Question:

ONe doc told me to put my inhalers in my mouth when i use them…..another told me not…..i would appreciate if others would share what their docs said!!

Response:

My doctor want wants a spacer used.

Response:

ONe doc told me to put my inhalers in my mouth when i use them…..another told me not…..i would appreciate if others would share what their docs said!!

Depending on the type of inhaler you’re using, you might want to consider a "spacer" device. I’m surprised neither doc actually mentioned them ! Chris — Chris King                    | Information provided here should NOT be used http://www.csking.demon.co.uk | practitioner.

Response:

If you do not have a spacer, then out. place the mouthpiece about two to three fingers away from the mouth and proceed. The idea is to slow the delivery of the aerosol so as not to just coat the inside of the mouth… basically what a straight spacer does. With less medication coating the mouth, the more you’re able to take in.

Response:

ONe doc told me to put my inhalers in my mouth when i use them…..another told me not…..i would appreciate if others would share what their docs said!!

Inhalers come with patient instructions so the first thing to do is read them. Different kinds of inhalers may be used differently. Probably the most common inhaler type at the moment is the MDI or metered-dose inhaler. There is more than one correct technique; theoretically spraying a short distance outside the mouth results in better aersolization, but aim is critical and its hard to get the spray going in the right direction. MDI instructions usually show the inhaler being inserted in the mouth since its easier to aim. The best way with an MDI is to use a spacer, like an AeroChamber–this results in good aersolization with minimum side effects due to overspray. The breath-actuated inhalers, like the Autohaler and DPI (dry powder inhaler), like the turbuhaler, require the mouthpace be inserted in the mouth to get proper suction. Also in general spacers can not be used with this type of inhaler. See: http://www.lung.ca/asthma/manage/devices.html  Inhalation Devices (MDI, DPI, Nebulizer) Canada http://www.lung.ca/devices/mdi.html  Proper Use of MDIs Canada http://www.caritas.ab.ca/~ther/respcare/asthma/medicat.html SPACER MED  ADMINISTRATION (MDI) Canada http://www.njc.org/MFhtml/AER_MF.html Using an Aerochamber

Question:

Thanks to all who responded on my Tilade problem-especially Bill Ellis Fleemore.  I have my medication on the way-thank goodness.  Seems like my mail-order pharmacy had the medicine discontinued when all that happened was another company had bought out the originial manufacturers.  After calling the new manufacturer, they called the pharmacy and sent the Tilade to them.  I had been trying to reduce my Tilade without much success and was really wondering just how I was going to do without any.  My doctor had tried to take me off of it 3 yrs ago to no avail so both he and I were quite concerned that my asthma was going to get out of control again.  Now I don’t have to worry about that!- Pam in TN

Response:

Judy- I can certainly say that I did not expect to here my mail order pharmacy to say that Tilade is no longer available either.  With the help of Ellis in this group, I was able to talk to the manufacturer today and found out that they have temporary stopped the old formula and are waiting for a new one that has already passed trials in Europe.  So it looks like that the new version will be available in the US but they could not give me a definite date.  So I am still looking for some of the old stuff and they are also helping me out there too. I have one canister left so I hope that I can get something worked out within 17 days before this one runs out.- Pam in TN

Response:

I found out this week that one of my mainstay medications is no longer available in the US thanks to that darn little law that was passed earlier regarding the propellants used in the inhalers.  Well, my Tilade has bit the dust-along with my treatment plan that has had me in control since 1993!  My plan was 2 puffs of Tilade 3 times a day and 2 sprays twice a day of FLovent 220.  My pulmonary physician has told me that we will have to try to find another plan that will work since there is no substitution on the market for the Tilade. Pam in TN

– The drug manufacturers have enough CFC’s to last for several years.   There should not be a problem getting Tilade if you check with a few pharmacies.  We have plenty of it in New York. Wellington S. Tichenor, M. D. 642 Park Avenue New York, New York 212 517 6611 Visit our website at: http://www.sinuses.com Sinusitis: A Treatment Plan that Works for Asthma and Allergy too Any information read here should not be viewed as medical advice, as individual medical problems must be addressed by your physician. If you are looking for a physician and cannot get to New York City, please see the FAQ page.

Response:

I have to admit that I need to grumble a little bit and felt like here was the place to do it.  I found out this week that one of my mainstay medications is no longer available in the US thanks to that darn little law that was passed earlier regarding the propellants used in the inhalers.  Well, my Tilade has bit the dust-along with my treatment plan that has had me in control since 1993!  My plan was 2 puffs of Tilade 3 times a day and 2 sprays twice a day of FLovent 220.  My pulmonary physician has told me that we will have to try to find another plan that will work since there is no substitution on the market for the Tilade. Until now, I never realized that my health would be at the hands of someone that knows absolutely nothing about me or my disease-just the "bottom" line boardroom tactics.  It is frustrating enough to have to deal with the uncertainties of the disease but I was always comfortable knowing that my medications were keeping it under control.  Now I have to go back to sqare one again- Pam in TN

Response:

Dosn’t Tilade and Intal have the same propellant ? So if one has been chucked shouldn’t the other one follow suit ? But I was under the understanding this was not going to happen until suitable replacements were available.

Response:

I found out this week that one of my mainstay medications is no longer available in the US thanks to that darn little law that was passed earlier regarding the propellants used in the inhalers.  Well, my Tilade has bit the dust-along with my treatment plan that has had me in control since 1993!  My plan was 2 puffs of Tilade 3 times a day and 2 sprays twice a day of FLovent 220.  My pulmonary physician has told me that we will have to try to find another plan that will work since there is no substitution on the market for the Tilade.

 Pam in TN I forwarded your post to Francis Adams, MD, author of the comprehensive asthma book ‘The Asthma Sourcebook’. Here is his response. "Dear Ellis: Tilade definitely has not been discontinued. I think you must be right that they are bringing out a new formulation, probably with HFA instead of CFC. That means that they won’t supply any more of the current formula and will hopefully ship the new one soon. In terms of finding the original formula, I think it depends on the individual pharmacy and what they have in stock.  I will try to find out more on Monday from the manufacturer. Good luck, Francis V. Adams, M.D." Here are some references to the manufacturer. Reference: http://www.rpr.rpna.com/  Rhone-Poulenc Rorer (mfgr of Tilade) http://www.prnewswire.com/cnoc/exec/menu?764050/ Company News Business Name                         Address                                                      Phone  Rhone-Poulenc Rorer  Incorporated                         500 Arcola Rd, Collegeville, PA                         19426-3930                                                      610-454-8000 Ellis

Response:

Question:

says… – Hide quoted text — Show quoted text – A patent does not last 20 or 30 years.  It is something like 7 or 11 years, (I don’t remember exactly). 20 years from the date it was filed with the patent office.  There are a few ways to extend them to a certain extent, if the patent office was really slow, or it took forever to get FDA approval. I thought so. Now, what if they "enhance" the design of the originally patented technology. Does the 20-year clock start over? I’m asking because it sounds like that’s what ALZA did for Concerta. They took their original design and added a coating of med on the outside so that it would release an initial dose of medication.

In that case I suspect that the patent is on the coating technology. — — –John Reply to jclarke at eye bee em dot net

Response:

The Concerta web page says that if you take 15 mg Methylphenidate 2x/day or 15 mg Methylphenidate 3x/day or 60 mg Methylphenidate-SR, then you should take  54 mg of Concerta every morning by taking a 36 mg and an 18 mg at the same time. Daily dosage above 54 mg is not recommended. The URL is http://www.concerta.net/info.html Katswan

– Hide quoted text — Show quoted text – Hello, I am going to my Doctor tomorrow, and he has expressed interest in trying Concerta. I have a question on this, however. I am an adult, 31 years old. I have been on 20mg (non-SR) Ritalin 3 times a day (60 mg total per day) for the past 5 years. Considering this, what dosage of Concerta should I be on? The 60 mg per day worked fine for me, but I dont see how that dose (per day) can be obtained from the size tablets being offered right now for Concerta (only 18mg or 36mg). I am at a total loss as to why there is no good indicators of what an adult should be taking for Concerta, if (s)he is coming from a regular release Ritalin dosage of 60mg per day? Taking 2 x 36mg. Concerta might be considered to be too high of a dose. There is a new 54mg coming out (I am wondering if it is out yet… possibly). But would this be enough for me? Also, I can find no literature that talks about how much (in mg) is released on the outside-coating ‘immediate release’ of Concerta tabs, and then, how much is released in each remaining layer (2 more layers), and at what time are they released? I went to Concerta.net, but cannot find any data that answers these questions. Can anyone provide some answers to these questions? Thanks. Chris

Response:

I just had a thought, they have generic Ritalin SR, do they have it yet for Concerta? <Christopher wrote No, it is brand new, less than one year old. (Curious again) How long does it take for a generic to be approved and shipping? I think only generics are approved for the type of insurance my daughter has, unless there is a good reason she has to take a brand name medication.

