The question is, does Prestiq have the effects I require for the depression reduction or am I simply spinning my wheels here?

This is a post from a different site about their take on Prestiq:

" Pristique is just a metabolite of effexor. It was marketed because the patent on effexor was lapsing. It is a cynical attempt to to make more money by marketing a drug that has no benefit over effexor except exclusive marketing rights. If you want to take pristique, take generic effexor and your liver will convert it to pristuque in a few hour for free. Nonsensical drug like this make healthcare needlessly expensive."

Comments??

I have been on almost every AD medication since the early 90's, Paxil,through the latest,Prestiq.

Between the mixes and eliminations of the different meds,I am still wondering about this one.The combination of Prestiq and Zoloft, along with Depakote ,Ativan,Sonata and Trazadone(for sleep), Lovaza for the increased cholesterol,(and Crestor), wow,too many meds for this guy.I am in the time of this round of recovery, where I question the meds overall effectiveness.Much less their necessity.I will continue with the doctors and therapy I have today, they are top notch, I just want to see how others have been on this medication.

Ken, I'm having a hard time finding it here at my hospital formulary by that name. Does it have a generic name?

Found it, but it's loooooong!

Classification:

Psychotropic Agents
Antidepressants
Serotonin norepinephrine reuptake inhibitors


Description: Desvenlafaxine succinate is an oral antidepressant of the serotonin-norepinephrine reuptake inhibitor (SNRI) class. It is the major active metabolite of venlafaxine (Effexor®). Desvenlafaxine is FDA approved for major depressive disorder (MDD) and pending approval for vasomotor symptoms associated with menopause. Symptoms of menopause which have been under evaluation in clinical trials include hot flashes, sleep disruption, overall climacteric symptoms, mood changes, and somatic symptoms. Desvenlafaxine is currently being evaluated in phase III trials as a potential treatment option for pain associated with peripheral diabetic neuropathy and fibromyalgia syndrome. The efficacy of SNRIs is similar to another major class of antidepressants, the selective serotonin reuptake inhibitors (SSRIs); however, they differ in mechanism of action and side effect profile as a result of the neurotransmitters they affect. Antidepressants such as desvenlafaxine which modulate norepinephrine as opposed to exhibiting serotonin selectivity are generally more beneficial in the treatment of pain syndromes. The related compound venlafaxine has been used in the treatment of neuropathic pain, diabetic neuropathy, headache, and fibromyalgia. Desvenlafaxine is likely to benefit women who want to avoid estrogen treatment for vasomotor symptoms associated with menopause, or women in whom estrogen therapy may be contraindicated, such as those with invasive estrogen receptor-positive breast cancer. An approvable letter was issued in July 2007 for the treatment of menopausal symptoms; final approval is pending. In February 2008, desvenlafaxine (Pristiq™) was approved by the FDA for major depressive disorder (MDD) in adults.

In October 2004, the FDA directed manufacturers of all antidepressants to include a Black Box warning, expanded warning statements, and clinical trial results detailing the increased risk of suicidality in children and adolescents. The warning was subsequently revised to include data on the increased risk of suicidality in young adults. A Patient Medication Guide (MedGuide) should accompany all prescriptions for antidepressants. It is advisable to prescribe medications, including desvenlafaxine, in the smallest quantity consistent with good clinical practice in patients with depressive disorders or other conditions with suicidal potential.

Mechanism of Action: Decreased adrenergic and serotoninergic neurotransmission has been proposed to play a key role in the etiology of depression. It is theorized that serotonin (5-HT) and norepinephrine (NE) reuptake inhibitors work by blocking the central presynaptic reuptake of 5-HT and NE, resulting in an increased sustained level of these neurotransmitters. Changes in postsynaptic receptor characteristics with chronic administration may also contribute to the efficacy of antidepressants. Serotonin is a neurotransmitter which regulates an extensive modulatory behavioral system in the brain. The serotoninergic system is known to modulate mood, emotion, sleep, and appetite and thus is implicated in the control of numerous behavioral and physiological functions. Norepinephrine is an adrenergic neurotransmitter which appears to be involved in a range of psychological processes, including mood stabilization, sleep regulation, overall alertness and arousal, and in regulating response to stressors which might initiate or exacerbate depressive symptomatology. Desvenlafaxine does not appear to possess monoamine oxidase inhibiting activity.

