![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by Lori on October 6, 1999, at 0:12:20
If someone has been depressed and on medication (mostly SSRIs) for years without any relief, is it possible for psychotherapy to work without medication? My daughter's new psychotherapist seems to think medication is not the answer to her problems, however, I don't know how therapy alone can help her since she is incapable of seeing the world the same way others do. She has been seeing this psychotherapist for three months now, three times a week, with no relief. She has become increasingly withdrawn at home, although she does hold a job and does go out with girlfriends on the weekends. It is sooo hard to see someone you love in so much pain and not be able to help. She does not want to live because she says life has no meaning to her -- just darkness and pain. Is it possible that therapy alone can help??
Posted by JohnL on October 6, 1999, at 2:54:54
In reply to What to expect from a psychotherapist, posted by Lori on October 6, 1999, at 0:12:20
> If someone has been depressed and on medication (mostly SSRIs) for years without any relief, is it possible for psychotherapy to work without medication? My daughter's new psychotherapist seems to think medication is not the answer to her problems, however, I don't know how therapy alone can help her since she is incapable of seeing the world the same way others do. She has been seeing this psychotherapist for three months now, three times a week, with no relief. She has become increasingly withdrawn at home, although she does hold a job and does go out with girlfriends on the weekends. It is sooo hard to see someone you love in so much pain and not be able to help. She does not want to live because she says life has no meaning to her -- just darkness and pain. Is it possible that therapy alone can help??
Some folks and some psychologist book-writers believe psychotherapy alone works. They believe drugs can be avoided. I personally disagree, based on my own experiences. For me psychotherapy was useless and frustrating until the medication was at least partially effective first. They both work together better than either alone, but even my own psychotherapist told me that continued meetings with him would provide little benefit until I find the right medication first. He was gracious and honest by telling me my highest priority is finding the right drug. He gave me a reference of an esteemed psychiatrist he trusted.
This is just my own experience. My own opinion. I'm sure there are those who can effectively debate the issue from the other side. However, three meetings a week for three months? No benefits yet? I bet my psychotherapist would tell you the same thing he told me...get a psychiatrist who's real good with pharmacology first. In your case, it doesn't take a rocket scientist to figure out the psychotherapy approach isn't working. TWO different antidepressant trials could have been attempted in the same time-frame. Three months is plenty of time to pass fair judegment on any trial.
I believe you need the best psychiatrist you can find. Or at least a cutting-edge doc who is known for antidepressant expertise. There are dozens of different drugs besides SSRIs, and countless augmentations and combinations. There is plenty of hope and plenty of things your daughter has not yet tried. If I was facing the same situation with a son or daughter, I would make prospecting the best doc I can find an urgent-priority project to be started ASAP.
Posted by Lori on October 6, 1999, at 9:19:36
In reply to Re: What to expect from a psychotherapist, posted by JohnL on October 6, 1999, at 2:54:54
JohnL -
Thanks for your thoughtful response. I have researched hours to find the best doctors for my daughter. I narrowed the list down to 3 in our area. The one she finally went to see was highly respected in NYC by other pdoc's, so we thought we had found the right one. This doctor was the one who forwarded her case to the psychotherapist and would not work further with my daughter at that time to change or adjust her medication saying she feels the answer does not lie in meds. The therapist, as mentioned before, believes the same. My daughter has basically given up hope because she doesn't know what to believe. I push her to see another pdoc who will work with the meds -- and she's tired of trying with no result. She keeps saying it won't do any good to change. She has been in therapy since the age of 13, she is now 23. She has also been taking meds since the age of 17 with no relief.
Another interesting fact is that the therapists and pdoc do not/will not talk to me. I wanted to question the therapist about my daughter's diagnosis and progress, but since my daughter is not a minor, they don't think it is a good idea; I have mixed emotions because the therapist may feel it is unhealthy for the mother to become too involved, but I can't stay uninvolved when I see my daughter not getting any relief and hear her say she doesn't want to live. My husband at times feels we should let the professionals do their job, but I'm not so sure we can trust them. We also know it is not good to keep switching her doctors because there is no stability. I don't totally understand the therapists refusal to talk to me because I'm sure spouses get involved if they know their partner continues to suffer.
