still can't find the right medication
 

So what I have is basically anxiety about any physical influence to the head, anxiety about getting setbacks and anxiety that I don't get my old life back. The anxiety causes extreme sleeping problems, what means that my condition will hardly get better.

I doubt that my doctor is able to get the point. She gave me 10mg Zyprexa and 3 mg Temesta. The zyprexa caused extreme muscle commotions so that we have to get off it. Now she decided to try Risperidal(for 6 months!), that has the same effect on dopamin receptors. So I end up trying to fall asleep for hours because of my restless legs. I think she completely misses the point of my problems and should rather consider Cymbalta,Cipralex, Lyrica etc.

I alread tried amitryptiline and trazodone for sleeping. My sleep didn't really improve. It is all anxiety that causes the troubles.

What should I do?

What dose Risperdal (Risperidone) and what condition/s exactly is she treating you for with this medication? Anxiety? :confused: This is a heavy duty neuroleptic medication.

I get 2mg. She might believe that I have more psychological problems than anxiety. Any time I asked her what it is for she said it is against anxiety and acts as a sleep aid.

What do you mean with heavy duty? Persobally I believe that I get meds that are very challenging for the brain, without a real reason. There should be more gently drugs for my issue.

Have you started it at 2mg already?

OK, so when my son was little he was treated with this medication for a number of years (at a much smaller dose most of that time. The max dose he got to was 2mg). Had severe tics, obsessive compulsive behaviours, anxiety and basically was having an extremely difficult time to the point of disabled and at that point in time it was suggested he be placed in a hospital and I refused to allow that. This is going back 17 years or so now when unfortunately it was prescribed for children who had multiple conditions as well as autism and/or tourette syndrome.

It's really important that you read up on this medication if you're going to accept it because it can have serious side effects. I don't want to give you horror stories about it because I'm just a regular person, but I saw how it affected his mental state and it was not good. It also caused weight gain and it was extremely difficult to get off. He has since told me as an adult that during those years he was not a "sentient being"... his words not mine. Makes me so sad just thinking about it. :(

As it turned out later my son had not been diagnosed properly and he was in fact on Autism spectrum. Once he got the diagnoses sorted, he went off that medication and we learned new ways to deal with everything else and he thrived.

It just seemed really odd to me that your doctor would prescribe Risperidone for anxiety.

http://www.janssenpharmaceuticalsinc.../risperdal.pdf
Prescribing Information Risperdal - Risperidone.

Edited to add: Usually a doctor will perform an ECG/EKG before starting a neuroleptic drug. I think you've had recently? I may be wrong.
Then there is one done every 6 months or so from memory. That's to rule out a condition that affects the heart called long QT syndrome.

Yes I started with 2mg(the red one) and I already had two EKG's.

I know that this kind of drugs are mainly for bp disorders and schizophrenia. I will definately talk to her about a change. I see no reason why I should take this. She first saw me on a single day when I was completely down. Maybe that was the reason for risperdal. But my problem is just anxiety and a little depression. What drugs would you suggest here?

This is a Neurologist or a Psychiatrist prescribing this?

Coming from a long genetic background of people dealing with OC behaviours/Anxiety, and depression etc. on and off, as I do, I would be looking into some Cognitive Behaviour Therapy or at least talking with a Psychologist about a. sleep problems b. anxiety and oc behaviours c. depression if you're depressed.

Sometimes if the right symptom is targeted, you can find other symptoms will ease up. That goes for tics as well strangely enough. People who have multiple conditions comorbid to tics can find that their tics subside when another symptom is treated e.g. OCD.

I am not the person to suggest a medication but if I could suggest something - that is you need proper diagnoses first. These medications are not ones that you can just use for x amount of time and then stop.

and by the way...

no one can function when sleep is badly affected. It's top priority especially for me. I find my days after lack of sleep filled with brain fog, what I call "brick brain" (Mark calls it mud brain I think) and terrible vertigo.

You could in your own time start looking into sleep hygiene changes. Everything is individual, but maybe you would start to feel a lot better as a whole if you could just learn to calm your mind without drugs right now.

Calming my mind without drugs is what I tried for several months. I decided that there has to be a change. I already receive cbt. The doc prescribing me the drugs is a psychiatrist. She clearly missed the point because of her first impression about me.

That happens all too often unfortunately.

Drugs will not stop your anxious thoughts. They will just lessen them and lower the physical way those anxieties effect your body. You seriously need help with your thought processes. Numbing your mind is not going to do it.