Pharmacokinetics:
Desvenlafaxine is administered orally. Desvenlafaxine is the major active metabolite and an enantiomer of racemic venlafaxine. Animal studies have shown that peak plasma and brain concentrations of the drug occur 30 minutes following a subcutaneous dose of 30 mg/kg.[33107] In the presence of a 5-HT1A antagonist, serotonin levels in the hypothalamus increased 225% after 1 hour. Norepinephrine levels increased 44% after 3 hours, while dopamine remained unchanged. Desvenlafaxine was not detectable in plasma 24 hours following the dose.[33107]

Pharmacokinetic study results obtained in humans are available from administration of the parent compound venlafaxine and subsequent observation of desvenlafaxine kinetics. These results indicate that protein binding of desvenlafaxine is 30%. The primary metabolite is the O-glucuronide conjugate of the drug. The elimination half-life is 11 hours.


•Special Populations
Hepatic Impairment
It appears that the half-life of desvenlafaxine is affected by the presence of hepatic disease. Data indicate that the elimination half-life of desvenlafaxine is 60% longer and clearance is 30% less in patients with hepatic disease compared to those with normal hepatic function. Guidelines for dosing in the presence of hepatic impairment are not available.

Renal Impairment
It appears that the half-life of desvenlafaxine is affected by the presence of renal disease. Compared to patients with normal renal function, the half-life of desvenlafaxine increases by about 40% in patients with renal impairment, but clearance appears to be unaffected. Guidelines for dosing in the presence of renal impairment are not available.

References

33107. Alfinito PD, Huselton C, Chen X, et al. Pharmacokinetic and pharmacodynamic profiles of the novel serotonin and norepinephrine reuptake inhibitor desvenlafaxine succinate in ovariectomized sprague-dawley rats. Brain Res 2006;1098:71-8.

[ Revised 5/14/2010 1:15:00 PM ]

I hope this helped. Here is the link, but I'm afraid you probably can't get into it.

Mosby's Nursing Consult -- Start Session Cookie Error (http://www.nursingconsult.com/das/pharm/view/202930440-2/full/3538/top?sid=1004318272&summaryresults=true&SEQNO=1)

J-9

Thank you for this information,I am making this a poll in hopes others can look at what questions like this can produce:)

I know that the info I posted was VERY clinical. I got the info from our pharmacy formulary at work. I felt that you had a good enough understanding of medication to be able to dig through this and get the info you need.

I spent about an hour of research on our patient care site trying to find the info in a more layman friendly structure, but it seems that we don't have any particular patient information on this medication.

I'll try to dig out my drug book (lost in the shuffle of remodeling last year) to see if I can break it down in to terms that are easier to understand.

Re-reading through this, I might ask my doctor about it tomorrow for my menopause symptoms. Maybe I can get into one of the clinical trials.

Ken,

The fact that one drug is a metabolite of another is not necessarily problematic. As example, oxymorphone is a minor metabolite of oxycodone. Oxymorphone is far more powerful that oxycodone. Basically, a metabolic step was removed and oxymorphone marketed independently. That's a benign example and doesn't necessarily address your instant question.

I have done a great deal of research on SSRI and depression. I'm going to take a moment to explain one component: The placebo effect. That means that treatment works because the patient believes and has confidence in the therapeutic process. Not necessarilyalthough possibly the drug. (This is my parapharse of placebo)

In the treatment of depression it has been a consistent finding that the placebo effect is extraordinarily high.

What does that mean for treatment? I believe, that much of the improvement in depression can be traced to non-pharmacologic elements of the treatment process. The research supports my view. Nonetheless many people currently on antidepressants (and that's almost anyone who ever uttered "depression" in front of their doctor) believe in the antidepressant.

The public never sees the research results. That is published in peer review journals and by the time it reaches popular publications it has been reworked and edited by writers from the pharm companies. Nonetheless, they have influenced public opinion to the point that there is a belief in SSRIs and the seratonin hypothesis in justifying their purported efficacy. This adds to the placebo effect noted foregoing.

I have intentionally avoided, here and in other public lay forums, the subject of antidepressants (SSRI class) so as not to negatively impact those currently being treated with same. If someone is deriving benefit, or believes they are deriving benefit which is procedurally the same thing, the research to the contrary is meaningless to them.

It sounds as though you are questioning and should be provided access to information. Some is available on line, most not.

I know that as an anonymous poster I am not going to change public opinion or expose medical science. It is just my concern that if I should jar even one person from the benefit they obtain from their antidepressant if I have not done more harm than good.

