Psych Meds

[LydsRN 1]

How did your medications change post op? Did you have to increase the dosage because of malabsorption? I'm having a sleeve to bypass revision and am concerned about how my depression medication with absorb. Thanks!

[Ed_NW 684]

If you're taking an extended release med like effexor, your doc might have to up the dosage due to malabsorption.

[CyclicalLoser 155]

I have a post on it if you search by my name. I think each person and each med varies significantly. That being said I'm a LGB to RNY convert and here's what I did:

Old Dosage:

Lamictal/Lamotrigine: 75mg morning (3 x 25mg tablet) - I'm not bipolar, I have cyclothymic disorder which is kind of like mild bipolar.

Luvox/Fluvoxamine: 25mg morning (1 x 25mg in morning, 1 x 25mg at night). This is for panic disorder / generalized anxiety (With some depression thrown in for fun )

New Dosage:

Lamictal/Lamotrigine: 100mg morning "ODT" (Orally disentigrating tablet) [Under the tongue]. Many, Many, Many thanks to a member here that helped me. I remember her username had "missouri" in it. Lamictal is highly absorbed in the stomach, so ODT was a necessity and even then, I had to bump up the meds.

Luvox: 100mg total, 50mg morning/50mg at night. Regular tablet. Part of this was because of absorbtion issues, but I think part of it is because I've been more stressed than normal. Is it "real" stress or just "the meds aren't working as good"? Hard to use a defective brain to diagnose itself. Whatever the cause is, the doubling to 100mg has helped out quite a bit.

Not that it matters in the slightest, but I spent 20 years to find what works for me. Lamictal is probably the best mental med I've ever taken, and I was prepared to chew the pills up if I had to (And did for a while, which tasted horrible). Luvox is the best of the worst LOL. SSRI's for me have tons of side effects, but Luvox has the least. Even better than Lexapro, which is arguably one of the newest "pure" SSRIs.

From one person on mental meds to another: I really hope you are able to get your doses working. Only us know how horrible/hard life is when the meds are off.

Last bit of advice: Get with your psychiatrist, and explain what surgery you're having done. They know the pharmacology, how it is absorbed and so forth. Then, since they are usually a royal pain to get in to be seen, I would schedule a few appointments maybe 2 weeks apart for the first 2 or 3 months. That way you can tweak as needed and not have to "hope" that they have an opening available. Dialing in my meds above/post surgery took two dosage adjustments.

[LydsRN 1]

4 minutes ago, CyclicalLoser said:

I have a post on it if you search by my name. I think each person and each med varies significantly. That being said I'm a LGB to RNY convert and here's what I did:

Old Dosage:

Lamictal/Lamotrigine: 75mg morning (3 x 25mg tablet) - I'm not bipolar, I have cyclothymic disorder which is kind of like mild bipolar.

Luvox/Fluvoxamine: 25mg morning (1 x 25mg in morning, 1 x 25mg at night). This is for panic disorder / generalized anxiety (With some depression thrown in for fun )

New Dosage:

Lamictal/Lamotrigine: 100mg morning "ODT" (Orally disentigrating tablet) [Under the tongue]. Many, Many, Many thanks to a member here that helped me. I remember her username had "missouri" in it. Lamictal is highly absorbed in the stomach, so ODT was a necessity and even then, I had to bump up the meds.

Luvox: 100mg total, 50mg morning/50mg at night. Regular tablet. Part of this was because of absorbtion issues, but I think part of it is because I've been more stressed than normal. Is it "real" stress or just "the meds aren't working as good"? Hard to use a defective brain to diagnose itself. Whatever the cause is, the doubling to 100mg has helped out quite a bit.

Not that it matters in the slightest, but I spent 20 years to find what works for me. Lamictal is probably the best mental med I've ever taken, and I was prepared to chew the pills up if I had to (And did for a while, which tasted horrible). Luvox is the best of the worst LOL. SSRI's for me have tons of side effects, but Luvox has the least. Even better than Lexapro, which is arguably one of the newest "pure" SSRIs.

