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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 31 to 55 of 434. Go back in thread:
Posted by Lorraine on July 11, 2001, at 10:15:48
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by Elizabeth on July 11, 2001, at 1:22:15
> > > [re Inderal]
> > Well, my hyperventilating is not short term unfortunately and I suspect that the Inderal isn't going to be my long term solution because of the pulse lowering effect--it kind of takes the wind out of my sails.
>
> It can do that, although I would expect you to adjust to the effect. There are alternative beta blockers, including one (nadolol?) that is non-cardioselective (like propranolol) but longer-acting than propranolol and so is better suited for long-term use.Thanks for the tip. I'll look into nadolol.
> > I never heard of anyone taking propranolol for sleep disorders (especially given its propensity to cause nightmares), but I'll keep that in mind. (Maybe I should give it a try.)My hunch is the sleeping issue with me (which is a very recent thing) is due to being overstimulated by my meds and the propranolol cuts through that like a hot knife thru butter < vbg >
[re: TCAs and hyperventilating]
> For your purposes, imipramine or nortripytline might be the best choices: they have moderate effects at muscarinic ACh receptors (anticholinergic side effects), H1 receptors (antihistaminic effects -- sedation in particular), and alpha1-adrenergic receptors (blood pressure effects).
Sounds like weight gain and sedation--(sexual dysfunction as well?) Yeah, I know, picky, picky, picky. But sedation is not good with me.
>
> My concern is that a TCA would not be an effective drug for you. What can you tell me about your depression (and/or other disorders)?I thought you'd never ask < vbg >. My depression is like walking through mud--no energy, weepy weepy hopeless stuff at its worst, poor working memory, impairment of cognitive skills (can not think my way out of a box--this from someone who graduated in the top of her class law school and 15 years later top of class in business school--"of all the things I've lost, it's my mind I miss the most".) What I do when I am depressed is hybernate--all my systems wink out bit-by-bit until I sit alone (social withdrawal) in a room (no activity) in the dark. I do not have eating disruption or sleep disruption normally. Since last November anxiety (especially physical as in hyperventilating--but also some mental, I don't read the newspaper, I can't follow the stock market--I used to run some portfolios for friends, family and so forth). I am not a big ruminator. Before the anxiety hit, after reading Stahl's book I decided I was NE deficient as opposed to Serotonin deficient.
At the end of the day, it may be MAOs that make the difference for me, although the Selegiline and Moclobemide were not the ticket. I think I should give the TCAs a try first because of their lower side effect profile, especially desipramine.
>
> [re: low dose propranolol sedating]
> It's too sedating for you, then (5 mg is a very low dose). Consider a different beta blocker, maybe.I'll think about this. The reason I suspect that there may be a P450 issue is because very low doses of meds affect me strongly and I am hypersensitive to side effects.
> For my purposes, Xanax is better in emergencies because of the rapid onset of action. But Klonopin works for a long time, and I can see where it might be better for other people. Klonopin is definitely easier to use if you're taking it on a regular, around-the-clock basis, because it needs to be taken 2-3 times/day instead of 4 or so (like Xanax).Probably Klonopin would do it for me--my emergencies are not very immediate and I took Xanax for a couple of days while I was working (long ago far away on a distant planet) and found it too sedating.
>
> > I think the Selegiline is making the hyperventilating worse.
>
> Definitely a possibility. Two of its metabolites (as I'm sure you know) are l-amphetamine and l-methamphetamine. I experienced jitters, agitation, and worsened insomnia and appetite on it.Yes, but then dexidrine didn't have this effect; nor is adderral having this effect.
>
> > How is the DMI working for you?
>
> I'm only up to 75 mg (not a very high dose). I'm supposed to increase by 25 mg every 3 days or so. The side effects (if any) are minimal, at least.I'll keep my fingers crossed. Low side effects are good. By the way, even tho "weeks" is the official time table for meds--I felt Wellbutrin within a couple days, Moclobemide and Selegiline as well. (maybe it's the puppy upper effect of these drugs).
>
> > > (Do you mean "melancholia," "melancholic featueres," "melancholic depression," etc.?)
> >
> > Yeah, that's what I mean. Sounds like it is a particularly tough kind of depression.
>
> It's "classic" depression. It tends to be rather severe, but it responds well to TCAs and ECT. That's why I'm hoping desipramine will be good for me.It also responds well to MAOs, doesn't it?
Lorraine
Posted by Elizabeth on July 11, 2001, at 16:08:04
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by Lorraine on July 11, 2001, at 10:15:48
> Thanks for the tip. I'll look into nadolol.
I'm not positive that's the one. There are oodles of beta blockers in clinical use, and it's hard to keep track of all of them.
> My hunch is the sleeping issue with me (which is a very recent thing) is due to being overstimulated by my meds and the propranolol cuts through that like a hot knife thru butter < vbg >
Lucky that you discovered it, then.
> > For your purposes, imipramine or nortripytline might be the best choices: they have moderate effects at muscarinic ACh receptors (anticholinergic side effects), H1 receptors (antihistaminic effects -- sedation in particular), and alpha1-adrenergic receptors (blood pressure effects).
>
> Sounds like weight gain and sedation--(sexual dysfunction as well?) Yeah, I know, picky, picky, picky. But sedation is not good with me.Weight gain and sedation are both attributed to the antihistaminic actions of tricyclics. Nortriptyline would be better than imipramine if you're concerned about this; it's generally well tolerated. Desipramine might be too activating.
> > My concern is that a TCA would not be an effective drug for you. What can you tell me about your depression (and/or other disorders)?
>
> I thought you'd never ask < vbg >. My depression is like walking through mud--no energy, weepy weepy hopeless stuff at its worst, poor working memory, impairment of cognitive skills (can not think my way out of a box--this from someone who graduated in the top of her class law school and 15 years later top of class in business school--"of all the things I've lost, it's my mind I miss the most".) What I do when I am depressed is hybernate--all my systems wink out bit-by-bit until I sit alone (social withdrawal) in a room (no activity) in the dark. I do not have eating disruption or sleep disruption normally. Since last November anxiety (especially physical as in hyperventilating--but also some mental, I don't read the newspaper, I can't follow the stock market--I used to run some portfolios for friends, family and so forth). I am not a big ruminator. Before the anxiety hit, after reading Stahl's book I decided I was NE deficient as opposed to Serotonin deficient.I think that it's been pretty well-established that the original monoamine hypothesis of depression was a vast oversimplification. Anyway, this is just a hunch, but if I were in your situation I'd give MAOIs a try before TCAs. Well, it's not entirely a hunch: the "hibernation," lethargy, social withdrawal, and anxiety/panic symptoms, and the lack of disturbances in eating or sleeping, suggest to me that TCAs might not be the best meds for you. OTOH, there are always surprises. I just think it'd be better to try a TCA only if MAOIs fail. FWIW, the traditional antidepressant MAOIs -- Nardil, Parnate, and Marplan -- worked pretty well for me, but selegiline sucked when I tried it.
> I think I should give the TCAs a try first because of their lower side effect profile, especially desipramine.
Having taken several TCAs and several MAOIs, I have to disagree about the side effects. The desipramine seems to be going okay for me so far (comparable to Parnate), but I'm not generally prone to overstimulation from ADs. If overstimulation has been a problem for you in the past, you might want to stay away from desipramine.
> The reason I suspect that there may be a P450 issue is because very low doses of meds affect me strongly and I am hypersensitive to side effects.
It's a possibility, but side effect sensitivity is very common among people with anxiety disorders. My pdoc described people with panic disorder as typically being "somatically attuned" -- they are very aware of what's going on in their bodies, and sometimes they overreact to minor changes.
> Probably Klonopin would do it for me--my emergencies are not very immediate and I took Xanax for a couple of days while I was working (long ago far away on a distant planet) and found it too sedating.
They're not exactly equipotent -- you might have taken more Xanax than you needed. But anyway, if Klonopin works for you, then that's probably for the best; its effects last a long time, which is nice.
> > Definitely a possibility. Two of its metabolites (as I'm sure you know) are l-amphetamine and l-methamphetamine. I experienced jitters, agitation, and worsened insomnia and appetite on it.
>
> Yes, but then dexidrine didn't have this effect; nor is adderral having this effect.Dexedrine is d-amphetamine -- fewer peripheral side effects. Adderall is a weird combination of isomers of amphetamine salts, but it seems (for whatever reason) to cause less "jittery"-type side effects than plain d,l-amphetamine.
> By the way, even tho "weeks" is the official time table for meds--I felt Wellbutrin within a couple days, Moclobemide and Selegiline as well. (maybe it's the puppy upper effect of these drugs).
Yes, those are all stimulating drugs. I also think that MAOIs sometimes work faster than other types of ADs.
[re melancholia]
> > It's "classic" depression. It tends to be rather severe, but it responds well to TCAs and ECT. That's why I'm hoping desipramine will be good for me.
