Took only one and a half vicodin yesterday. 11/23 1 1/2 vicodin Took them to make it through chruch and lunchs.  Barbara said I was becoming acid toungued.  She is right.  Mom was being mean - but do I have to take it out on others? no. I did okay for the rest of the day.  Slept good last night woke up at 9:30.  Feel remarkably good.  About 20% pain.  Spent all morning compiling a note to a possible doctor a neuropschiatrist: Dr. Kablinger, Lisa Schrott and I are friends from church.  She suggested I try to get an appt with you.  Word is that you don’t accept new patients.  This email is my attempt to be an exception…maybe my case is interesting?  Or maybe I could promise to be low-maintenance? I moved home to Shreveport one year ago to get well: “fibromyalgia” (on top of bipolar II, low thyroid).  I cut my speaking schedule 70% and surrounded myself with a social network.  In the past I’ve worked like a tornado – enough to write four books (www.groupprocessconsulting.com) and do well on the speaking circuit.  I’ve also weathered extreme depressions.  When fatigue and pain cut me down from a tornado to a mist I took drastic measures to get well.   I now wonder if “Fibromyalgia” could be in fact serotonin syndrome.  Or maybe I’m paranoid about ADE’s since working with the Joint Commission on this year’s project to decrease ADEs. The literature says I can’t take Imitrex (100 mg avg 3 X week) and Effexor XR (150mg) without risking serotonin syndrome.  I can’t imagine doing without Imitrex.  Without it, I have 4-day migraines that make me crazy with pain. If there is real evidence for serotonin syndrome maybe I should quit Effexor and try something like Wellbutrin? I also take 100 mg of Lamictal.  I have the next eight weeks without work so I could try this without too much danger of losing a client.  I’d hate to switch antidepressants without an expert confirming this sounds as if it might be a case along the spectrum of serotonin syndrome. There is every indication my Effexor “discontinuation syndrome” will be awful.   I might be grasping at straws, here.  This could be viral, an undiscovered infection …? (The Dallas doc ordered loads of diagnostic tests that didn’t find much except Epstein Barr and active herpes one) If you can’t see me, could you please forward this to someone who might?  I’ve tried Dr. Singh (March) and no answer yet from Dr. Fitzgerald’s staff. Warm Regards, Annette Simmons Annette Simmonswww.groupprocessconsulting.com318-861-9220  BACK STORY:I used therapy from the time I was 17 (1978) until 1999 when I started Effexor at 75 mg - extreme relief from suicidal thoughts BUT side effects: Nausea, sweats, lurid nightmares.  Suicidal thoughts again in 2002 so upped the dose to 115.5 mg.  Then the fatigue and pain (two car accidents?) cut me down by 2006, by 2007 I took Effexor ar 150 mg, started Lamictal at 50mg, thyroid meds, sold everything, restructured my business and moved “home.”  One year later I’ve taken supplements galore, a Dallas FM expert has me on Prometrium 100 mg, Valcyte 450 mg twice daily (herpes on my skin prevents sun exposure – might affect organs?), Cipro, slow release Cortisol, and slow release T3 62.5 mcg.  I had a bad mixed manic episode in August (after starting B12 and the antibiotics) when I increased Lamictal to 100 mg.  The migraines started in 2006 –peri-menopausal?  I also sleep 14 hours for a week or so, then can’t sleep.  Vicodin (avg of two a day) jacks me up so it may be the cause of sleep disturbances. I don’t have tachycardia and my reflexes seem good.  When I get migraines I have extreme nausea (I keep Zofran on hand for word days), on normal days I can experience moderate nausea, sweats, neck stiffness, body pain (joint and muscles), migraines.  I am constantly hypersensitive to these migraine triggers: light, sound, and extreme emotions (mine or others).  I am currently depressed but I think it is situational, not chemical.