Based on J_9 post (she has good manuals)

"Classification:

Psychotropic Agents
Antidepressants
Serotonin norepinephrine reuptake inhibitors"

I would conjecture that Pristique was introduced because of the last sentence. Behind the scenes there has been a movement away from the monoamine (seratonin hypothesis) as the primary neurotransmitter of interest in depression. You will see many new drugs entering the market that now target both seratonin and norepinephrine (SNRI). Interestingly, the monoamine hypothesis was first introduced in 1965 by Joseph Schildkraut and the focus was on norepinephrine. It was two years later, in 1967 that researchers began to theorize that serotonin was the neurotransmitter of interest (Coppen, 1967). So the idea isn't new nor does it have more scientific evidence in support than 50+ years past.

But I believe that's why you are seeing Pristique, Cimbalta, etal. It is a shift toward a new paradigm rather than an expiring patent. New only in the sense that the public is pharmacologically naïve and it will be portrayed as a medical research advancement by the pharmaceuticals as SNRIs displace SSRIs on the prescription pad. (Effexor is also SNRI)

Both of you, I am very much into this type of information, your input has greatly opened doors for questions and further research into the medications I(and others) take.

Thank you both!

To further this,Why then is there a need to continue on the Zoloft(in my case) and for many others,their need to continue using SSRI's in their regiment,if a product like this one does the work for 2 neurotransmitters?

Is there an over medicating or over treatment of the seratonin by using these in conjunction?(always been on my mind but was reluctant to ask, one too many doc would dismiss me as just a lay man,not schooled enough to understand)

Thanks again for any further discussion, I am out of 'greenies' for both of you, have to spread the rep more.

To further this,Why then is there a need to continue on the Zoloft(in my case) and for many others,their need to continue using SSRI's in their regiment,if a product like this one does the work for 2 neurotransmitters?

Is there an over medicating or over treatment of the seratonin by using these in conjunction?(always been on my mind but was reluctant to ask,,one too many doc would dismiss me as just a lay man,not schooled enough to understand)

Thanks again for any further discussion,,I am out of 'greenies' for both of you,,have to spread the rep more.

I'm going to pass this one on to Dr. Bill, it's more up his alley.

Well, went to doc today for a follow up on my thyroid. I have gained 7 pounds in 6 weeks, not good considering I'm on Synthroid. I also mentioned my hot flashes. It was the doc who suggested Prestiq for the hot flashes and to help reduce weight. We will see what the next month brings.

Well,birds of a feather.. :p

Welcome back to better living through modern chemistry!

I apologize for being slow to respond. I'm very anxious to provide what info I have gathered over the years. Right at the moment I've having connection problems. I get right in the middle of something and the system shuts down. This is computer 2 on the blink. So I may have to piece my posts together If it keeps working.

I apologize for being slow to respond. I'm very anxious to provide what info I have gathered over the years. Right at the moment I've having connection problems. I get right in the middle of something and the system shuts down. This is computer 2 on the blink. So I may have to piece my posts together If it keeps working.

I've got time Bill, These types of questions aren't life threatening, I am just looking for more information,like always.

First let me venture over to the left edge of your initial post/complaint and tie it together with information I have derived from other threads.

1) You're in the process of trying to quit smoking and using a nicotine patch.

2) Cigarette smoke has an antidepressant effect. To date, the chemical properties that inhibit Monoamine Oxidase (MAO) are unknown. It has been firmly established that it is not nicotine. See Researchers Explore Link Between Smoking, Depression ? Psychiatric News (http://pn.psychiatryonline.org/content/36/23/20.full)

This is probably just outside the subject matter but may have personal significance to you. Above I provided one link to research and there are more. Overall this is a very significant issue as persons with depression are likely to be smokers. An interesting variable that has received no popular media coverage.

The information provided to the public (including physicians) about depression and treatment is in direct conflict with medical research that is reported in peer review journals, select professional publications and the like. Elliott Valenstein, Professor Emeritus of Neuroscience, first noted this disparity in 1998, at the dawn of consumer advertising of SSRIs. He summarized the scientific data by concluding, “What physicians and the public are reading about mental illness is by no means a neutral reflection of all the information that is available”

The fact that antidepressants are being marketed directly to the public, that patients are going to a doctor and telling the doctor what medication, by brand name, they want is unprecedented. This direct to consumer advertising (DTCA) is the subject of widespread criticism within journals and the bain of most doctors. See as example: Lacasse & Leo (2005) (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1277931/)

It is largely due to the DTCA that the seratonin hypothesis took hold. Explaining depression as a chemical imbalance in the brain that pharmaceutical manufacturers claim to correct with SSRIs.

Since 1967 when a chap named Coppen first advanced the theory (Br. J. Psy (http://www.ncbi.nlm.nih.gov/pubmed/4169954)) not one single study has emerged to support the theory. The entire basis for asserting that seratonin is implicated in depression comes from the backward reasoning that since SSRIs are effective in treating depression and it works on seratonergic neurons therefore seratonin must be the cause.

