General Med Question

[Bill Simmons]

After three years of trying a zillion meds not much has worked. The best I have come up with is 50mg of Tramadol every night. That helps a lot with the depression. I take 10mg of Diazepam sometimes when I can not sleep. It works but I can not take it for more than a day or two at a time.

Here is the question. I can not predict how the meds will effect me all the time. Most of the time the Diazepam does just fine but...on some days I take it and the effect last for two or three times as long a normal. Same reason I do not drink. One day I drink half a bottle of rum and nothing the next time I drink one shot and I am on my ass.

WTF is up with this????

 

[Jimmy1]

Mate, everyone reacts differently to every different drug. I have been given Tramadol for pain after surgery, but I hate it because it's addictive. I use a combination of Valdoxan (which apparently restores the sleep rythm) and Avanza Soltab 30 mg. The Soltab is weird. Less is more. 30 mg works better than 60 mg, and 15 mg even better.

Valium screws me around like it does you. It must be the state of mind. Sometimes it's like it only works for half an hour yet other times it can last for 6. Valium or Diazipam is meant to be a slow release drug. Xanax is meant to work quickly. But once again I hate them too because they are addictive.

My psych told me that our bodies constantly change. Our metabolism changes constantly too as we get older therefor the medication has different effects. It's a constantly changing ballgame. If it were easy then PTSD would be a breeze to manage.

Just an opinion.

 

[Lee C]

Jimmy PTSD is a breeze, isnt it(n)
And totally agree Tramadol is a nasty piece of kit and a nightmare to get off. Just taken 200mg cos my head is battered, know its wrong but i dont wont to break anything in the house today.

 

[Jimmy1]

Love your sarcasm Lee. Yeah it is a breeze.....:whistle:

I use the Tramadol sparingly. More for pain than to calm me. Maybe I should try use it for when I feel wired....

 

[Bill Simmons]

My use of Tramadol started because of shoulder pain. I had to take about 300mg a day to control the pain. I took it for about 40 days. I made the mistake of stopping without reducing the dose. I went through about 12 hours of fairly severe withdrawal issues when I stopped. It was f*cked up.

I noticed that I got a lot of relief from the depression while I was using Tramadol. After a few days I tried a 50 mg dose daily for a few days and then stopped. I did not have any withdrawal issues with the low dose.

I have been using Tramadol for about six months now with no real side effects and it helps with the depression. I stop every few weeks to see if I will have withdrawal issues. So far so good.

Look guys I am not a chemist and do not have the math background to really understand all this in detail.

My guess is that because Tramadol produces serotonin that is the reason it is affecting the depression.

SRI’s and SSRI’s are commonly used drugs to try to correct these conditions. I cannot take these drugs and they make me want to kill myself and really f*ck me up.

For me the low dose of Tramadol helps most of the time. If I get really out of wack I take Diazepam which calms me down and lets me sleep. 10mg for me, no more no less. The effect is much less predictable because sometimes I wake up and I still feel drugged out. Most times Diazepam does a good job.

All this shit is addictive and can cause real problems. I am not recommending this course of action just telling you what has worked for me. Most doctors will not prescribe these drugs for PTSD and say they cause more problems than they solve. Well…WTF…if it works it works.

The more I look into these issues the more I understand that no one has much of a handle on this brain chemistry stuff. I have got to the level of understanding that I cannot even talk to the doctors any more because they understand even less than I do. Sucks but it is what it is. I wish I had a research biochemist to talk to.

The whole damn prescription thing is just a guessing game for the doctors.

Be careful who you trust!! Take control of you own health as much as you can and know how. You are living with PTSD not the doctors. Don’t take this as a put down of the medical profession; just know they don’t walk on water.

 

[Bill Simmons]

Getting a little deeper into the subject.

Serotonin acts as a neurotransmitter, a type of chemical that helps relay signals from one area of the brain to another. Although serotonin is manufactured in the brain, where it performs its primary function, some 90% of our serotonin supply is found in the digestive track and in the blood platelets.

There are many researchers who believe like I do that an imbalance in serotonin levels may influence mood in a way that leads to depression. Possible problems include low brain cell production of serotonin, a lack of receptor sites able to receive the serotonin that is made, inability of serotonin to reach the receptor sites, or a shortage in tryptophan, the chemical from which serotonin is made. If any of these biochemical glitches occur, researchers believe it can lead to depression, as well as obsessive-compulsive disorder, anxiety, panic, and even excess anger. Sound like something you experience?? Me too.

