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Author Topic: Questions about Lexapro
Toretha
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For hatrack medical people and anyone who's taken it, I have a few questions I couldn't get answered or want verified:

It says use caution operating heavy machinery on the bottle. Am I good to drive? Ride my scooter on dangerous areas? (by dangerous I mean bumpy and requiring a lot of concentration to navigate, not actually dangerous) Should I wait a bit before driving to adjust to the effects?

I've been told it takes a week to two weeks to become effective: will I be feeling any negative side effects before that? (drowsiness, whatever) Or does it also take the time for you to experience those?

If you miss a dose (I know not to quit without talking to a doctor and being tapered off) how bad is it?

The doctor, who is a temporary figure until I can see the psychiatrist, told me I would probably be on this a minimum of a year and possibly all my life. I'm not in the least comfortable with either time length, so how much will I be able to tell when I'm ready to come off it? Is it safe for me to ask for less time? Is it really having to be that long? I add here that I'm not taking it for depression but for OCD which I've kept under control without drugs since middle school-I just need some time to get back control and break the cycles, and all this talk of extremely long term medication is frightening me.

Also how dangerous is alcohol? I don't drink but on my 21st birthday (January) I'd like to at least be able to take a sip or two of the daquiri I'm going to order...Any chance I'll be off by then? Would a sip or two be dangerous?

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Theaca
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The answer to most of that is don't be alarmed, and most likely you won't have any side effects at all, and I've never had any patient be incapable of driving/working with it. It makes less than 10% of people drowsy. If you feel too drowsy to work/drive safely, you'll know. Just switch it to taking it in the evening and see if that is better.

I can address you questions in more detail later today. I have to go to work now. Lexapro is the fastest acting, lowest side effect SSRI on the market so relax a bit and see if it agrees with you. [Smile]

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Zarex
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I take Lexapro (along with a slew of other psychiatric drugs) and don't have any problems with driving or anything like that. However, once you adjust to Lexapro and miss a day, I can almost guarentee that you will be uber drowsy the next day. I wouldn't drive on those days.
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mackillian
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I also take a decent amount of psychiatric drugs (four, I think). I tend to have side effects from a lot of medications and get some interesting reactions (my grandmother is the same way). Lexapro is one of the medications that gave me no side effects. I think that's good news.
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Theaca
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Lexapro is an SSRI, in the class of prozac, paxil, zoloft, celexa. It is closely related to celexa but refined to make it stronger with less side effects.

The goal of the doctor is to find a medication without side effects, that will calm the OCD symptoms and anxiety. Lexapro can work more quickly than most other SSRIs, and people can start to feel better during the second week. It has a short half life, which is partly why it works faster. That means it wears off faster.

Most people who take if for depression are more irritable in the afternoon if they skipped a dose. It's not going to be severe and you should just go back to your usual schedule if you forget a dose. However, if you remember it only a few hours later, you can go ahead and take it. Also, you won't feel this effect (of skipping a dose) at all until you've been on it a month or two. When you and your doctor decide you are going to stop taking it, which is usually after at least six months of therapy, he might taper you off over a couple of weeks to avoid any side effects of stopping the drug more quickly. As far as needing it for six months versus forever, that's something you'll be better at assessing after you've had treatment for a few months. Don't worry about that for now.

As far as side effects, most people prefer taking lexapro in the morning. It is rather a neutral drug, as far as causing insomnia vesus drowsiness, but maybe a bit more on the activating side for most people. So taking it in the morning is the way most people start out. If it makes you drowsy, just switch it to nighttime. Taking it with food the first week usually prevents any nausea. Some few people also complain of a headache for 2-3 days when starting an SSRI, but it fades for good after the third day almost always. As far as long term effects, most people don't have any. Some few people complain of continued tiredness, and need to switch drugs. Some people have weight gain or weight loss or change in appetite. Some people have less interest in sex. Some people will feel like their mood is better, but start to have other problems with mood like poor motivation. Some few people who have undiagnosed bipolar disorder can become manic on an antidepressant. Again, the goal is to find a drug without side effects. So just keep in contact with your doctor if you start to have any concerns.

As far as alcohol, well, alcohol is a depressant and can counteract the drug if taken regularly. An occasional small amount (a serving) taken on special occasions will probably be just fine, but ask the psychiatrist when you get one.