It has been known for years that SSRIs were only minimally effective, and since 2005 when concealed studies were uncovered there is now the belief that SSRIs are "clinically insignificant." (See mega-analysis by Kirsch, 2008 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2253608/?tool=pubmed))

Therefore you are seeing a movement away from a badly flawed therapeutic approach. The development of an alternative therapy that also incorporates the neurotransmitter norepinephrine. The norepinephrine theory actually pre-dated the seratonin theory. There is no scientific evidence to demonstrate the involvement of any particular neurochemical in any mental disorder (See Kirsch, above)

So,if it isn't a chemical imbalance,what is the treatment option, if medications are the typical band-aid for this,a smoke screen covering the real problems, is the answer really in some form of psychotherapy?

Do the studies/speculations of Leo Booth/John Bradshaw have more validity to them than has been given credit for?Toxic Shame by Leo Booth/John Bradshaw (http://rds.yahoo.com/_ylt=A0geu88Xb25J1s4ArOxXNyoA;_ylu=X3oDMTEyN2FiNWh iBHNlYwNzcgRwb3MDNARjb2xvA2FjMgR2dGlkA00wMDFfNzY-/SIG=12juptdu0/EXP=1232060567/**http%3a//www.goddirect.org/mindemtn/writings/january/toxshame.htm)

OMG, this stuff is fantastic for hot flashes!! I have only had one in the past month where I was having several a day.

Unfortunately I cannot take any herbal supplements due to my past cancer issues, so I'm going to stick with this!

OMG, this stuff is fantastic for hot flashes!!! I have only had one in the past month where I was having several a day.

Unfortunately I cannot take any herbal supplements due to my past cancer issues, so I'm gonna stick with this!

Good stuff,huh? :p

That sounds awesome J, I am glad it's doing the trick for you!

To further this,Why then is there a need to continue on the Zoloft(in my case) and for many others,their need to continue using SSRI's in their regiment,if a product like this one does the work for 2 neurotransmitters?

Is there an over medicating or over treatment of the seratonin by using these in conjunction?(always been on my mind but was reluctant to ask,,one too many doc would dismiss me as just a lay man,not schooled enough to understand)

Thanks again for any further discussion,,I am out of 'greenies' for both of you,,have to spread the rep more.

Ken,

Here is a link to an article by Simon Sobo, M.D. in relation to SSRI and treatment in general. Pretty long but informative. Let me know what you think.

Simon Sobo, M.D. : A Reevaluation of the Relationship between Psychiatric Diagnosis and Chemical Imbalances (http://www.simonsobo.com/a-reevaluation-of-the-relationship-between-psychiatric-diagnosis-and-chemical-imbalances)

Instead of correcting imbalances, it is argued that pharmacological agents may be viewed as inducing particular psychological states which though not specifically related to diagnosis, are nonetheless the basis for the usefulness of the medication.

Hypo-mania,depressive states,etc?



... as well as the 15-minute, once-a-month medication visits that have become standard psychiatric practice...

Of which I used to be a part of,now I see him when I need to, or even feel the need to, weekly even,if I see the processes being to disruptive to daily life.

Finding the 'right way' to get yourself treatment is close to impossible in today's mental health area.I was seeing a social network therapist/psychiatrist(basically income based,state funded and although professionally run,it lacked funding for much more than that '15 minute,once a month' doctor visit,basically for prescriptions and a brief hello.)Today I see a private psychiatrist and therapist team,they both make less than they could by treating the rich and famous,but they also can be somewhat more lax in their ways, not a negative connotation,just that they can be more down to earth than the stiff hard core professionals I have been treated by in the past, much more user friendly:)


Substance-Induced Mood Disorder

Makes me wonder how much of MY diagnosis is actual chemical imbalance and how much is from all the drugs I took during my former career in basic street drugs.

Although I can recall having mood problems as a child(say from around 6-7 years old) and was treated by psychiatrists and therapy,then during my early teens(I had already began drinking daily at that time,and drugs were in the picture then also)in a mental hospital at 14.I still wonder how much of the younger 'preexisting' imbalance was a factor verses the introduction of outside chemicals which produced far more severe moods.
(Yes,I can see the danger of the uneducated being presented with information like this which can just compound the situation,making an ignorant person full of questions)


The implicit premise of the chemical imbalance perspective is that this will be temporary.

Again,back to my comment about how much was the 'childhood' problems a factor verses the addition of drugs and drinking.

