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Dr. Harriet
Dr. Harriet, Doctor
Category: Mental Health
Satisfied Customers: 117
Experience:  Board Certified Family Practitioner with 25 years of psychiatry medication management experience
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My doctor has currently has me on wellbutrin sr, buspar 3x

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my doctor has currently has me on wellbutrin sr, buspar 3x daily, xanx , relpax for migraines, lamictal and now wants to add 40 mg of something called geodon which i understand is in a class action law suit - i am constantly exhausted yet can not sleep without an over the counter sleeping medicine - am gaining weight but not eating - do i lack iron or doe i have chronic fatigue?? I have been on xanax for over 10 yrs and have told the dr repeadely that it no longer controls my panic but seems to go over his head and he just prescribes it again - what's up

Hi there,

well, I would have concerns about all these medications, too! Would you mind answering some additional questions for me? Then I can give you my thoughts about all of this.

First of all, what diagnoses have you been given? Is there anything besides anxiety/panic and migraines? Such as bipolar disorder or severe depression? Are you seeing a general doctor for these medications, or is a psychiatrist prescribing them? Have you ever been hospitalized for a psychiatric problem besides the panic? Have you ever taken any antidepressants other than the Wellbutrin in the past? Did your doctor say what he was trying to treat with the geodon? Was it anxiety or something else?

Do you have any medical problems? Do you take any other medications besides what you listed?

I look forward to hearing back from you.

Customer: replied 8 years ago.
I had been diagnosed with depression and post traumatic stress disorder many years ago - when in my twenties, i experienced two extremely traumatic events, one involving rape by knife point and the other resulted in the re construction of the right side of my face - i was originally thought to have an alchohol problem but after many, many treatment programs i went thru, i was not relating to anything these people were saying- i did not even like the taste of alchohol - i drank to die - i was about 120lbs and would go thru a liter of vodka within a day - a very wise doctor finally determined that the underlying cause was depression and post traumatic stress disorder and started me on medications - a few years ago all of a sudden, i started having manic spending sprees and unfortunately had alot of credit - i now have approx 75000.00 in unsecured debt on a 25,000 a year job at age 52 - this was adding more stress - my original dr moved to another facility and the new one said now I had developed a bipolar 2 disorder and started me on seroquel and lamictal and increased my intake of buspar and my xanax up to 4 mg a day - now he also wants to add geodon at 40 mg - i am tired all of the time, yet find it hard to go to sleep at night - i take an over the counter sleeping pill and then find i have to literallly force myself out of bed even by 10am and remain tired throughout the day - i do not know if i am lacking iron, or pssbly something - my primary dr did general bloodwork on me a few months ago as i was also complaining about my tremedous weith gain of over 50 lbs while eating virtually nothing and claimed everything came back within normal ranges - i do not know if i should look into homeopathic remedies as i have been on buspar and xanax for so long, they no longer help - i have told dr this but he never changes existing meds, onlly adds new ones .

Hi there,

I'm so sorry to hear about all your problems. With your long history, it is a trick to balance all your medications; the relpax affects serotonin, and can't be used with the SSRI antidepressants that are best for treating anxiety/panic/depression... So that makes rather a bind.

Geodon is an antipsychotic which helps paranoia and psychosis; some doctors are using antipsychotics for bipolar, too, although I am not that fond of them. Sometimes doctors will prescribe antipsychotics if you seeing things at night when you try to fall asleep. That is a common symptom with PTSD, although I find that medicines like Geodon don't really help it much. I've had patients with severe PTSD who never could figure out how to fall asleep at night. They tended to change their schedule as they felt safer trying to sleep in the daytime. That would be worth discussing with your therapist, if it seems to apply to you...

Wellbutrin is a very stimulating antidepressant which, at least in my experience, doesn't work very well for women, tends to trigger mania, and tends to aggravate anxiety. It may be contributing to your inability to sleep.. It doesn't interact with the Relpax, though....