Again, another problem is, as mentioned, getting my daughter to try another doc because she doesn't see the use.
Any additional thoughts would be appreciated.
Posted by Danny on October 6, 1999, at 23:59:22
In reply to What to expect from a psychotherapist, posted by Lori on October 6, 1999, at 0:12:20
> If someone has been depressed and on medication (mostly SSRIs) for years without any relief, is it possible for psychotherapy to work without medication? My daughter's new psychotherapist seems to think medication is not the answer to her problems, however, I don't know how therapy alone can help her since she is incapable of seeing the world the same way others do. She has been seeing this psychotherapist for three months now, three times a week, with no relief. She has become increasingly withdrawn at home, although she does hold a job and does go out with girlfriends on the weekends. It is sooo hard to see someone you love in so much pain and not be able to help. She does not want to live because she says life has no meaning to her -- just darkness and pain. Is it possible that therapy alone can help??
I agree with John L. My experience with depression over 10 years has made me believe that meds and therapy are the best treatment. Especially in cases of deep depression. I've also had great therapists who were blind to the benefits of meds. My personal preference is for a qualified psychopharmacologist for meds and a non-traditional therapist, ie someone who doesn't just sit there and take notes for therapy. It's much harder to find the right therapist. The gender of the therapist also can make a difference. best of luck, prayers etc.
Posted by Sara Ann on October 9, 1999, at 0:24:13
In reply to What to expect from a psychotherapist, posted by Lori on October 6, 1999, at 0:12:20
I did a lot of reading about treatment efficacy when I was suffering from mild to moderate depression. If the depression is mild to moderate, there is a mega study that showed both interpersonal therapy and cognitive behavioral therapy to be as effective as medication. If the depression is major depression, I think meds are the best way to not get stuck at the bottom. And there is another study that says that the longer that major depression is untreated, the more prone the suffering person will be to suffer recurrent depression. It sounds like your daughter deserves the best psychopharmacologist that she can find. They are NOT all created equal. If she is having psychoanalytic psychotherapy, it's time to run from that, psychoanalytic psychotherapy has not been proven effective for any psychiatric illness.
There's another issue here, that you don't say that your daughter is asking for your help. I think that offering advice in those circumstances could hurt your relationship with her. If she is depressed she needs all the support she can get. Maybe the best thing to do is listen and offer to help her explore other treatment modalities if this one doesn't work for her.
Hope some of this helps...
Sara Ann
Posted by Elizabeth on October 9, 1999, at 4:07:04
In reply to This must be hard to watch..., posted by Sara Ann on October 9, 1999, at 0:24:13
> I did a lot of reading about treatment efficacy when I was suffering from mild to moderate depression. If the depression is mild to moderate, there is a mega study that showed both interpersonal therapy and cognitive behavioral therapy to be as effective as medication.
I believe I know which study you mean. It also found all treatments equal to placebo in mild-to-moderate major depression. Oops. (In severe depression, it was medication > IPT > CBT > placebo.)
>If she is having psychoanalytic psychotherapy, it's time to run from that, psychoanalytic psychotherapy has not been proven effective for any psychiatric illness.
It hasn't been tested in the same way as CBT and IPT have (IPT is really a specific form of psychoanalytic therapy, though). It's probably better for some people. I know that *I* didn't get anything out of CBT -- it seemed insultingly simplistic and impersonal, even though the therapist was someone who I liked and got along with. Now I see a psychoanalyst (*not* five times a week, however!) and am finding it helpful.
I'm generally skeptical of systematic studies of talk therapies -- they deviate too much from the way such therapies are actually done. The success of talk therapy (I count CBT as a talk therapy, though some people don't) hinges as much as anything else on the relationship between the therapist and client.