Have you tried gabapentin to help your legs and body relax (let go of muscle tension) so you can sleep. I take 600 mgs before bed. Otherwise, my body tends to shake and have muscle tension.

You really need to find a way to accept that your brain was damaged. It may never recover to the level to get all of your old life back. Letting go of that thought is the best way to move forward.

As I have said in other threads, if you lost your foot to amputation, would you fret about when it will grow back ? You would need to just accept that it is gone and find the best ways to move forward within the limits that you have.

Believe me. It can be done. I have been living this life of reduced function for 40 years. My first injury was quite severe. I have suffered subsequent concussions. Most caused only short term struggles, if that. Some caused further decrease in my abilities to function and endure stress. But, I raised a family on a single income in a very high living expense area. I just found ways around my limitations.

The anxiety of hitting your head again will be self-fulling. Anxiety will reduce your coordination resulting in a higher risk of injury. Getting drugged up will further reduce your coordination.

Have your tried 5-HTP and L-Theanine as natural ways to increase serotonin ? L-Tyrptophan will increase serotonin and melatonin so you can sleep better.

And, find a CBT therapist to help with your thoughts.

Also a couple of good sites that kiwi33 posted on another thread recently about relaxation and sleep. It might all sound easier said than done considering all that you're feeling right now, but they can become very useful habits to learn for a lifetime.

Progressive Muscle Relaxation

http://healthysleep.med.harvard.edu/...vercoming/tips
Twelve Simple Tips to Improve Your Sleep

also

Useful Resources & Websites for Anxiety and OCD
http://neurotalk.psychcentral.com/thread1395.html

I alrady ungergo a CBT, but at the moment I really need the assistance of a med to sleep at least a bit. I have to say that the zyprexa, temesta combo has reduced my anxiety a lot. I don't fear the jerking anynore, I can keep my head on the pillow without correcting the position a hundred times. But I sleep not more than 5 hours each night with waking up many times. These meds gave me a lot of muscle problems as well.

The question I have now is what helpful med challanges an injured brain the least? Are anti psychotics harsher than cymbalta or lyrica? My doctor plans to get off temesta very soon and continue with an anti psychotic(seroquel probably). I would prefer cymbalta or lyrica or something from that group.

what I need is a good sleep, a positive attitude(mood) and a reduction of anxiety.

And what I want to admit is that my doctor(psychiatrist) has no experience with PCS patients..

Chris,

You've been given lots of comments. What choices are you making to improve your situation ?

Benzos are known to be difficult on the brain. The anti-psychotics are still newer and not as well understood long term. Cymbalta has lots of track record and probably is more understood. Lyrica is not like the others. It is similar to gabapentin, a well understood drug. Gabapentin is well tolerated by most. It really helps me with sleep issues.

Have you tried L-Tryptophan an hour before bed ?

No, I did not try l-tryptophan. I tried Gaba and 5-htp. Both were too weak.

The gabapentin seems to be for jerking issues only? Or why does it improve your sleep?

Tge only question I have is wheter I should stay away from anti psychotics(for whatever reason). I mean the reactions in this thread were quite negative. And I've seen that some people have difficult long term reactions with this stuff.

I feel like I am more on the secure site woth cymbalta against anxiety and for a good mood + amitryptiline or melatonin for sleeping

In case someone does not want to read the whole thread, but has a good advice to offer - I am looking for medications against anxiety, sleep problems, and a better mood(attitude) that do not impede the healing.

My comments were just our experience and from the little information you'd posted it concerned and puzzled me that you were being prescribed a medication such as Risperdal for anxiety.

You've mentioned so many different medications recently. It is confusing.

The best person to advise about medications is a knowledgeable and understanding professional. Maybe you need a second opinion. It worries me that perhaps you are grasping for straws. Meaning you seem willing to try almost anything.

CBT is usually done over a period of time. It takes a lot of commitment and involves homework. It's not something that works straight away in one session and of course, like everything, it may not be helpful for everyone. If you have already done a session in CBT in the past, it may be worth revisiting. It can take months but can be a useful adjunct therapy if you are taking a medication at the same time.

Anyway...
all the best to you in finding what will help you.

Lara, you understood it right, my doctor prescribed me Risperdal for anxiety. I am happy that you shared your experience here. From my research I came to the point that there are bunch of alternatives to Risperdal/Zyprexa. I justed named some of them here to maybe get a response from other users.

