Ask a Psychiatrist and Get Answers to Mental Health Questions ASAP
Hi Dr. Kaushik~I have been reading up on anti- depressants~ I know that you left my feed and I don't blame you~ I seemed so confused~ But I heard from another Doctor that one should NOT take an anti- depressant if suffering from glaucoma or high eye pressure~I have this~ so he suggested that I do not take one~ like you he was all for it until he heard how high my pressure gets~ maybe I did not tell you~I thus wonder if you agree~I value your opinion and wonder if you agree Martha~
I'm Camille, and I’m a moderator for this topic. I sent your requested professional a message to follow up with you here, when they are back online.
If I can help further, please let me know. Thank you for your continued patience.
I can understand your concern and I agree that almost all the anti depressants lead to hypertension which may further worsen your glaucoma but among all of them wellbutrin xl ( bupropion extended release ) at a low dose of 75 mg / day can be used with regular monitoring of blood pressure since this drug is least likely to cause blood pressure, only in rare cases there has been reporting of high blood pressure with this drug, in fact it many times leads to hypotension.
So I suggest you discuss this with your doctor and give this drug a try for a month or so while keeping regular monitoring on your blood pressure, if at any point you feel consistent headache for 2-3 days, eye pain with slightly raised blood pressure you shall ask your doctor to discontinue the drug at the very moment.
I hope this helps.
Wish you all the best.
Hi and Thanks~I see that you mention high blood pressure~ this is not the same as high eye pressure~ anyway I did not think that they were related~one to another~Martha~
As I mentioned this drug is safe in terms of both high blood pressure and intraocular pressure so you can give it a shot. Excessive blood pressure may at times lead to increased ocular pressure and thereby worsen glaucoma therefore I mentioned blood pressure above.
I always had normal blood pressure ~ but NOT low eye pressure~that is why I can't see the relation between the two~Martha~
Well increased blood pressure can be one of the risk factors for raised intraocular pressure but it is not the only risk factor leading up to it as there are other causes as well one of which being increased concentration of aqueous humor due to reduced drainage as it happens in glaucoma. So I just wanted to rule out other risk factor associated with the drug suggested which could otherwise have contributed to the worsening of your medical condition.
I see my quietiapine has teva before the name~is there a difference in this from others~ also I do not see where it reduces anxiety as much as a treatment for Bipolar and so on~does it also really reduce anxiety~or used for it as well~Martha~I am two drops to reduce eye pressure as well as a third at bedtime~I am called a glaucoma suspect~I hate to ask so many questions~ but does this drug harm your eyes~ Martha~
Teva- Quetiapine has quetiapine fumerate as it's ingredient which is a derivative of quetiapine so teva-quetiapine is same as quetiapine in it's properties and mechanism of action ,so there is no problem with respect to this form of quetiapine intake.
You see quetiapine/teva-quetiapine has one of it's off label uses in anxiety disorders so although it's use in anxiety disorders is not an approved one unlike the use in schizophrenia , bipolar disorder but clinicians world over use this drug as an augmenting agent in overcoming anxiety but the dose used for this is a low dose of 25 mg / day , so I reckon that you shall use this drug at dose of 25 mg / day to be taken at night after meals and you may assess your anxiety levels after a month of it's use.
One of the rare side effects of teva-quetiapine is glaucoma so it's use in your case needs to be discussed with your doctor although I believe at a low dose of quetiapine as has been suggested above along with regular intake of drug for ocular pressure you shall be able to use it but you need to discuss this with your doctor and seek his approval.
I hope this helps.
Thanks~I wondered why Doctors were not saying that this quietiapine was good for anxiety~in fact otherwise~ although you suggested not to take them in between ~ two halves a day~as she had prescribed for anxiety if needed~I showed my eye Specialist that I was on that drug and she did not seem concerned~ although I don't know what she would say about an anti~_depressant~with her drops the pressure dropped to 12 from 37~ Thanks~Martha
I believe you got to get the ophthalmologist's view on this addition of a drug.
Hi Again Doctor~ Thanks for all your help~I am doing what you suggested and have added the third quietiapine to my night ones~I take the zopiclone as well however~ and as you know the clonazepam in a I dose~ I sleep very well and sometimes even get up ~I take the remaining clonazepam during the day~ I did not eat breakfast~or Lunch~ I oftentimes do not as I am not hungary~although I got rid of that tired feeling~ I feel a little light headed~ is this lack of food in my stomach and hopefully the zopiclone is not too much~ I guess all that has changed is an added 25 mg of quietiapine~to the night version~I know I should eat~ but a person living alone oftentimes does not feel like bothering~thanks for your patience~I sure wish I could get by this phobia about going out~I think that you are right about an anti- depressant~I am seeing a Doctor soon~Martha~
Yes the light headedness that you have been feeling could be attributed to lack of proper nourishment ( due to irregular meal times) and to some extent to the recent revision of your drug regime which I believe will subside as the new revised drug regime sets in. But you got to maintain proper nourishment and adequate hydration with intake of liquids at regular intervals , all of this shall relieve this light headed feeling within the next few days.
But if in the next few days your light headedness continues to remain like this or increases in intensity then you shall seek your doctor's evaluation for your blood pressure and blood sugar levels and serum electrolytes.
It is good that you have genuinely considered use of anti depressant as I feel it's addition will make your drug regime complete and provide it the much needed efficacy to cater to all of your symptoms.
Hi Doctor~I followed all your sugestions and thus do not take any medication in the Morning~ I sleep in later anyway~I take the clonazepam at Noon and no quietiapine during the day now~ but although I feel less tired I seem to be sad and do not think I can go out~ do you suppose it is dropping that quietiapine during the morning~ I have tons of halves and wonder if I should take one in the morning also~ another Doctor said to quit the clonazepam and take the quietiapine and it is hard to figure it all out~I am sorry to bother you~ but I trust your opinions~I sleep very well and one would think this would make me feel good~I asked an On Line eye Specialist and he said since I am on eye drops for glaucoma anyway~ actually for high pressure~ quietiapine or an anti depressant should not hurt~sorry for bothering you again~Martha~
Well I will say again that adding a low dose of wellbutrin xl ( bupropion ) as an anti depressant drug at a dose of 75 mg in the morning will only uplift your mood but also it may not interfere with your glaucoma, so please give this a try putting aside all your apprehensions for once.