But anyway, I think "it's time to run" from any therapist of any orientation who tries to convince you that you shouldn't be taking medication without giving a convincing reason. It took me many tries to find medication that worked, but now I'm doing pretty well. Tell your daughter that, Lori. (I'm 23 now and have been struggling with depression since I was 14.) You said she had mostly tried SSRIs...maybe she needs to try a different class of medication. (SSRIs do not work very well for me, either.) What else has she tried? Older drugs? Newer drugs? Augmentation?
> There's another issue here, that you don't say that your daughter is asking for your help. I think that offering advice in those circumstances could hurt your relationship with her. If she is depressed she needs all the support she can get. Maybe the best thing to do is listen and offer to help her explore other treatment modalities if this one doesn't work for her.
This is a great point...advice is good, but sometimes a hug is better.
Posted by JohnL on October 9, 1999, at 6:30:59
In reply to JohnL - finding pdoc frustrating, posted by Lori on October 6, 1999, at 9:19:36
I hear your frustration. It's heartbreaking. In an effort to eliminate confusion though, let's look at the simple facts...the people she's seeing now are failing. That's the facts. Staying with current treatment seems the same to me as staying with a sinking ship. I wouldn't want to jump in the cold shark-infested water to swim to another boat, but if my ship is sinking I've got everything to gain and nothing to lose by taking the plunge. My opinion in this case (just an opinion) is to ditch current treatment and continue seeking a doc who is good with drugs. You can always come back to talk therapy later, but it sounds like a medicine is definitely needed.
There are other choices besides SSRIs. For starters, any of the TCAs. And considering the desperation of the situation, it might be quite realistic to go straight to an MAOI. Matter of fact, if I was a doc, I would say enough already, no more fooling around, let's end the suffering, let's try Nardil or Parnate. This whole case sounds perfectly scripted for an MAOI.
Keep calling around for docs. Find one who has patients on MAOIs. A doc of that calibre can be a life-saver, whether he/she chooses to use an MAOI or not. That might even be the one and only screening question to ask a prospective doc...do you currently prescribe MAOIs to patients? Any doc who prescribes MAOIs is a notch above the rest in my book. It is evidence of aggressiveness and expertise. That's what's needed I think.
I wouldn't hesitate. Ditch the current treatment. Begin prospecting immediately and frantically for a doc who is comfortable with MAOIs. That doc will likely have the agressiveness and expertise to intervene successfully. Again though, just my opinion. That's what I would do in a similar situation.
Posted by JohnL on October 9, 1999, at 8:35:38
In reply to Re: JohnL - finding pdoc frustrating, posted by JohnL on October 9, 1999, at 6:30:59
Hey, what magnificent timing. I just discovered a site I haven't seen (thought I'd seen them all!) Go to www.execpc.com/~corbeau/
Then click on "Andrew's Depression Resources Thingy". Then choose "Collected Writings of Dr Ivan Goldberg" (a prominent psychiatrist).
Then click on "alphabetical list of keywords".
Then check out dysthymia, fluoxetine, lithium, MAOIs, psychiatrists, psychoanalysts.I just briefly browsed through this stuff, but I was amazed at how well the info pertained to your case. It's not just my opinion any more, but the opinion of a prominent psychiatrist that indeed either a TCA or likely an MAOI is the preferred approach, with a possibility of very small dose lithium as well.
Furthermore, there are examples of exact questions to ask a psychiatrist or a psychoanalyst when screening them. Exactly the ammunition you need to weed through the choices. Ask these questions and you will definitely find the right doc. You might weed out quite a few though before finding the expert you need. But the right doc will answer these specific questions correctly. All others won't. It might be interesting to ask these questions of your current docs...I bet they don't do well with the answers.
This site could be very helpful. Check it out. There is a lot more there that I haven't even looked at yet. But what I did see could be massive assitance to you in determining your next move.
Hope very much this helps! Best Regards, John.
Posted by dj on October 9, 1999, at 11:58:39
In reply to Re: JohnL - finding pdoc tips-great site., posted by JohnL on October 9, 1999, at 8:35:38
JL,
Why all the hype about the MAOIs. What's so great about them, in your opinion?????