I am writing all this shit to let you know I did not just dream this shit up one night.

I think all this brain chemistry is a little different for each of us and the answers “may” be found by trying different things. How much is the dose?? What time of day works the best?? What are the risk/reward ratio??

These are all personal decisions that you should make with the help of the best consultants you can lay your hands on, doctors, other vets, and anyone you think can help.

 

[Docrobert82]

As a medical provider I should warn you about tramadol, but........yeah, its my favorite drug. The only problem with taking it for any amount of time is that your brain will stop producing enough serotonin on its own. It takes a while for your brain to kick it back up again. Also, if you take it with a SSRI/SRI you risk the chance of serotnin storm which is not pretty. I had one patient where mental health had prescribed way to many meds and didn't even think about the Tramadol I had prescribed him the week before, it sent him to the ER and he has to be admitted for a few days.
I do belive that everyones brain chemistry is different, otherwise there wouldn't be so many meds out there. Doing my tiny physc rotation I had a Dr admit that sometimes its just throw meds until they find the right one. That's one of the reasons it took me so long to go and get help.

Oh, I am for the momment still a Navy Independent Duty Corpsman and I totaly agree with you Bill.

 

[Bill Simmons]

Hi Doc....Good point about the "serotnin storm" also about the lack of serotnin production after stopping. This is one of the reasons you need to come off the drug in stages. As a pain med Tramadol is used up to 400mg per day and will cause withdrawal in most people, time and dost dependent. A effective dose without side effects for control of depression depends on the individual, and is a second line med to begin with.

As I stated there are several reasons the different parts of the "serotnin system" can fail. It is one of the reason for the several types of SSRIs.

I ment for this to be a general intro and what has worked for me. I do not think most people with PTSD will have a lot of interest in the chemical details, just the results. I tried to make this as simple as I could, and stress the down sides.

 

[Docrobert82]

That I can understand, I've had a lot of patients with PTSD, (so why has it taken me this long to get help? I can be retarded) and most of them just asked for a pill to make it all better. People need to get educated on the meds as best they can, I've seen a few of the Wounded Warriors from Camp Lejuene get themselfs messed up.
We have to help eachother out with the education and I thank you for putting out the good info.

 

[Jimmy1]

Hey Doc, the biggest problem we have is that different meds affect different people different ways, so many differences, haha, had to say that.
There are some MD/GP's/Psych's that should not be practicing. Their first IA is to prescribe Zoloft and Xanax, and they don't really monitor it either.

I am allergic to Codeine, so they prescribed me Tramadol after the last surgery, I only took two days worth then stopped taking them, what's a bit of pain if you can handle it. They have now prescribed Lyrica for both my pain and psych reasons, works well.

Look forward to getting more of your point of view on things mate.

 

[Docrobert82]

Lyrica is a good drug and yes zoloft/prozac/xanax/ativan are kind of getting over used. (Though if they handed me a bottle of ativan a month or two ago I'd be in a better place)
I think its a good idea to ask your provider what thier view is on PTSD or any other psych issues.
My training is mostly in trauma and sick call, (and tons of admin) but I spend as much time as I can learning what I can. I've had too many patients that have needed help and can't get it or have to wait weeks for an appointment.
No doubt drugs do need to be part of the treatment of PTSD but talking and behaivioral/cognitive therapy works well too. There is no magic cure for PTSD and not everything works for everyone.

 

[Jimmy1]

There is no cure at all for PTSD, but we can learn to manage it. If we can catch the veterans returning and give them therapy, then they might not have to suffer as much as some of us have.
You are right though, behavioral and cognitive therapy is the key, and not everybody needs medication either, but it helps to calm the overactive mind when the stress cup is full.
The biggest problem IMO is that veterans need to learn what triggers are and which of them set them off and then to remove themselves from the trigger or remove the trigger from around them. If that make sense. Sometimes it's things that we enjoy which are doing no good. For instance 'Military Service'. It can be a constant trigger. I will talk more later, I might even PM you mate.

Have you managed to read these yet??

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The one thing I will say is this though, all the articles, drugs, and therapy don't really matter if your feeling all alone and this forum is one place where veterans can come and be themselves and belong. They can sit and read (lurk), or they can have a say, or they can become really active and help others. It's their choice. Anthony made it so that there is no real rules. Its self moderated and we quickly get rid of those who don't qualify, they stand out.