More later,if you are up for further discussion like this:)

"Finding the 'right way' to get yourself treatment is close to impossible in today's mental health area."

Wonder if you could expand on that. Type of problems encountered, etc.

Thanks
Bill

I've been forgetting to draw your attention to an excellent article on the placebo effect and antidepressants. I think you will find this interesting:

Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why. (http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=all)

"Finding the 'right way' to get yourself treatment is close to impossible in today's mental health area."

Wonder if you could expand on that. Type of problems encountered, etc.

Thanks
Bill

From the earliest sign of my mental diagnosis's,I had serious Blue Cross/Blue Shield coverage, everything was covered, everything.Upon aging to my 20's,like all late teens of my peer group,we had no insurance,no real way to get help without feeling like a beggar and less than for asking for help,so we self medicated(at least all those I was around did,birds of a feather)

After 10 years or so of the self medicating,things got to a boiling point,I needed help worse than the idea that asking for it was going to be an option,is was going to become a legal issue(thankfully,mine never got that far, not quite anyway:) ) I was hospitalized for physically injuring myself,suicide attempts,etc... The state of Pennsylvania paid the bill for all those times as I was indigent,beyond functional in society.etc.

With time and therapy,I began to have some clarity and function,I began running my own business and keeping books,paying for insurance,payroll, stress:(,Eventually it all came back down,I buckled under the pressure,I stopped taking the medications,stopped therapy,stopped working,stopped participating in life,, all the things to return to that chaos I was so accustomed to.Safety in insanity.Safety in not having to be responsible(or think I wasn't responsible) for my actions.Escapism.

From a move to a new location,eventual returning to chaos,moving to another location,chaos,moving,chaos, each place had it's times of 'I'll go and try therapy and meds and keep my head,I can succeed'.Eventually I would want the old comfortable chaos and stop doing for me what I could and reject the simplistic order offered to me.

Now to answer your question.:o

Finding quality help in different locations(namely for the runners like myself).In Pennsylvania I went from insurance and good private care,to state funded,welfare(and inner city wasn't real good for care),moved to the mountains, out there,the care was still state covered,but the county care facilities were far superior to the inner city's.From there,New Orleans, If you know anything about the care facilities for public funded hospitals and clinics in New Orleans, you know they are seriously behind the times,20 or more years in a lot of areas, medications were still being given which were off the lists even in Pennsylvania at ten years before.A welfare area and built to stay that way:(

Moved up to Illinois,with no insurance again,but on medications, immediately went to the best option for sliding scale care, adequate for most patients/clients.. I was actually impressed after the Orleans time.. I was under their care for more than 12 years., now I have great coverage,a private doctor,private therapist,care is perhaps the best I have ever had since the early teens...

For others,new people in the area,patients who have to stay with the sliding scale facility(both state and local funded,plus a foundation/trust),they can't go where they choose to go,see who they want to see,if they have an issue with their doctor,too bad,that's who they have to deal with or have no doctor at all.

Yes,there are always times when a mentally unstably mind will be volatile,reluctant to accept anything,stubborn,etc.(Imagine I know about all this, wonder how:p ), where does that person go for treatment?How do they cope with the problem at hand?How,over time,can they be made to comply with the rules/regulations of a facility they no longer believe in?

(E-gads,I hope this is making sense,I am really rambling)

I used my resources and contacts,my ability to deal with certain situations,coping skills learned over the past 30 years,to find a way to get the help I was looking for.I am more resourceful than many others(not self adulation, just reality),I know I can do more than many others in my 'bi-polar diagnoses' do for themselves.(or I like to believe I can and put forth the effort to get it done)

Easy to say, go get the care you need people, when the cards are down,who has the willingness to even try looking behind that ant hill,much less the mountain?

The mental mind/state of mind I have been in during certain times, (wow),made it near impossible to look for help,much less be willing to ask for it.There is no easy way to find good therapy.There is no easy way to find a doctor you are going to like/trust/believe in/doesn't let you down/doesn't 'hit that raw nerve'with a jolt of electricity/Make you think you are inadequate/, this isn't rational,but we aren't talking here about rational minds either.

Yes,I am tired,yes I blabbered on and on.. thanks for being a sounding board.

I will look into the placebo link tonight, thanks Bill:

Ken

I have had some time since the last post to think things over a little.

I am off the Zoloft all together(again),I am on the Prestiq,Depakote and Ativan when necessary.(probably should take but haven't,I kind of like the manic stuff:),and who doesn't while they are in the mood?)