>
> It also responds well to MAOs, doesn't it?The available evidence says yes (it's important to use a sufficient dose of the MAOI -- older studies used low doses, e.g., 45 mg of phenelzine). My experience is that MAOIs work as well as any other AD I've tried has. TCAs are still the ADs of choice for this type of depression, though, and I'm hoping that desipramine will help with the problems that Parnate didn't address. (It is possible to combine them safely, which I may try if I respond partially to the desipramine.)
-elizabeth
Posted by Lorraine on July 12, 2001, at 11:49:25
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by Elizabeth on July 11, 2001, at 16:08:04
> > My hunch is the sleeping issue with me (which is a very recent thing) is due to being overstimulated by my meds and the propranolol cuts through that like a hot knife thru butter < vbg >
>
> Lucky that you discovered it, then.Luck. I also found out that a supplement called stablium stopped me from "skin picking". You know if you try enough things something will work, but usually not for the reason you are taking it < vbg >
[re: Desipramine might be too activating.] I haven't generally been too activated by my meds--usually it's been the other way around. Right now all of the drugs that I am on are activating. The problem I have had is the gas pedal/brake pedal dilemma. When I take enough puppy upper to be awake and alert and active, I hyperventilate. When I take enough doggy downer to control the hyperventilation, I am too sedated. So it's a three legged potatoe sack race I'm running. My hunch is that imipramine is going to be too sedating. I think what I found when I was just taking dexedrine and neurontin was that the hyperventilation was under control, but I didn't have mood support. Because I won't have a washout period to try Desipramine and because I will be weaning off of a more activating drug (Selegiline), I have little to lose by trying it. If it doesn't work out, then I'll have one more drug to cross off my list in my little experiment. Say--minor research on Desipramine suggests it increases the release of HGH.
: Laakmann G, Schumacher G, Benkert O.
Stimulation of growth hormone secretion by desimipramin and chlorimipramin in man.
J Clin Endocrinol Metab. 1977 May;44(5):1010-3.
PMID: 870511 [PubMed - indexed for MEDLINE]Also, stumbled on this article (that I can't access--no password):
The desipramine cortisol test--a selective noradrenergic challenge (relationship to other cortisol tests in depressives and normals).
This would probably be a good read, huh?
This one too, maybe:
: Barry S, Dinan TG. Related Articles
Neuroendocrine challenge tests in depression: a study of growth hormone, TRH and cortisol release.
J Affect Disord. 1990 Apr;18(4):229-34.
PMID: 2140374 [PubMed - indexed for MEDLINE]
Thought you might be interested in what they have to say about its effect on sleep patterns:Desipramine increases the percentage of Stage 4 sleep (deep sleep) and decreases the percentage of REM sleep. A partial recovery of REM sleep is seen after 3 to 5 weeks of drug administration. However, in spite of this recovery, a REM rebound occurs following rapid drug withdrawal, which is experienced as an increase in dreaming. The significance of these effects on the sleep cycle remains to be clarified. "
This latter is from:
http://www.mentalhealth.com/drug/p30-n03.html#Head_10
> > > My concern is that a TCA would not be an effective drug for you.You may be right. I'm really torn on this.
> > > I think that it's been pretty well-established that the original monoamine hypothesis of depression was a vast oversimplification.
I read an article recently, that you might enjoy: "Serotonergic and Noradrenergic Reuptake Inhibitors: Prediction of clinical effects From In Vitro Potencies by Alan Frazer, Ph.D. J Clin Psychiatry 2001; 62 (supp 12). I found it free on line, but I don't know where anymore.
> > >Well, it's not entirely a hunch: the "hibernation," lethargy, social withdrawal, and anxiety/panic symptoms, and the lack of disturbances in eating or sleeping, suggest to me that TCAs might not be the best meds for you. OTOH, there are always surprises. I just think it'd be better to try a TCA only if MAOIs fail. FWIW, the traditional antidepressant MAOIs -- Nardil, Parnate, and Marplan -- worked pretty well for me, but selegiline sucked when I tried it.
elizabeth: I appreciate the thought you put into this. I will need to reconsider what to do here.
> > The reason I suspect that there may be a P450 issue is because very low doses of meds affect me strongly and I am hypersensitive to side effects.
>
> It's a possibility, but side effect sensitivity is very common among people with anxiety disorders.Yeah, but I've had side effect sensitivity for 5 years and the anxiety is just a recent problem (since November). But then again, I am VERY aware of physical changes in my body.
[re overstimulation on Selegiline]
> > > Two of its metabolites (as I'm sure you know) are l-amphetamine and l-methamphetamine. I experienced jitters, agitation, and worsened insomnia and appetite on it.
> >
> > Yes, but then dexidrine didn't have this effect; nor is adderral having this effect.
>
> Dexedrine is d-amphetamine -- fewer peripheral side effects. Adderall is a weird combination of isomers of amphetamine salts, but it seems (for whatever reason) to cause less "jittery"-type side effects than plain d,l-amphetamine.Doesn't all this suggest that my response to Desipramine may be different than my response to Selegiline?
elizabeth: I hope the Desipramine works for you. Do keep me updated. It's nice to know that I am not that only playing medication roulette. Shelli also seems to be on this path. Anyway, i appreciate your thoughts and just knowing that someone else out there is struggling with their meds helps keep me sane.
Lorraine
Posted by Elizabeth on July 12, 2001, at 19:30:57
In reply to Re: I'll hold your hand if you'll hold mine, posted by Lorraine on July 12, 2001, at 11:49:25
> > > My hunch is the sleeping issue with me (which is a very recent thing) is due to being overstimulated by my meds and the propranolol cuts through that like a hot knife thru butter < vbg >
> >
> > Lucky that you discovered it, then.
>
> Luck. I also found out that a supplement called stablium stopped me from "skin picking". You know if you try enough things something will work, but usually not for the reason you are taking it < vbg >Hee hee. Do you know what the active (?) ingredients in "Stablium" are?
BTW, the skin picking is possibly a symptom of OCD (or subclinical OCD-spectrum syndrome). Stimulants could be expected to make it worse.
> [re: Desipramine might be too activating.] I haven't generally been too activated by my meds--usually it's been the other way around.
I haven't usually had a problem either way (some are activating, some sedating, some neutral). But if that's the case, desipramine is probably the best TCA for you to try, although I still think that MAOIs are a better choice for you.
> Right now all of the drugs that I am on are activating. The problem I have had is the gas pedal/brake pedal dilemma. When I take enough puppy upper to be awake and alert and active, I hyperventilate.
I sort of have that problem with buprenorphine, too: the effective dose causes psychomotor agitation (although that smooths out after a while, and benzos help with it too).
> My hunch is that imipramine is going to be too sedating.
Safe bet. I'd go with desipramine or nortriptyline. (I didn't have problems with sedation from either.)
> Thought you might be interested in what they have to say about its effect on sleep patterns:
Familiar with it, but thanks. :-) (The sleep architecture effect is one of the reasons I wanted to try a TCA -- I have major sleep problems.)
> > > > My concern is that a TCA would not be an effective drug for you.
>
> You may be right. I'm really torn on this.It's because of the atypical-like symptoms. My guess could be wrong: I knew one woman who seemed to have pretty clear-cut atypical depression but who responded well to nortriptyline (for panic, depression, and alcoholism, with low-dose Xanax).
> I read an article recently, that you might enjoy: "Serotonergic and Noradrenergic Reuptake Inhibitors: Prediction of clinical effects From In Vitro Potencies by Alan Frazer, Ph.D. J Clin Psychiatry 2001; 62 (supp 12). I found it free on line, but I don't know where anymore.
I'll look around for it (I'm pretty good at perusing the web). It is true that there are clinically observed differences between selective serotonin vs. noradrenaline reuptake inhibitors (for example, serotoninergic drugs seem to be more effective in atypical depression and panic disorder), but this doesn't mean that the depression/anxiety/whatever is due to a "monoamine deficiency."
> elizabeth: I appreciate the thought you put into this. I will need to reconsider what to do here.
Good. BTW, I really feel that I tolerated the MAOIs much better than the TCAs. With the MAOIs, I was always able to get up to a therapeutic dose within a couple of days; I've only now started taking 100 mg of desipramine (100-300 is the accepted therapeutic dose range; I haven't had a serum level taken yet), and that's been the most benign of the TCAs for me. (It's starting to cause a little dry mouth, BTW.)
About the MAOIs: Parnate might be better for you than Nardil because Nardil has a high rate of weight gain. Some people are overstimulated on Parnate, but since this isn't generally a problem for you, I think it's a minor concern.
> Yeah, but I've had side effect sensitivity for 5 years and the anxiety is just a recent problem (since November). But then again, I am VERY aware of physical changes in my body.
Side effect sensitivity is very common among people with panic disorder, but it's not limited to anxiety disorders. The "somatic attunement" you mention may have been a symptom of a predisposition to anxiety.
> [re overstimulation on Selegiline]
> Doesn't all this suggest that my response to Desipramine may be different than my response to Selegiline?Of course it probably will (though not because of the differences between l- and d-amphetamine). They're very different drugs. I just don't want to get your hopes up about desipramine.