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Mariann
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I think you can drive. Lexapro is a newer anti-depressant with less side effects. You might be a little drowsy at first, but after a few weeks your body will get used to it. From my experiences with psychotropic meds, it's the physical side effects that effect you first, then lessen as the medication goes into effect. No worries. (I think people slap that cautionary label on there in case of those who suffer from extreme drowsiness, which happens but not usually.)

As for your concern over the length of time- *BIG HUGS.* I take a variety of medications to combat a schizo-like disorder (we're not sure what it is exactly- I'm also going to a neurologist to figure it out), and I always grow annoyed when a doctor tries to tell me that I'll have to be on medication for the rest of my life. The fact is, I've suffered from this illness for years, and for years I've been uninsured and therefore unmedicated. While this probably sounds either farfetched or extremely rare that a person can deal with psychotic symptoms unmedicated- after hooking up with my local NAMI chapter (National Alliance For the Mentally Ill) I discovered that there are plenty of people just like you and me who feel that sometimes medication doesn't need to be a lifelong thing. It's not irrational to believe you have a greater level of control over your symptoms. A lot of people gain a lot of strength and coping skills from cognitive therapy- and eventually wean themselves off meds.

So my advice to you is to continue to believe in yourself. In my experience with psychiatrists and other doctors (and I've had a LOT of experience [Razz] ) they like to tell you that you have little control over yourself, and that medication is the most beneficial form of treatment. But there are people out there who believe in reforming this attitude- http://www.power2u.org is an excellent website that advocates self-recovery. (Actually, the head of that organization is a recovere schizophrenic who went to med school and became a psychiatrist!)

Not to say that meds can't help, but like you I believe that some people should use them as a means to stabilize themselves after a crisis or relapse, instead of depending on them (and then having to deal with their side effects) for the rest of their life. As for how long you think you should take them- sometimes people make the mistake of quitting their meds when they think they're alright, and then have another crisis because they're not ready to get off them yet. My advice is to keep track of your symptoms while you're weaning yourself- and if you feel like you're getting worse then it may not be the right time to stop taking them. Give yourself more time, work on some coping skills, and then try it again. [Smile]

Also, here's a website about Lexapro. You'll find all the answers to your questions there. http://lexapro.com/

~M

P.S. Sorry if I sounded preachy or overzealous. I just really sympathize with your feelings right now, because I've struggled with the same thing. Good luck to you, and I hope you can keep the forum updated with your progress!! [Smile]

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Alucard...
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The best place to start is the beginning with Prozac, which revolutionized therapy for depression. Prozac had a long half-life (72 hours) meaning if you missed a dose, you were still OK. What they found is that Serotonin Specific Reuptake Inhibitors (SSRIs) like Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro could be used for depression, social anxiety disorder (shyness), OCD, and other conditions like Alheimer's and ADHD. For expample, Paxil was the first to get an FDA approved indication for Social Anx. Disorder, and Luvox is only indicated for OCD. But ALL of these drugs are so similar that they can be used SOMEWHAT interchangably. Celexa came out in Europe shortly after the release of Prozac in the US. I have read accounts by some clinicians who believe that if Celexa had been marketed next to Prozac in the US that Prozac would have been pushed to the side because Celexa had a much more tolerated side-effect profile, meaning patients simply did better on Celexa for the most part.

Why is this important?, Theaca touched on it, but SPECIFICALLY, Lexapro (escitalopram) is a metabolite of Celexa (citalopram). What this means is that the body breaks Celexa down chemically to Lexapro anyway, so the medications are nearly chemically identical. BUT, what is important is that many drugs are re-released by manufacturers to keep making money, but sometimes, the metabolites are BETTER drugs. Sush is the case with Seldane/Allegra. Seldane had horrible drug interactions, and Allegra bypassed those interactions because it is a metabolite (further down the chemical pathway) that does not have the same interactions. Lexapro may be a "cleaner"-acting drug than Celexa in the same way that Allegra improved over Seldane...

Recently there has been concern over the use of SSRIs in children and adolescents especially. The FDA now requires an insert to be included with each prescription for many antidepressants (SSRIs included) warning of thoughts of suicide. This is so hard to distinguish between a medication side-effect and a part of depression. What I would tell you is to not worry about any of these warnings you see or hear. Stay close with your doctors and let them know if you have any feelings like this and go forward...

Finally, to answer your questions, I believe that the above posts did an EXCELLENT job of that I have very little to add.

I would be very surprised if Lexapro affected you in such a way that you could not drive. You would very likely find out that bit after one or two doses. You know, the horror stories you hear of a medication incapacitating someone for a day and a half...But the warnings are there for everyone to be aware of.