When a new med is developed, that company that developed it has exclusive rights to market it, as with any patented invention. After, I think, 20 or 30 years or so, they lose the exclusivity and other products can copy their design/formula. They can also "lease" the right to use the patented formula/design during their exclusive rights period. ALZA’s web site says that their OROS delivery system has been used for 20 years, but that Concerta uses an enhanced OROS system, so the clock may have restarted ticking, it may be like a new patent. Most health/medical insurance policies push generics (list of covered meds). When my daughter was on Ritalin, I had to make certain the doctor put "Brand name medically necessary" on every prescription, or our previous insurance company would only pay for the generic, since it was available. To get our new insurance company to pay for Concerta, we had to jump through some hoops. The doctor had to write a letter (for which I had to provide him information since we’re new to the practice), detailing all the meds daughter has been on, why they weren’t effective or were problematic, and why we think Concerta will be different. Since daughter’s tried everything, they approved our request and are paying for Concerta. They did not approve it for son, however, as he hasn’t tried Ritalin-SR (much cheaper than Concerta and theoretically similar). I won’t put him on Ritalin-SR, however, because I think the dose is too high for him. When he was on Ritalin, he took 5mg 3x/day. He currently takes 5mg Adderall 2x/day. No way do these dosages compare to 20 mg R-SR, which would be expected to dump 20mg of meds into his system in 4 hours less than he got 15mg of meds (and twice as much meds as he’s taking now). He doesn’t need more med, he needs it spread over a longer day. So I paid for his first month’s Rx for Concerta (nearly $70). Now that we know it’s working well for him, the doctor will write another letter requesting approval. Katswan

Response:

<part of reply snipped They did not approve it for son, however, as he hasn’t tried Ritalin-SR (much cheaper than Concerta and theoretically similar). I won’t put him on Ritalin-SR, however, because I think the dose is too high for him. When he was on Ritalin, he took 5mg 3x/day. He currently takes 5mg Adderall 2x/day. No way do these dosages compare to 20 mg R-SR, which would be expected to dump 20mg of meds into his system in 4 hours less than he got 15mg of meds (and twice as much meds as he’s taking now). He doesn’t need more med, he needs it spread over a longer day. So I paid for his first month’s Rx for Concerta (nearly $70). Now that we know it’s working well for him, the doctor will write another letter requesting approval. Katswan

Thanks for the reply. It is something for me to think about.        Norma   <Sigline space for rent

Response:

- Hide quoted text — Show quoted text – I just had a thought, they have generic Ritalin SR, do they have it yet for Concerta? <Christopher wrote No, it is brand new, less than one year old. (Curious again) How long does it take for a generic to be approved and shipping? I think only generics are approved for the type of insurance my daughter has, unless there is a good reason she has to take a brand name medication. When a new med is developed, that company that developed it has exclusive rights to market it, as with any patented invention. After, I think, 20 or 30 years or so, they lose the exclusivity and other products can copy their design/formula.

A patent does not last 20 or 30 years.  It is something like 7 or 11 years, (I don’t remember exactly). Copyrights last longer than patents and can be renewed.  Copyrights don’t cover the same thing; they protect expressions of ideas, like books or pictures. Patents give companies (or people) the exclusive right to construct or sell or use a process or principle of operation. However, to get copyright protection for a period, you must disclose exactly how to do it, and anyone can get copies from the patent office after it has expired. Alternatively, companies can just keep things secret.  These are trade secrets, but if someone else comes up with the same idea, the company has nothing they can legally do about it. -Chris Eliot

Response:

says… – Hide quoted text — Show quoted text – I just had a thought, they have generic Ritalin SR, do they have it yet for Concerta? <Christopher wrote No, it is brand new, less than one year old. (Curious again) How long does it take for a generic to be approved and shipping? I think only generics are approved for the type of insurance my daughter has, unless there is a good reason she has to take a brand name medication. When a new med is developed, that company that developed it has exclusive rights to market it, as with any patented invention. After, I think, 20 or 30 years or so, they lose the exclusivity and other products can copy their design/formula. A patent does not last 20 or 30 years.  It is something like 7 or 11 years, (I don’t remember exactly). Copyrights last longer than patents and can be renewed.  Copyrights don’t cover the same thing; they protect expressions of ideas, like books or pictures. Patents give companies (or people) the exclusive right to construct or sell or use a process or principle of operation. However, to get copyright protection for a period, you must disclose exactly how to do it, and anyone can get copies from the patent office after it has expired.

Well, sorta.  The "game", I am told by folks who have cause to know such things, is to tell enough to get the patent but not enough that someone can reproduce the technology.  Georgia Tech has a course in which you are given a patent and required to design a working device based on that patent.  It very quickly becomes evident how much information is _not_ included in the patent.  Of course this assumes that the device described by the patent will actually work.  One engineer I knew collected whacky patents for stuff that couldn’t possibly work–had his office wallpapered with them. Alternatively, companies can just keep things secret.  These are trade secrets, but if someone else comes up with the same idea, the company has nothing they can legally do about it. -Chris Eliot

– — –John Reply to jclarke at eye bee em dot net

Response:

We switched daughter back to Adderall this morning largely based on what daughter was telling us. It just wasn’t working for her. Now we her taking 30 long however I wonder if she can take another 20 mg dose around 2PM? Is there an Adderall website?? Is anyone taking Adderall this way, three doses a day? Last time we talked to her doctor we found that she was splitting her afternoon dose by taking 10 mg at lunch plus 10 mg later in the afternoon which the the lower split dose. This was one of the reasons he suggested trying Concerta

Response:

A patent does not last 20 or 30 years.  It is something like 7 or 11 years, (I don’t remember exactly).

20 years from the date it was filed with the patent office.  There are a few ways to extend them to a certain extent, if the patent office was really slow, or it took forever to get FDA approval.

Response:

A patent does not last 20 or 30 years.  It is something like 7 or 11 years, (I don’t remember exactly). 20 years from the date it was filed with the patent office.  There are a few ways to extend them to a certain extent, if the patent office was really slow, or it took forever to get FDA approval.

Really?? OK, I didn’t think it was so long.

Response:

A patent does not last 20 or 30 years.  It is something like 7 or 11 years, (I don’t remember exactly). 20 years from the date it was filed with the patent office.  There are a few ways to extend them to a certain extent, if the patent office was really slow, or it took forever to get FDA approval.

I thought so. Now, what if they "enhance" the design of the originally patented technology. Does the 20-year clock start over? I’m asking because it sounds like that’s what ALZA did for Concerta. They took their original design and added a coating of med on the outside so that it would release an initial dose of medication. Katswan

Response:

– Hide quoted text — Show quoted text – Anyone know of a free online PDR reference for Concerta and Adderall? We are at 56 mg/day on a 14yr old and wonder if we have the option of increasing or possibly we may end up going back to the Adderall and try to figure out a better way of managing its level As a medic, I would recommend talking to her Dr first. PDR’s should be available at most libraries. While my USP DI is a bit old (1996, they ain’t cheap), the usual pediatric dose for 6 years of age and older for Adderall, states that the dose does not usually exceed 40 mg daily. Concerta is not listed, as it is newer than my book. I saw a company chart comparing 18 mg concerta with 5 mg Ritalin taken three times a day. My guess is that there is some loss due to the special delivery capsule, and that otherwise you can do very rough dosing estimates by comparing 18 mg concerta to 15 mg Ritalin spread out over a day.  This is only my guess, though; no one who understands about it has told me anything like this.

That’s how our pediatrician explained it to us. — Light, Love, & Laughter, Kitten, Goddess of Mischief "Thousands of years ago, cats were worshipped as gods. Cats have never forgotten this." – Anonymous "Just for today, do not worry;  Just for today, do not anger; Earn your living honestly; Honor your parents, teachers and elders; Show gratitude for every living thing."- Dr. Mikao Usui

Response:

As a medic, I would recommend talking to her Dr first. PDR’s should be available at most libraries.

Concerta does not appear in our Libraries 2000 PDR and of course although I have to talk to her psychiatrist before we increase (ie to get a script) I was wondering if increasing the dose was an option. I don’t think she gets the kick (maybe poor choice of words) that she got from the Adderall. The Concerta is probably much slower and more gradual delivery and change in the blood level.

Response:

I saw a company chart comparing 18 mg concerta with 5 mg Ritalin taken three times a day. My guess is that there is some loss due to the special delivery capsule, and that otherwise you can do very rough dosing estimates by comparing 18 mg concerta to 15 mg Ritalin spread out over a day.  This is only my guess, though; no one who understands about it has told me anything like this. That’s how our pediatrician explained it to us.

I just had a thought, they have generic Ritalin SR, do they have it yet for Concerta?  Curious,            Norma        Norma   <Sigline space for rent

Response:

I got confused about the attributions here.  Sorry if I’m misquoting. I saw a company chart comparing 18 mg concerta with 5 mg Ritalin taken three times a day. My guess is that there is some loss due to the special delivery capsule, and that otherwise you can do very rough dosing estimates by comparing 18 mg concerta to 15 mg Ritalin spread out over a day.  This is only my guess, though; no one who understands about it has told me anything like this.

That’s how we’ve switched dosages here. Son went from 5mg Ritalin 3x/day to 5mg Adderall 2x/day (but really needing a 3rd dose too late to give it to him) to 18mg Concerta 1x/day. Daughter went from 20mg Ritalin-SR in the AM plus 10mg Ritalin regular in the PM (and still never being stable in the meds’ effects) to 10mg Adderall 2x/day (but really needing a third dose too late to give it to her) to 36mg Concerta 1x/day. That’s how our pediatrician explained it to us.

I just had a thought, they have generic Ritalin SR, do they have it yet for Concerta?

Well, the med in Concerta is methylphenidate HCl (a form of Ritalin), so it’s already a generic. The delivery system in the body is what is unique and what makes it so expensive. It’s called OROS and was developed by ALZA. It’s been used to deliver other medications for about 20 years, although it’s been enhanced for Concerta to give an intial "shot" of medication. I’m sure ALZA with hold on to the rights/patents for as long as they can. Here’s ALZA’s Concerta web site URL: http://www.concerta.net/index.htm Katswan

Response:

- Hide quoted text — Show quoted text – I saw a company chart comparing 18 mg concerta with 5 mg Ritalin taken three times a day. My guess is that there is some loss due to the special delivery capsule, and that otherwise you can do very rough dosing estimates by comparing 18 mg concerta to 15 mg Ritalin spread out over a day.  This is only my guess, though; no one who understands about it has told me anything like this. That’s how our pediatrician explained it to us. I just had a thought, they have generic Ritalin SR, do they have it yet for Concerta?

No, it is brand new, less than one year old. – Hide quoted text — Show quoted text –  Curious,            Norma        Norma   <Sigline space for rent

Response:

- Hide quoted text — Show quoted text – I just had a thought, they have generic Ritalin SR, do they have it yet for Concerta? <Christopher wrote No, it is brand new, less than one year old. (Curious again) How long does it take for a generic to be approved and shipping? I think only generics are approved for the type of insurance my daughter has, unless there is a good reason she has to take a brand name medication.