Did I at least get your message right, that there are better options than Risperdal for anxiety?

Risperdol is an anti-psychotic. It is used off-label for anxiety. That is a strange off-label use of Risperdol. Same goes for Zyprexa. My doc said Xyprexa is best for short term use. For me, it was while Celexa became effective.

Gabapentin is similar to Lyrica. For me, it lets my body and mind 'let go' of tension. It also reduces/eliminates the body twitches. I took 1200 mgs in the beginning. My twitches were bad. Now, I only take 600 mgs an hour before bed. If I don't take it, my tired body stays alert, not relaxed.

L-Tryptophan is the precursor to 5-HTP. It breaks down to 5-HTP.

How much 5-HTP did you take ?

Cymbalta is an SSNRI. It enhances Norepinephrine and Serotonin. Different people get a different level of effectiveness from these types of drugs. It should be helping with anxiety so you would not need to add the benzo. Maybe you need to try a different SSNRI. ??

Anti-anxiety meds do best when combined with talk therapy, CBT or other. They will not stop your anxious thoughts. Just allow you to choose to stop the anxious thoughts.

What steps are you taking to control your anxious thoughts ? Are you continuing CBT ?

I took 100mg 5 htp. Wasn t really effective.

You listed it up very well what I need. An SSRI/SSNRI for depression and anxiety and something to assist my sleep. This gabapentin sounds great. I always had the feeling that I cant let go and something keeps me awake. Some people had also success with melatonine.
I think I will stop taking these anti psychotics and benzos. Dont feel comfortable taking them

And yes, I have regular speech therapy

Speech therapy is entirely different than talk therapy. Talk therapy would be with a CBT or other therapist who helps you with how you think about issues that cause you anxiety. Speech therapy is for memory issues and how they may effect your ability to speak. Word finding strategies, memorization skills, etc.

Anxiety meds usually work best when combined with talk therapy, the "How does that make you feel" kind or "When this thought arises, try to think this......"

Speech therapy is for rehabilitating neurological function.
Talk therapy is for psychological issues.

100 mgs of 5-HTP is a light to moderate dose. You can take twice that in most cases.

I also have to prepare for sleep two hours before bed. No discussions with my wife. No stimulating TV. I use mind numbing TV to settle my mind and get it off any thoughts that might cause anxiety. If I go to bed and these thoughts arise and my mind starts 'thinking,' I need to get up and start the process over. I do better losing an hour starting over because the restless sleep I would get with a thinking mind will be worthless.

I have dealt with PCS and PTSD insomnia for 15+ years. It takes discipline to get good sleep.

Early in my struggles, I spent many nights sleeping in my recliner with the TV one, maybe with a music video/DVD playing. I use headphones with a volume control to listen to TV and would turn the volume down as things got quiet. There are cordless headphones that recharge on a stand. Sony makes a good set but they are pricey.

My mind wants to be active continuously so I have to have something safe to focus on. It depends on the time of day as to what is safe. At night, it needs to be very low key. Think of the excitement of watching golf. Enough to occupy your mind but not enough to need to stay awake.

Quick update: my doctor has put me on seroquel now. We start at 50 and move up to 600
mg. I am not really happy, as there were some comments in this forum that adviced to avoid seroquel. She said I need a med of this group. I asked many times about an SSRI, but she said it does not help against anxiety and sleep problems. Btw I am inpatient at the moment.

I feel not good overall. I currently take 3mg temesta until next week, 2mg risperdal until next week and increasing seroquel.

SSRI's can be very good with anxiety. At least that is my experience. Are you taking B-12 and the others recommended vitamins ?

Yes I take the complete regimen.

Sounds like I made a bad choice with my doctor. I asked several times about SSRI and anxiety. She said they won't help.

There are not many people on this forum who where treated with anti psychotics. That has to have a reason. I am definately not taking seroquel 6 months, as my doctor plans.

I have experience with using Seroquel while recovering from a head injury. Overall, if you're simultaneously dealing with anxiety disorders and a TBI, I would stray away from Seroquel. While it helped immensely with sleep, it totally erased much of my personality. I was zombified, in short. I never went above 150 mg's.

As far as I'm aware 600 mg is a dose prescribed, generally, to those suffering from issues like schizoaffective disorder, bipolar psychosis or schizophrenia.