> elizabeth: I hope the Desipramine works for you. Do keep me updated.
I sure will keep the whole board updated, like it or not. :-)
> It's nice to know that I am not that only playing medication roulette.
Hey! There's, uh, some logic to my medication choices. < g > Seriously, I wanted you to know that you can make logical choices too, that you don't just have to spin the roulette wheel.
best,
-elizabeth
Posted by Lorraine on July 14, 2001, at 22:30:43
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by Elizabeth on July 12, 2001, at 19:30:57
> > Luck. I also found out that a supplement called stablium stopped me from "skin picking". > Hee hee. Do you know what the active (?) ingredients in "Stablium" are?Garum Armoricum, a fish and salt preparation discovered by the ancient Celts as a food supplement to improve resilience to physical and emotional stress. An eight week, double blind, placebo controlled study showed Stabilium® 200- to be effective in reducing the discomfort experienced by college students before and during examinations. It was also effective in another double blind, placebo controlled study, concerning cognitive function, memory and fatigue in adults.*
>
> BTW, the skin picking is possibly a symptom of OCD (or subclinical OCD-spectrum syndrome). Stimulants could be expected to make it worse.Some do; some don't. Dexidrine did; thyroid T3 did; selegiline does. But I don't think Adderal does.
>
> > [re: Desipramine might be too activating.] I haven't generally been too activated by my meds--usually it's been the other way around.Now that I think about this statement, I can't say that it is true. The problem is that I am sensitive to overactivation and underactivation. Sedation seems the worst and my depression is a lack of energy. But I think the hyperventilation is worse when I am activated. So who knows--it's a d****** if you do, d****** if you don't situation.
>
> I sort of have that problem with buprenorphine, too: the effective dose causes psychomotor agitation (although that smooths out after a while, and benzos help with it too).This sounds familiar.
> It's because of the atypical-like symptoms. My guess could be wrong: I knew one woman who seemed to have pretty clear-cut atypical depression but who responded well to nortriptyline (for panic, depression, and alcoholism, with low-dose Xanax).
I'm sorry, what do you mean atypical-like symptoms.
> About the MAOIs: Parnate might be better for you than Nardil because Nardil has a high rate of weight gain. Some people are overstimulated on Parnate, but since this isn't generally a problem for you, I think it's a minor concern.
What about Nardil with a stimulant?
> Side effect sensitivity is very common among people with panic disorder, but it's not limited to anxiety disorders. The "somatic attunement" you mention may have been a symptom of a predisposition to anxiety.
Ain't that a b****. I suspect your right though. Still wish I hadn't opened that particular pandora's box.
> >I just don't want to get your hopes up about desipramine.
Yeah, me too I guess.
How is Desipramine working for you now?
> Hey! There's, uh, some logic to my medication choices. < g > Seriously, I wanted you to know that you can make logical choices too, that you don't just have to spin the roulette wheel.I don't know, it feels pretty roulettish to me. No one knows how these drugs work. No one knows the mechanism of depression. No one know why one drug is more likely to work for a person than another (with few exceptions--like now i know SSRI's don't work, but TCAs--wont know till I try them, MAOs--wont know till I try them. All in all pretty frustrating. And while my pdoc is open minded and adventurous (which helps with TRD), I don't see a real plan of attack and I'm really at a loss on how to find another pdoc who maybe has a more concrete method of action BUT who is open minded as well (eg will LISTEN and respect what I have to say). The pdoc I had before this watched me gain 40 lbs on EFFexor and lose my sexuality and told me that was the price of remission. When I suggested adding in a stimulant, she absolutely refused. So there I was with a very unhappy hubby and an unsympathetic pdoc. I went off the Effexor (which no longer works for me) and fell back into my little cradle of despair. I'm near UCLA, which would be an obvious choice, but I don't want to pick a random name out of the hat and then find out that I'm stuck with someone who has a frame of mind that prevents them from listening and learning themselves. Sometimes, I wish I was stupid so I'd be oblivious to all this, but then when I slip into depression I literally feel my IQ going down and I feel stupid, but I KNOW that I am stupid so it doesn't work out that well if you know what I mean. < vbg > or < vbc > (very big cry).
Wasn't it the Pretenders who said "stop all you sobbing on me". Sorry--long rant.
Lorraine
Posted by shelliR on July 15, 2001, at 9:34:42
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by Lorraine on July 14, 2001, at 22:30:43
>And while my pdoc is open minded and adventurous (which helps with TRD), I don't see a real plan of attack and I'm really >at a loss on how to find another pdoc who maybe has a more concrete method of action BUT who is open minded as well (eg >will LISTEN and respect what I have to say).
Hi Lorraine,I'm jumping into the thread between you and elizabeth; I hope you don't mind.
I have been to two of the top TRD pdocs in my city. I think the only thing that separates them out from dozens of other pdocs is that they read everything, and they go to conferences, so they know what's being tried out there. On the other hand, you participate in PB, so you also know what is being tried. There is nothing that either of them have suggested that I have not already been aware of through this board. I really agree with you. A real plan of attack is an illusion. I left my pdoc of ten years because (1) she was so against opitates; and (2) She was pushing APs heavily; and (3) she told me I didn't want to get better because I wouldn't take stuff that made me gain 15 or more lbs. She was more interested in augmenting nardil than changing altogether, so I tried about ten augmentation strategies; I did have success with lamictal, but it gave me an immediate 15lb weight gain. I knew I wanted to try lamictal first; the rest of the augmentation strategy felt like picking the next try out of a hat. Even when they try to make sense (lamictal worked, let's try another anti-convulsent--topomax) my body rejects the sense--I totally slept on topomax for three weeks with no improvement.
I was sitting in the waiting room of my current pdoc and talking to another patient. She told me that this doctor was a genius with medications. I asked her what had worked for her, and also what she had tried. She was on effexor, I think, and a stimulent. She had tried about four other SSRIs which didn't help, or she couldn't tolerate. So what was the genius here; we both could have choosen for her the same route, i.e., try everything, and something will work. I do have to give this guy credit though for putting me on oxycontin--that did take some bravery. And he was aware of the ERT study and he had me try concerta before giving up on stimulents, and I didn't have the same horrible body feelings with it. Yet in the long run, I am choosing next to try Parnate. AND this guy doesn't return phone calls and makes you wait forever for your eight minute appt.
I would stay with a pdoc who was open and adventurous. If the two of you are feeling stuck, you can always go for a consultation with another pdoc, and ask what would be her/his direction with you, with your symptoms and history of meds.
BTW, I think your idea of doing nardil with a stimulent is an excellent one. I loved nardil (when it worked) because I never felt shaky or drugged. And I didn't gain weight. YMMV!
Shelli
Posted by Lorraine on July 15, 2001, at 11:55:03
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by shelliR on July 15, 2001, at 9:34:42
> >I'm jumping into the thread between you and elizabeth; I hope you don't mind.
Shelli, I so appreciate you jumping in. I value what you have to say and it really helps me to talk with people who have really been there before (or are there now)< vbg >
> I have been to two of the top TRD pdocs in my city. I think the only thing that separates them out from dozens of other pdocs is that they read everything, and they go to conferences, so they know what's being tried out there. On the other hand, you participate in PB, so you also know what is being tried. There is nothing that either of them have suggested that I have not already been aware of through this board. I really agree with you. A real plan of attack is an illusion.I can't tell you how useful this advice is to me. It confirms my gut instinct and is going to save me a lot of time, aggravation and, knowing me, anger. I'll stick with my guy. He charges a lot (too much), but he is a genuinely concerned guy who listens and hears better than most, values my insights and is adventurous. When I told him I wanted to try Inderal for the panic attacks, he mulled it over saying "I've never really used it for that. I'd be willing to entertain that" and finally "that's actually a brilliant idea" (Elizabeth take a bow)--all this within a 20 minute phone call.
> >she told me I didn't want to get better because I wouldn't take stuff that made me gain 15 or more lbs.
This sort of stuff just really fries my butt. I mean who are they to say that sort of stuff. In my case, I gained 45 and lost sexual response. The truth is that even though I have a wonderful husband, this was eating away at the marriage. And, of course, vigorous walking or hiking was almost painful given the amount of weight I was carrying. There were some tremendous costs to the med this pdoc had me on.
> >She was more interested in augmenting nardil than changing altogether, so I tried about ten augmentation strategies.Did you try adding a stimulant?
> >So what was the genius here; we both could have choosen for her the same route, i.e., try everything, and something will work.
This is a really good point. I have to confess that I have been tempted to try Martin Jensen (who is local here--an hour commute) just because he tries to race through the drugs to find the fit. He points out that if you do this another way the "odds" of finding the right two or three drugs become astronomical. It doesn't work with all drugs to give them brief trials, but certainly it works for stimulants, probably benzos and probably anti-convulsants. I'm not sure that I need to actually see him. I do have his book and although I haven't been racing through the trial like he suggests, I do try to make sure that I try something new frequently. Especially with the stimulants it makes sense--I wish that the pdocs had samples of these like they do of the SSRIs (although I know why they don't). I feel the drug effects pretty quickly generally--although Effexor took forever and it sounds like the MAOs and TCAs may as well.