I do not have glaucoma~ just high eye pressure~I will tell the Doctor about wellbutrin ~ is it as good as the others you once mentioned~ such as Prozac~ Zoloft and Lexapro and so on~will it help my social phobia and to stop me from being a real pain~:-) to you and my son~as I said the eye on Line Specialist did not seem concerned about these drugs at all~especially when I am on drops for it~ the pressure is a way down to a 12~I am discouraged about my social phobia and I always was a people person~I guess it is depression~Martha~this just came on recently and I was able to attend all my eye appointments~now I don't want to or think I cannot now~
Well wellbutrin will be a good drug fro your depression which once gets resurrected will invariably improve your socializing efforts and comfort level as I feel that the social phobia that you are talking about is more like social withdrawal stemming from underlying depression.
This drug will be safe for your ocular pressure.
I hope my use of marijuana in the past did not harm my brain~it is over a year ago now that I took it and it was small amounts~I never got High~ it just made me feel so much better~usually once a day in a pipe~Martha
Well I do not think that it caused any permanent damage to brain but you should refrain yourself from using it since it has high potential for abuse and addiction and long term use of it may lead to worsening if your condition.
Hi Again Doctor~ I spoke with an Eye Speciaist On Line and he spoke like an anti- depressant would not hurt my high eye pressure~ especially since I am on three drops to control it and it is a way down now~ anyway my main question today is what would happen if I took a half a quietiapine for anxiety~ as my Doctor originally prescribed~ until I see a new Doctor anyway~ I am doing as you say and put my morning one at night and take the clonazepam during the day ~ which is only a 1 with two 5's put together~I have two halves also~ should I keep them for PRN's or take them~ I feel anxiety come on sometimes and knowing I have no other pill to take it perhaps gets worse~I have tons of the quietiapine in halves~ would it help or upset my system~I think that you said it would~Martha~
Welcome to the site.
Well it seems like you are doing better than before and your anxiety is more of an anticipatory anxiety which comes to you as a fear / dread about an impending bout of anxiety, so this shall not bother you as much.
As far as taking quetiapine on PRN basis is concerned you got to understand that it is not a drug like clonazepam which has short half life that enables it to be taken on PRN basis but quetiapine on the other hand has longer half because of which if you take it on PRN basis there will be fluctuation in it's blood levels that may lead to precipitation of untoward side effects thereby worsening the clinical picture.
So there is no problem if you take clonazepam on PRN basis but quetiapine cannot be taken in this particular fashion but if you want to take it then it has to be taken regularly on a daily basis.
That is why I have been so supportive of use of an anti depressant because it will take care of your anxiety so effectively that none of the current drugs can compete with it on that front. So better will be to pass these days of waiting for an anti depressant prescription while continuing on the current drug regime and if the need arises in case of a sporadic episode of overwhelming anxiety then an additional PRN use of clonazepam can be carried out but quetiapine on PRN basis is strict no.
I hope this makes it clear to you.
I find it odd how that Doctor~ a Psychiatrist besides~ gave me tons of half quietiapines for in between use~for anxiety~as PRN's~when obviously they are not meant for that~is there any other use for them~ as I have lots of bottles left and actually no clonazepam extras~ except those two halves~I have Ativan from another Doctor and if I get an attack could I use that instead of the quietiapine~if the clonazepam are used up~until I can see a Doctor anyway~Martha~ Thanks~
what dose of Ativan do you have with you ?
I had this in my Province from an Out Patients Doctor when my husband first died~ it is called Ativan Sublingual .5 or Lorazepam Sublingual .5 ~ BOTH names are XXXXX XXXXX Bottle and they are small and green~Martha~
Well Ativan ( generic name --lorazepam) is almost same as clonazepam as both of them belong to the same class of benzodiazepine anti anxiety drugs so you may take half of 0.5 mg Ativan sublingual tablet when you feel overwhelmed with anxiety In more serious non-remitting cases of anxiety even a dose of 0.5 mg -1 mg PRN can also be taken but kindly start with lower dose of 1/2 of 0.5 mg sublingual tablet and used the raised dose when the half tablet does not work.
Hopefully this will help you to buy some time until you meet up with the doctor and seek prescription of an anti depressant drug.
Thanks so much~it just brings me some peace of mind~the Ativan are very small however ~ so breaking them in half will make it a bit difficult~ are Lectopam also the same~ I once used those for sleep problems years ago~ Many Thanks~Martha~
Well yes lectopam is also same class drug and can be used but Ativan is much better in comparison because of it's faster onset of action so use Ativan instead.
It can be broken or else you may take full 0.5 mg.
Thanks again~I do not have any lectopam left anyway~I just wondered~ as back a while a 3 mg ~three of them~ put me to sleep well~is that normal~of course my husband was living then~ I see these pills I have are the kind you put under your tongue~ does that make any difference~Martha~
Well Ativan sublingual that you keep under the tongue is much more faster acting than the normal Ativan , other than this the function is similar.
As mentioned earlier Ativan is much better than lectopam so kindly adhere to it in the time of need.
Please kindly leave a Positive rating if you are satisfied with the answer.
Hi Doctor~I have been reading up on Wellbutrin and will this help OCD symptons~ as well as anxiety~ does one have many side effects on this drug~ as when you read about it many are mentioned~of course maybe not all happen ~does quietiapine help OCD~I read it does Bipolar~but I do not see OCD mentioned often~ what would you prescribe quietiapine for with your patients~maybe every Country is different~I live in Canada~I think that you are from India?? Martha
Thanks for the valuable inputs.
First and foremost I will like to tell you that all the psychiatrists follow international guidelines of prescription including me so the place one belongs to has only limited importance when it comes to prescription of drugs.
Now coming to your queries.
-- Well wellbutrin has weak anti anxiety action and therefore it is not the ideal drug to use in anxiety disorders like OCD and Generalized Anxiety. So wellbutrin for managing OCD and anxiety is not the right choice. Although I must admit it is the safest anti depressant drug out of all the anti depressants and I may also add here that the adverse effects that you have read need not necessarily occur in all the consumers of the drug, in fact only a minority of users develop few of these side effects which are reversible with discontinuation of the drug.
-- Yes, Quetapine does indeed help managing symptoms of OCD and even it is helpful in mitigating anxiety symptoms but it is used more like an adjuvant/supporting drug in both these cases. Also it is seen that this drug works against OCD and anxiety when used in lower doses such as 25-50 mg/ day , to be taken as night time dose.