Drowsiness is the most common side-effect, but there is another reason to take Lexapro in the morning. If you experience a Serotonin surge and have been taking Lexapro in the evening, you might find youself ironing or vacuuming the whole house at 3AM. You usually want that surge to occur during the day. Chances are, you may never even experience such a surge like that, so again, this is just more information to arm yourself with, not problems to expect in your treatment.

As a class, SSRIs can cause some degree of GI upset, nausea, etc. But again, Lexapro is such a mild drug with such a good side-effect profile that you may have none of this either...

Lexapro and SSRIs can be used for as little as 6 weeks for mild depression, to every day, continually for years for other conditions.

As far as alcohol, a drink or two in moderation should be fine. Keep in mind that if you are sensitive to alcohol and get woosy on a couple drinks that Lexapro could make this tendency even more pronounced. But have a daquiri for me on your 21st!

Lastly, I wish you well and hope this helps!

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kojabu
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I've never had a problem with Lexapro and sleepiness, but my tolerance for alcohol has gone way down. This may be in part due to the Depakote I'm also taking, but if you don't drink and then you have a daiquiri, chances are that you'll feel it more than if you a)weren't on it and b) drank more regularly.
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Alucard...
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kojabu,

Depakote and alcohol both affect GABA receptors...

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Shigosei
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Hey, Alucard, I was just wondering...

-Does Trazodone stay in my body long enough that if I miss a dose, I'm okay? (This is actually relevant today...)
-Is it all right to have a single drink with Trazodone?

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kojabu
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What's GABA?

edited: I started taking Depakote about 3 months before I started on the Lexapro. Most of what I noticed with alcohol I noticed before I started taking the Lexapro.

[ October 22, 2005, 12:10 PM: Message edited by: kojabu ]

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pH
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GABA is...oh, crap. I used to know all this stuff. [Frown] I'm slipping.

Anyways, I have severe OCD, and I've been on plenty of medications for it (though I'm not taking anything now). I've taken Lexapro. My personal opinion: Lexapro is the devil. The side effects it gave me were awful. But from what I've heard, most people don't have side effects from it at all.

If you're worried about the drowsiness, ask your doctor if you can take it at night. He shouldn't have a problem with that, and as long as you take it 8 hours before you need to get up, the drowsiness should have mostly worn off by then, I think.

As for alcohol, I was prescribed Lexapro by a doctor who definitely knew I liked to go to bars and drink, and he never made a big deal over it. I think you'd be okay with one drink.

Now I miss my old psychiatrist. [Frown]

-pH

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pH
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GABA.

-pH

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ketchupqueen
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Does the name "Lexapro" remind anyone else of a product or company made/owned by Lex Luthor?

*needs to return Rivka's L&C*

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Megan
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No, but it does make me think of printers.
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Alucard...
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Trazodone is usually dosed once or twice a day. I had to look up the half-life and it was hard to find!, pleak plasma concentrations occur within 1-2 hours after taking orally. The half-life is biphasic at 3-6 hours and 5-9 hours, repectfully.

This means you would not want to miss a dose if possible.

As far as alcohol, same as above. Anything in moderation is OK (this means one drink occasionally). However, if you are taking larger doses above 150MG per day, I would refrain from alcohol entirely.

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kojabu
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150 MG of depakote?
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Alucard...
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The post above deals with Trazodone, kojabu. Depakote has a much higher ceiling, at 2000MG daily or thereabouts...

:-)

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kojabu
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Yea, I don't know the chemical name of Depakote which is why I wanted to clarify.

Oh just found it on my patient information leaflet: Divalproex Sodium Enteric Coated Tablet - Oral. [Smile]

edit: Is there any reason why lighter drinks, such as hard cider and Smirnoff ices, seem to affect me a lot more than say a White Russian or Fuzzy Navel, etc?

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pH
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kojabu, what kinds of side effects did you have with Depakote, if any?

-pH

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kojabu
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When I first started taking it, I would get really really tired when I increased. I think that's it though.

When I upped my Lexapro, I think I had some mild nausea.

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pH
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As for the drinks, maybe it has something to do with the sugar or something?

-pH

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Alucard...
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kojabu, you might have trouble fiding a study that compares the effects of various drinks on a patient on concomitant therapy of divalproex, but it sounds promising :-)

To be truthful, I have no idea!