> >I do have to give this guy credit though for putting me on oxycontin--that did take some bravery.
Is oxycontin an opiate? Do you have anxiety, pain or autonomical symptoms? What does it do for you? Just curious. I cannot even tolerate codeine with tylenol. I makes me weepy and shakey and emotionally fragile. I sit here fretting over even trying benzos because of the withdrawal issues. (I hated withdrawal from Effexor--it took me about 6 months. Course I didn't know to take Prozac to relieve the withdrawal.) I really have to wrestle myself down sometimes to move onto the next treatment option.
> >And he was aware of the ERT study and he had me try concerta before giving up on stimulents, and I didn't have the same horrible body feelings with it.What is ERT?
>Yet in the long run, I am choosing next to try Parnate.
Good luck with Parnate, Shelli. I have been looking at it also.
Do you mind if I ask you how functional you are generally? Are you able to work? I have not been able to work because I am not stabilized and cannot from day-to-day know where my mood will land. I am beginning to come to the realization that I have some "acceptance" work to do in terms of my condition and I need to figure out how to make a life where I am right now. This always putting life on hold until I figure out my meds doesn't work for me--it's been too long and my focus becomes myopic. I'm longing for the sense of community that one finds at the workplace--but now perhaps charity oriented, maybe even dealing with depression or mental illness--kind of a need to see and help people who are in worse condition than me. Unfortunately, I don't even know how to approach finding this type of volunteer work or getting involved with this type of community so the idea just hangs in midair.
> I would stay with a pdoc who was open and adventurous. If the two of you are feeling stuck, you can always go for a consultation with another pdoc, and ask what would be her/his direction with you, with your symptoms and history of meds.You are right. Thank-you for helping me think this through.
>
> BTW, I think your idea of doing nardil with a stimulent is an excellent one. I loved nardil (when it worked) because I never felt shaky or drugged. And I didn't gain weight. YMMV!Shelli--Did you gain weight on SSRI's?
Keep me posted on your Parnate trial.
Posted by Elizabeth on July 15, 2001, at 14:42:39
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by Lorraine on July 14, 2001, at 22:30:43
> > Hee hee. Do you know what the active (?) ingredients in "Stablium" are?
>
> Garum Armoricum, a fish and salt preparation discovered by the ancient Celts as a food supplement to improve resilience to physical and emotional stress.What's your understanding of the mechanism of action? (By "active ingredients" I really meant the chemical(s), not the name of the plant, BTW.) I looked it up in a few places; it sounds interesting.
> An eight week, double blind, placebo controlled study showed Stabilium® 200- to be effective in reducing the discomfort experienced by college students before and during examinations.
Oh yeah, I could definitely use that. < g > I used to be pretty laid-back about tests (like, I took a nap during the SAT), but these days they stress me out a lot.
> It was also effective in another double blind, placebo controlled study, concerning cognitive function, memory and fatigue in adults.*
I always wonder exactly what it is that those research types are talking about when they refer to "cognitive function."
> > BTW, the skin picking is possibly a symptom of OCD (or subclinical OCD-spectrum syndrome). Stimulants could be expected to make it worse.
>
> Some do; some don't. Dexidrine did; thyroid T3 did; selegiline does. But I don't think Adderal does.Adderall seems to be smoother than Dexedrine in a lot of ways (I don't know about Dexedrine Spansules, the slow-release formulation).
Although I don't generally have skin-picking problems, I developed one (temporary, thankfully) when I tried adding Cylert to Nardil (MAOIs can be expected to potentiate psychomotor stimulants). I got very twitchy and kept scratching or picking at my skin. The pdoc at the medical centre at my school said it was probably "just anxiety." (I later talked to my pdoc, who confirmed that people who take too many amphetamines often have problems of that sort.)
[Re activating and sedating side fx]
> The problem is that I am sensitive to overactivation and underactivation.Some people are just sensitive to side effects in general. I'm like that about temperature (I don't tolerate heat or cold very well).
Anxiety with ADD or lethargy can be very hard to treat because anxious people tend to get jittery (to put it mildly) on stimulants (and, often, antidepressants -- my guess is that Serzone, Remeron, or Nardil would probably be the best one for this type of patient). It sucks because a lot of anxious people have problems with fatigue, lethargy, low energy, etc.
And on the other hand, benzodiazepines can make ADD symptoms and fatigue worse. I've never had a problem with being overly sedated by benzos, personally. I'm just hard to sedate, I guess < g >. Although just 10 mg of Mellaril did the job rather neatly.
> > I sort of have that problem with buprenorphine, too: the effective dose causes psychomotor agitation (although that smooths out after a while, and benzos help with it too).
>
> This sounds familiar.Non-cardioselective beta blockers (like propranolol/Inderal) also help, BTW (although I think benzos do a more thorough job). It's pretty weird how I get jittery on opioids. It's not limited to buprenorphine, although it is worse with bup. than it is with pure full agonists (morphine, codeine, hydrocodone, fentanyl, etc.). I've encountered people who weren't so zonked on them, but never anyone who got actively wired the way I do.
> > It's because of the atypical-like symptoms. My guess could be wrong: I knew one woman who seemed to have pretty clear-cut atypical depression but who responded well to nortriptyline (for panic, depression, and alcoholism, with low-dose Xanax).
>
> I'm sorry, what do you mean atypical-like symptoms.Well, the picture you provided was suggestive of atypical depression, although it didn't include the obvious "reversed vegetative symptoms" (hypersomnia and hyperphagia). Lethargy is a common feature in atypical depression. In particular, the "walking through mud" feeling sounds a bit like what is often described as "leaden paralysis" (yes, this is a real clinical term!). I also think that crying spells and social withdrawal tend to be more common in atypical depression than other types. Panic disorder (or panic-like anxiety symptoms, such as hyperventilating) is definitely more associated with atypical depression than with other types. "Hibernating" is a very common word people with atypical depression use to describe their condition.
Anyway, MAOIs aren't just for atypical depression (and what you described, though suggestive, isn't the textbook picture of atypical depression by any means): they've been touted as being effective for it because tricyclics (which, for a long time, were the main alternative) are so ineffective. TCAs work great for "classic" depression (melancholia) but aren't much help for other types (which really are far more common, IMO).
> > About the MAOIs: Parnate might be better for you than Nardil because Nardil has a high rate of weight gain. Some people are overstimulated on Parnate, but since this isn't generally a problem for you, I think it's a minor concern.
>
> What about Nardil with a stimulant?That's a thought, although I think weight gain is still quite likely (stimulants don't work as appetite suppressants in the long term -- people generally develop tolerance to that effect very quickly). There's always the risk of paroxysmal hypertension from the combination. I don't consider this a major issue because I can check my blood pressure if I need to, and it's always reversible. (Also, I'm a young, average weight woman, and my cardiovascular health is fine. I'd be more concerned for someone with preexisting hypertension.)
OTOH, no AD beats Nardil for anxiety, and some people don't gain weight on it so it might be worth a try.
[re side effect sensitivity]
> Ain't that a b****. I suspect your right though. Still wish I hadn't opened that particular pandora's box.Huh. In what sense is it a Pandora's box?
> > >I just don't want to get your hopes up about desipramine.
>
> Yeah, me too I guess.Well, optimism is often helpful when taking on something like this. But it's good to know what to be optimistic about. < g >
> How is Desipramine working for you now?
I just got up to 150 mg today. No side effects except a little dry mouth. Too soon to know if it's working, although I do seem to have a little more energy.
[re choosing which med to try]
> I don't know, it feels pretty roulettish to me. No one knows how these drugs work. No one knows the mechanism of depression. No one know why one drug is more likely to work for a person than another (with few exceptions--like now i know SSRI's don't work, but TCAs--wont know till I try them, MAOs--wont know till I try them.I disagree about the last part. Although it's not a certainty, you can make predictions about who will respond to what based on observed symptoms. You're right, though, we're venturing into largely uncharted territory when we start messing with our brains. (A little bit exciting, perhaps, but scary and frustrating too.)
And I know how you feel about finding a pdoc -- there aren't that many who can formulate a plan for how to attempt to deal with TRD, are willing to try weird stuff if necessary, and are good listeners. If you find one, hang on. < g >
> I'm near UCLA, which would be an obvious choice, but I don't want to pick a random name out of the hat and then find out that I'm stuck with someone who has a frame of mind that prevents them from listening and learning themselves.
That's a big problem with pdocs, yeah. A suggestion: try talking to the receptionist at the mood disorders clinic and ask her about the personalities of the doctors there. She (it's usually a she) might not know, but it's worth trying.
Also, LA is a big metro area. If there's a branch of the National Depressive and Manic Depressive Association (www.ndmda.org) nearby (and I'm guessing there is), start going to support groups and asking around about various pdocs.
> Sometimes, I wish I was stupid so I'd be oblivious to all this, but then when I slip into depression I literally feel my IQ going down and I feel stupid, but I KNOW that I am stupid so it doesn't work out that well if you know what I mean. < vbg > or < vbc > (very big cry).