Hi Doctor again~I am not sure what you mean~I need a medication to help anxiety and OCD symptons~you mentioned wellbutrin I am quite sure as one which would help me~ also I think that you are saying that the smaller doses of quietiapine I am on at night~ which is 75 mg in total would not help my anxiety~but work against it???~I started taking it at night as it made me so tired during the day~on your advice ~of the daytime 25 mg~ what then will help my anxiety and OCD symptons the best~maybe I read you incorrectly~Martha~PS The reason I asked about Doctors is the one I had here gave me tons of quietiapine for anxiety PRN's~plus the daytime one that made me so tired~ you said to NOT use them as PRN's~another Psychiatrist on here~ also from India I think had the opposite view~ to stop the cloranzapam and keep the quietiapine for daytime~ I liked your approach~ as thus far your advice helped me ~ what I need is a drug that will help my anxiety and social phobia and OCD symptons~ please Help me~Martha~
The 25-50 mg dose that I mentioned was the starting dose of quetiapine so the current dose of quetiapine that is 75 mg / day is still a lower dose only and works fine for OCD as well as for anxiety and you shall continue on it without any apprehension and confusion.
Secondly, wellbutrin is a very good and safe anti depressant drug which works well for depression but when used alone as a single drug it is not that effective against anxiety disorders but in your case this drug will be used as a supportive therapy and so shall work just fine in combination with the other drugs of yours. Another reason why wellbutrin was mentioned by me instead of other anti depressants which may prove to be more effective than this drug is because this drug is the safest among it's peers and so for a person like you who is overly sensitive and has underly9ing condition of high ocular pressure this drug seems to be the most safe ploy.
Otherwise there are other more effective drugs such as Lexapro at dose of 10-20 mg / day or Zoloft at dose of 50-150 mg / day which can be taken in the morning but they are not as safe as wellbutrin.
So to summarize you shall continue on the same dose of quetiapine that you are currently taking and it should be taken in the night time only and wellbutrin shall be added at dose of 150 mg / day in the morning so that it can help with your social phobia and anxiety by acting in tandem with other drugs of your drug regime.
Thanks~I know people from India are very intelligent~ my son's GP is actually from there as well~I just wondered to the big difference from my NB Canadian Doctor with the quietiapine~why she would prescribe all those PRN's during the day and also such a big dose of that and clonanzpam in the Morning and another dose at Noon~I was so tired~you at first mentioned 75 mg of the anti- depressant~now you say 150 mg~ I know I am a pain ~whatever caused me to get so bad when I always was a people person~never afraid to go out places and worked in a Bank 30 years~ I take it that clonanzpam is the best for anxiety over quietiapine~I don't want a drug working against it~ so I was not sure what you meant~when you stated this~I think that you would still agree that taking quietiapine PRN's during the day will not help?? Martha~
H I Again~Poor You~ The Doctor I had in my own Province was actually from Haiti~ I admitted myself in the hospital when I was not sleeping and I got her~ thus I wondered in the different treatments recommended~I think that you can see how I could get confused~ she said I would feel better on her program than on Marijuana~ she was sure wrong~ I just want to be rid of anxiety and sleep well~ I am alone now and thus more nervous and sad~ would an occasional glass of wine hurt me~ everyone likes to do that I would say~ you have been so so patient ~can one hopefully get over social phobia~I am worse at certain times than others~Martha~
Also it is seen that this drug works against OCD and anxiety when used in lower doses such as 25-50 mg/ day , to be taken as night time dose~
I am a pain I know~ BUT I pasted your words above and wonder what you mean when you say it works against OCD and anxiety~ do you really mean it helps it or hurts it~ it was these words that I did not understand~ sorry~I don't mind paying for added service~ as you have been more than patient with me~the word against to me means it does not help it and I need it to help~if you get my meaning~maybe it was a play on words~Martha
Well it means that quetiapine at low doses of 25-50 mg / day is seen to mitigate / reduce intensity of OCD and anxiety therefore this drug is useful in managing these two disorders. You are currently taking 75 mg / day dose at night time which is also a lower dose so this drug at this dose is good ploy in reducing the OCD and Anxiety symptoms.
I hope this clears your doubt.
Hi Again~ My son visited his GP today and she is willing to come over and talk with me about medication~before prescribing something new~ she is also from India and David said she seems real smart~ she knew right a way that quietiapine helps when one has a Bipolar background going on an anti- depressant~she is also willing to renew my currant medication which is a relief~someone told me that an anti- depressant can make one more depressed~ gosh I hope that is not true~does wellutrin cause weight gain like most do and would I be better to see a Psychiatrist eventually ~plus would I be on this for life~ Thanks again Martha~
Well Wellbutrin is the only anti depressant which does not cause weight gain, so you can consider using this drug.
Yes a psychiatrist will be the best person to eventually take over your drug prescription and prescribe you drugs since he/she has expertize in this.
No, the drugs shall not be continued throughout life but yes they need to be taken continuously for few months so as to complete the course and prevent a relapse/ recurrence.
Also please do not believe everything that you get to know from others or via internet and you should refrain yourself from generalizing things because the side effects which you get to known from various sources of information do not apply to all and effects only a handful of consumers so you shall not include yourself amongst those even before starting on the drug.
The rebound depression that you are talking about upon use of an anti depressant is seen in rarest of rare cases and should not be generalized.
Hi Again~If I indeed have OCD would I not have it for life~thus would have to take medication for life too~ like Bipolar people~ my niece went off hers for Bipolar~ as she is trying to get pregnant~ she has tried suicide in the past~ so would not going off her drugs not cause concern and it is almost a year now~ as she is not getting pregnant~my brother would go off his and thus become very ill~when they feel better they think they are cured I guess~ my sister said she had a chemical imbalance that controls nausea~she was sick for a year a while back and even called it chronic fatigue syndrone at one point~ now she says she is off medication~she never went to a psychiatrist~just GP's~anyway is there a chemical imbalance that causes nausea~would just the 75 mg of the wellbutrin be enough or should it be definitely increased~a friend of mine said I should be over grief from the loss of my husband by now and it has to be something else~it is hard moving to a strange place where everything is so unfamiliar~ plus you do not have that special someone in your life anymore~ I think one has to experience it before judging~Martha~
Well I agree that OCD is a stubborn condition and it may require long term treatment but it is also true that with proper drug regime coupled with CBT ( Cognitive Behavior Therapy) specially it's sub-type Exposure Response Prevention (ERP) Therapy one can overcome this condition and come off the drugs. So please do not compare it with a psychotic disorder like Bipolar disorder as OCD is more of a neurotic illness and has more likely chances for complete remission provided the drug regime and psychotherapy aka counselling are carried out for the minimum effective time period which varies from person to person based on intensity of OCD which is variable from one person to the other.