> It's not just my opinion any more, but the opinion of a prominent psychiatrist that indeed either a TCA or likely an MAOI is the preferred approach, with a possibility of very small dose lithium as well.
>
Posted by JohnL on October 9, 1999, at 16:43:11
In reply to Re: JohnL - MAOI?????, posted by dj on October 9, 1999, at 11:58:39
> JL,
>
> Why all the hype about the MAOIs. What's so great about them, in your opinion?????
>
> > It's not just my opinion any more, but the opinion of a prominent psychiatrist that indeed either a TCA or likely an MAOI is the preferred approach, with a possibility of very small dose lithium as well.
> >Hi dj. I'm sorry, I don't mean to sound like I'm hyping MAOIs. I've never even tried one, so I'm not one to speak from experience. Lori's case seemed especially troubling to me and I was trying to find suggestions that might hasten recovery. Since SSRIs have already been tried and failed, it would seem logical to me to try a different approach. And in this particular case, a big guns approach.
Hagop Akiskal, a prominent international psychiatrist, stated in his book 'Dysthymia and the Spectrum of Chronic Depressions' that one of the primary causes of AD failure is physicians' underuse of MAOIs. And it seems whatever I read or study, MAOIs often end up being the big guns that probably could have prevented a lot of suffering if tried earlier in treatment, rather than using them as a last resort. Hardly any GPs will prescribe them, and only about half of the psychiatrists use them. This is due to the fatal risk of eating improper diets and the risk of being sued for malpractice. Most ADs don't pose these risks and they usually work OK. But Dr Akiskal believes MAOI underuse is a primary reason for unnecesssary suffering.
Ivan Goldberg, another prominent psychiatrist, states that SSRIs no matter how high the dose are ineffective with certain types of depressions and that the TCAs and MAOIs often provide better results, though the side effect profile is more difficult to tolerate than SSRIs.
He also says it is hard to get excited about re-trying a drug that didn't provide good results initially. Lori's case has already been the SSRI route. Of course both of these psychiatrists seem to endorse lithium augmentation as a favored strategy as well. So MAOIs certianly aren't the only choice. I don't mean to sound like I'm hyping them. It's just that they are big guns. And they are a way to separate the feeble docs from the experts. Lori needs an expert.
And again, these are just my opinions. I'm no expert at all. My opinions are based on lots of literature as well as threads at this site going way back. In particular, these opinions are based on Akiskal's book and the 'Collected Writings of Ivan Goldberg', which can be found at www.execpc.com/~corbeau/. Heck, the more I read, I wonder why I haven't tried an MAOI myself yet! :)
Posted by no worries... on October 9, 1999, at 17:14:33
In reply to Re: dj, posted by JohnL on October 9, 1999, at 16:43:11
JL,
I wasn't doubting that your recommedation was well thought out, just curious what it was based on and as usual you have provided ample explanation and then some. Thanks!> Hi dj. I'm sorry, I don't mean to sound like I'm hyping MAOIs.... So MAOIs certianly aren't the only choice. I don't mean to sound like I'm hyping them. It's just that they are big guns. And they are a way to separate the feeble docs from the experts. Lori needs an expert.
>
Posted by Tom on October 9, 1999, at 21:57:53
In reply to Re: dj, posted by JohnL on October 9, 1999, at 16:43:11
Why haven't you tried an MAOI? Because you love pepperoni pizza, thats why!
Posted by Lori on October 10, 1999, at 1:34:49
In reply to This must be hard to watch..., posted by Sara Ann on October 9, 1999, at 0:24:13
>
> There's another issue here, that you don't say that your daughter is asking for your help. I think that offering advice in those circumstances could hurt your relationship with her. If she is depressed she needs all the support she can get. Maybe the best thing to do is listen and offer to help her explore other treatment modalities if this one doesn't work for her.
