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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 36 to 60 of 434. Go back in thread:
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.
Posted by Lorraine on July 19, 2001, at 20:29:44
In reply to Re: I'll hold your hand if you'll hold mine » shelliR, posted by Elizabeth on July 18, 2001, at 0:35:42
[re bad reaction to opiates]
> > > You have a much better memory than I do. I agree, then. I wonder what Stadol or ReVia would do for her, though.So these are opiate antagonists?
Lorraine
Posted by Elizabeth on July 19, 2001, at 22:49:31
In reply to Re: I'll hold your hand if you'll hold mine » Elizabeth, posted by Lorraine on July 19, 2001, at 20:29:44
> > > > You have a much better memory than I do. I agree, then. I wonder what Stadol or ReVia would do for her, though.
>
> So these are opiate antagonists?Revia is naltrexone, an antagonist. Stadol is a mixed agonist-antagonist with a different profile than buprenorphine.
-elizabeth
Posted by Elizabeth on July 19, 2001, at 22:57:43
In reply to Re: hand holding » Elizabeth, posted by Lorraine on July 19, 2001, at 20:20:06
> [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.Sort of. I'm also a compulsive procrastinator.
> When I was in school--they kept us too busy to think.< vbg >
I went to a school that's considered very tough academically, but I found time to party too.
> > > > Isn't temperature intolerance tied to thyroid function?
>
> Did you do the armpit test? (No, it's not a sniff test!)Uhh...what is it, then?
> 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.
Ahh, ok. That's where antidepressants come in; they can be simultaneously activating and anxiolytic. (Nardil is probably the most extreme example of this.)
> [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.That might not be a bad idea; see if there're any patterns (seasonal, circadian, etc.).
> My pdoc decided that trying another beta-blocker didn't make sense given my reaction to Inderal (although cause and effect are never clear).
I think that the cardioselective beta blockers would be fine if your reaction was strictly an "above the neck" one.
> 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.
1 mg??? That's a *really* small amount (it's half of the smallest strength pill). Valium is much less potent than Klonopin and Xanax are.
I take Klonopin sometimes to counteract the jitters from buprenorphine. It really helps. Inderal helps too but isn't as thorough.
> > > 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.Oh, I see. Which one(s) have you taken that caused this reaction? It's true that some people (perhaps up to a third of the population) feel dysphoric on opioids.
> > 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.Feeling so lethargic that you can't move is how some people describe it.
> > > > > > 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.Good, it's nice to know I can still be entertaining. :-)
> But in case this was one of those senior moments, the it was anxiety.
"senior moments?"
> 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.
Huh. I don't get the analogy -- in what sense is your anxiety like the contents of a box that you opened?
-elizabeth
Posted by Lorraine on July 20, 2001, at 10:29:50
In reply to Re: hand holding » Lorraine, posted by Elizabeth on July 19, 2001, at 22:57:43
> > > I went to a school that's considered very tough academically, but I found time to party too.
That's great, elizabeth. It shows that you have great confidence in your intellectual abilities. I did all my heavy partying in high school and managed to miss attending most of it. I had no idea that I was smart until I started performing well in college ( a local state school), but I don't think I was always a bit insecure about it and so didn't tempt fate by partying at school.
> > > Did you do the armpit test? (No, it's not a sniff test!)You test your basil temperature by putting a thermometer under you armpit for 15 minutes upon awaking but before leaving the bed. If you temperature is below 98 degrees consistently, then it suggests that there is a thyroid deficiency notwithstanding the results on the standardized thyroid tests.
> > > 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.
>
> Ahh, ok. That's where antidepressants come in; they can be simultaneously activating and anxiolytic. (Nardil is probably the most extreme example of this.)I'm confused. Doesn't the weight gain associated with Nardil indicate that it is not activating? I do wish that weight gain and sexual dysfunction were not part of the Nardil profile. I also wonder if I am more likely to have these side effects given the fact that I have had them on SSRIs.
[re charting moods]
> That might not be a bad idea; see if there're any patterns (seasonal, circadian, etc.).You know the pathetic piece is this--I need to track them in part because I don't "trust" my reactions to drugs. I mean when my pdoc says how is it going with ___, my reaction may very well depend on how things are going that day. The mood clouds everything. So the mood charts help keep me honest, so to speak, and provide me with some information as to triggers etc.
> > > I think that the cardioselective beta blockers would be fine if your reaction was strictly an "above the neck" one.
Well, I wasn't wild about my pulse rate fluctuations on it either. One day (early on), my pulse ranged from 120 to 58 during the day. And, I didn't like the amount of exertion I felt on running up the stairs.
> > > 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.
>
> 1 mg??? That's a *really* small amount (it's half of the smallest strength pill). Valium is much less potent than Klonopin and Xanax are.I know, but I'm very sensitive to drugs. (When I go into a new store, the first place I go is to the pill crushers to see if they have a better one than I use. By the way, the one at Kmart seems to be the best). I can go up on the Valium to 2 mg if I need to. I am just trying to control the physical anxiety. I have felt the hyperventilating decrease pretty significantly on it--but we'll see. Initial reactions don't alway pan out for me. I'm also concerned about the withdrawal issues. My pdoc's response to this concern was: "Lorraine, you take so little of these drugs I just don't think it will be a major issue for you." I'm wondering if this is true or whether the addiction issues are not absolute dose dependent but rather dose dependent relative to the amount that works for that person.
>
> > > I take Klonopin sometimes to counteract the jitters from buprenorphine. It really helps. Inderal helps too but isn't as thorough.I suggested Klonopin to my pdoc. His thought was that it was sedating and that Valium has a very long half life. By the way, I did take Xanax for about a week once. I hated it because I felt so drugged even at low doses.
[re: opiates reaction]
> > I don't know, they just make me aggitated, shakey, edgy, weepy and so forth.
>
> Oh, I see. Which one(s) have you taken that caused this reaction? It's true that some people (perhaps up to a third of the population) feel dysphoric on opioids.Codeine is the only legal one I have tried. Dysphoric may be too strong a word. My reaction to the drug was immediate (within an hour of taking it) and, of course, I took no more. It was prescribed for a root canal. I had thought I could go back to my staid law firm and work the rest of the day. Talk about a bad place to feel unsafe and vulnerable.
> > > 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.
>
> Feeling so lethargic that you can't move is how some people describe it.OK, now we're cooking with gas! That's the feeling all right.
> > > > > > > Huh. In what sense is it a Pandora's box?
> > > > You can't close it.
> > > Wait -- what was "it" again? < g >
> > But in case this was one of those senior moments, the it was anxiety.
>
> "senior moments?"If you don't know what they are, then you are young and lucky.
> > > Huh. I don't get the analogy -- in what sense is your anxiety like the contents of a box that you opened?
OK, elizabeth, but don't say you didn't ask. It's like the bell that can't be unrung.
Lorraine
Posted by Lorraine on July 20, 2001, at 10:31:02
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
Shelli: How are you doing with your meds? Are they finally treating you right?
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