Dude, you're *not* stupid. Although I don't have an opinion about how smart you are, I can tell that you're insightful, which is a good sign.
> Wasn't it the Pretenders who said "stop all you sobbing on me". Sorry--long rant.
No apologies necessary.
Posted by Elizabeth on July 15, 2001, at 14:50:19
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by shelliR on July 15, 2001, at 9:34:42
> I'm jumping into the thread between you and elizabeth; I hope you don't mind.
Join the party. < g >
You're so right about this board. It's a great source of information. Although on the other hand, that sometimes leaves us feeling like we know more than our doctors do, which isn't entirely pleasant (unless you're really narcissistic :-) ).
> I did have success with lamictal, but it gave me an immediate 15lb weight gain.
I'll note that for future reference. I don't think I'd ever heard of weight gain from Lamictal.
> I do have to give this guy credit though for putting me on oxycontin--that did take some bravery.
No kidding, especially with the reaming that OxyContin is getting in the popular press. (Sensationalistic garbage, IMO.)
> Yet in the long run, I am choosing next to try Parnate.
I'd like to hear about how that goes for you. Are you going to continue taking Concerta and oxycodone?
> AND this guy doesn't return phone calls and makes you wait forever for your eight minute appt.
All the good ones are flakes. < g > (Not entirely true, but a lot of them are.)
> BTW, I think your idea of doing nardil with a stimulent is an excellent one. I loved nardil (when it worked) because I never felt shaky or drugged. And I didn't gain weight. YMMV!
Lucky! But it stopped working for you too? (At least it didn't leave you with an extra 50 lbs!)
-elizabeth
Posted by Elizabeth on July 15, 2001, at 16:44:26
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Lorraine on July 15, 2001, at 11:55:03
> Shelli, I so appreciate you jumping in. I value what you have to say and it really helps me to talk with people who have really been there before (or are there now)< vbg >
I second that.
> I'll stick with my guy. He charges a lot (too much), but he is a genuinely concerned guy who listens and hears better than most, values my insights and is adventurous.
He truly sounds like he's worth it.
> This sort of stuff just really fries my butt. I mean who are they to say that sort of stuff.
Especially men. Jeez.
> And, of course, vigorous walking or hiking was almost painful given the amount of weight I was carrying.
I remember that! I was living in a 4th-floor apartment (no elevator) when I was on Nardil, and that climb got tough.
> There were some tremendous costs to the med this pdoc had me on.
Weight gain is bad for all kinds of reasons. It's not just a cosmetic thing, and it shouldn't be trivialised.
> It doesn't work with all drugs to give them brief trials, but certainly it works for stimulants, probably benzos and probably anti-convulsants.
And opioids.
Actually, I'm not so clear that the 4-6 week estimate applies to ADs other than tricyclics. My recollection is that the MAOIs worked much faster than that, within 2 weeks.
> Especially with the stimulants it makes sense--I wish that the pdocs had samples of these like they do of the SSRIs (although I know why they don't).
Not even Concerta? (Do they just not get samples of C-IIs? That seems pretty goofy.)
> I feel the drug effects pretty quickly generally--although Effexor took forever and it sounds like the MAOs and TCAs may as well.
(See above.)
> Is oxycontin an opiate?
It's sustained-release oxycodone (yes, an opiate).
> I cannot even tolerate codeine with tylenol. I makes me weepy and shakey and emotionally fragile.
That's odd. Opiates make me feel jittery, but they definitely do away with the depression. Shaking, tearfulness, depression, and hypersensitivity sound more like withdrawal symptoms than direct drug effects.
> I sit here fretting over even trying benzos because of the withdrawal issues.
2 words: short term. Try, say, Klonopin, for a month or so (even two weeks might be enough), and you probably won't have trouble getting off of it.
About volunteering: your local hospital should have a volunteer program. Especially if it's a teaching hospital and there's a university in town. (All the pre-meds need to get some sort of experience, and volunteering is by far the easiest way to do that.)
-elizabeth
Posted by Lorraine on July 15, 2001, at 21:11:31
In reply to hand holding » Lorraine, posted by Elizabeth on July 15, 2001, at 14:42:39
> > >What's your understanding of the mechanism of action? (By "active ingredients" I really meant the chemical(s), not the name of the plant, BTW.) I looked it up in a few places; it sounds interesting.
I was afraid you'd ask that and, of course, I haven't a clue. I suspect noone does. It was one of those did it on a flyer type of things. I think LEF.org was where I first heard about it.
> > >I used to be pretty laid-back about tests (like, I took a nap during the SAT), but these days they stress me out a lot.
GABA might help also.
>
> > It was also effective in another double blind, placebo controlled study, concerning cognitive function, memory and fatigue in adults.*
>
> > >I always wonder exactly what it is that those research types are talking about when they refer to "cognitive function."well, you know, some stupid memory test or inventory. I'm sure the tests were nonsense like they normally are. No, actually I think it was students' test results.
>
> > > Although I don't generally have skin-picking problems, I developed one (temporary, thankfully) when I tried adding Cylert to Nardil (MAOIs can be expected to potentiate psychomotor stimulants).Good to know. So you tried Nardil with a stimulant? And, I take it has edgy results?
> > >(I later talked to my pdoc, who confirmed that people who take too many amphetamines often have problems of that sort.)
Sounds right to me.
> > > Some people are just sensitive to side effects in general. I'm like that about temperature (I don't tolerate heat or cold very well)
Isn't temperature intolerance tied to thyroid function? Also, I read somewhere about excess dopamine causing this.
>
> Anxiety with ADD or lethargy can be very hard to treat because anxious people tend to get jittery (to put it mildly) on stimulants (and, often, antidepressants -- my guess is that Serzone, Remeron, or Nardil would probably be the best one for this type of patient). It sucks because a lot of anxious people have problems with fatigue, lethargy, low energy, etc.Yeah, it really sucks, but I think you have hit it right on the nose here. Serzone put me to sleep--even with Wellbutrin in the am. I hated it. Remeron and Nardil remain to be tried.
>
> And on the other hand, benzodiazepines can make ADD symptoms and fatigue worse. I've never had a problem with being overly sedated by benzos, personally. I'm just hard to sedate, I guess < g >. Although just 10 mg of Mellaril did the job rather neatly.So, this is the other piece of bad news. I know--just seems impossible so that probably means back to an all-purpose AD of some sort and your hunch about an MAO may be right.
> Non-cardioselective beta blockers (like propranolol/Inderal) also help
I had a pretty bad reaction to Inderal. I think it worsened my depression, which Jenson says it's prone to do--actually he says that people who take it have a five-fold increase in their AD dosage. Anyway, bad luck for me. But he also mentions long lasting Betaxolol and I'm wondering if that might be your long lasting Beta-blocker.
He notes that Inderal is a Beta 1 & 2 blocker and Betaxolol is a Beta 1 blocker. Given my response to Inderal, I'm wondering if it is worth my while to try or not.
> > >It's pretty weird how I get jittery on opioids. It's not limited to buprenorphine, although it is worse with bup. than it is with pure full agonists (morphine, codeine, hydrocodone, fentanyl, etc.). I've encountered people who weren't so zonked on them, but never anyone who got actively wired the way I do.Well, that's funny because I think I thought I'd jump out of my skin on them.
> > I'm sorry, what do you mean atypical-like symptoms.
>
> > >Well, the picture you provided was suggestive of atypical depression, although it didn't include the obvious "reversed vegetative symptoms" (hypersomnia and hyperphagia). Lethargy is a common feature in atypical depression. In particular, the "walking through mud" feeling sounds a bit like what is often described as "leaden paralysis" (yes, this is a real clinical term!). I also think that crying spells and social withdrawal tend to be more common in atypical depression than other types. Panic disorder (or panic-like anxiety symptoms, such as hyperventilating) is definitely more associated with atypical depression than with other types. "Hibernating" is a very common word people with atypical depression use to describe their condition.Hypersomnia. Well, I'd say unmedicated I sleep a lot, always have and it got worse with depression. Leaden paralysis--that pretty much describes it to a tee.
>
> Anyway, MAOIs aren't just for atypical depression (and what you described, though suggestive, isn't the textbook picture of atypical depression by any means): they've been touted as being effective for it because tricyclics (which, for a long time, were the main alternative) are so ineffective. TCAs work great for "classic" depression (melancholia) but aren't much help for other types (which really are far more common, IMO).OK--I'm moving toward MAOs I think. Thanks for really sticking with me on this. It helps immeasurably.
>
>
> [re side effect sensitivity]
> > Ain't that a b****. I suspect your right though. Still wish I hadn't opened that particular pandora's box.
>
> > > Huh. In what sense is it a Pandora's box?You can't close it.
> > > That's a big problem with pdocs, yeah. A suggestion: try talking to the receptionist at the mood disorders clinic and ask her about the personalities of the doctors there. She (it's usually a she) might not know, but it's worth trying.Good idea.