Sara Ann-Great insight! In the past my daughter did ask for my help - usually when she was at her lowest. Her plea was usually made in anger saying "Why haven't you done anything to help me?". Since she has started seeing this therapist, she no longer asks. I think you are absolutely right that what she needs right now is someone just to listen. That has been a hard lesson for me to learn.
My son, who has had a very difficult time understanding his sister's illness (by the way he is 2 1/2 years older and has not lived at home since High School), is now in training to volunteer his time on a suicide hotline. One of the first instructions he received was not to offer suggestions to the caller in an effort to help, but simply listen and show empathy. I have to work harder at developing that skill -- and not offer advice when she doesn't ask for it.
Thanks so much for your insight :o)
Lori
Posted by Lori on October 10, 1999, at 2:34:54
In reply to Re: This must be hard to watch..., posted by Elizabeth on October 9, 1999, at 4:07:04
Elizabeth -
I know that *I* didn't get anything out of CBT -- it seemed insultingly simplistic and impersonal
My daughter would agree. She would do the exercises suggested in CBT, but did not believe any of the restated thoughts were true -- therefore it just became a frustrating exercise; most of the time she left her sessions feeling worse because she could not change. Again, my understanding of severe depression is that it cannot be willed away -- so how can therapy help if she can't even get to first base?She recently has started to ween herself off Paxil (which she has been on for one year) and Buspar (4 months) because they are not helping. She started taking SAMe, currently up to 600 mgs. and increasing it 200 mg. a week. She does not tell me how she feels, but from observation I would have to say she is struggling.
She has not tried Celexa, but has taken several drugs to augment the SSRIs - such as Ritalin, Adderal, Risperdone, Remeron (excuse the spellings if incorrect) and probably others that I have forgotten.I was wondering whether TMS should be considered?
I'm in a difficult spot because I don't think my daughter is at a stage where she can help herself and initiate a change in doctors or medications; she truly believes nothing will help. I hesitate "offering suggestions" because she doesn't ask for my advice. Do I let her find her own way? Can I live with that if she continues to fall and I lose her? She was in a partial hospitalization program a few months ago at the Payne Whitney Clinic, NYC because she was cutting at her wrists. She left the program after a few days because the other patients in the program were struggling to be functional in the outside world, whereas she wanted to work because it provided a distraction.
Sorry to ramble - but it truly helps to receive advise from people who have been in the same place as my daughter.
Thanks for your support.
Lori
Posted by Lori on October 10, 1999, at 2:41:25
In reply to Re: JohnL - finding pdoc tips-great site., posted by JohnL on October 9, 1999, at 8:35:38
Ahhhhhh, John. You're like water to a dying plant. Many thanks.
Lori
Posted by Lori on October 10, 1999, at 2:49:05
In reply to Re: dj, posted by JohnL on October 9, 1999, at 16:43:11
Lori's case has already been the SSRI route. Of course both of these psychiatrists seem to endorse lithium augmentation as a favored strategy as well.
Just a note - my daughter has tried Lithium without success. She is concerned about MAOI's because of the side effects, but I think more research on our part about this medication is definitely needed. Thanks again. I think I'll start the research tomorrow since its 4 AM and I'm getting a little tired....... :o)
Lori
Posted by Bob on October 10, 1999, at 7:47:55
In reply to Lithium, posted by Lori on October 10, 1999, at 2:49:05
> Do I let her find her own way? Can I live with that if she continues to fall and I lose her?
It's so hard to read that, Lori. Whatever my genetic background, my problems kicked in full steam when a brother of mine died. The grief tore my parents apart. I was only eight at the time. I spent so much of my youth trying to make things right. I pray that you never come close to walking that road.
May I hazard a suggestion? I'm no fan of CBT either, since it is so overt and the habits and modes of thought its meant to defeat, to change are so often motivated by covert thoughts beneath our notice, "flying under the radar" you could say. That doesn't mean that Behavioral, "operant" approaches don't work ... but maybe there is another way to approach it....
