What is your opinion on the list of medications I am on?

What is your opinion on the list of medications I am on?

  • Lithium
  • Lamictal
  • Wellbutrin
  • cytomel  .025 cmg
  • celexa  40 mg
  • dexidrine 40 mg
  • Lorazepan  4 mg prn
  • Seraqual  200mg

I have been on this combination now for the last 2 months and a bit.  I was feeling a bit better then all out of sudden my depression got so bad that I found myself curled up on the couch in a ball thinking this was it.

I think the medication is playing havoc with me and I phoned my doctor, who I only see for 15 minutes once in 2 months.  I need a doctor who will listen and reassure me.  There are 2 doctors here but they, for some reason will not see me.  I have been trying to get a professional opinion for the last 2 months and I have gotten nowhere.  I can’t concentrate.  I cant focus and I am finding myself in a dark place and just wants to sleep.  M mind is going in so many negative ways I can’t stand it.

Anyone have any ideas.  I am basically stuck in a corner with no way out or help .

Oh how I do love  challenging medication question.  Now I must tell you that I am NOT a physician which means I cannot diagnose, I cannot give medical advice and I cannot tell  you what drugs to take or not take.  What I can do is tell you what each drug can be used for, side effects and drug/drug interactions and drug/food interactions.

Let me tell you just a little bit about myself and my training.  I’ve been a practicing Licensed Psychiatric Technician in the state of California for 29 years now. Among other things I have quite a bit of training in Psychiatric disorders and pharmacology especially in psychopharmacology.   What that means is I’ve had training in medications with particular emphasis on psychiatric medications.

Now the first thing I want to tell you is that you need to find a psychiatrist who will see you as soon as possible.  The symptoms you’ve described are serious and should not be continuing on this long two months after a medication change.  Please get help immediately.

Now I never like to assume anything.  I will however surmise from the medications you are taking and based on my experience that you are most likely bipolar.  So now I’m going to list each drug and tell you what I said I could tell you under the scope of my license.

There are many common side effects shared by many of these medications.  The one side effect that is consistent with ALL the medications is; when taking this drug use extreme caution with alcohol as it can either increase/decrease its efficacy.  Another little fact I’d like to impart is that you or anyone taking psychiatric medications should avoid ingesting grapefruit or grapefruit juice.  Dr.’s and researchers aren’t sure of the direct correlation between the two, but for some reason it interferes with the absorption of  the medications.    (Just a bit of FYI)

Now about your medications.  I have divided them into the drug classification they fall under.

Non Psychiatric

1) Cytomel; This drug is used to treat hypothyroidism. I found no contraindications with the psychiatric drugs you are taking.

Mood Stabilizers  (MS)

1) Lithium; this drug is used to treat mania and Dr’s have found that this is the only MS that reduces depression as well.

Common side effects; dry mouth, metallic taste, indigestion and psoriasis.

Less common, possibly rare side effects; dizziness, high or low blood pressure, speech impairment, loss of coordination, blackouts, nausea/diarrhea, confusion.  Any of these symptoms could possibly be due to lithium toxicity.  This is a LIFE THREATENING complication!  Seek immediate medical attention.  Suggested max/day dosage: 300 to 2,400 mgs

Lithium is an excellent drug and works well for many.  It does have the potential to become toxic if blood levels aren’t monitored properly.  When first beginning lithium you will need to have blood draws done once per month for about 3 to 6 months.  This varies with each patient.  Once stability is reached the blood draws are less frequent, and are done anywhere from every 3 to 6 months or even once or twice a year.

Lithium level parameters can be very precise without much room for interpretation, however as we are all individuals, a very small number of cases fall outside these parameters and the patient is at a therapeutic range.

Ranges for acute mania(or first starting lithium):  1 – 1.5  mEq/l

Ranges for maintained doses:  0.6 – 1.2  mEq/l

(mEq/l  is scientific/biologic measurement for how much lithium is in the body).

2) Lamictal; this drug is actually an anticonvulsant but as I said many different classifications of drugs can be used to treat a variety of other illnesses.  Many psychiatrists are finding this an excellent MS.  There are some very important things about this drug I need to mention before we continue. 1) If at ANY time you develop a rash while taking this medication, stop taking it immediately and seek medical attention.  This is an uncommon/rare side effect   is called Steven Johnson Syndrome and in some cases can be fatal. 2) Lamictal must be titrated (increased/decreased) extremely slowly or your potential for severe side effects as the one mentioned above drastically increases.

common side effects; dizziness, headache, insomnia, sensitivity to sunlight, thinning of hair, blurred vision and runny nose.

Less common/possibly rare side effects; interference with Depakote/Folic Acid absorption, palpitations, muscle spasms, depression, Steven Johnson Syndrome, too rapid titration and seizure.