Nausea could be related to a chemical imbalance, in fact there are so many chemicals which when undergo imbalance may lead to nausea, but having said that, this cause for nausea is only second to the primary gastro-intestinal tract cause of it as would be nausea due to a drug side effect as there so many drugs which lead to nausea as their side effect.
Wellbutrin should be started at 75 mg dose but usually it's minimum effective dose comes out to be 150 mg / day so after 2 weeks of being on 75 mg dose you shall be titrated up to 150 mg / day dose.
Well you see your mourning / grievance has been too prolonged to be still called by the same term, now it has taken shape and form of depressive cognition or mild to moderate depression which again justifies the selection of Wellbutrin since it is best drug for this kind of situation and condition.
I hope this helps to answer your queries.
Hi Once Again~I always think that I have only one last question~ you stated that three 25 mg of quietiapine would give me a good night's sleep~I took two before~ but also a 1mg of clonazepam and a zopiclone~ it always gave me a great sleep and nice dreams~lately I seem to wake up ~but eventually fall back to sleep again~ my cat tends to wake me and will jump in the bed at times~ I sometimes get up and just do chores for a bit~I am afraid that the medication may be wearing off~ I sure hope not as it is one thing I look forward to at night~ no anxiety and a good sleep~ hopefully I do not have to yet increase the dosage of say zopiclone~as no doubt one gets addictive after a while~I hope wellbutrin does not cause nausea~ as there is no worse feeling~maybe it was my sister's medication that caused the nausea then?? she did not tell me what she was on~ surely with all the meds I take at night I should sleep well??? Martha~
Well sometimes fluctuation in the sleep pattern with these set of drugs is expected especially when the drug regime is relatively new or revised, so do not worry about these occasional incidents of mid night awakenings as long as you are waking up fresh and energetic.
As far as wellbutrin is concerned it is extremely safe in terms of nausea as usually it does not lead to this side effect and I will reiterate the fact that this drug is the safest of them all.
I believe your revised drug regime inclusive of wellbutrin will prove it's worth so the only thing you got to do is to wait for 2-3 weeks for the new drug regime to get settled in your system and once that happens the results will there for you to appreciate.
So you think my sleep regime is still good~Many Thanks again~Martha~I guess I cannot take that many more pills for night???
Yes I think as of now you got to be patient with your drug regime and do not get hasty in altering your drug regime too much and too fast since the body needs some time to adapt to the drug changes and so it shall be allowed to that much time so kindly be patient and wait for 1 -2 weeks more on this night time drug regime and then we shall discuss how and what all drugs need to go away so as to keep you on minimum yet effective drugs without compromising on your sleep and other symptoms.
I assume what you are saying is I am on enough night time drugs for now and in fact they even be cut back eventually???
Yes this is exactly what I mean to say.
OOP I forgot~I meant to also ask you if it is okay to take a half quietiapine~that was supposed to be for PRN's~ when I wake up at night and thus afraid I will not go back to sleep ~otherwise I do not take them anymore on your advice~Martha~
No you are not supposed to take it in between , as I said let your body system adapt to the new revised format of drug intake and lets give this 1 week's time after which we can assess your sleep pattern and if the need arises I shall ask you to add this half dose to the current three doses of 25 mg quetiapine but as of now please refrain yourself from using this 1/2 dose of quetiapine in between the sleep when you wake up.
Oh Oh I did take it a couple of times~ afraid that I would not go back to sleep~ I always did before on this drug regime~go back to sleep that is~ I guess I have lots on my mind lately~ if I do have OCD ~ I think people like us are like this~I just wish I was normal like so many people seem to be~ they seem to carefree next to me~not a care in the world it seems~ actually we are supposed to be like this and just take one day at a time~I know the answers and yet cannot apply them to my own life~ I had a lens removed from my left eye 30 years ago~ to make a long story short~I could not have an Implant done~ so now I am trying hard in a new place to find the right fitting contact~they have changed since my last one~I have to wear a contact to replace the removed lens~so it is not like I can wear glasses in between and I am finding it hard to go out~Martha~PS I thought perhaps taking that small pill would be okay at night~I only took a couple however~
Well a couple of doses would not do much of a harm but please do not use it again in that pattern and kindly stick to the strategy that we have discussed already.
Me Again~ I always wondered to WHY if I get up during the night~ or even late at night~ I have more energy~ for instance when I got up during the night last night I did things that normally during the day I find hard~ and even have all these plans for supper and start getting things ready~ then the next day when I wake up I hardly feel like getting up~let alone doing things~ but I consistently make myself~ I even will write cheques when I am up and it is still dark~ what would this have to do with how I feel ~I even noticed this a way back in my former Province~thus thinkingI was Finally well again~Martha~
Well it seems like you have had sleep - wake cycle disturbance which makes your sleep very irregular and inconsistent so while the current drug regime will help you to achieve a more consistent pattern of sleep but you need to adhere to what is called as proper Sleep Hygiene which entails below mentioned points.
1) Change the place or room where you sleep so as to provide a new surrounding for sleep.
2) Avoid heavy and oil rich and fried meals at night.
3) Avoid late night meals.
4) Avoid stimulant substances at night like coffee, tea, colas or any caffeine rich beverages.
5) Adhere strictly to a disciplined schedule of wake up and sleep.
6) Avoid listening to music or watching television late at night since these tend to stimulate one's brain. Instead try reading a book if not able to sleep.
7) stop taking up chores or important errands at the time when you wake up in the middle of night instead try to read a book.
8) Start doing regular walking and meditation / yoga exercises to ease your nerves and calm you from within.
9) Wear loose and light clothing while sleep.
10) Make the room well ventilated and with dim lights.
11) If you are not able to sleep for 10-15 minutes then try reading a book or take a stroll in the alley or drink warm milk or take a warm shower.
So these are some of the important points of sleep hygiene which you need to consistently practice and this should help you to regain a disciplined pattern of sleep while the drugs do their work.
