behind. The back HURTS because of all of the fat sticking out everywhere.  And when people look at us with contempt, it doesn’t bother Terra but it does bother me!!  I’m the one who feels the pain.  They sin in haste, while I repent at leisure. She is a wonderful person! Not from where I’m looking.  You should see how the rest of the family walks on eggshells because of the combination of US.  No one ever knows what to expect. I knew I should have stayed inside.  Now my negatory vibes are gonna make people not like me. VM tierra…. hoping I didn’t offend anybody but felt I had to say that                          You yourself, as much as anybody in the                      entire universe, deserve your love and attention                                               -Buddha From the ashes, Phoenix — "Fear is the true enemy, the only enemy." — For more information about this service, send e-mail to:

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Well, I’m glad I didn’t come off as rude…. If it’s any consollation, I think you are real.  I will listen to you.  I understand your anger.  It just hurts me to hear you say such negative things about someone. Bunch a zen freaks.

Hey, I’m a Zen "freak" too thank you.  :) But if you get sick and tired of seeing her like that, why don’t you do something about it?  cursing and complaining and insulting won’t do a d*mn thing to change anything. And no matter what you say, I still think of her as a wonderful peson. But you are as well, in your own rights.  Your emotions are justified!  Maybe I had no right to say anything to start, but hearing insults is one of my defensive  trigger buttons. I knew I should have stayed inside.  Now my negatory vibes are gonna make people not like me

No, it’s okay to come out.  You can’t keep this tension and anger locked up inside for ever!  I don’t think any less of you, I just think there are other ways than insults. Hoping to hear from you, tierra                           You yourself, as much as anybody in the                       entire universe, deserve your love and attention                                                -Buddha

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You are right: you are best judge of what your body is up to. I now insist my doctor let me titrate. I leave each session with an upper dose I cannot exceed. There is also a suggested rate of increase I should not exceed (fat chance). Then I increase at the rate which is comfortable for me. (Reverse holds true for going off meds.) I note you’ve been on the new stuff only. Is there a reason you haven’t tried tricyclics or MAOIs? Some people report mircles from them, when the new SSRIs and variation are unsuccessful. Good luck. Stuck

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Well…..I’ve tried eight AD’s …..First was zoloft..did that for 8 months, and for a time added trazodone along with it.  It worked so-so…. Next was paxil…did that for about 3 months.  I didn’t have energy to do much of anything.  The withdrawl was 2 weeks of misery.   Next I went without anything for about 2 months.  Signed up for a 10 week self esteem class which used a workbook on Cognitive Behavioral Therapy.  I felt worse about myself at the end than I did when I started.   Then I tried prozac for 4 months….helped some (any improvement was better than I was).  Started having significant side effects after the dose went beyond 50mg.  Started feeling more depressed as the dose increased. Started effexor…almost stopped it cuz I felt so yucky, but I think it was due to coming off the prozac.  Effexor worked real well for me for about 15 months.  Added wellbutrin for a time, supposedly to help the sexual dysfunction, but it didn’t help. **SOAP BOX TIME** I really don’t think that doctors who work in the field of prescribing antidepressant medications fully appreciate how powerful these drugs are, and how strongly they affect the body.  My doctor, for instance, tends to believe that you can just taper a person (me) off one drug for a week or so and add a new drug at the same time or immediately thereafter, and everything will be hunky dory.  WRONG!!!!  As far as I am concerned, there is always some sort of withdrawl the body goes through when stopping one antidepressant, even if you start another at the same time.  I have gone through this a number of times, and I hope I have been instrumental in helping my doctor learn more about this.  Still, there is that transition period where my life sucks even more when I have changed meds. **END OF SOAP BOX** Anyway, coming off the prozac made it seem like the effexor was giving me a bad reaction at first, but I hung in and after about a week things were ok.   After about 15 months, I was feeling sort of down, more depressed than I had been in a while.  I was also feeling "chemicalized" and kind of wanted to stop.  My pdoc was gonna have me start serzone, but I tapered off the effexor (again with a two week withdrawl) and stopped. So, I then went 3 months taking St. John’s Wort.  It helped some, but I gradually sank down badly again, and when work took a stressful turn, I went down fast.  Back to Depression City. Then I took serzone for 4 months.  It is supposed to make most people a little drowsy, but it had the opposite effect on me.  I felt wired.  It leveled out a bit over time, but during this period I did not sleep very soundly.  It was just moderately effective for the depression. At the beginning of february I started remeron.  Again, in changing meds, I had the usual nausea and stuff associated with withdrawl, but man o man that remeron!! It was like Night of the Living Dead!!  I slept HARD for the 3 weeks I took that stuff.  Supposedly the higher the dose, the more that symptom of sleepiness goes away, but I was still a space cadet even after increasing the dose. So I practically begged my pdoc to let me go back on effexor, which I started again this week.  Right now I’m going through the remeron withdrawls, nausea, diarhea and such, but I feel human again. **THEORY** I believe in my case, having taken antidepressants off and on now for over 3 years, that whatever my depression is, drugs only help it to a moderate degree.  It has been my experience that continually increasing the dosage yields diminishing returns.  It does appear, at least at this time in my life, that I need the help of the antidepressants to handle life.  I am working in other ways on "handling life," and perhaps someday I will obtain some results that will make it unnecessary to take antidepressants. I really don’t know.   But, I think I do best if I take the lowest dose that gives any decent effect. And, I am beginning to believe that my system needs a periodic chemical free period.  So my plan at this point is to take the lowest dose of effexor that will stabilize my mood, which from past experience I think is either 150mg or 225mg.  I think that I will also try to go about a month a year chemical free. I guess to summarize, at least maybe to summarize to myself, it takes a long period of trial and error to find out what works and what doesnt.  The hard part is to somehow hang in there while going through all the ups and downs. Best wishes, Patrick *** To reply by email, remove the zzz from my email address ***

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