> > > Also, LA is a big metro area. If there's a branch of the National Depressive and Manic Depressive Association (www.ndmda.org) nearby (and I'm guessing there is), start going to support groups and asking around about various pdocs.
Great idea, I'll try that.
> > > Dude, you're *not* stupid. Although I don't have an opinion about how smart you are, I can tell that you're insightful, which is a good sign.
Dudette to you < vbg >
> > > No apologies necessary.Among friends. Thanx again.
Posted by Neal on July 15, 2001, at 23:28:09
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by Lorraine on July 14, 2001, at 22:30:43
Lorraine- I have a guy that I go to in Santa Monica, who teaches at UCLA I believe. He seems pretty good about listening and is open to suggestions about meds. If you want to post your email address, I'll send along his name and number.
Elizabeth- I have some Temgesic .2mg sublingual tabs and I seem to be getting a good effect from just one. Is that possible? What is and "average" daily dose of this sublingual variety of bup?
Posted by shelliR on July 16, 2001, at 0:27:49
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Lorraine on July 15, 2001, at 11:55:03
> > >She was more interested in augmenting nardil than changing altogether, so I tried about ten augmentation strategies.
> Did you try adding a stimulant?I tried lots of stimulents with nardil and they all made my body feel really weird. It was only after I stopped taking nardil that I tried concerta, and did not have bad feelings. So actually, before I try parnate, probably I should try nardil with concerta.
>> > >I do have to give this guy credit though for putting me on oxycontin--that did take some bravery.
> Is oxycontin an opiate? Do you have anxiety, pain or autonomical symptoms? What does it do for you?I had discovered that vicodin, along with relieving pain--most frequently premenstrual pain, lifted my spirits. So for the past three years I've been taking it, first just premenstrually, then almost everyday to control the depression. I found that I didn't need to increase to get the antidepressant effect. When I went into the hospital last month I was in horrible shape and felt like I couldn't hold on to see if the selegiline worked. So one of the doctors prescribed oxycontin for me--it's longer acting than vicidin and I was only taking the vicidin in the early evening, so basically I was having horrible depressed days. But my therapist was so against me taking it, that I didn't want to increase it per day. So now that I'm on the oxy, it is in action all day and evening for me (I take it when I wake up and in the late afternoon). So this hasn't been a bad waiting period for me so far.
It doesn't sound from your description that you would be a good candidate for opiate treatment.
> > >And he was aware of the ERT study and he had me try concerta before giving up on stimulents, and I didn't have the same horrible body feelings with it.
> What is ERT?Estrogen replacement therapy.
> Do you mind if I ask you how functional you are generally? Are you able to work?
With the oxycontin and klonopin, I've been very functional. I think I need to add an anti-depressant because I think if I don't, I will be more likely to need to increase my opiate dose. So far, it's been about six weeks and no tolerance has developed, but I don't know how long that will last. It still is not as good, though, as when nardil worked for me.
I own a small business--I'm a fine arts (sort of) photographer, so I get to totally set my own schedule. I don't, however, have the sense of community in working you refer to. All my work is commissioned and everything is done in my house, except I do make trips to the lab and framing shops quite often. But otherwise I'm here, which has definite advantages and disadvantages. During the worst days of my depression, I have only been able to work because I set my own schedule. When I shoot I am never depressed, no matter how I felt before the shoot. I am really lucky about that. It may have to do with the absolute focus that I must have. But other parts of the work are very difficult for me when I am very depressed.
Clients come here, but much of the time I am alone and I work a lot. It is hard to sort out work time from non-work time when you work at home. But I had a hard time with relationships and bordom when I worked regular jobs--I never learned how to be around someone everyday if there was tension between us and I hate repetition. And when I was depressed, work made me more, not less depressesd. So I am satisfied that this is the best situation for me.
If I had more initiative, I'd try to start a breakfast/brunch club for other people in the arts who work at home, maybe meet once a week. There are business decision that come up that I have to deal with completely by myself, although I do ask my best friend for a lot of advise in dealing with a situation. He's much better than I am at people stuff.
> Shelli--Did you gain weight on SSRI's?
The only SSRIs I've tried for more than two weeks have been prozac, serzone, and luvox. I didn't gain weight on those three, but I've either not been able to take others (effexor, for one), and I've been unwilling to try the newer, weight gainers like remeron, celexa.
> Keep me posted on your Parnate trial.Well, actually I may try two things first. The estrogen patch, maybe, and I think I will run trying nardil again with cercerta by my pdoc. Nardil, concerta, and oxycontin could be good.
There are a million volunteer things you can do, like even once a week, but I don't know if you can depend on yourself to have that initiative now. I don't have much initiative myself--luckily I don't really have to for my work. I did work very hard (but it was really fun) designing a website for my business and that has proved to a lot more helpful that I had anticipated. I should have done it years ago.
One type of volunteer work I'd like to look into is mediation. Apparently there are both community and court programs that use volunteers. I don't like mindless things (like handing out food) even though I know they are important, so this mediation thing appeals to me because it uses both people and thinking skills. I may look into that after labor day.
Does your pdoc have any preference for nardil or parnate for you? Keep writing...
Take care, Shelli
Posted by Lorraine on July 16, 2001, at 9:44:25
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by Neal on July 15, 2001, at 23:28:09
> Lorraine- I have a guy that I go to in Santa Monica, who teaches at UCLA I believe. He seems pretty good about listening and is open to suggestions about meds. If you want to post your email address, I'll send along his name and number.
Thank-you Neil. That would be very helpful. My email is lbj90068@yahoo.com
>
> Elizabeth- I have some Temgesic .2mg sublingual tabs and I seem to be getting a good effect from just one. Is that possible? What is and "average" daily dose of this sublingual variety of bup?
Posted by Lorraine on July 16, 2001, at 10:26:03
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by shelliR on July 16, 2001, at 0:27:49
> > >So this hasn't been a bad waiting period for me so far.
I'm glad to hear that. The transitions can really be the pits.
> > > It doesn't sound from your description that you would be a good candidate for opiate treatment.I know that this is true. We are all different though and I am glad it's working for you. You have your head up about the addiciton issue. So if you are watching yourself like a hawk hopefully you will be ok. Jensen gives a case example of a woman for whom Opiate Replacement therapy worked. She ended up taking Hycomine (opiate with decongestant and caffeine) one tablet 4x day for 5 years which cleared her fibromylagia, agoraphobia, depression, fatigue and ADD without any evidence of tolerance or addiction. She also took .5 Klonopin at night. He says "This house bound agoraphobic became an outgoing, happy, and frequently traveling airline stewardess". Just in case you are looking for a career switch < vbg >
> > What is ERT?
>
> Estrogen replacement therapy.Course now I am reading that an imbalance in the ratio of estrogen to progesterin can cause panic attacks and anxiety--which is a possibility for me because my hyperventilating started about 6 months after I started estrogen replacement therapy with no progesterin augmentation.
> > > I own a small business--I'm a fine arts (sort of) photographer, so I get to totally set my own schedule. During the worst days of my depression, I have only been able to work because I set my own schedule. When I shoot I am never depressed, no matter how I felt before the shoot. I am really lucky about that. It may have to do with the absolute focus that I must have.I think this is extraordinary and wonderful. I'm glad you see both the good and the bad. This is a great example of making a life even when your depression is not under control. I have been trying to force myself to make commitments and just "do" even when I don't feel good--because this waiting for tomorrow thing is not working. Sometimes I surprise myself and end up functioning pretty well despite the depression.
> > > It is hard to sort out work time from non-work time when you work at home. But I had a hard time with relationships and bordom when I worked regular jobs--I never learned how to be around someone everyday if there was tension between us and I hate repetition.You mean work relationships?
> > > If I had more initiative, I'd try to start a breakfast/brunch club for other people in the arts who work at home, maybe meet once a week.Even once a month would be good. What would be great would be if you could form a group and nominate someone else with more consistent energy to head it up. < vbg >
> > >There are business decision that come up that I have to deal with completely by myself, although I do ask my best friend for a lot of advise in dealing with a situation.
I have a law degree and a business degree burning a hole in my pocket. I don't miss the law so much, but I do miss the business planning and deal making. I have found that when I try to consult, I have a very hard time transitioning from the work to the non-work phase. I mean I get spacey and miss deadlines--which is so unlike me when I worked. And, of course, regular work in this area is very stressful and, I suspect that like a skier who has to protect his previously injured leg, I will no longer be able to put myself in situations of stress. So I have some rethinking to do..
> > Keep me posted on your Parnate trial.
>
> Well, actually I may try two things first. The estrogen patch, maybe, and I think I will run trying nardil again with cercerta by my pdoc. Nardil, concerta, and oxycontin could be good.Good luck with it. I hope the Nardil works second time around.
> > > There are a million volunteer things you can do, like even once a week, but I don't know if you can depend on yourself to have that initiative now.
Well, you are right about not being able to depend on myself--but this situation is just dragging on too long and I absolutely have to pull myself out of the house and make the first step. I think I'll look into the group that Elizabeth spoke about--the national depression support group. It will be a start.