The patents have to expire first, and that takes a number of years. – Hide quoted text — Show quoted text –        Norma   <Sigline space for rent

Response:

Hello, I am going to my Doctor tomorrow, and he has expressed interest in trying Concerta. I have a question on this, however. I am an adult, 31 years old. I have been on 20mg (non-SR) Ritalin 3 times a day (60 mg total per day) for the past 5 years. Considering this, what dosage of Concerta should I be on? The 60 mg per day worked fine for me, but I dont see how that dose (per day) can be obtained from the size tablets being offered right now for Concerta (only 18mg or 36mg). I am at a total loss as to why there is no good indicators of what an adult should be taking for Concerta, if (s)he is coming from a regular release Ritalin dosage of 60mg per day? Taking 2 x 36mg. Concerta might be considered to be too high of a dose. There is a new 54mg coming out (I am wondering if it is out yet… possibly). But would this be enough for me? Also, I can find no literature that talks about how much (in mg) is released on the outside-coating ‘immediate release’ of Concerta tabs, and then, how much is released in each remaining layer (2 more layers), and at what time are they released? I went to Concerta.net, but cannot find any data that answers these questions. Can anyone provide some answers to these questions? Thanks. Chris

Response:

I am going to my Doctor tomorrow, and he has expressed interest in trying Concerta. I have a question on this, however. I am an adult, 31 years old. I have been on 20mg (non-CR) Ritalin 3 times a day (60 mg total per day) for the past 5 years. What dosage of Concerta should I be on? The 60 mg per day worked fine for me, but I dont see how that dose (per day) can be obtained from the size tablets being offered right now for Concerta (18 or 36mg).

From what our pediatrician told us about the conversion from Ritalin to Concerta, you would need 2 36mg caplets in the morning to receive the equivalent of your current 60mg/day of Ritalin.  (18mg Concerta = 15mg {3 5mg doses} Ritalin) I am at a total loss as to why there is no good indicators of what an adult should be taking for Concerta, if (s)he is coming from a regular release Ritalin dosage of 60mg per day? Taking 2 36mg. Concerta might be considered to be too high of a dose. There is a new 54mg coming out (maybe out now, possibly). But would this be enough?

With the conversion above, I don’t see how 2 36mg would be considered too high.  It’s an equivalent dosage to what you are currently taking. Also, I can find no literature that talks about how much (in mg) is released on the outside coating immediate release of Concerta tabs, and then, how much is released in each remaining layer (2 more layers), and at what time are they released? I went to Concerta.net, but cannot find any of this data. Can anyone provide some info on this?

I’ve a pdf on Concerta.  I’m not sure if it has the info you’re looking for, but if you’d like me to email it to you, let me know. — Light, Love, & Laughter, Kitten, Goddess of Mischief "Thousands of years ago, cats were worshipped as gods. Cats have never forgotten this." – Anonymous "Just for today, do not worry;  Just for today, do not anger; Earn your living honestly; Honor your parents, teachers and elders; Show gratitude for every living thing."- Dr. Mikao Usui

Response:

I just had a thought, they have generic Ritalin SR, do they have it yet for Concerta?

<Christopher wrote No, it is brand new, less than one year old.

(Curious again) How long does it take for a generic to be approved and shipping? I think only generics are approved for the type of insurance my daughter has, unless there is a good reason she has to take a brand name medication.        Norma   <Sigline space for rent

Response:

I am going to my Doctor tomorrow, and he has expressed interest in trying Concerta. I have a question on this, however. I am an adult, 31 years old. I have been on 20mg (non-CR) Ritalin 3 times a day (60 mg total per day) for the past 5 years. What dosage of Concerta should I be on? The 60 mg per day worked fine for me, but I dont see how that dose (per day) can be obtained from the size tablets being offered right now for Concerta (18 or 36mg). I am at a total loss as to why there is no good indicators of what an adult should be taking for Concerta, if (s)he is coming from a regular release Ritalin dosage of 60mg per day? Taking 2 36mg. Concerta might be considered to be too high of a dose. There is a new 54mg coming out (maybe out now, possibly). But would this be enough? Also, I can find no literature that talks about how much (in mg) is released on the outside coating immediate release of Concerta tabs, and then, how much is released in each remaining layer (2 more layers), and at what time are they released? I went to Concerta.net, but cannot find any of this data. Can anyone provide some info on this? Thanks. Chris

Response:

- Hide quoted text — Show quoted text – I just had a thought, they have generic Ritalin SR, do they have it yet for Concerta? Well, the med in Concerta is methylphenidate HCl (a form of Ritalin), so it’s already a generic. The delivery system in the body is what is unique and what makes it so expensive. It’s called OROS and was developed by ALZA. It’s been used to deliver other medications for about 20 years, although it’s been enhanced for Concerta to give an intial "shot" of medication. I’m sure ALZA with hold on to the rights/patents for as long as they can. Here’s ALZA’s Concerta web site URL: http://www.concerta.net/index.htm Katswan

Thanks for the info.        Norma   <Sigline space for rent

Response:

Anyone know of a free online PDR reference for Concerta and Adderall? We are at 56 mg/day on a 14yr old and wonder if we have the option of increasing or possibly we may end up going back to the Adderall and try to figure out a better way of managing its level

Response:

Anyone know of a free online PDR reference for Concerta and Adderall? We are at 56 mg/day on a 14yr old and wonder if we have the option of increasing or possibly we may end up going back to the Adderall and try to figure out a better way of managing its level

Have you talked to her doctor?   Nessa — Life’s a dance. You learn as you go. Sometimes you lead, sometimes you follow Don’t worry ’bout what you don’t know, life’s a dance you learn as you go!

Response:

Anyone know of a free online PDR reference for Concerta and Adderall? We are at 56 mg/day on a 14yr old and wonder if we have the option of increasing or possibly we may end up going back to the Adderall and try to figure out a better way of managing its level

As a medic, I would recommend talking to her Dr first. PDR’s should be available at most libraries. While my USP DI is a bit old (1996, they ain’t cheap), the usual pediatric dose for 6 years of age and older for Adderall, states that the dose does not usually exceed 40 mg daily. Concerta is not listed, as it is newer than my book. The dosage info for Adderal is backed by the PDR info at: http://www.healthsquare.com/drugmain.htm You should also be able to find the info on Concerta there. Chewy — Kitten’s Main Squeeze We live in a technological society that creates many illusions of reality…it’s the most irresponsible behaving entity that ever lived on this planet.  This civilization is not about responsibility, it’s about guilt, sin, blame and aggressive bad behavior.  That is the shadow world… The real world is about fulfilling our responsibility to life. — John Trudell

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– Hide quoted text — Show quoted text – Anyone know of a free online PDR reference for Concerta and Adderall? We are at 56 mg/day on a 14yr old and wonder if we have the option of increasing or possibly we may end up going back to the Adderall and try to figure out a better way of managing its level As a medic, I would recommend talking to her Dr first. PDR’s should be available at most libraries. While my USP DI is a bit old (1996, they ain’t cheap), the usual pediatric dose for 6 years of age and older for Adderall, states that the dose does not usually exceed 40 mg daily. Concerta is not listed, as it is newer than my book.

I saw a company chart comparing 18 mg concerta with 5 mg Ritalin taken three times a day. My guess is that there is some loss due to the special delivery capsule, and that otherwise you can do very rough dosing estimates by comparing 18 mg concerta to 15 mg Ritalin spread out over a day.  This is only my guess, though; no one who understands about it has told me anything like this. – Hide quoted text — Show quoted text – The dosage info for Adderal is backed by the PDR info at: http://www.healthsquare.com/drugmain.htm You should also be able to find the info on Concerta there. Chewy — Kitten’s Main Squeeze We live in a technological society that creates many illusions of reality…it’s the most irresponsible behaving entity that ever lived on this planet.  This civilization is not about responsibility, it’s about guilt, sin, blame and aggressive bad behavior.  That is the shadow world… The real world is about fulfilling our responsibility to life. — John Trudell

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Question:

I quit all daiary products may 1 1997 and my asthma is almost gone. What does anybody know anything aabout dairy foods and asthma? Harlan Lee

If your asthma stays in remission, it would indicate that you were/are allergic to milk.  I don’t know of any other connection that milk could have with asthma other than allergic reaction. Yana

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<<I quit all daiary products may 1 1997 and my asthma is almost gone. What does anybody know anything aabout dairy foods and asthma? Harlan Lee

i went to an accupuncturist/holistic medicine specialist for my allergies and asthma. he strongly believes that the high amount of antibiotics given to cows is a bad thing for our immune system and suggested i stop dairy. i have done this, but also stayed on serevent and flovent. connection? don’t know. i do note that the one or two times i strayed and recently had dairy, that i felt some tightness. good health to all…

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I quit all daiary products may 1 1997 and my asthma is almost gone. What does anybody know anything aabout dairy foods and asthma? Harlan Lee

Response:

I quit all daiary products may 1 1997 and my asthma is almost gone. What does anybody know anything aabout dairy foods and asthma? Harlan Lee

This could be a coincidence; I’m not aware of a relationship between asthma and dairy products. Also a 4-month remission is not proof that your asthma is cured. A 12-month remission would be more convincing. There is an article indicating some outgrow their asthma. See http://www.ama-assn.org/special/asthma/library/scan/outgrow.htm American Journal of Respiratory and Critical Care Medicine          Vol. 155, pp. 1267-1272, Apr. 1997          Adult Patients May Outgrow Their Asthma: A 25-Year Follow-up Study

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Question:

Thanks for the help. Brian’s chest specialist is planning to substitute Singulair for Flovent. My husband and I are still deciding whether to stop the Flovent and change to Singulair or put up with the behaviour changes and leave him on Flovent. The Flovent does work.         I’ve been using the other powerful effective steroid Pulmicort for some nine months and it’s done me a whole lot of good.           Last month I started taking Singulair. Didn’t notice any effect for a few days.  But now, thirty days later, I’m using a whole lot less of the rescue inhaler (albuterol) And from time to time, I’m  forgetting to take the Pulmicort.          I can’t believe your doctor want’s to stop the Flovent before seeing what effect the Singulair may have. (From the point of view of "If it works, don’ mess with it."  Are you sure you read him right?