I agree with you on certain issues~ I sleep pretty well when I go back to bed~ it just seems I feel better late at night or during the night~is what I mean~I watch a Religious show before bed usually~that should be okay ???~ I read my Bible in bed~ I must sound like a religious nut to you maybe~ I tend to munch though when I get up and that is probably not good~I am more hungary at that time of night for some reason~I crave chips or cookies~in other words I feel normal at this time and moreso than during the day~ whether it is all in my head~knowing it is a quiet time for everyone and no one will bother me~I just don't understand it~things just seem easier for me to tend to~ I often get up to adjust the air conditioner as an example~ maybe I should not be getting up at all ~ But I feel good ~ as I previously said~ at this time~ no anxiety or stressed feelings~maybe I am just a night person ~I just can't figure it out~I try to not lie down during the day~but I do sleep in later~ as I go to bed kind of late too~I just don't know anymore and I must be such a nuisance to you~I am a complicated case~I wish I felt like I do during the night~ONLY during the day~is what I am trying to say~Martha ~Yes Again :-(
Well watching a religious show or reading the holy Bible are just fine but you try to do all these activities at an earlier time and also please refrain yourself from eating chips and cookies when you get up in the middle of night.
Now other than this if despite of this sleep - wake disturbance you are able to carry out your duties as efficiently as before and you end up happy then I do not think you should worry about this as much , just try to bring in discipline.
I have heard that St. John's Wort is very good for depression~do you know about this and if it is true~Martha
Well yes St. John's wort is a herbal medication which is used effectively in treating depression and to some extent anxiety also, so this can be given a try instead of an anti depressant drug. The recommended dose is 300 mg dose of 0.3 % hypericin leaf extract of St. John's wort to be taken two times a day.
Would it be as good as wellutrin and go with the medication I already take~ I always heard about it and thought it was just a figment of a person's imagination ~Martha~In your expert opinion would it help me??
Would it be as good as wellutrin and go with the medication I already take~ I always heard about it and thought it was just a figment of a person's imagination ~Martha~In your expert opinion would it help me??Can one get this just at the drug store??
Well it is not only as good as wellbutrin in treating depression but in fact it may even prove to be better than wellbutrin in managing anxiety. Yes I believe it can help you and yes you may ask for it from a pharmacy but make sure you mention it's use to your doctor. Yes it may be taken with with your current drug regime but it should not be taken with any other anti depressant including wellbutrin.
Also if at any point you want to come off this herbal drug please apply slow tapering process spanning over two weeks so as to avoid development of any withdrawal side effects.
As of now you may give it a try instead of wellbutrin , start at 300 mg dose of 0.3 % hypericin leaf extract once a day in the morning and after 1 week raise the dose to 300 mg dose twice a day and stay on it, you shall have to wait for 2-3 weeks in order to appreciate the positive effects of this drug on your depression and anxiety.
Oh My~Does this not sound too good to be true~ a natural thing~ sort of like marijuana~Why would Psychiatrists not give this moreso I wonder or even mention it~ when taken twice a day when and what times would it be~would there be any side effects~Martha~ Would it affect my sleep medication in any way and would the kind you get at the drug store be as good as a Health Store~also would it affect my eye pressure like some anti- depressants~you deserve a big Bonus for all this help and your Patience~
-- Well because it is a natural remedy probably therefore it runs out of favour from psychiatrists.
-- You got to take 300 mg dose in the morning at 9-10 am and 300 mg dose in the evening at 6-7 pm thus making the dose twice a day.
-- Well usually it is a safe remedy but on rare occasions side effects like nausea, vomiting, dizziness, stomach upset, may occur but as mentioned it is seen only in a handful individuals.
-- Well the dose of 300 mg of 0.3% hypericin leaf extract can be taken from a good and reputed drug store.
-- No, it will not effect your sleep medication.
-- No, eye pressure shall not be effected.
Oh My~I called my Pharmacy to see if they had it and the Pharmacist was entirely against it~ he said he saw too many bad reactions and especially with my present medications~I deal there so he knows what I am on already~ I am SO SO disappointed~ is the .3% hypericin leaf extract a different one from the dose for the second week of 300 mg~or are they both the same~are they both available at a Pharmacy~ my son is trying to get his GP to ask her what she thinks~it is hard to get a Psychiatrist right a way in a new place~Martha~
Well the 0.3% hypericin leaf extract is same in both the first and second week.
May be you did not understand what I said.
In the first week you have to start taking 300 mg dose of 0.3% hypericin leaf extract only once a day in the morning hours.
In the second week you shall have to take 300 mg dose of 0.3% hypericin leaf extract in the morning as well as in the evening.
I told you before too that allopathic doctors / psychiatrists / pharmacists alike do not prefer to use herbal remedies like St. John's wort because of their belief in allopathic drug regimes.
However St. john's wort is not as harmful a remedy as your pharmacist made it to look like.
Anyways approval of your gp is necessary for trying this remedy otherwise you shall try out the before talked about wellbutrin xl.
Hi Doctor~ I have an appointment next Saturday with my son's GP~ she is nice enough to even come to my Condo~ anyway I want to leave my medication ~ especially the night one the same as I have~ will I ask her to change my PRN's to clonazepam and leave out those quietiapines~ I had been given halves twice a day for anxiety~ what would you suggest she give me instead of these~ I assume clonazepam and if so how many~I do not like to tell a Doctor what to do ~ but she may like suggestions????~ if I go the Wellbutrin way I take it I start at 75 mg and then after two weeks go to 150 mg .in the Mornings~I think that you said it was safe for my high eye pressure and had few side effects~like weight gain or nausea~ if I was your Patient would you choose this route or the St. John's Wort ~ starting with 300 mg and after a week twice a day ~ morning and night~ my son said she seemed familiar with Wellubrin~ I think you said it helps anxiety and depression~ at one point you just suggested 75 mg of Wellubrin~ so is going up to 150 better in two weeks~even if a drug caused one's eye pressure to increase ~ the fact that I am on three drugs for it twice a day~ and it is a way down to a 12 from 37~ would that not take care of this problem~ Many Many thanks for All your help~ May God Bless you~Martha~
Well as I have told you previously also that quetiapine's PRN use needs to be stopped since it disrupts the steady state levels of quetiapine within the system thereby leading to turbulent response which is not good to contain your symptoms. So clonazepam as mentioned earlier needs to be taken on PRN basis at times of overwhelming anxiety which seems to persist despite the use of routine drug regime. A dose of 0.5 mg clonazepam can be asked for prescription from your doctor and 1 tablet of this dose shall be taken on PRN basis as per the need.