From one person on mental meds to another: I really hope you are able to get your doses working. Only us know how horrible/hard life is when the meds are off.

Last bit of advice: Get with your psychiatrist, and explain what surgery you're having done. They know the pharmacology, how it is absorbed and so forth. Then, since they are usually a royal pain to get in to be seen, I would schedule a few appointments maybe 2 weeks apart for the first 2 or 3 months. That way you can tweak as needed and not have to "hope" that they have an opening available. Dialing in my meds above/post surgery took two dosage adjustments.

Thanks so very much for this amazing and thorough response! I have Major Depressive Disorder and have finally found a balance in my medication. I don't want to go back into the grey cloud again, especially after surgery. I appreciate your advice and will get in touch with my psychiatrist before and after surgery. I'm maxed on Cymbalta which is my SSNRI of choice, its a sustained release so might be an issue in dosing. We shall see. Thanks again!

[CyclicalLoser 155]

The SSNRI's are really hard on me. I gave effexor a shot for a couple of weeks, and my anxiety was literally off the scale. Blood pressure was outrageous. But yeah, since it is an sustained release, they might want to put you on effexor, which is the "father" of cymbalta, and is available in an immediate dose. They might break it into multiple smaller doses so the GI tract doesn't become coated/overwhelmed by the medication - but I'm not a doctor, so I'd talk to yours about it.

Boy did the SSNRI's wipe out my back pain though, that was an immediate and really nice side effect!

You could try to switch over now (If your psychiatrist won't let you stay on cymbalta) to get through the transition to effexor, but, remember that even then you will have to tweak the amount of it after surgery.

[LydsRN 1]

25 minutes ago, CyclicalLoser said:

The SSNRI's are really hard on me. I gave effexor a shot for a couple of weeks, and my anxiety was literally off the scale. Blood pressure was outrageous. But yeah, since it is an sustained release, they might want to put you on effexor, which is the "father" of cymbalta, and is available in an immediate dose. They might break it into multiple smaller doses so the GI tract doesn't become coated/overwhelmed by the medication - but I'm not a doctor, so I'd talk to yours about it.

Boy did the SSNRI's wipe out my back pain though, that was an immediate and really nice side effect!

You could try to switch over now (If your psychiatrist won't let you stay on cymbalta) to get through the transition to effexor, but, remember that even then you will have to tweak the amount of it after surgery.

is it worth messing with your psych meds?

[mousecat88 2,279]

13 hours ago, LydsRN said:

How did your medications change post op? Did you have to increase the dosage because of malabsorption? I'm having a sleeve to bypass revision and am concerned about how my depression medication with absorb. Thanks!

None of my medications changed post-op. My dose didn't go up from when I was 140lbs to 280lbs, either. The only thing I had them switch was my Ambien XR to the regular Ambien. But I took the extended release that I had left and it worked just fine. I take Ambien, Guanfacine, Lexapro, and Valium.

Edited February 4, 2019 by mousecat88

[CyclicalLoser 155]

13 hours ago, LydsRN said:

is it worth messing with your psych meds?

No, but if the psychiatrist is concerned about the extended release absorption then unfortunately you have to. Mine was, but none were extended release before surgery, so it was simply tweaking the dosages post surgery. I'm assuming the same could apply with extended release, but the absorption might be so low that you might have to take many multiples of the original dose to compensate for it.

I believe most of these drugs can be tested for in the blood (Not in the brain, but that's a different story). Pre and post surgery, it would probably be a good idea to test the blood to make the dosing process more accurate/scientific. But, the process itself can make the mental issues change (food depression or anxiety) so even getting the same blood levels may no longer be what works best.

I wish it was easier than this. 😕

[Frustr8 7,886]

My Wellbutrin went from 150mg bid of ER to 100mg tid of SR. That and my Iron went from Ferrous Sulfate over the counter to Ferrous Fumerate ( Ferricite) prescription. Most everything stayed the same after my RnY last September 5th.