Response:

I may be a little late with this response. My son has been sporatically on Singular since he was 3 y.o… The reason for only being on it once in a while is because it gave him headaches.  It took me a while to figure out they were related to the Singular, but it is listed as a side effect.  Our doctor initially had given him a 5mg chewable.  Then had us break it in half when the headaches started.   The headaches continued so I gave up on it until recently I’ve tried him on 1/2 tablets again (he is 5 now) and he seems to do better on them. Just FYI …keep it in mind that there are side effects to the Singular. Marina – Hide quoted text — Show quoted text – Thanks for the help.  Brian’s chest specialist is planning to substitute Singulair for Flovent.  My husband and I are still deciding whether to stop the Flovent and change to Singulair or put up with the behaviour changes and leave him on Flovent. The Flovent does work.  He has gotten sick this week with the flu and his asthma has not flared yet (yay!!!). I have talked to other parents who have had the same experience we have with using flovent.  I haven’t seen any studies that say flovent causes behaviour changes but can only go by what I am seeing. Debbie If you haven’t already tried it, you might be surprised about your son’s reaction to Singulair. It tastes _so_ pleasing to children that I’ve read (sorry, can’t recall the source) that there is pressure on the maker to change the flavor to something less palatable. There’ve been incidents of children overdosing on it, perhaps seeing it more as It’s small, cute, pink and tastes great. Even my 10-year old, for whom Singulair proved ineffective, whined the other day he wishes he could take it again, it tasted so good. Crushing it and sprinkling it in something should be no problem for him. ~Jacy

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Thanks for the help.  Brian’s chest specialist is planning to substitute Singulair for Flovent.  My husband and I are still deciding whether to stop the Flovent and change to Singulair or put up with the behaviour changes and leave him on Flovent. The Flovent does work.  He has gotten sick this week with the flu and his asthma has not flared yet (yay!!!).   I have talked to other parents who have had the same experience we have with using flovent.  I haven’t seen any studies that say flovent causes behaviour changes but can only go by what I am seeing. Debbie – Hide quoted text — Show quoted text – If you haven’t already tried it, you might be surprised about your son’s reaction to Singulair. It tastes _so_ pleasing to children that I’ve read (sorry, can’t recall the source) that there is pressure on the maker to change the flavor to something less palatable. There’ve been incidents of children overdosing on it, perhaps seeing it more as It’s small, cute, pink and tastes great. Even my 10-year old, for whom Singulair proved ineffective, whined the other day he wishes he could take it again, it tasted so good. Crushing it and sprinkling it in something should be no problem for him. ~Jacy

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If you haven’t already tried it, you might be surprised about your son’s reaction to Singulair. It tastes _so_ pleasing to children that I’ve read (sorry, can’t recall the source) that there is pressure on the maker to change the flavor to something less palatable. There’ve been incidents of children overdosing on it, perhaps seeing it more as It’s small, cute, pink and tastes great. Even my 10-year old, for whom Singulair proved ineffective, whined the other day he wishes he could take it again, it tasted so good. Crushing it and sprinkling it in something should be no problem for him. ~Jacy

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Hi, I’m on flovent since 1999, i’ve never had behavior and personality affects and never heard of some in children. You may try to check other places than flovent side effects. It’s working well, for singulair, headache can occur, if it doesn’t disappear after 2-3 days see your MD to quit singulair. Singulair work well in 1/3 of the peoples, there’s majority of children in this 1/3, another 1/3 get some result, and finally 1/3 don’t get any benifit. You can see result 2-3 days after the first treatment. Don’t quit flovent, for your child don’t worry you’re in the "terrible 2 years" period, they always say no, it like the small angel tranform itself in a little devil! Good luck! AT – Hide quoted text — Show quoted text – My 2 1/2 year old son is currently using flovent as his preventer medication.  We have found that this affects his behaviour and personality.  When I discussed this with his chest specialist he claims that flovent should not affect his personality.  He suggested that we try singulair with him. Two questions immediately come to mind. One, how do you give a chewable singulair tablet to a child who will refuse to chew it?  (He will not chew anything hard). Two, does anyone have experience with giving singulair to a child this young?  I was told that there should not be any side effects but my husband and I are concerned about using this drug.  We are considering living with the flovent because we know it works. Thanks in advance.  Debbie

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My 2 1/2 year old son is currently using flovent as his preventer medication.  We have found that this affects his behaviour and personality.  When I discussed this with his chest specialist he claims that flovent should not affect his personality.  He suggested that we try singulair with him. Two questions immediately come to mind. One, how do you give a chewable singulair tablet to a child who will refuse to chew it?  (He will not chew anything hard). Two, does anyone have experience with giving singulair to a child this young?  I was told that there should not be any side effects but my husband and I are concerned about using this drug.  We are considering living with the flovent because we know it works. Thanks in advance.  Debbie

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Question:

I’m having a root canal done on Friday. I’m going to a dentist that I’ve never seen before and I don’t know the name of the novacaine that doesn’t accelerate the heart. ‘Lil help? Peace, John — The charter is available at:

Question:

Thanks. I am curious does a psychiatrist have to prescribe?

No, GPs can do it too. But chances are they will know less about how to treat anxiety disorders than psychiatrists do. I only trust psychiatrists with a lot of experience in the treatment of anxiety disorders and an open mind (not *benzophobic*, for instance). Reason is my psychiatrist can be hard to get a hold of–ie he just have several offices he shares around town. Whereas my general practioner is always at his office day after day in case I need a dosage switch or whatever. Do general practiioner/internal medicine physcians have a enough info to reliably presribe SSRI’s?

Basically the main rule is *start low, go slow* to prevent initial worsening of symptoms. I think you should be able to reach your pdoc when necessary, maybe it will take some calls to find out where he is but it seems you *can* reach him. That would be better IMO.   Also I am very concerned SSRI’s will turn me into a robot–I have never taken any. I really dont want to get drowsy at work, etc.

Most of us are med phobic, it’s always difficult to start a (new) med. You will *not* turn into a robot though, I can assure you. Drowsiness on Zoloft is also not the first thing to expect but YMMV.   But I do want to get these racing anxiety oriented thoughts out of my head. Due to an injury I am nearly impotent at 36 yrs old so obviously those thoughts constantly race through my head—I want them to disappear.

I am very sorry to hear that. I do wonder if an SSRI like Zoloft will be the right med for you as SSRI’s very often cause sexual dysfunction including impotence as a side effect. Maybe a TCA like imipramine would be a more appropriate choice. Possibly even better would be a benzo like Xanax XR. It *is* obvious that you’d better talk to your psychiatrist about this. I find it strange that he prescribed Zoloft while knowing about your problems with impotence. I would certainly ask him about that. Philip – Hide quoted text — Show quoted text – my psych has me starting out on zoloft at 50mg,,,after doing some reading should I ask him for 25mg starting dose? Yes, that will make for a smoother ride. Ideal starting dose is 12.5 mg IMO. Philip

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my psych has me starting out on zoloft at 50mg,,,after doing some reading should I ask him for 25mg starting dose?

Response:

my psych has me starting out on zoloft at 50mg,,,after doing some reading should I ask him for 25mg starting dose?

Yes, that will make for a smoother ride. Ideal starting dose is 12.5 mg IMO. Philip – Hide quoted text — Show quoted text –

Response:

Thanks. I am curious does a psychiatrist have to prescribe? Reason is my psychiatrist can be hard to get a hold of–ie he just have several offices he shares around town. Whereas my general practioner is always at his office day after day in case I need a dosage switch or whatever. Do general practiioner/internal medicine physcians have a enough info to reliably presribe SSRI’s? Also I am very concerned SSRI’s will turn me into a robot–I have never taken any. I really dont want to get drowsy at work, etc. But I do want to get these racing anxiety oriented thoughts out of my head. Due to an injury I am nearly impotent at 36 yrs old so obviously those thoughts constantly race through my head—I want them to disappear.

– Hide quoted text — Show quoted text – my psych has me starting out on zoloft at 50mg,,,after doing some reading should I ask him for 25mg starting dose? Yes, that will make for a smoother ride. Ideal starting dose is 12.5 mg IMO. Philip

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Question:

– Hide quoted text — Show quoted text – you have the right to ask him this very question-there may be enumerable reasons why he wants you to go off zoloft-some may even be valid, but that does not mean you have to, or he is right. It is fine for a doc to change their mind,  but their principal obligation is to you as your medical doctor who’s goal is to make your life better, not more confusing or anxiety producing. Please don’t spend time worrying about his motives his comments or his attitude. Enjoy your holiday as best as you can and deal with this next week. If he does not give you a reasonable explanation, it may be time to find another doctor-you may have outgrown this one. LM, Brilliant post.  You know, now that you mention it, one of my main complaints with him  is that I don’t think this particular doc specializes in Anxiety disorders.  Thus, if we are talking about anxiety or GAD, he doesn’t mind saying what "could" happen.  As in: "Yes, zoloft works for you, but it ‘could’ fail you.", etc.  I feel like saying:  Well, Gee whiz doc, I had never thought of what ‘could’ happen….Why don’t you tell me something else that COULD happen? Could Zoloft cause any permanent physical problems?  "There is no evidence that it causes heart valve failure, but similar drugs do, so heart valve failure ‘could’ happen." I have left many appointments feeling more anxious than when I went in. I think for the new year I’ll hunt for a new Pdoc  (by the way, why do people use the term Pdoc in here?)

Hi, Ron — I think it’s the convention of the group to use the term pdoc to refer to the doctor one sees to treat one’s complaints/problems or whatnot.  For a lot of people, if not most, I think the word pdoc is seen as a shortened term for psychiatrist.  However, there are instances in which people are being treated for their anxiety/panic disorder by someone who is not a psychiatrist – be it psychologist, general practice doctor, or medicine man. Best Wishes — Blue (one who is now seeing a psychiatrist – FINALLY!… ) Remove mypants to email me

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Yes that’s me…sigh.  I don’t know.  5 years ago he said I’d probably be on it the rest of my life.  Now this year, there is this push for me to scale back.  I don’t get it.

you have the right to ask him this very question-there may be enumerable reasons why he wants you to go off zoloft-some may even be valid, but that does not mean you have to, or he is right. It is fine for a doc to change their mind,  but their principal obligation is to you as your medical doctor who’s goal is to make your life better, not more confusing or anxiety producing. Please don’t spend time worrying about his motives his comments or his attitude. Enjoy your holiday as best as you can and deal with this next week. If he does not give you a reasonable explanation, it may be time to find another doctor-you may have outgrown this one. LM

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Ron, Find a new psychiatrist. Run away from this guy.  Run don’t walk !!!! Start looking now while you still have a prescription. Try to speak to potential psychiatrists and explain the situation to them. See how they respond and go with the pdoc that you feel understands you. You are the customer. Find a new source for your health care. Tony

Response:

Well, I just got back from meeting with my Psychiatrist.  I told him I am feeling much better now that I am back up to my original dose of 100mg. of Zoloft.  And the whole nine yards… After I finished my speal about "whew, I’m glad all that (anxiety) is over…."  He then took that opportunity to tell me he recommends I still scale down if not off completely from zoloft and that I see a therapist to work through some issues I have with my childhood.  He said this process will take a long time possibly years, but it would be for the best.