As far as Wellbutrin xl is concerned it is to be started at a low dose of 75 mg taken in the morning and after 2 weeks the dose shall be raised to 150 mg in the morning. You shall maintain on this dose for 3-4 weeks and assess your symptoms of depression and anxiety for improvement. If you think that you need more improvement then you may further go up the dose to 300 mg and even to the maximum recommended dose of 450 mg taken as a full one time dose in the morning.
May I also add that wellbutrin xl is considered to be the safest drug of it's class since unlike other anti depressants it does not lead to weight gain and sexual side effects , nausea may or may not develop ( rarely develops in handful of users and is often easily manageable).
I hope this answers all your queries.
Thanks so much once again~I wonder if this Doctor is open to it~ would St. John's Wort be as good in your opinion~or would you prefer the Wellutrin~Martha~
Well both wellbutrin and St. John's wort will be good for you but definitely wellbutrin is safer.
I am just curious what you mean by safer~it just seemed too easy to get and not have to wait for a Doctor~ the sad part is it takes so long to work~before even attaining the medication~it seems I have to push myself to do things recently~maybe it is depression or maybe lonliness~Martha
Well what I meant to say was that wellbutrin is safer in terms of the side effects as St. john's wort has slightly higher risk for side effects ( however the side effects are seen in handful of users but if we compare these two so wellbutrin still will come out to be safer).
Other than this if you want to go ahead with the use of St. john's wort it will still be a good ploy to counter your underlying complaints as it is effective against depression and anxiety both.
You seem to be reeling under depression which only gets worsened by your loneliness so it is a combination of these two which makes you feel like this.
I realize it is hard moving to an unfamiliar place and I hope that I shall pull out of this down feeling~I do make myself do things and I guess I might as well wait to talk to this Doctor who is coming~to see what she suggests as far as the two medications~ which one to take~ do you really think it will help this mode I am in~hopefully some people don't always remain depressed~I do have many Blessings as compared to many people ~ who would have it harder ~ it is just sort of discouraging to know how long it takes for it to work~some people seem to be able to handle hardships better than others~ or maybe behind closed doors they are different~ like this cancer lady~ she needs more surgery and chemo~yet when she called me she sounded up beat~ Martha~
Well although I have full empathy for you but I will like to request you to stop feeling sorry for yourself and just look around to see people who are much more miserable in their lives but still they gather courage to endure every day hardships with a brave and happy face. So please count your blessings each day and start the drug discusses above, hopefully you will soon find tranquillity from within.
I hope you see the bigger picture.
I realize that you are right~ but depression runs in my family that is all~I don't want to be this way~ I don't think my going off quietiapine in the Mornings would change my mood ~ as would it not be still in my system from the night dose~I always feel much better at night~ so sorry to be bothering you~ but it is a known fact that one should not move so soon after losing a mate~I had no choice and everything was done so fast~I will try harder~you have been so patient~I saw some of my family members endure shock treatments even and it sometimes scares me~I take it from what you are saying one can overcome by one's own strength~and not always drugs~I have Strong Faith too and I am ashamed of myself~Martha~
Well I will urge you to hang in there and wait patiently until one of the two above discussed medications is started and when that happens then you shall start appreciating improvement in your mood and anxiety.
Thanks Doctor~the only thing is it takes a while for the drug to work~I should have started this sooner~ always believing Doctors that I could not take an anti- depressant~ due to my background~which really was not true~Martha~
Better late than never , so still you have a lot of scope for improvement and time is still there, please do not brood too much over the lost time just do as mentioned above.
Hi Again~Is Klonopin the same as clonazepam~if so there is really bad write ups on it as a drug from Hell~ did you hear this and hopefully it is not true~I always took lectopam years ago~ Martha~I have rated you and sent a tip ~ you sure deserve one :-)
Klonopin is same as clonazepam and no, it is not that bad a drug as it is made out to be, you see almost all medications have some side effects but it is not necessary that these side effects will surely develop in all those who use these drugs.
In fact klonopin is a very effective and relatively safer ( in terms of side effects) drug belonging to the same class of lectopam and since you have tolerated lectopam well in the past so you are more likely to tolerate klonopin also.
Hopefully one more question~ Does marijuana make you sort of lose touch with reality~ as when I was on that even my husband's death was easier for me to handle~I could handle everything back then with no problem~a different person entirely from me today off of it~that is why I liked it so much~ maybe it affects everyone differently~I don't know how good it was for anxiety though~or if it does help~probably it affects everyone differently and I think there are different kinds~ I can tell that you are against it and yet not St. John's Wort~ so it is not that you are one of those Doctors against natural things~ it made life so much easier for me~ or so I thought~ Martha
Well you see marijuana is known to cause masking of one's perception of his / her surroundings which makes the person loose connection with his or her life events and this probably happened with you as back then marijuana just took away your sensitivity towards real life events such as your husband's death but since this substance has a great potential for abuse and dependence therefore it's use is not appreciated by many clinicians.
So I am supportive of natural remedies such as St. John's wort because they are not only effective but also relatively safe and non-addictive, so you may give it a try after discussing it with your doctor.