Seroquel is, I don't believe, labeled to treat anxiety disorders. So it's odd he would prescribe Seroquel, and then rail against the use of SSRI's to treat anxiety, when Seroquel's primary use is for the treatment of psychosis.

As others have mentioned, it is an atypical antipsychotic. It is a very strong drug with at times alarming side effects. Doctors sometimes prescribe it off-label for sleep, but I believe this reflects irresponsible prescription practices. But, it is an effective sleep medicine. If anything, I would use it sparingly for sleep, if you have any issues with insomnia or symptoms of that sort.

Try and see if you can find another doctor.

Thanks for sharing your experience.

I have huge sleeping disorders. I think the main reason for them is anxiety. The first night with seroquel.was just like the others. I needed 2-3 hours to fall asleep and woke up 4 times.
I took 50mg yesterday, today we will raise it to 100mg. I am still on 2 mg risperdal and 3 mg temesta!

I found some unfo on the internet that anti psychotics cause brain shrinkage over time. Very concerning. I am going to take this stuff for a long time.
Nonetheless it should not impede the healing.

I found some interessting info about this

http://www.currentpsychiatry.com/fil...P_Article4.pdf

If anti-psychotics do cause brain shrinking, that is also called atrophy or encephalopathy. There is no way the brain can heal while brain cells are dying.

The research I have read says anti-psychotics should not be used for more than 6 months except in extreme circumstances such as keeping a psychotic person from becoming unable to care for themselves or a danger. My doc wanted me on Xyprexa for only 30 days. I was having a severe PTSD response and it helped me get past it.

Mark, did you take a look at the link I posted?

Research claims that quetiapine is safe for tbi patients. The brain shrinkage just occurs when it is taken over several years.

Chris,

I don't know if this will help or even if I should say it but I have managed to work my way back from an hour a day at a half hour per nap to a more respectable sleep now without meds...took 8 months. I still have nights that I awake and sleep fretfully quite unexplained such as last night.

Mostly I wake at 11, 2 and 4 but I fall back asleep and I don't wake in panic or worry about being awake.

Not trying to influence your decision just to let you know my story.

Bud

Chris,

Read the second to last page of that article. The 'considered safe' claim is just that. Your mileage may vary.

I don't see where you have answered about what your evening routine is long before trying to sleep. That routine makes a huge difference to me as I try to get to sleep.

Mark,

Fascinating article.

My worry about some of the meds is it can be a crap shoot as to whether it works for you or makes you worse. I just don't want the gamble. I am thankful that I am well enough despite all the stuff to have a choice, others are much worse than I and need all the help they can get. I don't know if I am being naive or not.

My routine for sleep starts when I wake up. I work real hard at dispelling worry and any thoughts that do not pertain to what has to be done today and planning for tomorrow. That is a difficult vital chore.

My wife and I watch some tv together while she massages my head which really helps relieve anxiety


My biggest weapon is the scripture. They are my brain break during the day and the last thing I read before lights out. Really helps me get my focus and gives me something to ponder.

Bud

Could you please tell me in other words what you mean by that?

It looks like seroquel is the go to drug for me. My doctor and psychologist think that I developed a psychosis(the problem that I just can't let go) and bipolar disorder because of my concussion. The seroquel helps with all those things and I can finally sleep again.

What worries me really are the negative comments about it. I would take a low dose of 100 mg

This is the first time you've mentioned having diagnoses of Bipolar Disorder and Psychosis.
Is this new?

Now it is understandable as to why the psych prescribed the Seroquel. Previously, you only said you had depression issues.

Your concussion is not your primary issue.

With this new information, please disregard any of my previous posts.

Please disregard any of my posts as well.

It is the firstt time somebody told me that I have this. It was actually my psychologist who analysed my condition and came to this result. I probably have this since several months. The bipolar disorder occurs just very occasionally and the psychosis is not a full one(hard to describe the explaination of my psychologist)My doctor does not talk a lot and keeps giving me pills.

If your doctor is prescribing anti-psychotics but was not willing to give you this diagnosis earlier, I suggest you find someone who is a better communicator.

When did your doctor tell you 'bi-polar and psychotic' ?

Bi-polar is by its definition an on and off cycling condition with the swings of varying amplitude.

You need to find someone who will help you understand what is happening and teach you how to communicate your experiences. I don't think this forum is appropriate for you.

Here is the link to our PsychCentral forum Chris2828
http://forums.psychcentral.com/

With the diagnoses that you have, that community will be a better source of support and information for you.