> > >I don't have much initiative myself--luckily I don't really have to for my work. I did work very hard (but it was really fun) designing a website for my business and that has proved to a lot more helpful that I had anticipated. I should have done it years ago.
Yeah, I surprised myself by pretty much heading up the 6th grade graduation party at my son's school this year. Extraordinary long hours for about a month.
> > > One type of volunteer work I'd like to look into is mediation. Apparently there are both community and court programs that use volunteers. I don't like mindless things (like handing out food) even though I know they are important, so this mediation thing appeals to me because it uses both people and thinking skills. I may look into that after labor day.Mediation? That would be up my alley as well, although I don't know that whole law side is pretty blah for me right now. Still, it is worth looking into.
>
> Does your pdoc have any preference for nardil or parnate for you?
I speak to him today at 4pm. I'll see what he says. He has this odd belief that if the "right" medication is chosen for you, you will not have side effects. When I say things like "but don't people gain weight on Nardil", he'll say "my patients don't". Anyway, we'll see.> > > Keep writing...
Try to stop me < vbg >
Posted by Elizabeth on July 16, 2001, at 21:20:07
In reply to Re: hand holding » Elizabeth, posted by Lorraine on July 15, 2001, at 21:11:31
> > > >What's your understanding of the mechanism of action? (By "active ingredients" I really meant the chemical(s), not the name of the plant, BTW.) I looked it up in a few places; it sounds interesting.
>
> I was afraid you'd ask that and, of course, I haven't a clue.Of course I'd ask it! Seriously, I'm planning on looking it up myself at some point (it's right at the bottom of my things-to-do list < g >).
> GABA might help also.
I have trouble believing that oral GABA would ever make it into the CNS.
> > > > Although I don't generally have skin-picking problems, I developed one (temporary, thankfully) when I tried adding Cylert to Nardil (MAOIs can be expected to potentiate psychomotor stimulants).
>
> Good to know. So you tried Nardil with a stimulant? And, I take it has edgy results?Several stimulants, not just Cylert. Some people can tolerate it, some can't. The main risk is hypertension, of course.
> Isn't temperature intolerance tied to thyroid function?
Theoretically. But I've had a lot of thyroid tests and they've always been fine.
> Also, I read somewhere about excess dopamine causing this.
I have a feeling that's not a problem I have. < g >
> Yeah, it really sucks, but I think you have hit it right on the nose here. Serzone put me to sleep--even with Wellbutrin in the am. I hated it. Remeron and Nardil remain to be tried.FWIW, I didn't get tired on either of those. (Then again, I'm hard to sedate, as I mentioned.)
> So, this is the other piece of bad news. I know--just seems impossible so that probably means back to an all-purpose AD of some sort and your hunch about an MAO may be right.
I don't understand -- what was the bad news?
> I had a pretty bad reaction to Inderal. I think it worsened my depression, which Jenson says it's prone to do--actually he says that people who take it have a five-fold increase in their AD dosage.
That's interesting. What I've read has suggested that the "beta blockers cause depression" thing has been greatly exaggerated (because people with cardiac disease are at increased risk of depression to start with).
> Anyway, bad luck for me. But he also mentions long lasting Betaxolol and I'm wondering if that might be your long lasting Beta-blocker.
Betaxolol is a good one. It's considered safer if it's necessary for a person with asthma to take a beta-blocker. It's beta1-selective, as your doctor says (so is atenolol, which I found didn't work for panic).
> Well, that's funny because I think I thought I'd jump out of my skin on them.
On opioids? Why?
> Hypersomnia. Well, I'd say unmedicated I sleep a lot, always have and it got worse with depression. Leaden paralysis--that pretty much describes it to a tee.
Leaden paralysis is specifically supposed to mean a feeling of heaviness in the arms and legs.
> OK--I'm moving toward MAOs I think. Thanks for really sticking with me on this. It helps immeasurably.
Well, sure thing. It's nice to talk to you.
> > [re side effect sensitivity]
> > > Ain't that a b****. I suspect your right though. Still wish I hadn't opened that particular pandora's box.
> >
> > > > Huh. In what sense is it a Pandora's box?
>
> You can't close it.Wait -- what was "it" again? < g >
> Dudette to you < vbg >
Your Dudeliness.
-elizabeth
Posted by Elizabeth on July 16, 2001, at 21:21:23
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by Neal on July 15, 2001, at 23:28:09
> Elizabeth- I have some Temgesic .2mg sublingual tabs and I seem to be getting a good effect from just one. Is that possible? What is and "average" daily dose of this sublingual variety of bup?
I don't know. It's usually given to addicts who need much more than people without any tolerance. The amount I take is 0.3 mg (3x/day), intranasally.
-elizabeth
Posted by Elizabeth on July 16, 2001, at 21:24:41
In reply to Re: I'll hold your hand if you'll hold mine » Lorraine, posted by shelliR on July 16, 2001, at 0:27:49
> It doesn't sound from your description that you would be a good candidate for opiate treatment.
Why do you say that, out of curiosity?
> The only SSRIs I've tried for more than two weeks have been prozac, serzone, and luvox. I didn't gain weight on those three, but I've either not been able to take others (effexor, for one), and I've been unwilling to try the newer, weight gainers like remeron, celexa.
FWIW: Serzone isn't really an SSRI, and I seem to hear many fewer reports of weight gain related to it. (That could just be because it's not used nearly as much as the SSRIs and Effexor, though.)
-elizabeth
Posted by shelliR on July 16, 2001, at 22:51:19
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Elizabeth on July 15, 2001, at 14:50:19
Hi Elizabeth.
> > I did have success with lamictal, but it gave me an immediate 15lb weight gain.
> I'll note that for future reference. I don't think I'd ever heard of weight gain from Lamictal.I called the manufacturer and they said there was something like a 17% weight gain, but I couldn't find any source where they were getting that information. Then they sent me a study with an N of 40, with 17 % having a weight gain over a certain percent of their body. It was too strange. I don't think they want to really know, only that it causes much less weight gain than some other anticonvulsants (sort of like the new AP and the old AP--no stats, just comparisons).
> > Yet in the long run, I am choosing next to try Parnate.
> I'd like to hear about how that goes for you. Are you going to continue taking Concerta and oxycodone?I've already dropped concerta. I may try it again, but I have this feeling that there was no synergy or whatever
between the oxycontin and concerta. And I am going to next try the estrogen patch that was so successful in
a study of perimenopausal women and the estradiol patch. I am of that age, and so far no physical symtoms, but
it seems worth a try since my depression got so much worse in the last two years.
>> > BTW, I think your idea of doing nardil with a stimulent is an excellent one. I loved nardil (when it worked) because I never felt shaky or drugged. And I didn't gain weight. YMMV!
> Lucky! But it stopped working for you too? (At least it didn't leave you with an extra 50 lbs!)But I never tried it with concerta. I rather try something I've know that venture into new side effects with parnate. So that may be an option. The question would be if I'd need to drop the oxy to take concerta. I don't think I'd be willing. It's getting me though life right now and I can't imagine feeling safe enough to let it go.
I don't know much about the tricyclic you're taking. I don't even remember what trycyclics I tried, it was so long ago and I was in Sheppard Pratt. My early twenties, centuries ago! I've never tried one since, and actually surprisingly, no one, including my present pdoc (the cocktail guy) ever brought it up. I'll have to ask him (in my eight minutes) if he ever uses them. Just out of curiousity.
Take care, Shelli
Posted by shelliR on July 16, 2001, at 23:09:41
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Elizabeth on July 16, 2001, at 21:24:41
> > It doesn't sound from your description that you would be a good candidate for opiate treatment.
>
> Why do you say that, out of curiosity?
>
Certainly not out of intuitive sense. Actually, in response to this statement by Lorraine:
"Is oxycontin an opiate? Do you have anxiety, pain or autonomical symptoms? What does it do for you? Just curious. I cannot even tolerate codeine with tylenol. I makes me weepy and shakey and emotionally fragile"Why, do you think she can have that reaction to codeine and still be a candidate for Buprenorphine?
Shelli
Posted by Elizabeth on July 18, 2001, at 0:34:14
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by shelliR on July 16, 2001, at 22:51:19
That's a weird story about the Lamictal. Drug companies are rather unsavory, aren't they?
> I've already dropped concerta. I may try it again, but I have this feeling that there was no synergy or whatever
> between the oxycontin and concerta.It sounds a little too much like a speedball to me. < g >
> And I am going to next try the estrogen patch that was so successful in
> a study of perimenopausal women and the estradiol patch. I am of that age, and so far no physical symtoms, but
> it seems worth a try since my depression got so much worse in the last two years.It might be, I don't know too much about that. I had a bad reaction to the pill (depression got worse all of a sudden, got better when I stopped the pill) so I'm not into taking hormones.
> > Lucky! But it stopped working for you too? (At least it didn't leave you with an extra 50 lbs!)
>
> But I never tried it with concerta.I don't really see why Concerta would prevent it from pooping out. Then again, what do we know about why ADs poop out, anyway?