Thanks~I thought that perhaps I was just in Shock and looking back I guess it was good that things maybe were masked~ so I could get through the worst part~ but now I can hardly handle things and do not want to venture out~ I sort of freeze up and yet as I told you before I worked in a bank for 30 years and could handle public with no problem~so I don't know if it is grief now or what~ to make me so backward in some areas~I don't feel like cooking and just look forward for bedtime~ as I know I will sleep~I am not sure even if it is anxiety I feel~maybe depression~people do not make up for your mate~ as they talk about their own lives almost constantly~or problems~no one understands one's grief~or great loss unless they went through it~I never bonded with my grandchildren~ as we always lived so far from them~ so when they come they tend to bother me more than anything~ kids today are so demanding~I feel ashamed of myself~yet I always was and am good to them financially~ which they don't seem to appreciate~I wonder if many people get through these sorts of things without medication~ or help~ that cancer woman made me feel bad in saying she never heard of anyone taking anxiety medication or sleep ones~she is older than me and maybe she just never heard of people admitting it~some people are ashamed of this~or seeing a Psychiatrist~days can be so long and when I had my husband we did not have enough hours in a day~I saw my former home up for sale again yesterday~a friend told me~ plus the new décor~ the people apparently find it too big~ this sort of saddened me too~will I ever be normal again~Martha~I mentioned this before and it confuses me~ I feel fine at night ~like when I get up for a bit~ it is days that bother me~also would I be considered as having a mental Illness~the last Psychiatrist said a grey area and the other three I saw in my Lifetime said I was just a Perfectionist~
You are so Sweet and Understanding~years ago when I saw a Psychiatrist he told me that many people came late for appointments~ just to avoid anyone seeing them there~ as they were ashamed to be seeing such a Doctor~it never bothered me as I knew that I was very smart~only down and not mentally retarded~ as I guess some look at people such as myself~NO doubt you too may have experienced this~ I wonder if taking two .5 mg of clonazepam once a day and sometimes a couple of halves of this for PRN's in between too much to be on for so long~again reading the Internet makes one feel this has been too long~as they are addictive~ plus my sleep medication~ would you say this was okay after so long~ I can't imagine not taking it and staying awake all night~sorry for so many maybe unnecessary questions~Martha~
I do hope so also~ I guess maybe I got spoiled on marijuana and it made me feel so good all the time and yet it took very little~ when I read up on the meds I am on~ perhaps I should not be doing this~ it seems that I should not be on them this long and yet I feel sure that I am not ready to wean off~for a while anyway and hopefully in your expert opinion you would agree~ that I am safe taking them thus far and they are not too much ~as the Internet seems to suggest~ I guess they can be addictive~ but I did not mention to you I don't think~that I took three 3mg of lectopam for a long time at bedtime and they never seemed to hurt me~I just slept good~Martha
Well I believe you should continue on the drugs until you are completely asymptomatic and if a drug like lectopam works for you then you may continue it as long as you do not become addicted on it.
Sorry I meant that if I did not become addicted to lectopam I also maybe should not to my present drugs~ as people say on articles on the Internet all the time~I have not taken lectopam in a year ~maybe I did suffer withdrawal symptons and did not realize it~I wish I did not have to take drugs~ but as you often say~ many people are worse off than me~Martha~ I meant that I hope that I am not over drugged with what I am on~
No, you are not definitely over-drugged and yes I agree that you will not become dependent on these drugs when you could tolerate lectopam well in the past without getting dependent on it.
I guess I so often read that taking sleep medication for grief is wrong ~yet this is a good way to get quietiapine into my system~ is there people who do always take sleep aids~I would never sleep if I did not~is the quality of sleep a good one~the REM kind I think they call it that XXXXX XXXXX was not getting~ Martha~
Hate to ask~ But do some people take sleep medication for life~I know of people who fall asleep almost immediately after going to bed~like my late husband~ whereas I always had trouble in this area all my life~would something like melatonin help me down the road~ it really works on some people~Martha~I seem like such a hopeless case!!!
Well those dealing with chronic insomnia do end up taking the sleep aid drugs for a long period.
Yes I feel melatonin can be taken for your insomnia as it does help in sleeping.
I guess what I mean is would it be strong enough to put such a person as me to sleep~ who has been on so much sleep medication for quite a while ~you once said three quietiapine would put me to sleep probably~ would ALL those halves I have left as PRN's help if I was stuck~like six halves so to speak~Does anxiety cause one's head and ear to feel rather heavy at times~like pressure maybe~Hopefully I don't have a brain tumour~ some days it feels fine~usually after a good sleep~Martha
Well melatonin will act as a n adjuvant drug to quetiapine and boost up the action of quetiapine and induce sleep.
As I said earlier PRN use of quetiapine is not advisable.
Yes the pressure sensation in head and ear are a part of anxiety.
Hi Dr.~Thanks for that reassurance~ as sometimes the feeling is not there~ I know that you realize what I am taking for sleep~ I may wake up at 4 AM ~ but quickly go back to sleep again~ I again may get up at 6 or 7 to care for my cat~ then I even may do some housework~but it is too early to stay up~ as it makes the day so long~ which I find it anyway~yet I feel rested enough~ when I do go back however I think I will not sleep and yet do and this time I seem to find it harder to get up and just want to stay there~so I assume the sleep medication is still working~ as if not I am sure I would not fall asleep again~I am afraid I could stay all day if I let myself~ why would I feel more tired later like that than earlier in the morning when I originally get up~ I even feel hungary then and yet not when I get up the second time~I sure have some crazy things happening~I sure hope Wellbutrin works to relieve my symptons~sadly it may not be the right one~as many anti- depressants are not always right the first time~ are GP's good enough to prescribe them~ as it is hard to get a Psychiatrist in a new place~I feel that you are sort of my one for now~for guidance~I hope she listens to the not taking the quietiapines during the day for PRN's~do many people get through hard times without medical aid of any sort~if so they must be very strong people~or is it just that I have mental illness in my background~hopefully it does not make one worse~I always feel better towards Evening for some unknown reason~I realize that there is no pill for lonliness~Martha~I guess I read the Internet too much~but how does a person know the difference between a brain tumour and depression~
Well first of all the variation in your mood and energy that you notice during the day is called as Diurnal variation and it is part and parcel of your underlying depression.
Yes a GP can prescribe these drugs but he needs to approve of what has been suggested / advised.
Well people can manage to endure hard times like these on their own provided they have strong coping mechanisms which unfortunately you lack may be because your husband was a strong pillar of strength for you who used to help you earlier to get through tough times and when he is not around now so your only coping mechanism stands compromised.
Thanks again Doctor~I was divorced when I was 29 and brought up a son alone and worked~ I was actually stronger then ~ when I married the second time at age 39 my husband was a bit older than me and thus Retired before I did and wanted to do all the errands and grocery shopping~it gave him something to do~he liked looking for bargains too~ we lived in the Country and he liked to get out everyday in his Jeep and I was left home tending to it~it was a huge home~ so there was lots to do~ so I did not mind his getting out and leaving me behind~he liked the contact with coffee friends ad so on~ I can see now though how it has left me not used to doing all these things~I guess I took him for granted~so you make sense~it will be hard for me now~ as we live in a City and I do not drive here~I can see that I will continue to have it hard~ going out to Malls and so on makes me sad~as we did that together~ I can't see how a pill will pull me out of this~ but I guess I have to try~when one's head does not feel right you worry about a brain tumour~I guess one would not really know for sure unless tested~Thanks again~Martha~
Well you have understood the crux of your problem, so it is about time to make some progress in terms of trying the drug suggested and waiting for results.