It’s time to go doctor shopping, Ron. Finally something works again and he wants to take you off it…that is not only bad medicine, it’s also downright cruel. Many people need meds and at this pojt you seem to be one of them (as am I). Moreover *working through issues you have with your childhood* is totally useless as a therapy to get rid of anxiety symptoms as any doc worth his salt should know. The therapy of choice is *Cognitive Behavioral Therapy* which is very much a here-and-now therapy. Have you ever tried it? If not, it is highly recommended. I asked him what gave him the idea that I could be off of meds and still function?  His response was that my depression/anxiety was at a moderate to moderate/low level and as such, doesn’t necessarily require medication to fight.

I see…*he* know what you go through better than *you* do? I don’t think so. I am feeling totally confused now.  I’ve tried to scale off of zoloft twice now.  Perhaps I went too rapidly both times, I don’t know.  I dropped off Zoloft completely the first time in about 8 weeks.  The second time I dropped my dosage by .25mg increments and started having anxiety attacks when I hit .50mg (1/2 my optimal dose)   How am I supposed to scale off this time?  Drop by 12.5mg increments and pray?

I wouldn’t stop taking it. It helps you. I *would* do CBT, see what that gets me and if I can maybe do without meds then. If not, that’s fine too. I don’t know folks…what do you think?  Cut my dose in half?  I’d love to.  Elliminate it completely?  There is nothing I’d like better – I’d even do back flips.

Why? If it works, it works. And a med that works is a thing to cherish.  But I just don’t know how I’m going to do it unless I could be hospitalized or something.  I lost 6 months of my life to anxiety the first time I agressively quit zoloft.  When I scaled back, I suffered for 3 weeks till I got stabilized again.  

Please find another pdoc, someone who knows what (s)he is talking about,. Don’t let this clown confuse you. Philip – Hide quoted text — Show quoted text –

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:Also, this whole situation is causing me alot of anxiety as well. amn.  After almost 2 weeks without Xanax I am feeling like I need one :now. {{{{{Ron}}}}} Your pdoc is suppose to help decrease your anxiety, not add to it. Your anxiety might be trying to tell you that you aren`t ready to stop taking zoloft. Listen to your gut. Jackie ~*~The bad things of life were very transitory.It was the good things , the ribbed sand, the wind blowing over the white capped waves , the sunshine and the stars, that were so tough and durable~*~

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.S. I am going out of town tomorrow to spend the day and night at the :in-laws….that has me anxious as well – I suppose many of you can :relate. Very understandable! Happy Thanksgiving I hope you are able to enjoy yourself. Jackie ~*~The bad things of life were very transitory.It was the good things , the ribbed sand, the wind blowing over the white capped waves , the sunshine and the stars, that were so tough and durable~*~

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I just got back from meeting with my Psychiatrist. he recommends I still scale down if not off completely from zoloft and that I see a therapist to work through some issues I have with my childhood.

That’s bullshit. Going into all the perils of your childhood won’t replace the zoloft and your being anxiety free, – what is done is done, (in my opinion).  I think it’s time you shopped around for someone who knows how to treat anxiety disorders. I wish you well – K  

Response:

you have the right to ask him this very question-there may be enumerable reasons why he wants you to go off zoloft-some may even be valid, but that does not mean you have to, or he is right. It is fine for a doc to change their mind,  but their principal obligation is to you as your medical doctor who’s goal is to make your life better, not more confusing or anxiety producing. Please don’t spend time worrying about his motives his comments or his attitude. Enjoy your holiday as best as you can and deal with this next week. If he does not give you a reasonable explanation, it may be time to find another doctor-you may have outgrown this one.

LM, Brilliant post.  You know, now that you mention it, one of my main complaints with him  is that I don’t think this particular doc specializes in Anxiety disorders.  Thus, if we are talking about anxiety or GAD, he doesn’t mind saying what "could" happen.  As in: "Yes, zoloft works for you, but it ‘could’ fail you.", etc.  I feel like saying:  Well, Gee whiz doc, I had never thought of what ‘could’ happen….Why don’t you tell me something else that COULD happen? Could Zoloft cause any permanent physical problems?  "There is no evidence that it causes heart valve failure, but similar drugs do, so heart valve failure ‘could’ happen." I have left many appointments feeling more anxious than when I went in. I think for the new year I’ll hunt for a new Pdoc  (by the way, why do people use the term Pdoc in here?)

Response:

– Hide quoted text — Show quoted text – Ron, Find a new psychiatrist. Run away from this guy.  Run don’t walk !!!! Start looking now while you still have a prescription. Try to speak to potential psychiatrists and explain the situation to them. See how they respond and go with the pdoc that you feel understands you. You are the customer. Find a new source for your health care. Tony

Tony, I think you are right.  I’ve still got some time – time to go pdoc shopping. Ron

Response:

- Hide quoted text — Show quoted text – Well, I just got back from meeting with my Psychiatrist.  I told him I am feeling much better now that I am back up to my original dose of 100mg. of Zoloft.  And the whole nine yards… After I finished my speal about "whew, I’m glad all that (anxiety) is over…."  He then took that opportunity to tell me he recommends I still scale down if not off completely from zoloft and that I see a therapist to work through some issues I have with my childhood.  He said this process will take a long time possibly years, but it would be for the best. I asked him what gave him the idea that I could be off of meds and still function?  His response was that my depression/anxiety was at a moderate to moderate/low level and as such, doesn’t necessarily require medication to fight. I am feeling totally confused now.  I’ve tried to scale off of zoloft twice now.  Perhaps I went too rapidly both times, I don’t know.  I dropped off Zoloft completely the first time in about 8 weeks.  The second time I dropped my dosage by .25mg increments and started having anxiety attacks when I hit .50mg (1/2 my optimal dose)   How am I supposed to scale off this time?  Drop by 12.5mg increments and pray? I don’t know folks…what do you think?  Cut my dose in half?  I’d love to.  Elliminate it completely?  There is nothing I’d like better – I’d even do back flips.  But I just don’t know how I’m going to do it unless I could be hospitalized or something.  I lost 6 months of my life to anxiety the first time I agressively quit zoloft.  When I scaled back, I suffered for 3 weeks till I got stabilized again.   Ron

Dear Ron. My suggestion is to get a second opinion… You are doing better by being on that dose of zoloft. It is imo that you should remain on that while you talk with a therapist and not worry about weaning. I don’t understand why your pysch would even mention this to you at this point. You need to get your meds adjusted, then work with a therapist. I don’t want to sound negative but I would get a second viewpoint regarding your anxiety, medications etc. I feel when a doctor or pyschiatrist starts to disgust tapering off BEFORE any set therapy or mentions that you should be off it altogether is not in your best intersests at this point in your recovery. Some people, regardless of therapy, have to maintain medications through out there life time. That shouldn’t be the issue. SO I suggest the second opinion. My doc has been so good regarding the Effexor and Ativan that I take. I wish everyone had a doctor as compassionate and patient as mine. I tried to wean off the effxor and got down to 150 per day when I started to feel so sad and anxious. So I am taking the 300 per day and am doing just fine. I take the Ativan as needed. I had childhood issues to deal with and even though I am comfortable with the results, I am still taking the medications. Maybe in a year or so I can try and wean again but my doctor says it is when I AM READY to do it… I wish you all the best and please let me know if and when you see another doctor regarding your anxiety and medications. Julie

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– Hide quoted text — Show quoted text – :I don’t know folks…what do you think?  Cut my dose in half?  I’d :love to.  Elliminate it completely?  There is nothing I’d like better :- I’d even do back flips.  But I just don’t know how I’m going to do :it unless I could be hospitalized or something.  I lost 6 months of my :life to anxiety the first time I agressively quit zoloft.  When I :scaled back, I suffered for 3 weeks till I got stabilized again.   Dear Ron, Aren`t you the poster that increased their zoloft dose about 3 1/2 weeks ago because you were having a setback? If so, then I really don`t understand why your doctor would want you to stop taking a med after you just got stabilized on it. I also question his recommending "analyze your childhood" type of therapy. A lot of people, myself included have done the talk therapy, rehashing one`s childhood and the past with very little to no impact on our anxiety disorder. That`s not saying that no one benefits from disorders is congnitive behavioral therapy. You can also do therapy while on medication. If I were you I would get a second opinion. What do you want to do? You seem hesitant about getting off zoloft which is understandable. Take care Jackie ~*~The bad things of life were very transitory.It was the good things , the ribbed sand, the wind blowing over the white capped waves , the sunshine and the stars, that were so tough and durable~*~

Jackie, Yes that’s me…sigh.  I don’t know.  5 years ago he said I’d probably be on it the rest of my life.  Now this year, there is this push for me to scale back.  I don’t get it. Also, this whole situation is causing me alot of anxiety as well. Damn.  After almost 2 weeks without Xanax I am feeling like I need one now. Ron

Response:

Hey Ron, He sounds like he needs those TALK sessions in HIS piggy bank, you just aren’t worth the effort for him if you are so easily managed on meds. sorry to sound so cold and heartless, but thats my NSHO ( NOT so humble opinion) Once in this anx/pan thing we seem to go round on a merry go round, maybe its NOT childhood issues but real life/real time issues. My GP and I do not always see eye to eye on details, but his philosophy here in this hospitality/resort area is that most of us in hospitality professions need medication support because our jobs are so seasonally whacky, we go from 100 MPH to zip  and back and must always be cheerful, helpful, and  NOT STRESSED~~, the epitome of   Yassa Massta. He has joked with me in the past that he thinks he ought to sneak a patent ~~~~~~~ not serious. He’s your doc, but you don’t have to be Yassa Massta.  Good point that you are comfortable at your current dose and want to stay there for a while…… in 3 or 6 or 9 months  or more you may have different insights. Feel Well Ron.  Make it a body memory like walking, running, breathing, eating, laughing, sleeping.   Most of us get stable on a med and then want to get off, we don’t take the time to internalize the good feeling and  own it. Thanks for bringing this up, disagreements with docs should give us opportunities to express our own thoughts. have a happy gobbleday, stay in your PJ/s as long as possible and absolutely indulge in the after meal nap. Sue