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ketchupqueen
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Depakote is very scary stuff. I know it works for some people, but I saw 8 girls out of 17 who were taking it develop PCOS. [Angst]
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Alucard...
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Do you mix the fuzzy navels and white russians yourself, or is the bartender? A Smirnoff Ice has quite a bit of alcohol, if I remember correctly. As for sugars, white russians and fuzzy navels have plenty though...

I dunno. Maybe the mixed drinks are watered down???

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kojabu
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Smirnoff Ice is only about 15% alcohol, whereas there's vodka + something else that's about 15% alcohol in both of the other drinks.

They have ice in them, but there's a shot of each of the other two ingredients + OJ or milk, so who knows.

If I mix it myself, it's usually a tall glass, 1.5 shots ish of vodka, 1.5 shots ish of other thing, the rest OJ or milk (depending). I don't like really strong drinks.

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pH
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kq, I think that's also a danger with drugs like Zoloft. At least, I remember my doctor being concerned while I was on it.

And Smirnoff Ice is only 5% alcohol.

-pH

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Mariann
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quote:
Originally posted by ketchupqueen:
Depakote is very scary stuff. I know it works for some people, but I saw 8 girls out of 17 who were taking it develop PCOS. [Angst]

What is that? (My doc is trying to get me to take Depakote, despite being on two working medications.)
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kojabu
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Polycsytic Ovarian Syndrome

pH: even better! (about the Smirnoff) But it also doesn't make sense that when I have a few of those I feel really sick and when I have vodka I don't. It never used to happen that way. And when I choose what I'm going to drink, if I'm drinking, it's either hard or stuff like cider/Smirnoff ices, so there's no mixing of alcohols.

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Theaca
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kq, girls start showing signs of pcos as they start to gain significant weight after puberty. For many, that is late teenage years or college years. So some of these girls might have been going to develop PCOS anyway. There is a lean version of PCOS too, of course, but most people only develop symptoms once there weight starts rising out of the low end of normal range. Does that make sense? Just because they happened to be on depakote during those years doesn't mean it was to blame for all of them developing. Just a thought. Also, it could have caused weight gain which then caused the PCOS to show up, which isn't the same thing as causing the PCOS.
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ketchupqueen
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Polycystic Ovarian Syndrome. Oh, and this was over the course of 11 months. :|

I had another friend who was on Depakote and had PCOS, which kept getting worse. My mom found some articles about the link and gave it to her, and she told her doctor she wanted to switch. She switched medications and her symptoms improved dramatically, and the other medication worked just as well to control her BPD.

The risk is highest in girls and women between the ages of 12 and 29.

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ketchupqueen
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quote:
Just because they happened to be on depakote during those years doesn't mean it was to blame for all of them. Just a thought.
I know that. But after seeing that and reading three papers on it, it was the one medication I refused to take no matter how much they tried to threaten me into it. And remarkably, my mom backed me up on it. I'm glad-- I have enough gynecological problems as it is.
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pH
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kojabu: I have the same reaction. I feel nauseous if I drink what I like to call "designer girlie drinks," but I really don't think it's the alcohol because I don't have problems with vodka, Jager, etc. either alone or mixed with something.

-pH

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ketchupqueen
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quote:
kq, girls start showing signs of pcos as they start to gain significant weight after puberty.
These girls, except for one, did not gain significant weight. And they were all between the ages of 12 and 16.
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Mariann
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http://www.psycheducation.org/hormones/Insulin/polycystic.htm

"Currently there is considerable debate in psychiatry as to whether Depakote might cause PCOS. It's tricky because it looks like the things we treat with Depakote, at least epilepsy and possibly bipolar disorder itself, can cause PCOS with no Depakote around. However, it may be that Depakote adds to that risk."

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ketchupqueen
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I should probably also add that at least three of them were being treated for bipolar disorder despite uncertain/unreliable diagnoses.

It was a bad situation all around. Most of them were also on medication on which they should have had monthly liver function tests. Unless their parents took them independently (impossible in some of their cases-- foster care, etc.), they did not get said tests.

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kojabu
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Oh yea, I had to get tons of those stupid liver tests. They took so much of my blood. At least now I don't have to have it done so often because I'm no longer increasing the amount.
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ketchupqueen
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I never minded the blood sticks. After the first little while, I even liked to watch. I think this is because after I got my blood drawn, my mom always took me to get a donut. Positive associations, you know?

Of course, I did develop a sensitivity (which has now become a full-blown allergy) to rubbing alcohol. Starting when I was about 16 1/2, they had to use betadine. Caused some problems when I was having a baby-- it's hard to keep track of what they're swabbing you with when you're in severe pain and being prepped for an epidural, my nurse had trouble remembering because "it's kind of like being allergic to water", and my husband was kicked out of the room for that part (despite my being told beforehand it was okay if he would stay and my requesting he be allowed to just step back. Grrr.)