Just listening is great. It lets your daughter know that she can talk without being rejected, denied, whatever. But you are also teaching her to be a good listener by example. So, can you model talking, asking for help as well as you can model listening? Can you say "Can I talk with you" in a voice that says "I need your help" and not "Now listen up"? What kind of help can you ask her for that will not convey the message "This is your fault" by asking for it? Can you share your thoughts without asking, just opening up and confiding in her?
We learn a great deal -- probably most of what we know about day to day living -- from modelled behaviors. If she is responding to your listening, maybe she can respond as well to your asking for help.
Besides, just look at how much we all get here from reaching out out TO help, even when we need for ourselves to reach out FOR help.
Just a thought.
Since it sounds like you're in the area, are you coming to Babblefest? It would be nice to meet you ... and your daughter and son. What a great thing he's doing with that hotline! Have you let him know what you've learned from his lessons?
Be strong,
Bob
Posted by Elizabeth on October 12, 1999, at 1:22:02
In reply to Re: JohnL, posted by Tom on October 9, 1999, at 21:57:53
> Why haven't you tried an MAOI? Because you love pepperoni pizza, thats why!
I love pepperoni pizza. (Or at least, we're good friends.) I take Parnate. See:
Shulman KI, et al. Refining the MAOI diet: tyramine content of pizzas and soy products. J Clin Psychiatry 1999 Mar;60(3):191-3.
Many doctors share the view that MAOIs are underutilized. Shulman and colleagues have taken the effort to show that they are also safer than has been thought. (Remind me to send them a thank-you note.)
Posted by Elizabeth on October 12, 1999, at 1:28:22
In reply to Lithium, posted by Lori on October 10, 1999, at 2:49:05
> Just a note - my daughter has tried Lithium without success. She is concerned about MAOI's because of the side effects, but I think more research on our part about this medication is definitely needed. Thanks again. I think I'll start the research tomorrow since its 4 AM and I'm getting a little tired....... :o)
Hi Lori. I think lithium is more likely to improve a partial response than to turn a nonresponse into a response (did that make sense?). I take Parnate (tranylcypromine, a MAOI) with lithium (and a couple other things that aren't really here or there). I credit MAOIs with saving my life - I couldn't tolerate the side effects of tricyclics, and SSRIs just didn't work. Parnate is pretty well tolerated in general; I'm an exception (I had cardiovascular side effects from normal doses, so I'm taking a lowish dose with lithium).
Take care....
Posted by Noa on October 12, 1999, at 8:31:37
In reply to Re: Lithium, posted by Elizabeth on October 12, 1999, at 1:28:22
Elizabeth, what dose of lithium do you take? Do you experience any unwanted effects from it? I have responded to an effexor based cocktail, but might add lithium to augment. I have gained a lot of wait in the past few years, and am not thrilled about the prospect of more...
Posted by Elizabeth on October 14, 1999, at 0:48:04
In reply to Re: Lithium, posted by Noa on October 12, 1999, at 8:31:37
Hi Noa. I take 600mg of lithium with 30mg of Parnate (though I just decreased that to 20 - more on that in another thread). The 30mg of Parnate wasn't enough; a few days after I started lithium, I found myself enjoying things again (music, food, sex, going out, etc.).
My lithium level was 0.7 the first time and 0.5 (the accepted range for augmentation is 0.5-0.8 or so) the second (after I divided the dose - taking it all at night can skew the level). No noticeable side effects except maybe a little urinary frequency and slightly increased acne (I already had some of that, though - I keep hoping some day I will "grow out of it!").