– Hide quoted text — Show quoted text – Well, I just got back from meeting with my Psychiatrist.  I told him I am feeling much better now that I am back up to my original dose of 100mg. of Zoloft.  And the whole nine yards… After I finished my speal about "whew, I’m glad all that (anxiety) is over…."  He then took that opportunity to tell me he recommends I still scale down if not off completely from zoloft and that I see a therapist to work through some issues I have with my childhood.  He said this process will take a long time possibly years, but it would be for the best. I asked him what gave him the idea that I could be off of meds and still function?  His response was that my depression/anxiety was at a moderate to moderate/low level and as such, doesn’t necessarily require medication to fight. I am feeling totally confused now.  I’ve tried to scale off of zoloft twice now.  Perhaps I went too rapidly both times, I don’t know.  I dropped off Zoloft completely the first time in about 8 weeks.  The second time I dropped my dosage by .25mg increments and started having anxiety attacks when I hit .50mg (1/2 my optimal dose) How am I supposed to scale off this time?  Drop by 12.5mg increments and pray? I don’t know folks…what do you think?  Cut my dose in half?  I’d love to.  Elliminate it completely?  There is nothing I’d like better – I’d even do back flips.  But I just don’t know how I’m going to do it unless I could be hospitalized or something.  I lost 6 months of my life to anxiety the first time I agressively quit zoloft.  When I scaled back, I suffered for 3 weeks till I got stabilized again. Ron

Response:

– Hide quoted text — Show quoted text – :I don’t know folks…what do you think?  Cut my dose in half?  I’d :love to.  Elliminate it completely?  There is nothing I’d like better :- I’d even do back flips.  But I just don’t know how I’m going to do :it unless I could be hospitalized or something.  I lost 6 months of my :life to anxiety the first time I agressively quit zoloft.  When I :scaled back, I suffered for 3 weeks till I got stabilized again.   Dear Ron, Aren`t you the poster that increased their zoloft dose about 3 1/2 weeks ago because you were having a setback? If so, then I really don`t understand why your doctor would want you to stop taking a med after you just got stabilized on it. I also question his recommending "analyze your childhood" type of therapy. A lot of people, myself included have done the talk therapy, rehashing one`s childhood and the past with very little to no impact on our anxiety disorder. That`s not saying that no one benefits from disorders is congnitive behavioral therapy. You can also do therapy while on medication. If I were you I would get a second opinion. What do you want to do? You seem hesitant about getting off zoloft which is understandable. Take care Jackie ~*~The bad things of life were very transitory.It was the good things , the ribbed sand, the wind blowing over the white capped waves , the sunshine and the stars, that were so tough and durable~*~

P.S. I am going out of town tomorrow to spend the day and night at the in-laws….that has me anxious as well – I suppose many of you can relate.

Response:

If you are comfortable on the med and doing well, then I fail to understand your pdoc’s point of view.  I think you are right to stay on it. Take care, Liz – Hide quoted text — Show quoted text – Well, I just got back from meeting with my Psychiatrist.  I told him I am feeling much better now that I am back up to my original dose of 100mg. of Zoloft.  And the whole nine yards… After I finished my speal about "whew, I’m glad all that (anxiety) is over…."  He then took that opportunity to tell me he recommends I still scale down if not off completely from zoloft and that I see a therapist to work through some issues I have with my childhood.  He said this process will take a long time possibly years, but it would be for the best. I asked him what gave him the idea that I could be off of meds and still function?  His response was that my depression/anxiety was at a moderate to moderate/low level and as such, doesn’t necessarily require medication to fight. I am feeling totally confused now.  I’ve tried to scale off of zoloft twice now.  Perhaps I went too rapidly both times, I don’t know.  I dropped off Zoloft completely the first time in about 8 weeks.  The second time I dropped my dosage by .25mg increments and started having anxiety attacks when I hit .50mg (1/2 my optimal dose)   How am I supposed to scale off this time?  Drop by 12.5mg increments and pray? I don’t know folks…what do you think?  Cut my dose in half?  I’d love to.  Elliminate it completely?  There is nothing I’d like better – I’d even do back flips.  But I just don’t know how I’m going to do it unless I could be hospitalized or something.  I lost 6 months of my life to anxiety the first time I agressively quit zoloft.  When I scaled back, I suffered for 3 weeks till I got stabilized again.   Ron

Response:

:I don’t know folks…what do you think?  Cut my dose in half?  I’d :love to.  Elliminate it completely?  There is nothing I’d like better :- I’d even do back flips.  But I just don’t know how I’m going to do :it unless I could be hospitalized or something.  I lost 6 months of my :life to anxiety the first time I agressively quit zoloft.  When I :scaled back, I suffered for 3 weeks till I got stabilized again.   Dear Ron, Aren`t you the poster that increased their zoloft dose about 3 1/2 weeks ago because you were having a setback? If so, then I really don`t understand why your doctor would want you to stop taking a med after you just got stabilized on it. I also question his recommending "analyze your childhood" type of therapy. A lot of people, myself included have done the talk therapy, rehashing one`s childhood and the past with very little to no impact on our anxiety disorder. That`s not saying that no one benefits from disorders is congnitive behavioral therapy. You can also do therapy while on medication. If I were you I would get a second opinion. What do you want to do? You seem hesitant about getting off zoloft which is understandable. Take care Jackie ~*~The bad things of life were very transitory.It was the good things , the ribbed sand, the wind blowing over the white capped waves , the sunshine and the stars, that were so tough and durable~*~

Response:

Well, I just got back from meeting with my Psychiatrist.  I told him I am feeling much better now that I am back up to my original dose of 100mg. of Zoloft.  And the whole nine yards… After I finished my speal about "whew, I’m glad all that (anxiety) is over…."  He then took that opportunity to tell me he recommends I still scale down if not off completely from zoloft and that I see a therapist to work through some issues I have with my childhood.  He said this process will take a long time possibly years, but it would be for the best. I asked him what gave him the idea that I could be off of meds and still function?  His response was that my depression/anxiety was at a moderate to moderate/low level and as such, doesn’t necessarily require medication to fight. I am feeling totally confused now.  I’ve tried to scale off of zoloft twice now.  Perhaps I went too rapidly both times, I don’t know.  I dropped off Zoloft completely the first time in about 8 weeks.  The second time I dropped my dosage by .25mg increments and started having anxiety attacks when I hit .50mg (1/2 my optimal dose)   How am I supposed to scale off this time?  Drop by 12.5mg increments and pray? I don’t know folks…what do you think?  Cut my dose in half?  I’d love to.  Elliminate it completely?  There is nothing I’d like better – I’d even do back flips.  But I just don’t know how I’m going to do it unless I could be hospitalized or something.  I lost 6 months of my life to anxiety the first time I agressively quit zoloft.  When I scaled back, I suffered for 3 weeks till I got stabilized again.   Ron

Response:

Question:

I can hardly keep my thoughts together today…..I’m not going in to work again today. ….and, when I called in, she tried to make me feel guilty.   It’s almost like my hormones override these medications.  I become overly sensitive, irritable, paranoid, fearful, anxious, restless…..just to name a few symptoms.  I know that stupid depo shot is still in my system.  I can feel it. I don’t have anything to grip on to, and this is a horrible feeling.  Maybe that’s why that show Greed kept my heart pounding last night.   I know this will go away in a few days, but what do I do in the meantime? I haven’t done a "pity party" post for awhile, so I guess it was overdue.     My doc is out of town AGAIN for the weekend….. I feel like Sharyn today…..I just want to cry. ( Maria

Response:

Thanks Chip, I really like these articles…. For anyone interested, or that has PMS problems…   I took the other half of my celexa pill the other day, (because of feeling horrible, and PMS) and noticed quite immediate effects….as I was laying down for a nap, I realized she had given me 40 mg. tabs, which I break in half so they last me 2 months, or so that I can increase to 40 if I want to.  So, it turns out I’ve been taking double my usual dosage these past couple days.  (It never occurred to me, because I always broke my paxil in half). Well, the funny part is when I did this once before, not during PMS…..I was so tired, I could barely walk. This time, I feel great…..no PMS symptoms!! Today I feel very calm….and, even spent the day at the mall with some friends, (which usually makes me cranky being around crowds for long periods of time). I wasn’t a bit irritated…and, before the extra celexa I was a wreck. Now, I’m curious to see the effect it will have on me after my period….if it will be too high of a dose.   I really like this 40 mg. right now. Just an interesting self observation of my situation…. Bye, Maria    

Response:

: : Valerie Davis Raskin, MD, wrote a very good book titled, : "When Words Are Not Enough; The Women’s Prescription for : Depression and Anxiety." The book is not too expensive : and written for the general public, so you may want to : buy a copy via Amazon or some other book shop. It covers : a lot of issues that are important to women who suffer : from anxiety and depression. : : Thankyou for that information Arthur. I remember it being one of the trivia : questions, but I didn’t know what it was about. : Maria I had originally bought the book for my mother. However, she didn’t read it at first (being very psychoanalysis oriented) so I borrowed it for a while. The book is very practical; with chapters on sex, pregnancy, menstral cycles, etc. It addresses medication questions that I often see posted here in ASAP and has some nice tables on medications. I’m tempted to buy a copy for my own little anxiety-panic library. Which reminds me, mom still has my copy of Sheehan. I ought to start distributing library cards (grin). Best Wishes, Arthur

Response:

Biological Therapies in Psychiatry Alan J. Gelenberg, M.D. Treating PMS While most women experience some physical and emotional changes premenstrually, a minority are clinically impaired by the premenstrual syndrome (PMS). For ages, unproven and largely ineffectual remedies were promulgated. In recent years, however, greater methodologic rigor has enhanced clinical research on this condition. Better still, the advent of the serotonin-selective reuptake inhibitor (SSRI) antidepressants has shown that medication can alleviate PMS symptoms and reverse dysfunction. Several recent reviews present evidence and knowledgeable opinions on treating PMS. Dr Walter Brown notes that SSRIs have a much more rapid onset of action when used to treat PMS than when the same drugs are used to treat depression. (1) PMS symptoms improve almost immediately, while depressive symptoms typically take several weeks to lift. This author also observes that while serotonergic, noradrenergic, and other agents appear equal in efficacy when treating depression, only highly serotonergic antidepressants are effective for PMS. Further evidence for the role of serotonin in PMS is that tryptophan, the essential amino acid that serves as a dietary precursor for serotonin, and fenfluramine (Pondimin and Redux), which stimulates serotonin neurotransmission, also appear effective against PMS. Moreover, women with PMS show abnormalities in blood serotonin. What about other antidepressants? Yonkers and Brown write about an ongoing, multicenter trial of venlafaxine (Effexor) for premenstrual dysphoric disorder (PMDD). (2) Venlafaxine can be started at 25 mg bid to manage side effects and then increased by 25 to 37.5 mg/day each cycle until remission is achieved. Investigators hope venlafaxine’s rapid onset of action will be beneficial in this type of intermittent disorder. An open trial suggested that nefazodone (Serzone) may be effective against PMDD or premenstrual exacerbation (PME) of a preexisting mood disorder when administered in daily doses of 200 to 500 mg throughout the menstrual cycle. Anxiolytic agents too might have a role to play. Limited data suggest possible efficacy for buspirone (Buspar). Yonkers and Brown also use alprazolam (Xanax) for women with mild PMS symptoms of limited duration. They recommend a starting dose of 0.25 mg bid or tid, increased as needed. In many studies of drugs to treat PMS, agents are administered daily throughout the month. But some women appear to benefit from taking a drug only during the premenstrual week or starting with the first symptom and ending with the beginning of menses. For example, clomipramine (Anafranil) is efficacious when administered only in the luteal phase of the menstrual cycle. Although there are no systematic data on the long-term use of drugs for premenstrual disorders, Yonkers and Brown state that symptom relief appears to be maintained. What else can be done to combat PMS symptoms? Pearlstein cites recommendations to increase complex carbohydrate consumption. (3) When combined with more frequent meals, this strategy might enhance cerebral uptake of tryptophan, thereby making more serotonin available. Some women find exercise alleviates symptoms. Other nonpharmacologic strategies include cognitive behavioral therapy and relaxation training. When symptoms of PMS, PMDD, or PME rise to the level of clinical significance, serotonergic antidepressants often can bring relief, with dosage and timing individualized for each patient. Recommendations for diet, exercise, and other nonpharmacologic strategies — as alternatives or additions to drug treatment — also can be considered based on preferences and circumstances. (1) Brown WA: PMS: A quiet breakthrough. Psychiatr Ann 1996; 26: 569-570. (2) Yonkers KA, Brown WA: Pharmacologic treatments for premenstrual dysphoric disorder. Psychiatr Ann 1996; 26: 586-589. (3) Pearlstein T: Nonpharmacologic treatment of premenstrual syndrome. Psychiatr Ann 1996; 26: 590-594.

Response:

Thanks Chip, I’m actually saving this in my files.   BTW, I do feel much better today, and will from now on increase my celexa dose during PMS.  I’ve actually learned a lot over the  last couple of days.  I apologize if I snapped anyone’s head off in the meantime.   Bye, Maria   – Hide quoted text — Show quoted text – Int Clin Psychopharmacol 1999 May;14 Suppl 2:S27-33 Serotonin reuptake inhibitors for the treatment of premenstrual dysphoria. Eriksson E Department of Pharmacology, Goteborg University, Sweden. Premenstrual dysphoria (PMD) is a severe form of premenstrual syndrome, afflicting approximately 5% of all women of fertile age. The cardinal symptoms are irritability and anger. In addition, sadness, tension and carbohydrate craving are common complaints. The symptoms surface regularly between ovulation and menstruation, and disappear completely within a few days after the onset of the bleeding; in patients with remaining symptoms during the follicular phase, alternative diagnoses should be considered. In a large number of recent trials, serotonin reuptake inhibitors (clomipramine, citalopram, fluoxetine, paroxetine, sertraline) have been shown to reduce the symptoms of PMD much more effectively than placebo; in contrast, non-serotonergic antidepressants (maprotiline, bupropion) appear to be ineffective. Interestingly, the onset of action of clomipramine and selective serotonin reuptake inhibitors (SSRIs) is much shorter when used for PMD than when used for depression, panic disorder, or obsessive-compulsive disorder. Consequently, patients with PMD can restrict the medication to the luteal phase of the cycle. In a recent placebo-controlled trial, intermittent administration of the SSRI citalopram was shown to reduce the symptoms of PMD significantly better than placebo, but also better than continuous administration of the drug. A reasonable interpretation of the latter, unexpected finding is that continuous medication may be associated with a certain development of tolerance than can be avoided by intermittent drug administration. The observation that the symptoms of PMD may be effectively reduced by SSRIs is of considerable clinical importance since previously no effective treatment for this common condition – apart from those disrupting ovarian cyclicity – has been available. It is also of theoretical importance because it constitutes one of the first pharmacological observations supporting the concept that serotonin may dampen irritability and anger in humans. PMID: 10471170, UI: 99397771

Response:

Int Clin Psychopharmacol 1999 May;14 Suppl 2:S27-33 Serotonin reuptake inhibitors for the treatment of premenstrual dysphoria. Eriksson E Department of Pharmacology, Goteborg University, Sweden. Premenstrual dysphoria (PMD) is a severe form of premenstrual syndrome, afflicting approximately 5% of all women of fertile age. The cardinal symptoms are irritability and anger. In addition, sadness, tension and carbohydrate craving are common complaints. The symptoms surface regularly between ovulation and menstruation, and disappear completely within a few days after the onset of the bleeding; in patients with remaining symptoms during the follicular phase, alternative diagnoses should be considered. In a large number of recent trials, serotonin reuptake inhibitors (clomipramine, citalopram, fluoxetine, paroxetine, sertraline) have been shown to reduce the symptoms of PMD much more effectively than placebo; in contrast, non-serotonergic antidepressants (maprotiline, bupropion) appear to be ineffective. Interestingly, the onset of action of clomipramine and selective serotonin reuptake inhibitors (SSRIs) is much shorter when used for PMD than when used for depression, panic disorder, or obsessive-compulsive disorder. Consequently, patients with PMD can restrict the medication to the luteal phase of the cycle. In a recent placebo-controlled trial, intermittent administration of the SSRI citalopram was shown to reduce the symptoms of PMD significantly better than placebo, but also better than continuous administration of the drug. A reasonable interpretation of the latter, unexpected finding is that continuous medication may be associated with a certain development of tolerance than can be avoided by intermittent drug administration. The observation that the symptoms of PMD may be effectively reduced by SSRIs is of considerable clinical importance since previously no effective treatment for this common condition – apart from those disrupting ovarian cyclicity – has been available. It is also of theoretical importance because it constitutes one of the first pharmacological observations supporting the concept that serotonin may dampen irritability and anger in humans. PMID: 10471170, UI: 99397771

Response:

its been documented that ssri’s and benzo’s blood plasma levels change when women ovulate and vice versa when they don’t-since you are changing your bodies ability to ovulate the plasma levels may drop somewhat-you may want to ask your doc to augment some benzo or ad meds with your next shot-medroxyprogesterone acetate is a known sensitizer of depression-you can just try and pamper yourself until the effects slough off LM

Margrove, you hit the nail on the head again.  I took extra celexa today, thinking at least it will do "something."    (I don’t think she’s gonna go for increasing my benzos, and I don’t want to ask her to), but I had a really nice nap, and feel better.   That is a very very very good idea.  I think I will increase my celexa during this time of the month.   It was a one time shot (depression is putting it mildly, I was thinking of ways to end my life).  It is still in my system, and I can feel the effects during this time of the month.   Thanks, Maria

Response:

- Hide quoted text — Show quoted text – Hi Maria, Being male, I can’t personally relate to PMS, but the hormonal character of panic disorder has given me some appreciation of the subject. Valerie Davis Raskin, MD, wrote a very good book titled, "When Words Are Not Enough; The Women’s Prescription for Depression and Anxiety." The book is not too expensive and written for the general public, so you may want to buy a copy via Amazon or some other book shop. It covers a lot of issues that are important to women who suffer from anxiety and depression. Best Wishes, Arthur

Thankyou for that information Arthur. I remember it being one of the trivia questions, but I didn’t know what it was about. Maria

Response:

its been documented that ssri’s and benzo’s blood plasma levels change when women ovulate and vice versa when they don’t-since you are changing your bodies ability to ovulate the plasma levels may drop somewhat-you may want to ask your doc to augment some benzo or ad meds with your next shot-medroxyprogesterone acetate is a known sensitizer of depression-you can just try and pamper yourself until the effects slough off LM

Response:

Maria – YIKES…..deprovera.  I’ve heard enough nightmare stories from my two daughters and my soon-to-be daughter-in-law.  All three have had unpleasant reactions to it and some very unpleasant effects getting off.

Hi Cindy,   For the first time since I got this shot, I feel that "someone understands." My face actually lit up while reading this. (not that they had to go through the horrid mess, but that I’m not alone).   It was a one time shot…..that was enough…it just about killed me.  (literally). Thankyou for the information!! Maria – Hide quoted text — Show quoted text – I can hardly keep my thoughts together today…..I’m not going in to work again today. ….and, when I called in, she tried to make me feel guilty.   It’s almost like my hormones override these medications.  I become overly sensitive, irritable, paranoid, fearful, anxious, restless…..just to name a few symptoms.  I know that stupid depo shot is still in my system.  I can feel it. I don’t have anything to grip on to, and this is a horrible feeling.  Maybe that’s why that show Greed kept my heart pounding last night.   I know this will go away in a few days, but what do I do in the meantime? I haven’t done a "pity party" post for awhile, so I guess it was overdue. My doc is out of town AGAIN for the weekend….. I feel like Sharyn today…..I just want to cry. ( Maria Maria – YIKES…..deprovera.  I’ve heard enough nightmare stories from my two daughters and my soon-to-be daughter-in-law.  All three have had unpleasant reactions to it and some very unpleasant effects getting off. It might be of some comfort to know that your emotional reaction to the provera in depovera is typical.  Also know that symptoms of normalizing can go on for 18mo to two years.  The progesterone in depovera is a chemically synthesized progestin, not natural hormone and SOME people are terribly sensitive to it. The good news is that although it’s EXTREMELY uncomfortable, kind of like your skin wants to walk off your body and your brain wants to escape, it DOES eventually go away. Some months you may find your own production of hormones will fluctuate and some months may be worse than others.   Other chemically synthesized birth control hormones can have the same effect and even when stopped it can take up to and longer than a year to normalize your natural horomes.   So you aren’t going crazy, it’s just the hormones talking and it WILL go away. for more information about what you, in your particular situation, can do to help yourself get right sooner…a book I highly recommend (easy read too)…. "Hormonal Health" Michael Colgan, MD. Hope this helps KC Cindy

