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Dr. Bob is Robert Hsiung, MD,
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Posted by Elizabeth on August 3, 2001, at 17:10:52
In reply to Re: jumping in » Elizabeth, posted by Lorraine on August 3, 2001, at 12:28:54
Hi Lorraine.
> Well, I do have ADD like cognitive issues now clearly.
I think I mentioned that I believe it's possible for ADD (or something similar) to manifest in adulthood, perhaps secondary to depression. I know that I've become more mentally disorganised.
> But what I'm talking about above just involves a level of energy, exhilerating, and exhaltation of self that seems odd. I mean I have come to "distrust" myself when I have a sudden interest in something. My husband distrusts it also and it has become somewhat of a joke among my friends "oh, that's just Lorraine, first she reads the 30 books on the subject, then...."
My suggestion: cherish your zeal and nurture it. It's precious.
> Yeah, who knows "why" it's working--it's not clear that it matters really.
I think it's important to research the reasons why drugs work as they do, but it's not necessary to know that for purposes of treating your difficulties. FWIW, when I tried Neurontin, the feeling reminded me of Xanax.
> A skipped dose of Effexor did this to me and withdrawal from it was really, really awful. Is there anything to alleviate MAOI withdrawal if it comes down to that?
I've found that benzos work well; not sure about non-benzodiazepine anticonvulsants. Psychostimulants might help also.
> There is also something called depression induced dementia, which has a lot of cognitive impairment features as you would expect.
Yes, I've heard of it. It's believed to be reversible, unlike degenerative dementias (e.g., Alzheimer's). Sometimes it's called "pseudodementia." It is sort of controversial whether it's completely a product of depression, although cognitive impairment is recognised as a sequela of depression; some believe that "depressive dementia" is the result of comorbid depression and dementia, not dementia as a result of depression.
> One cool thing about my pdoc is that he really cares about cognitive impairment.
My experience has been that they usually understand how important cognitive functioning is for me when I tell them I want to go to medical school. < g >
> Cognitive impairment is really awful I think especially if your life has revolved much around your intellectual activities. It must be distressing to you.
Very much so, yes.
> My SIL--who believes that depression is all in your mind--tells me to just sit with the depression and let it take it's course and quit fighting it. I tell her it is like asking someone to just sit with Alzheimers.
*groan* Yeah, a lot of people who've never been depressed [clinically, that is] seem to think they understand what we go through, even though it's obvious to us that they don't have a clue.
> I realized, for one thing, that I learn better by reading rather than listening to lectures--so I was always the student buying supplemental text books if I didn't understand a professor.
That's interesting. I learn better from lectures than from reading, I think. I wonder whether this difference has any broader significance.
> I'm very happy for you. The Desipramine seems to be a lucky ticket for you. (although i know you research it before taking it). I hope the blood levels prove ok.
The serum level was over 600 this time, so I'm cutting the dose in half. The doctor who's covering for my pdoc is supposedly going to call me on Monday to discuss what to do next.
> The ECT next step sounds right to me--plus they have that monitor that you strap on that monitors your heart for 24 hours for irregularities.
Okay, I'm confused now. What are you talking about here? (Sorry, I'm probably just being scatterbrained, as usual.)
> There is a degree of acknowledgment about mental illness and our lack of control over the disease that comes from taking a drug--plus all the stigma associated with it. My SIL believes that people who are mentally ill are self indulgent and that they take drugs as "cosmetic mood brighteners".
Oh jeez. That's just awful. I suppose she's never had a conversation with a homeless person before. Who's she to make that kind of judgement?
I've met a lot of people who have a hard time understanding or believing that I could ever have been very depressed, because when I'm not depressed I'm outgoing, inquisitive, etc.
About atenolol: my dad takes it (for cardiovascular disease), and he seems to be fine with it. I could ask him if he's noticed any side effects. (He takes a bunch of other things too -- hypertension is very complicated to treat -- so it might be hard to sort out what's doing what.)
> > Ahh, I can understand that. (Can I ask whence the scars? I don't think I've seen you mention that before.)
>
> 3d degree burns over 1/3 of my body (thighs and upper abdomine) when I was 8.My god. At least it's on parts that are usually covered by clothes. Still, I can see how that would cause you problems, especially with intimate relationships.
> > > > My dad's a professor (both my parents are) -- his field is philosophy and history of science. It's not light reading. < g >
>
> Doesn't sound like it, but it does sound like it is right up my husband's alley. He loves this stuff.Really? What particular interests does he have?
> > Small comfort. Still, it's probably less damaging if it happened when you were older.
>
> Yes, and it was mild, I don't believe he ever touched me. It was all about his self-pleasuring really.I'm a little confused by this remark, but if you don't feel comfortable I won't demand elaboration.
> certainly not the familial dystonia, which is incapacitating. I don't know--I've just read a lot about "muscle" tension and cramps being associated with meds. I get muscle cramps depending on my meds also. My muscle strength (during workouts) varies remarkably depending on my meds.Huh. Which meds have had which effects in that regard?
> > FWIW, the time that I was first diagnosed with depression (when I was 14), I was having very bad headaches. Prozac did away with them, so I have to credit it for that, at least.
>
> Some vascular relaxation thing or muscle relaxant type of action maybe.No idea what the cause was. Depression and pain syndromes often co-occur, though. It was very obvious to me that the Prozac was responsible for the headaches going away -- although I'm less certain that it actually caused my depression to remit!
> Interesting take on the issue. That the meds medicate a physiological problem.
Well, they have peripheral effects as well as central ones. And chronic pain is probably centrally mediated, I think.
> My chiropractor always said my back aches were mechanical in nature.