Posted by Adam on October 15, 1999, at 18:01:57
In reply to pepperoni pizza, posted by Elizabeth on October 12, 1999, at 1:22:02
Hey, Elizabeth,
I find the fact that you can eat pepperoni pizza pretty encouraging, as in a few months I'm
going to have to get off the "patch" and take whatever MAOI I wind up taking orally. I have
read a number of articles (well, abstracts) where a number of foods thought to be "forbidden"
actually had little or no tyramine content. I think in one they looked at pizzas from a number
of major chains (Dominos, Pizza Hut, etc.) and found them all to be OK. I wonder if it's the
same one you referenced, or perhaps Shulman, et al. cite them.Anyway, what do you figure are the absolute no-no's? It seems to be almost universal that tap
beer is definitely something to avoid. I can't tell you how much this bums me out. I simply love
beer. Good beer, that is. Domestic bottles? Ick, with a few exceptions. I just don't think
sipping a martini would be in any way an adequate substitute. I'm not in it for the EtOH. Well,
maybe just a little. :)Also, how do you find your response to alcohol? I'm known among my friends as being the guy who
could drink large amounts for my size and be fine. The other night I had like two beers in an
hour and was definitely quite buzzed. It seems selegiline has turned me into a lightweight. I've
heard as much about MAOIs, but I wonder if this is true of all of them, or just some, and if it is
true, why? Is it related to enhanced levels of dopamine? And if so, would selegiline be more of
a problem than, say, Nardil, due to its potent dopaminergic properties?OK, I know this is off the thread a little, but I figured I would ask...
> > Why haven't you tried an MAOI? Because you love pepperoni pizza, thats why!
>
> I love pepperoni pizza. (Or at least, we're good friends.) I take Parnate. See:
>
> Shulman KI, et al. Refining the MAOI diet: tyramine content of pizzas and soy products. J Clin Psychiatry 1999 Mar;60(3):191-3.
>
> Many doctors share the view that MAOIs are underutilized. Shulman and colleagues have taken the effort to show that they are also safer than has been thought. (Remind me to send them a thank-you note.)
Posted by Elizabeth on October 15, 1999, at 20:52:35
In reply to Re: pepperoni pizza, posted by Adam on October 15, 1999, at 18:01:57
>I think in one they looked at pizzas from a number
> of major chains (Dominos, Pizza Hut, etc.) and found them all to be OK. I wonder if it's the
> same one you referenced, or perhaps Shulman, et al. cite them.Same article. Not too many people are looking into this, alas.
> Anyway, what do you figure are the absolute no-no's? It seems to be almost universal that tap
> beer is definitely something to avoid. I can't tell you how much this bums me out. I simply love
> beer. Good beer, that is. Domestic bottles? Ick, with a few exceptions. I just don't think
> sipping a martini would be in any way an adequate substitute. I'm not in it for the EtOH. Well,
> maybe just a little. :)Hey, there are some good American beers. FWIW, only a couple of rather odd European ones are known to have caused problems. Which ones do you like? (I'd still avoid tap beer.)
I think I've posted this before, but here's the things-to-avoid list that I use:
-aged cheeses
-tap beer
-aged/air-dried meat, poultry, and fish
-sauerkraut
-broad beans [I think it's just the pods that are a problem but I'm not 100% sure]
-banana peels
-concentrated yeast extracts (this mainly refers to marmite and bovril, neither of which is used in the U.S.)
-meat, poultry, or fish that may have been stored improperly (sometimes a tough call)> Also, how do you find your response to alcohol?
I don't really get "drunk" as such. I just get sleepy. I haven't had much to drink since college, and it's almost exclusively been wine. I'm not sure how the Parnate has affected my response to alcohol, but here's a story: when I was taking Nardil, my PPD converted and I had to go on isoniazid for 6 months. Isoniazid is pretty hepatotoxic, and between that and the Nardil I just decided to forgo alcohol altogether for that period. When I went off the INH, I decided to celebrate (conveniently, it was the weekend of a well-known annual party known as "bar golf"). Much to my surprise, the etoh had little to no effect on me that I could identify (though I didn't test my coordination or anything). The amount I drank ordinarily would have had me under the table (I'm kinda small).
Posted by Adam on October 18, 1999, at 13:59:11
In reply to pizza & beer :-), posted by Elizabeth on October 15, 1999, at 20:52:35
> Same article. Not too many people are looking into this, alas.It really is too bad. The money just isn't there, I would imagine.