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Theaca
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Did you ever get a diagnosis back then, kq? Not that you have any illness TO diagnose these days.
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Tante Shvester
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Carbonation (bubbles) in alcohlic drinks causes the blood alcohol levels to rise faster than the same amount of alcohol in a non-bubbly drink.

So Champagne might go to your head faster than Chardonnay.

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ketchupqueen
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Theaca, I was diagnosed with major depression at 12-- and later told it was most probably not chemical at all, but a reactive depression (I had just been told that I wouldn't see my dad at all for who knew how long.) Also, the psychiatrist never talked to me alone; he prescribed medication based on what my mom said my teacher said about me (my teacher later denied it.) Then, of course, the not-needed large doses of antidepressants screwed with my brain chemistry. Instead of scaling back and seeing if that was what was causing it, I was diagnosed Bipolar Type II and put on lithium and mood stabilizers in addition to the anti-depressants. I had every side effect in the book-- I ended up off one antidepressant when I did a homework exercise for my P.E. class and my mom discovered that my resting pulse before I got up in the morning was 162-- and they just kept switching me from medication to medication. I learned to completely compartmentalize these impulses away from the real feelings I had, and controlled myself pretty well. They kept upping my dosage anyway-- mainly because my mom would do things like get me hospitalized, saying I was manic, because I was laughing. This persisted through 7 or 8 changes of doctors-- I kept telling them that there was nothing wrong with me but the medication, and all of them took that to mean that a) I was in denial and b) I needed more medication. I learned to just say, "everything is fine. I'm doing great. I feel happy except when something upsets me." That seemed to result in the least amounts of increase in dosage.

When I finally ended up in placement, I saw a lot of teenagers who had iffy diagnoses and a lot who had conditions that were definitely being aggravated by the treatment they were receiving, as well as side effects and problems that were systematically ignored. One girl had a seizure in class one day (the teacher didn't even know what to do; another student finally went AWOL, ran to the office, and told them to dial 911 right away) and later found out that it was probably the result of abruptly stopping a medication she had been on-- the doctor ordered them to stop it and forgot to order them to taper it off.

I don't mean to sound like I think all psychiatric treatment or all psychotropic medication is bad. I've seen some bad situations. (Besides the ones I mentioned, there were the boys put in placement because they came out to their parents and their parents decided they were crazy to be gay, and all kinds of other horror stories-- the girl who had been in foster care since she was 3 or something and faked depression so they would give her medication because she felt left out not taking any, etc., etc.) I have also seen many people, teenagers and adults, who have really needed medication and have benefited greatly from it and whose lives are improved drastically.

I'm just wary of people not being aware of the real possible side effects, doctors who dismiss them because "it's working otherwise" and it's better to have a patient with side effects but less depression than to try to find another medication, drug companies who hide side effects and conceal important information from doctors and consumers, and most especially dangerous medications being given to teenagers and children who have no recourse but to take them (they are threatened with loss of all privileges and/or confinement to a locked-down treatment facility and/or hospitalization if they don't take them) without real informed consent or any kind of say in the matter. Which is not what this thread is about. Sorry. [/rant]

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Theaca
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I don't know why some doctors don't LISTEN to patients more. I remember when I was 20ish I had some serious concerns prompting me to ask my mom to suggest a gynecologist for me. She asked me why, so I made up a couple things for her. Then she planned her own visit to coincide with mine (she's blind, so driving us both to the gynecologist made a lot of sense to me). She arranged to make her visit first, told the doctor what I was there for, told him I was too shy to tell him anything. When he came in he asked me a couple close ended questions then did my first pap smear, which was quite an ordeal for me. He never gave me a chance to talk to him. I didn't get to say more than yes and no. I was furious afterwards when I realized how I'd been handled by my own mom. And the doctor took her word and talked to her about me even though I was 20. Still angers me.

Did your mom ever apologize to you?

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ketchupqueen
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No.

She doesn't think she did anything wrong. In her own twisted reality, she did everything she did (does) out of love and caring for her children. At least in my case and my oldest sister's, she realized when she needed to let go, step back, and let us have our own lives. (That's why she's still involved in them.) My other sister still has a very unhealthy relationship with her (at 32) and of course she's trying to get legal control over my (19-year-old) brother's future now...

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