I missed the Prestiq and Depakote both this AM,I didn't remember the nightly Depakote till right now, that's mania for sure, I have been running around like a mad man for more than a week.Getting lots done,only thing I am missing is... well.. not much of anything, I am a lot more moody(angry quick,better off left to my own devices than co-mingling with the world.)Doctor said to run with it,as long as I don't make any 'bad decisions', hmm, I guess I'll know if their bad decisions after I make them.. most things I do today are on instinct and desire.

Withdraws from Prestiq,I don't know if they will show up in the short time it took with Zoloft(that took a day or 2 off it then a week of 'manic like' hyperactivity and then a therapeutic return to 'normalcy')

Is there a placebo effect there or did I really suffer like I think I did(and it happened so many times,I don't think there is any doubt as to the effects)

Right now I am the polar opposite of my winter self.. If only I could regulate half this high with half the winter low I would have some confidence about living life to it's potential, right now, this is too much, the winter times, it's too little.. :(

I guess this is just a sounding board,a place to journal online with friends as the choir I am singing to:D

Based on your statement, I assume you ran this past the prescribing doc? What made you decide to cut off the Zoloft and/or other meds?

How do you differentiate between manic and energetic?

One further question, is this winter/summer swing the basis of the bi-polarity?

Bill

Yes the med doc and I are in agreement about the Zoloft,I really do try t stay compliant to meds,sometimes life has me running out the door before meds are in the picture, rare mind you,but it does happen.

Manic is an out of control high,like too many hypers all tied up in one.Actions and decisions are not thought out,they are instinctively(or a netter word would be, compulsively) acted on.. without thought of the real outcome, that can be felt with when I think I might have messed up.I seem to get argumentative,feel compelled to make the 'other person' see things MY way(which I am totally right in it), even later on I don't regret making statements like that, but I am aware that I could have done so in a kinder manner.

Energetic on the other hand,is like a sugar high,caffeine buzz,etc.. muck lower level of 'excitement' and I do much better about thinking about the outcomes, play the tape through,thinking.And the results are better also.

In the beginning of my diagnosis,yes,winter blues and summer highs, I simply attributed it to work(I am a trades person,work in the outdoor trades in the winter slows to a snails pace then picks back up and is off and running for some 9 months,this has been discussed with many of my doctors.

One wanted me on light therapy... ehh.

One wanted me on breathing therapy.. skipped that one.

One was convinced that I didn't need medications(bad choice there,)I was in patient within 3 weeks, for a while.:(

Mania returns from withdraws from the antidepressants.Depression can come from any 'situational' item that arises, it only takes a frame of mind which doesn't co-inside with society.Perception has a major roll in that.

Mania also come on with too many things on my plate(over stressed with too many responsibilities),I either ran,(new location,new relationship, new doctors,etc.)or I acted out,made bad decisions and had the regret bring me down to a low.. manic dealt with.

Again,I am super tired tonight, did much in a short time(6AM-9:30 PM), just racing around getting huge amounts of things done,hurting no one.. and now paying the price,fatigue and still the necessity to do more in the AM.

Does this answer your inquiry?

Why not light therapy?

I opted for tanning beds instead of light therapy.

Light therapy was a solitary operation which kept me isolated, tanning beds made me go out and see other people,I loved the heat in the winter time,the company was 'normally' of a type of people I related to and seemed to be accepted by(at least that was my take on things,and that's half the battle in any depression)I also made customer contacts for my furniture building.(I could show anyone what I was building at that time via pic. Phone and then they would make further inquiries as they saw fit.. :).. win.win.

AND!!

As it turned out,the spa wanted my help in many areas and so it has only run me 1/2 the fees during the first year of services,since then I have built items,done services,etc,for the owner and the spa itself, making this a non monetary issue as well.

Since I know I won't be forever young I chose to look like I want to(tan in the winter) and don't have to consider light therapy much(Yes,I wear the glasses in the booth,but I am of the mind that the heat,light,social outwardness,etc.Much outweigh the (potential) negatives.)

I am more awake now! :D

Ken,

I sincerely hope that your current doctor and therapist are active listeners and give due weight to your observations and thoughts.

You have a very good feel for your personal circumstance, a remarkable understanding of how many of the problematic (seemingly self-defeating) activities developed. You have put together a retrospective of your relapses, in your own words, with sufficient clarity that even a psychiatrist should be able to understand it. (a little caustic wit aimed at my compadres)

Your observation of the "safety of insanity" is a keenly penetrating bit of self awareness. Where did that term come from? I wonder if that is directly related to your expression "return to the chaos"? In other words, the "return to chaos" being the road back to the "safety of insanity"?