> Hey, there are some good American beers. FWIW, only a couple of rather odd European ones are known to have caused problems. Which ones do you like? (I'd still avoid tap beer.)Oh, of course. It's just that, in order of goodness, bad beer bottled
> I think I've posted this before, but here's the things-to-avoid list that I use:
>
> -aged cheeses
> -tap beer
> -aged/air-dried meat, poultry, and fish
> -sauerkraut
> -broad beans [I think it's just the pods that are a problem but I'm not 100% sure]
> -banana peels
> -concentrated yeast extracts (this mainly refers to marmite and bovril, neither of which is used in the U.S.)
> -meat, poultry, or fish that may have been stored improperly (sometimes a tough call)
Boy, I'll miss sinking my teeth into a good banana peel.
> I don't really get "drunk" as such. I just get sleepy. I haven't had much to drink since college, and it's almost exclusively been wine. I'm not sure how the Parnate has affected my response to alcohol, but here's a story: when I was taking Nardil, my PPD converted and I had to go on isoniazid for 6 months. Isoniazid is pretty hepatotoxic, and between that and the Nardil I just decided to forgo alcohol altogether for that period. When I went off the INH, I decided to celebrate (conveniently, it was the weekend of a well-known annual party known as "bar golf"). Much to my surprise, the etoh had little to no effect on me that I could identify (though I didn't test my coordination or anything). The amount I drank ordinarily would have had me under the table (I'm kinda small).Interesting. I had about the same response to Remeron. I figured my sensitivity to EtOH would be greater on that, but found to my suprise that I could put away large amounts by even my
standards and felt just fine. A couple weeks after (definitely) starting selegiline, I drank what was a moderate amount for me and had the rather embarassing experience of blacking out,
meaning I said and did things that night that I had no recollection of even after being told. This is not something that has happened since I was in college, and even there, despite the
insane amounts I and just about everyone around me consumed, that happened only twice. I found this very disturbing, and have since been very careful about how much I consume. And it seems
very clear, even without this unhappy occurrance: less is more these days. A subsequent discussion with my doctor (in which he scolded me for drinking much at all, good guy that he is) has
lent credance to my observation: MAOIs can really enhance alcohol's effects.I guess the result of all this is I'm happier, more responsible, and I spend less at the bar. All in all, things could be worse.
Posted by Elizabeth on October 19, 1999, at 11:59:30
In reply to Re: pizza & beer :-), posted by Adam on October 18, 1999, at 13:59:11
> It really is too bad. The money just isn't there, I would imagine.
I'd guess it's not so much the money as the interest: people want to research new and exciting drugs.
> Oh, of course. It's just that, in order of goodness, bad beer bottled
...complete this sentence?
> Boy, I'll miss sinking my teeth into a good banana peel.
Yeah I know what you mean. It is a big sacrifice. But we must do what we must for our health! :-)
> Interesting. I had about the same response to Remeron. I figured my sensitivity to EtOH would be greater on that, but found to my suprise that I could put away large amounts by even my
> standards and felt just fine. A couple weeks after (definitely) starting selegiline, I drank what was a moderate amount for me and had the rather embarassing experience of blacking out,
> meaning I said and did things that night that I had no recollection of even after being told. This is not something that has happened since I was in college, and even there, despite the
> insane amounts I and just about everyone around me consumed, that happened only twice. I found this very disturbing, and have since been very careful about how much I consume. And it seems
> very clear, even without this unhappy occurrance: less is more these days. A subsequent discussion with my doctor (in which he scolded me for drinking much at all, good guy that he is) has
> lent credance to my observation: MAOIs can really enhance alcohol's effects.Possibly. But as we've seen, it is unpredictable. I wonder what the mechanisms of sedation and memory loss from alcohol are. Did you happen to take benzodiazepines with selegiline, ever?
> I guess the result of all this is I'm happier, more responsible, and I spend less at the bar. All in all, things could be worse.
I dunno, that banana peel thing is about as bad as it can get!
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