Suggested max/day dosage 400 mgs

Antidepressants

1) Wellbutrin; It is not exactly known how this drug helps depression.  The prevailing theory among scientific experts is that it weakly inhibits Norepinephrine, Serotonin and Dopamine reuptake (that means it keeps these brain chemicals that affect mood more in balance).  This drug is considered and “older line” antidepressant because it was used for many years before the advent of SSRI’s and  SNRI’s  Psychiatrist’s like using Wellbutrin for some patients as it can work very well for some.

Common side effects;  headaches, insomnia, dizziness, cough and sensitivity to sunlight.

Less common/even rare side effects;  anxiety, hostility, depression,weight gain and seizures (it is important to note that seizures are considered rare and tend to happen more at higher dosages).  Suggested max/day dosage 450 mgs

2) Celexa;  Celexa is one of the newer antidepressants in the SSRI classification.  Psychiatrists I have talked to have mixed feelings about this drug.  On the one hand it has relatively fewer side effects than some of the other antidepressants, but on the other hand its efficacy rate varies among patients.  It can also take one to four weeks to reach therapeutic efficacy.

Common side effects;  dry mouth, insomnia, mild to none nausea and apathy.

Less common/rare side effects;  depression, anxiety, tachycardia (fast heart rate), high/low blood pressure and suicidal thoughts or ideations.  Suggested max/day dosage 40 mgs

PLEASE NOTE; some unfortunate side effects of any of the SSRI’s and SNRI’s can be decrease in libido, and either a decrease or increase in weight.

Antipsychotics

1) Seroquel; Seroquel is an atypical antipsychotic that was approved for use in patients with Bipolar DO in 1994 as an adjunct therapy to MS and antidepressants.  It can help reduce anxiety in some patients.

common side effects; dry mouth, constipation, rash, dizziness, sweating and rhinitis.

less common/even rare side effects; tachycardia (fast heart rate), palpitations, seizures, anorexia, weight gain and hyperglycemia (high blood sugar).  There has been an increasing concern about the fact that Seroquel is inducing Diabetes in a somewhat small amount of patients taking Seroquel.  Scientists and researchers are seriously examining the component of the drug that could be causing this to happen.  Suggested max/day dosage 800 mgs

Stimulants

1) Dexedrine; Dexedrine is a stimulant used to treat ADHD and Narcolepsy.  insomnia, dizziness, headaches, Some Dr.’s are using it for patients to bring  them out of a very severe depression although it has not been approved for this type of use.  Please note that this drug has high potential for addiction and abuse.

Common side effects; insomnia, dizziness, headaches, dry mouth, constipation, diarrhea, dysphoria, euphoria, nervousness and over-stimulation.

Less common/even rare side effects; palpitations, high blood pressure, arrhythmia’s, anorexia, tachycardia, seizures and the lowering of seizure threshold for patients with seizure DO.  Suggested max/day dosage 60 mgs

Drug/Drug interactions; antacids, ascorbic acid, Thorazine, Insulin and oral anti-diabetic medications (may decrease efficacy and cause increase in blood sugar), Phenobarbital & Dilantin: both anti-convulsants (lowers efficacy therefore increasing risk for seizures).

Drug/Food; caffeine and orange juice as it contains ascorbic acid.

PLEASE NOTE: This drug should be used with education and caution.

Anxiolytics

1)Lorazepam: trade name Ativan;  Ativan is a drug basically used to reduce anxiety and/or panic.  which is a group of   It can also be used for insomnia from anxiety, and is given immediately intramuscular to a person who is having a seizure.  It is classified as Benzodiazapine which is a group of drugs used to treat anxiety.  Benzodiazapines can lead to abuse and addiction, use responsively.  Ativan has been known to cause depression and secondary depression.

common side effects;  insomnia, headaches, nausea and drowsiness

Less common/ even rare side effects; amnesia, low blood pressure, agitation, weakness and DEPRESSION.  Suggested max/day dosage 10 mgs.

Like I said earlier I am NOT a Dr.  I do however believe you should find a Dr that is willing to spend more time with you than 15 minutes every two months.  You need help now. I really hope that you listen and do just that.

I sincerely helped to answer your question.


3 thoughts on “What is your opinion on the list of medications I am on?

  1. I am not in a position to offer any professional advice. However, I have taken my fair share of medication over the years and it seems that your doctor has prescribed lots. 2 mood stabilisers, 2 antidepressants, an atipsychotic and a big dose of a benzodiazepine. I would be getting a second opinion NOW and if possible, a psychopharmacolgist to review the medication you are taking. I take Lithium and know that it has the potential to ‘accentuate’ the effects of other drugs I am taking. Have you had a lithium level taken recently? Your doctor is letting you down with the 15 minute appointment and reliance on a grab bag of drugs to fix the problem. You REALLY need to get another opinion right now. Tell your family or a friend that you need help NOW.

  2. Very nice, Catherine! Thank you for your time and thoroughness. I love learning new things, especially when it helps me to help my son 🙂

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