Buspar and Xanax taken together isn't really logical... I have had good luck with Buspar in my patients, especially if the dose is at the maximum level. However, Buspar is made less effective by the Xanax, and Xanax isn't good as a chronic, daily medication because it is short acting and can trigger anxiety when it wears off. It is best used if taken only occassionally, not every day, and only to break a panic attack if one has started. It doesn't work that well to prevent panic attacks. Klonopin is used more frequently for chronic anxiety and doesn't have the withdrawal effects that xanax has. Over all, though, the SSRI's work best for treating anxiety and preventing panic...

You may want to talk with your doctor about overhauling your medications. It looks like you can't really change one without having to juggle all the rest... While I suspect you have been on SSRI's like Celexa or Lexapro or Zoloft in the past, it may be worth another trial of that, if you can stop the Relpax, that is, as these tend to work better than wellbutrin for anxiety and panic. Another option would be something like Anafranil or an older antidepressant which would also help anxiety. Remeron is a sedating antidepressant that doesn't have many drug interactions, and can help with sleep, although you have to watch out for weight gain. Trazodone is also helpful for insomnia. Even adding a second mood stabilizer to the lamictal for treatment of possible mania, might make more sense than adding geodon...

Well, as you can see, there are many possiblities out there, and I suspect you have been on many of these medications in various combinations in the past...

As far as other reasons for the fatigue, well, as long as you are sleeping so poorly I wouldn't expect the fatigue to necessarily be from anything else other than sleep deprivation. Sleep deprivation itself can cause depression, so is a major problem worth addressing. Over the counter sleep medications are often problematic as they lead to morning hangover and a slowing of brain functioning... Again, something like trazodone might be helpful.

One last suggestion - you didn't mention if you are in therapy or not. If not, I highly recommend it; it is the most effective treatment there is for PTSD and anxiety/panic. Usually the medications only add to the effectiveness of the therapy but don't replace it. If you are in therapy, you might want to increase the frequency or add a group session to your treatment.

And one final suggestion is to review the exercise you get in a day. Exercise is very effective for treating depression and anxiety, and can help with sleep, as it helps your body burn up all that adrenaline that is triggered by the anxiety, and can wear you out enough to sleep...

Well, I know I haven't figured out any easy answers for you, but I hope my suggestions may help a little. Feel free to write back if you have more questions. Best Wishes

Customer: replied 8 years ago.

you have been most helpful and am saving your suggestions in my files - i had no idea that relpax interacted with so many things and that xanax along with the buspar was counter productive - i think some of the problems may have began due to my primary dr actually being the one to diagnose the depression and ptsd and yes, i have been on nearly all of the other medications you mentioned - zoloft and paxil were actually some of the first - my primary dr seemed to think paxil might help me in the evening but did not work - funny you should mention klonopin - i have a friend who suffers from anxitey and that is what she was on - after my primary dr left, he referred me to a phsyciatrist and now also have a new primary - the doctors do not communicate with each other so that makes it harder for me - i would love to be back in therapy - i was in individual therapy twice a month and it helped me with my esteem issues greatly but now, with the cost of all of this prescription medication, it is draining me - relpax alone cost 100.00 for 9 pills and that is with insurance - my meds cost me roughly 350.00 every three months and then he wants to add the geodon which is another 100.00 - i had asked my pharmacy about it and they also had negative comments on its use in my particular case - they had thought maybe an increase in the lamictal would help with the mania - i do not see things at night - i just think too much and have extreme racing thoughts - my triggers seem to come more in the day time if i see something or someone that takes me back- to date as far as i know, i have only had one body memory where i completely shut down and did not speak for hours (the drs had thought i had a stroke as i had collapsed) but ruled out after much testing - i really and truely appreciated your response - i now have more knowledge when i go back to see the pshyciatrist on may 11 and ask him about klonopin as now i am aware that may be a better option for me - the relpax was prescribed for me strictly for migraines as no other migraine medication worked.

It sounds like you are really on top of things here. Good luck with everything and best wishes.
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