Regardless, these are all your personalized descriptors of actual psychodynamic processes (so called) that are well established in treatment (using psychiatric jargon, of course). Yet you have identified the relatedness of these behaviors through experience and introspection. That's much to your credit and benefit. It would be a shame if your insight wasn't being fully exploited to develop a concordant treatment plan.

There are several loose items involving past treatment recommendations and disparity in quality of care that I believe I can tie together for you (without stepping on your doctor's toes) but I'm pressed right now.

How are you coming with the Zoloft cessation and how did you fare with quitting smoking?

The Zoloft has many items which have been more than problematic.The sexual side effects of being on it,much less being taken off it(and all the times I stopped taking it,returned to it,etc.)have made me unable to function.

It is a deep regret.(wonder how Freud would respond to THIS treatment response)

The last week or 2 have taken their toll on me,I spent 4 hours in the ER today,major complaint:Unspecified fatigue.Treatment:Rest,push liquids,follow up with MD in 2 days if it continues, Return to ER if it progresses:(, I could barely drive there in the first place,it's 12 miles away and with the amount of pain,returning will be in the ambulance,not by my driving.

I have been to the extreme lately.. bad decisions?Over working to complete exhaustion might be considered that(and looking over my spelling from the last few posts,, I know I wasn't fully aware of myself, I am a perfectionist when it comes to writing and communication, at least to the best of my abilities,, those posts were atrocious.

Is this withdraws from Zoloft?I am not sure.

Is this mania?I am not sure.

Am I fatigued enough for outside help,yes.

Has my doctor or therapist been apprised of any of this?no.

I am not prepared for the expected backlash from either of them(projection and perception keep me from 'dealing' with either of them)

The smoking cessation didn't go far,I am afraid.I returned to the smoking shortly after I stopped.No further thoughts to the cessation for a while,I have the patches,but no desire anymore.

I am not 100% sure where to go right now,I guess calling the doc would be a good decision,but work and responsibilities also weigh in on what I need to do.Time off for doctors and other personal pursuits just don't seem productive.(I am wondering how rational I am right now,I sense that I am not fully aware of what it is I am trying to express)

The effects of the medications have just surfaced,that would account for this post being from lucid to hazy.

I am not 100% sure where to go right now,I guess calling the doc would be a good decision,but work and responsibilities also weigh in on what I need to do.Time off for doctors and other personal pursuits just don't seem productive.(I am wondering how rational I am right now,I sense that I am not fully aware of what it is I am trying to express)

The effects of the medications have just surfaced,that would account for this post being from lucid to hazy.

I'm not following your train of thought or reasoning. That is unusual.

It is very clear that something is awry and a third-party ER doctor isn't about to piece it together based on a complaint of fatigue. You should be in touch with the doctor that is familiar with your history, demeanor and the medications he prescribed.

Reading your message it's obvious you are in no condition to work anyway. Please focus your complete attention on your present problem and contact the doctor most likely to have the answer without delay.

This is just a bump in the road and you have overcome worse. But you have to take directive action and forget the avoidance you mentioned.

Keep in touch.

Bill

The Zoloft has many items which have been more than problematic.The sexual side effects of being on it,much less being taken off it(and all the times I stopped taking it,returned to it,etc.)have made me unable to function.

It is a deep regret.(wonder how Freud would respond to THIS treatment response)

The last week or 2 have taken their toll on me,I spent 4 hours in the ER today,major complaint:Unspecified fatigue.Treatment:Rest,push liquids,follow up with MD in 2 days if it continues,,Return to ER if it progresses:(,,I could barely drive there in the first place,it's 12 miles away and with the amount of pain,returning will be in the ambulance,not by my driving.

I have been to the extreme lately..bad decisions?Over working to complete exhaustion might be considered that(and looking over my spelling from the last few posts,,,I know I wasn't fully aware of my self,,I am a perfectionist when it comes to writing and communication,,at least to the best of my abilities,,,those posts were atrocious.

Is this withdraws from Zoloft?I am not sure.

Is this mania?I am not sure.

Am I fatigued enough for outside help,yes.

Has my doctor or therapist been apprised of any of this?no.

I am not prepared for the expected backlash from either of them(projection and perception keep me from 'dealing' with either of them)

The smoking cessation didn't go far,I am afraid.I returned to the smoking shortly after I stopped.No further thoughts to the cessation for a while,I have the patches,but no desire anymore.