> I rather try something I've know that venture into new side effects with parnate.
That makes sense. Although Nardil and Parnate are lumped together as monoamine oxidase inhibitors, they're really quite different -- Nardil is related to hydrazine, while Parnate is a phenethylamine (very similar to amphetamine, actually).
> So that may be an option. The question would be if I'd need to drop the oxy to take concerta.
I don't see any reason why that would be necessary.
> I don't think I'd be willing. It's getting me though life right now and I can't imagine feeling safe enough to let it go.
I understand, believe me!
> I don't know much about the tricyclic you're taking.
It's generally got the least side effects, although it's more likely to cause jitters than other TCAs. It's a fairly selective NE reuptake inhibitor.
> I don't even remember what trycyclics I tried, it was so long ago and I was in Sheppard Pratt.
What's Sheppard Pratt? And do you remember if any of the TCAs worked at all?
> My early twenties, centuries ago!
Shhh, you're dating yourself. ;-)
> I've never tried one since, and actually surprisingly, no one, including my present pdoc (the cocktail guy) ever brought it up. I'll have to ask him (in my eight minutes) if he ever uses them. Just out of curiousity.
Eight minutes -- jeez. Good luck!
-e
Posted by Elizabeth on July 18, 2001, at 0:35:42
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by shelliR on July 16, 2001, at 23:09:41
> Actually, in response to this statement by Lorraine:
> "Is oxycontin an opiate? Do you have anxiety, pain or autonomical symptoms? What does it do for you? Just curious. I cannot even tolerate codeine with tylenol. I makes me weepy and shakey and emotionally fragile"You have a much better memory than I do. I agree, then. I wonder what Stadol or ReVia would do for her, though.
-e
Posted by shelliR on July 18, 2001, at 22:46:02
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Elizabeth on July 18, 2001, at 0:34:14
Hi Elizabeth,
> What's Sheppard Pratt? And do you remember if any of the TCAs worked at all?
Sheppard Pratt is a private psychiatric hospital, outside of Baltimore. Zelda Fitzgerald had several stays there during her life. They have beautiful grounds there and a gazebo, where she apparently sipped wine to help her sleep through the night.
As far as the TCAs working, I never got past the first day on two different ones. They made me so disoriented, that I could barely dress myself. That hospitalization was the lowest point of my life. I had hit rock bottom, signed in there, and realized there was a basement to rock bottom. Soon after I was discharged to a day hospital, I started nardil ; TCAs have never come up for me again.
Sheppard Pratt has a good reputation, but the particular unit I was on (short-term evaluative) was awful. I was there for a month (which is what my insurance covered), but there were people in there up to a year. The federal government used to have awesome psychiatric benefits, so half of Washington was in psychoanalysis, and hospital stays, well they could be months and months. And it was nearly impossible to be fired from a government job once you'd been there for a few years, so there was no fear of coming out having lost your job. I was not really part of that era, and never part of the federal government at all.
From what I've heard Sheppard Pratt now gets through on endowments. It has a well known dissociative disorders program, but I always chose another hospital in Washington with the same type of unit. It's closer and I think almost everyone on that unit ends up with an MPD (DID) diagnosis. Someone I know from one of my hospital stays was in there with Rosanne Barr, during her "multiple period"--she was going on talk shows afterwards talking about how much fun it was to have different personalities. The woman who was in with her, did not believe that Roseanne was really multiple. Anyone that thinks multiplicity is a lot of fun is almost definitely not multiple.
What does are you hoping to get up to on desiprimine ?
Shelli
Posted by Elizabeth on July 19, 2001, at 11:59:19
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by shelliR on July 18, 2001, at 22:46:02
> Sheppard Pratt is a private psychiatric hospital, outside of Baltimore. Zelda Fitzgerald had several stays there during her life. They have beautiful grounds there and a gazebo, where she apparently sipped wine to help her sleep through the night.
Ahh -- sounds much like McLean (a Harvard teaching psych hospital in Belmont, MA, about a half hour drive out of Cambridge, which has housed a number of celebrities -- the book _Girl, Interrupted_ takes place there). Good to know if I'm ever in Maryland again (I'm from Rockville originally) and happen to go insane. :-)
Is Sheppard Pratt affiliated with Johns Hopkins, by any chance? It sounds like a teaching hospital.
> As far as the TCAs working, I never got past the first day on two different ones.
Which two?
> That hospitalization was the lowest point of my life.
Hospital stays of any kind are no fun, and psych hospitals can be especially unpleasant in their own unique ways.
> I had hit rock bottom, signed in there, and realized there was a basement to rock bottom.
That's a great line. < g >
> Sheppard Pratt has a good reputation, but the particular unit I was on (short-term evaluative) was awful.
Again, sounds a lot like McLean! People I knew when I was in college who went there had awful things to say about it.
> I was there for a month (which is what my insurance covered), but there were people in there up to a year.
I don't know about Maryland, but Medicaid in Massachusetts will cover a lot, probably more than most private insurance. I've encountered people who had MassHealth and spent a year or more in the hospital.
> I was not really part of that era, and never part of the federal government at all.
What era was that? (chronologically, I mean)
> From what I've heard Sheppard Pratt now gets through on endowments.
Private psych hospitals aren't doing so well these days, with managed care and all.
> It's closer and I think almost everyone on that unit ends up with an MPD (DID) diagnosis.
At McLean, it's "borderline personality" (John Gunderson, who pretty much invented the concept as it's known today (in DSM-III and IV), has been there for many years).
> Someone I know from one of my hospital stays was in there with Rosanne Barr, during her "multiple period"--she was going on talk shows afterwards talking about how much fun it was to have different personalities. The woman who was in with her, did not believe that Roseanne was really multiple. Anyone that thinks multiplicity is a lot of fun is almost definitely not multiple.
That's pretty funny. I didn't know anything about Roseanne being in "the bin." If what you heard is true, I agree that she's probably not experiencing dissociation. MPD is a sort of fad diagnosis in some hospitals (just as borderline personality is at McLean), and some people who crave attention or are very suggestible probably pretend to have it, or are convinced by their therapists that they actually do have it. I think it's probably a real condition, but not nearly as common as some people seem to think.
> What does are you hoping to get up to on desiprimine ?
300 mg. I need to talk to my pdoc about getting my serum levels tested; there are some weird things in my history (like an oddball reaction to dextromethorphan) that suggest that I might not metabolise tricyclics normally.
-elizabeth
Posted by Lorraine on July 19, 2001, at 20:20:06
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 16, 2001, at 21:20:07
[re mechanism of action Stabilium]
> > > Of course I'd ask it! Seriously, I'm planning on looking it up myself at some point (it's right at the bottom of my things-to-do list < g >).Well, unless you are a skin picker, you must have lots of extra time on your hands. When I was in school--they kept us too busy to think.< vbg >
> > > Isn't temperature intolerance tied to thyroid function?Did you do the armpit test? (No, it's not a sniff test!)
> > > So, this is the other piece of bad news. I know--just seems impossible so that probably means back to an all-purpose AD of some sort and your hunch about an MAO may be right.
>
> I don't understand -- what was the bad news?I think the bad news was that the drugs that treat anxiety aren't energizing and the drugs that are energizing are terrible for anxiety.
[re inderal and depression]
> > > That's interesting. What I've read has suggested that the "beta blockers cause depression" thing has been greatly exaggerated (because people with cardiac disease are at increased risk of depression to start with).Who knows? My mood really spiraled down and I have to blame it on something--although it could just be cyclical. I am now charting my moods.
> > > Betaxolol is a good one. It's considered safer if it's necessary for a person with asthma to take a beta-blocker. It's beta1-selective, as your doctor says (so is atenolol, which I found didn't work for panic).This is good to know. My pdoc decided that trying another beta-blocker didn't make sense given my reaction to Inderal (although cause and effect are never clear). He put me on Valium 1 mg a day staying the course with my regular meds (Selegiline, Nardill and Adderal), but dropping the Inderal. We'll see, it's just day 2.
> > Well, that's funny because I think I thought I'd jump out of my skin on them.
>
> On opioids? Why?I don't know, they just make me aggitated, shakey, edgy, weepy and so forth.
>
> > Hypersomnia. Well, I'd say unmedicated I sleep a lot, always have and it got worse with depression. Leaden paralysis--that pretty much describes it to a tee.
>
> Leaden paralysis is specifically supposed to mean a feeling of heaviness in the arms and legs.That's too bad, about the definition. It really sounded like my mental state.
> > > [re side effect sensitivity]
> > > > Ain't that a b****. I suspect your right though. Still wish I hadn't opened that particular pandora's box.
> > >
> > > > > Huh. In what sense is it a Pandora's box?
> >
> > You can't close it.
>
> Wait -- what was "it" again? < g >I did laugh when I read this. But in case this was one of those senior moments, the it was anxiety. It sounds like once you have the motor running, it becomes a perpetual machine that can be controlled with meds but never really turned off.
Sorry to take so long to respond to you, Elizabeth. I was out of town the last three days.
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