Response:

: I can hardly keep my thoughts together today…..I’m not going in to work again : today. ….and, when I called in, she tried to make me feel guilty.   It’s : almost like my hormones override these medications.  I become overly sensitive, : irritable, paranoid, fearful, anxious, restless…..just to name a few : symptoms.  I know that stupid depo shot is still in my system.  I can feel it. : : I don’t have anything to grip on to, and this is a horrible feeling.  Maybe : that’s why that show Greed kept my heart pounding last night.   : I know this will go away in a few days, but what do I do in the meantime? : I haven’t done a "pity party" post for awhile, so I guess it was overdue.     : My doc is out of town AGAIN for the weekend….. : I feel like Sharyn today…..I just want to cry. : ( : Maria Hi Maria, Being male, I can’t personally relate to PMS, but the hormonal character of panic disorder has given me some appreciation of the subject. Valerie Davis Raskin, MD, wrote a very good book titled, "When Words Are Not Enough; The Women’s Prescription for Depression and Anxiety." The book is not too expensive and written for the general public, so you may want to buy a copy via Amazon or some other book shop. It covers a lot of issues that are important to women who suffer from anxiety and depression. Best Wishes, Arthur

Response:

- Hide quoted text — Show quoted text -I can hardly keep my thoughts together today…..I’m not going in to work again today. ….and, when I called in, she tried to make me feel guilty.   It’s almost like my hormones override these medications.  I become overly sensitive, irritable, paranoid, fearful, anxious, restless…..just to name a few symptoms.  I know that stupid depo shot is still in my system.  I can feel it. I don’t have anything to grip on to, and this is a horrible feeling.  Maybe that’s why that show Greed kept my heart pounding last night.   I know this will go away in a few days, but what do I do in the meantime? I haven’t done a "pity party" post for awhile, so I guess it was overdue. My doc is out of town AGAIN for the weekend….. I feel like Sharyn today…..I just want to cry. ( Maria

Maria – YIKES…..deprovera.  I’ve heard enough nightmare stories from my two daughters and my soon-to-be daughter-in-law.  All three have had unpleasant reactions to it and some very unpleasant effects getting off. It might be of some comfort to know that your emotional reaction to the provera in depovera is typical.  Also know that symptoms of normalizing can go on for 18mo to two years.  The progesterone in depovera is a chemically synthesized progestin, not natural hormone and SOME people are terribly sensitive to it. The good news is that although it’s EXTREMELY uncomfortable, kind of like your skin wants to walk off your body and your brain wants to escape, it DOES eventually go away. Some months you may find your own production of hormones will fluctuate and some months may be worse than others.   Other chemically synthesized birth control hormones can have the same effect and even when stopped it can take up to and longer than a year to normalize your natural horomes.   So you aren’t going crazy, it’s just the hormones talking and it WILL go away. for more information about what you, in your particular situation, can do to help yourself get right sooner…a book I highly recommend (easy read too)…. "Hormonal Health" Michael Colgan, MD. Hope this helps KC Cindy

Response:

Question:

Cyndie  I’ve had PAs that last about a second and can leave me shattered for hours afterwards. The last time it happened it was a sudden escalation of fear caused by rapid thought connections. Something made me think of death and life. How this is the life bit, and the other was the death bit. The result – sudden terror and then nothing except – what the fuck was that? I have no idea why I became so frightened. It happened once when looking in the mirror. All of a sudden I couldn’t decide which was me – the looker or the reflection. They sound a bit like bad trips or temporal lobe seizures rather than PAs. On the other hand I’ve had PAs that last for days, almost seemlessly. Fred

Response:

- Hide quoted text — Show quoted text – This is going to sound weird, but this hasnt happened to me before and I would like to know what you think about it.  Today while I was working on a project with the Col. (no not KFC <g)  I noticed a flash of a PA.  It was so weird!  It was like it lasted a second!  It wasnt like a head rush, more like an extremely fast PA! I didnt get upset and nothing else happened, but thought about it off and on cause it was so weird.  I was wondering if it might have been a PA trying to come on but stopped short? I know this sounds weird, but it felt weird too!  I have been on 20mg ever other day of Prozac for a week and a half? and started lowering my dose of Xanax by .5mg a day about a week ago.  Maybe rebound from withdrawel?  I also noticed that in the past few nights I see weird monsters and images (in my mind, not hallucinating) right as I am about to fall asleep and I wake with a start.  I remember having that problem before, when this first started for me 7 years ago.  When I awake I dont have a PA, I just keep trying to go back to sleep, it happens a few times, then I am out like a light until morning.  Does anyone else have these problems? Cyndie

Hi Cyndie: Those PA flashes could very well mean that the Prozac is starting to take effect.  It somehow seems to cut them off before they get going.  Just a guess though, based on my own experience. Also, again just a thought, I would have thought that the rate you’re reducing the Xanax is a little too fast and too soon.  Just my own personal experience and what I’ve read talking here……but usually you stay on your regular doseage of Xanax for the first week or so at least and then, very slowly and minimally, taper down over a period of months.  You might want to check this out with your doctor. Take care. Mally  

Response:

<snipped I have been on 20mg ever other day of Prozac for a week and a half? and started lowering my dose of Xanax by .5mg a day about a week ago.

Maybe rebound from withdrawel?  I also noticed that in the past few nights I see weird monsters and images (in my mind, not hallucinating) right as I am about to fall asleep and I wake with a start.  I remember having that problem before, when this first started for me 7 years ago. When I awake I dont have a PA, I just keep trying to go back to sleep, it happens a few times, then I am out like a  light until morning.  Does anyone else have these problems? Cyndie

Dear Cyndie, Although I’m sorry that you’re having this problem with sleeping, I have to tell you that I am relieved to know that you share this problem with me.  I having had these sorts of images while trying to get to sleep all of my life.  It’s one of the reasons I know that I’ve been having panic attacks for so long.  I think the images are just a way for my mind to cope with the nocturnal PA’s.  When you wake up scared to death, your mind might be inserting a "reason" for your fears.  I’ve often tried to describe these images as little mini-dreams because they’re not hallucinations, although I’m not sure if I’m entirely asleep when it happens.  Anyway, these are just a few theories I have about them.  When you describe waking "with a start," you might actually be describing a panic attack.  My nocturnal PA’s are much different from my daytime PA’s.  It’s something I’ve realized recently. The good news is that when I was on Zoloft (similar to Prozac) these images went away.  In fact, although insomnia is a possible side-effect of Zoloft, my horrible insomnia went away.  I think my insomnia is caused by these nocturnal attacks as well as depression, and the Zoloft helped with both.  And, I wasn’t using Xanax or any other benzodiazepine at the time.  It DID take a few weeks, though: about 6 weeks after I built up to the full dosage for me. Because of that length of time, you might want to consider tapering off the Xanax more slowly.  I realize that this is up to you and your doctor, but going off a benzodiazepine too quickly can be uncomfortable. It does NOT mean that you are addicted.  In his book "Panic Disorder: The Medical Point of View," William D. Kernodle states that everyone will have a different experience when going off a benzodiazepine and that you should go as SLOWLY as you need to.  By the way, I highly recommend this book (1995 edition), if you want some sensible, professional answers to your questions about anxiety medications.  I have been fearful of medication in the past, and this book has explained a lot to me. You’re not alone in these particular experiences, Cyndie, and I want to thank you so much for letting me know that I’m not alone.   Take care, Cathleen P.S.: The reason I stopped the Zoloft had nothing to do with its effectiveness but rather with my financial situation at that time (and my ignorance–and my psychiatrist’s–of financial aid for these sorts of things).

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: This is going to sound weird, but this hasnt happened to me before and I : would like to know what you think about it.  Today while I was working on : a project with the Col. (no not KFC <g)  I noticed a flash of a PA.  It : was so weird!  It was like it lasted a second!  … Wow, that is wierd. The fastest PA I’ve ever had lasted 5 minutes. But then, 5 min is quick compared to the 45 min endurance terror PAs. Perhaps its a good sign?                                         Best Wishes,                                         Arthur

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– Hide quoted text — Show quoted text -This is going to sound weird, but this hasnt happened to me before and I would like to know what you think about it.  Today while I was working on a project with the Col. (no not KFC <g)  I noticed a flash of a PA.  It was so weird!  It was like it lasted a second!  It wasnt like a head rush, more like an extremely fast PA! I didnt get upset and nothing else happened, but thought about it off and on cause it was so weird.  I was wondering if it might have been a PA trying to come on but stopped short? I know this sounds weird, but it felt weird too!  I have been on 20mg ever other day of Prozac for a week and a half? and started lowering my dose of Xanax by .5mg a day about a week ago.  Maybe rebound from withdrawel?  I also noticed that in the past few nights I see weird monsters and images (in my mind, not hallucinating) right as I am about to fall asleep and I wake with a start.  I remember having that problem before, when this first started for me 7 years ago.  When I awake I dont have a PA, I just keep trying to go back to sleep, it happens a few times, then I am out like a light until morning.  Does anyone else have these problems? Cyndie

Cyndie, Happens to me all the time…like 10-20 times a day.  They last 1-2 sec’s and don’t really bother me at all…in fact i kind of laugh at them.   -Scott

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This is going to sound weird, but this hasnt happened to me before and I would like to know what you think about it.  Today while I was working on a project with the Col. (no not KFC <g)  I noticed a flash of a PA.  It was so weird!  It was like it lasted a second!  It wasnt like a head rush, more like an extremely fast PA! I didnt get upset and nothing else happened, but thought about it off and on cause it was so weird.  I was wondering if it might have been a PA trying to come on but stopped short? I know this sounds weird, but it felt weird too!  I have been on 20mg ever other day of Prozac for a week and a half? and started lowering my dose of Xanax by .5mg a day about a week ago.  Maybe rebound from withdrawel?  I also noticed that in the past few nights I see weird monsters and images (in my mind, not hallucinating) right as I am about to fall asleep and I wake with a start.  I remember having that problem before, when this first started for me 7 years ago.  When I awake I dont have a PA, I just keep trying to go back to sleep, it happens a few times, then I am out like a light until morning.  Does anyone else have these problems? Cyndie

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