You have always been more than patient with me and deserve a Medal~I asked about brain tumours~ when your head does not feel right~ as it often does with depression~is there much difference with brain tumour symptons~ I know and realize that I worry far too much and read too much on the internet~Martha~PS~ I think that you stated to take only one mg of clonazepam at around Noon~ I leave the other two halves in a dish in case of anxiety as a PRN~should I ask this Doctor for this as a PRN~ since you do not agree with the quietiapine for this reason~I see early on in my quest for answers~ that another Doctor also suggested I take the 75 quietiapines at night~ not the 25 in the Morning~I was over dosed ~I put the morning .5 with the Noon .5 and this makes a one~easy Math I see~:-) anyway should this actually carry me through the day concerning anxiety~or should I ask for more~I have tons of halves of quietiaines that you tell me not to take~I hope this Doctor agrees~ she is only a GP though~
Well your symptoms do not suggest of brain tumour since a tumour being a space occupying lesion would have caused headache, dizziness, fainting attacks, loss of balance and lack of coordination of movements.
Yes you shall continue to take clonazepam 0.5 mg in the morning and afternoon for another 1 month and also ask for PRN doses of the same from your doctor.
I was taking the two .5's together at Noon as you I think originally suggested~Thanks for the reassurance about a brain tumour~Martha
Yes right, I remember now that is what I suggested , kindly continue taking them as morning dose used to cause drowsiness.
Now there are two halves of .5's left~I assume that I can take them as I feel anxiety~would a small amount like that help~Martha
Yes you may take them as per the need ( i.e. PRN ) and yes they are effective albeit their low dose.
Thanks so much again~ I know my mother~ who was Bipolar~ needed Shock treatments~ as well as my brother~ who also is Bipolar~I am terrified if I would ever need them~do they still do them now a days~Martha~
Yes shock treatments which are clinically called as ECT ( Electro-convulsive therapy) are still very much part of treatment of bipolar disorder but they are nowadays given with a lot of safety measures having been incorporated and given under short acting general anaesthesia which reduces any sort of risk manifold.
Whether you will need them or not in the future is a far-fetched thought but as of now you do not need them so I suggest you to concentrate on present condition and stop procrastinating and jumping to hasty conclusions.
Hi Doctor~ Well the Doctor just left ~ who agreed to come to see me~ she more or less just talked with me to get to know me I guess~she is willing to re~ new my present prescription and agreed with you about the PRN's for quietiapine as not being the right thing~she also wants a blood test before starting me on Wellutrin~ is that normal and she also wants to check on my B12 ~ to see if I still need pills for that~since I find it hard to go out she is going to see if someone would come here to take the blood~I was hoping that I could get the prescription today~as I am sick and tired of being sick and tired~she did not take my blood pressure or anything~ maybe she should have~the back of my neck feels rather sore and tight~ I did not sleep most of the night~ due to thunder storms and I am not used to them here~ they are worse than where I lived~plus no doubt I was nervous about the visit~now I am scared of a stroke~what a case I am~ I felt pretty good yesterday~so don't know what is wrong with my neck ~ living alone makes one more nervous I guess~Thanks for all your help~I am starting in the right direction at least~ she could not see my history of Bipolar as being a problem at all~although she would like my son to check on me for a bit~when I am on it~ Martha~
Well when I was in my other Province the Psychiatrist said my B12 was low and to take the medication until someone told me to stop~it has been almost a year now~ so I can see that~she seems very smart and understanding~I did not tell her about my neck~as I said I hardly slept last night~ those pills always normally work at night~when you are on Wellbutrin do you still have to have blood checks often~she also agreed with St. John's Wort~unlike that Pharmacist~I guess a stiffness in the neck is not a sign of a stroke~ hopefully anyway~ I am the one who is a Real Pain I guess~Martha~
No, wellbutrin drug use does not require frequent blood tests but you shall at least get your vit.b12 levels checked.
Neck stiffness is not associated with stroke.\
Boy at the end of this session you shall sure deserve a huge TIP~I never encountered anyone as patient as you~funny how those sleep pills did not work last night~ they always did before~she assured me~unlike my neighbour~ that Many people take anti- depressants~I felt weak because of this~she said many take Prozac~she did not hear anything about these pills causing high eye pressure~I wonder to why then~ besides my B12 levels~she would want blood work done~have you actually seen people like me~ with Social Phobia actually overcome it~ I just wonder what happened to me~as I said~ I worked in the Public for 30 years~I know when my mother was on lithium she had to have regular blood work done~I hope marijuana did not damage me~ this Doctor claims that it tends to hurt younger users moreso~ than old ones like me~ as their brains are still developing~Martha~PS~ I always thought that an OCD brain needed Serotonin~ marijuana has this which I think is why it helped me~ but I don't see where Wellutrin has Serotonin or does it~I think too that a person's posture has something to do with how your head feels~ as we age our heads tend to droop forward~
Well you are taking undue tension about the blood work up that she has advised, believe me it has nothing to do with serious condition prediction, she has probably suggested this as a routine investigation, so just carry it out. She probably wants to know your vit b12 levels which may have a bearing on your depressed mood and anxiety/social phobia ,so if vit b12 deficiency comes out in the investigation then a vit b12 supplement shall be used in your case to compensate for the deficit and this will boost up your recovery.
Wellbutrin does not require any regular blood work up unlike lithium.
I do not think marijuana caused any permanent damage to your brain but yes it could have contributed to your depression and social phobia.
I hope this clears your doubts.
But I have been taking a B12 supplement for almost a year now~my former Psychiatrist said to keep taking it until someone tells me to stop~so it can't be that~is Serotonin what is needed for a brain such as mine~ a hopeless one I might add~Martha~
Well in that case you just need to add wellbutrin xl at dose of 150 mg / day in the morning which will take care of your symptoms.
Do you have any reason why she would thus want a blood test before starting Wellbutrin~ can blood tests tell if you have cancer~ you mentioned maybe marijuana may have had something to do with my social phobia~if so can this be reversed by Wellbutrin and you had mentioned to start on 75 mg first I think~ does XL mean anything~ is there another kind~ also I asked about serotonin~ does not an OCD brain need this~and would it supply it~ I know marijuana does~ the sad part is on that I never felt better in my life~I took advil last night for my neck and a half clonazapam later and my head felt awful~the sleep medication seems to start me off fresh the next day when I get these feelings~Martha~