I am not 100% sure where to go right now,I guess calling the doc would be a good decision,but work and responsibilities also weigh in on what I need to do.Time off for doctors and other personal pursuits just don't seem productive.(I am wondering how rational I am right now,I sense that I am not fully aware of what it is I am trying to express)

The effects of the medications have just surfaced,that would account for this post being from lucid to hazy.

Ken, are you okay? Your post here is quit cryptic compared to what ou usually post.

Ken, are you okay? Your post here is quit cryptic compared to what ou usually post.

No,not really.

I am over the edge,yet again.

I pushed the envelope too much lately,fatigue was decided at the ER,but nothing else showed on CBC results as being awry:(,I really wanted something to be PHYSICALLY wrong, not a mental issue.

I'll be calling both docs in the AM for consults much less a possible stint inhouse, I am really not all here.:(

No real improvement in the last few days,I am sore,muscles hurt all over,head and body feel flu like,if this is a virus the med doc says it'll pass.5 new blood tests yesterday,results today(hopefully).

Psyche doc isn't thinking this is anything to do with meds.

I had an hour massage(first one in a LONG time)I felt better,but pains returned soon after.Heat exhaustion was discussed also.

On plenty of liquids and all other vitals seem OK.

It also has signs of fibromyalgia(sp)(checker doesn't recognize).My moods are stable,, bad at a regular rate.:(

I'm dealing with some carp myself. No not me personally, but a family friend. Seems she is rapid cycling. Shaved her head, ran around naked. Her husband gave her an at-home drug test.. she made her daughter pee in the cup... when she was caught she drank the pee.

Drained all of the money out of the bank account... Drove over 100mph in the pouring rain with 3 young kids in the car, hydroplaining.

I left work this morning only to find her arrested and had pot. She's on a 603 right now waiting to be evaluated by psych and find a bed.

I'm lost and don't know what to do.

No real improvement in the last few days,I am sore,muscles hurt all over,head and body feel flu like,if this is a virus the med doc says it'll pass.5 new blood tests yesterday,results today(hopefully).(

Sounds like you have all the right resources at work. It's beginning to sound as if this is a "physical" ailment as you were hoping for in your earlier post. Whatever the source you're doing everything possible to define it. Hopefully you'll be feeling better soon.

Bill

...Seems she is rapid cycling. Shaved her head, ran around naked. Her husband gave her an at-home drug test..she made her daughter pee in the cup...when she was caught she drank the pee.

Drained all of the money out of the bank account...Drove over 100mph in the pouring rain with 3 young kids in the car, hydroplaining.

I left work this morning only to find her arrested and had pot. She's on a 603 right now waiting to be evaluated by psych and find a bed.

I'm lost and don't know what to do.

Hope you can clarify a couple of items.

You mention "rapid cycling." Diagnosed bi-polar or a euphemism?

"603"?

She was diagnosed as bipolar and was in the hospital last year, but was able to con her way out after 9 days. She is supposed to be on Rispeardol (sp) and Effexor XR.

603 is a psychiatric hold. It basically means that she has to be evaluated to see if she is a danger to herself or others.

"not too happy with the lack of results thus far,,but then again,patience isn't one of my strong points."

I'm not a patient individual either. In your present circumstance however thoroughness is the order of the day. Your discomfort aside, the lack of immediate results is a good indicator although understandably vexing.

And now a 'cryptic' phone call from his nurse...

One count was high but doesn't explain the pains/situation.And he is on vacation for the next 3 weeks.. I'll tell you.. lol.

This guy seems to take more vacations than I have days on the job.But,whatever, I guess if things get worse there is always the reliable,overused ER.

First are you feeling any better?

Then what was high and I lost track of which dr ordered the test. Thought it was ER.

Am I to understand that you have to wait for 3 weeks for the dr to return. Aren't there other MDs in group there?

First are you feeling any better?

Then what was high and I lost track of which dr ordered the test. Thought it was ER.

Am I to understand that you have to wait for 3 weeks for the dr to return. Aren't there other MDs in group there?

If I was toxic(which I have been in the past) and the level of toxicity was then at say 60%, and now I am at 45%,does this make it clear how I am doing now?

I can't say I am toxic as I don't actually know what the 'high' test result was, the nurse wouldn't/couldn't say, she didn't have the information or was reluctant to tell me, I really can't tell(mind is still kind of foggy)

My MD(gp) ordered the latest bloodwork,and yes,I am on 'hold' for 3 weeks till he returns,or I get sicker and go back to the ER, what a waste of resources using the ER as a doctors office visit:mad:

Now you can see some of what I referenced to about finding proper care for those in need,, not only in the mental care but also in medical,, out here in the boonies the quality might be good,but quantity can be greatly lacking.