I'm dubious (of vague "diagnoses" made by chiropractors, that is). Did you ever get a more precise explanation?
> But my experience seems to prove otherwise. I guess the chicken and the egg question (do the med alleviate the symptoms or cause them) becomes apparent when you are off meds entirely. I haven't really tried this (for obvious reasons) < g >
I had the misfortune to be off antidepressants completely for several months after Nardil pooped out the second time. It was rough. I tried Paxil, selegiline, and Neurontin during that time, but they didn't really help.
> Yeah, I'm pretty high on him right now because of his ability to think outside the box--the fact that he let me do the 3 day wash out between MAOIs, that he was willing to try Moclobemide by writing rxs for a Canadian Pharmacy and the fact that he is willing to try meds fairly aggressively has me feeling pretty good about him right now.
Those are good traits for a pdoc, IMO.
> Yeah, I know. By the way, do you have Jensen's book--I find it really useful.
Jensen...which one is he? (No, I don't have his book.)
> > I think that a lot of different childhood disorders all get lumped together as "ADD."
>
> True. Amen identifies 6 types of ADD, but I think some of these are not ADD truly.Probably not. I perused his web site; neat stuff. I've been thinking about calling him up and asking if he can refer me to somebody closer to home who could interpret my SPECT scan.
> > May I offer a counterexample? I was 14 when I started taking Prozac, and while Prozac didn't cause me much difficulty, I most definitely did have a sexual identity by that age.
>
> elizabeth, this is really very helpful to me to hear.Good, I'm always gratified if I feel I've been able to help someone.
> also, i suppose there's the point of developing an identity and coping skills of someone who is depressed as opposed to healthy?
I think this really sums it up nicely, yes.
> No, she's not doing CBT. I've suggested it, but the logistics have been unmanagable because her mother (who had lost control over her completely) sent her to live with her father (who is more structured in his discipline approach) and to a smaller school (10 kids per class). She completely flunked out of 8th grade, 3 F's and 2 D's (in drill team and PE). So the problem had become an emergency.
Sure, she needs medication. But that doesn't preclude the possibility of CBT.
> Good luck on the Desipramine retest.
Sorry to disappointn, but as I mentioned earlier, I'm afraid I wasn't lucky. I guess one could say I failed the test. :)
-elizabeth
Posted by shelliR on August 3, 2001, at 18:28:03
In reply to Re: jumping in » Lorraine, posted by Elizabeth on August 3, 2001, at 17:10:52
Hi Lorraine, Elizabeth, et. al.
>
> > My SIL--who believes that depression is all in your mind--tells me to just sit with the depression and let it take it's course and quit fighting it. I tell her it is like asking someone to just sit with Alzheimers.
>
> *groan* Yeah, a lot of people who've never been depressed [clinically, that is] seem to think they understand what we go through, even though it's obvious to us that they don't have a clue.It's interesting, my sister just told me recently that my SIL thinks that I don't try hard enough to overcome my depression. This is actually fascinating to me. I dislike my brother and sil enough to never get together with them unless it is an occasion surrounding my parents, e.g. special birthday, anniversary. I don't live near my family, so this is not a major problem, although it does upset my parents. Anyway, I've never discussed my depression with her and I run a business full time, so I feel almost a sense of disbelief that she would have any opinions about me that have nothing to do with our relationship, let alone my depression. Actually she was at a wedding in her city seated with some people from my city, and they had heard of me, and my work and one of their friends was a client of mine here. So she knows I am well known in my profession. Try harder? I don't even know what she could mean. It is amazing how ignorant people can be, although I find my SIL pretty ignorant and unkind anyway, so I chalk it off to that. If someone I cared about ever thought that about me, it would hurt me really badly.
>
> > I'm very happy for you. The Desipramine seems to be a lucky ticket for you. (although i know you research it before taking it). I hope the blood levels prove ok.
> The serum level was over 600 this time, so I'm cutting the dose in half. The doctor who's covering for my pdoc is supposedly going to call me on Monday to discuss what to do next.Elizabeth, what is would be affected by having too high a blood level. Could it affect your organs? Like liver damage, etc.?
>
> > The ECT next step sounds right to me--plus they have that monitor that you strap on that monitors your heart for 24 hours for irregularities.
>
> Okay, I'm confused now. What are you talking about here? (Sorry, I'm probably just being scatterbrained, as usual.)
Lorraine, I'm confused also because I've never known you were considering ECT. You would try ETC before nardil or buph?
Wow, I really hope parnate is it for you.> > 3d degree burns over 1/3 of my body (thighs and upper abdomine) when I was 8.
> My god. At least it's on parts that are usually covered by clothes. Still, I can see how that would cause you problems, especially with intimate relationships.
Did you go through lots of skin grafts or was there really not enough skin to take from anywhere? How long til your life got back to some type of stability after the fire?
>
>BTW, in regard to back pain and meds, selegiline gave me back pain, really shoulder pain almost from the start, although I didn't think to associate it with it until I started to get bad pains in my legs. When I went off of it, both the shoulder pain and leg pain went away.
Shelli
Posted by shelliR on August 3, 2001, at 22:41:01
In reply to Re: stuff » shelliR, posted by Elizabeth on August 3, 2001, at 15:12:14
>
> I can see the utility of that. I think I've encountered other people who are co-conscious, like you are. Was there ever a time when you weren't co-conscious? Because I think that the only cases of this version of DDNOS that I've heard of have been the result of people achieving co-consciousness through therapy, so it could be considered "DID in partial remission."Once I knew I had kids inside, as each one let her presence be known, I was always co-conscious. This is also true for several other people I have met in the hospital or at a support group that I was part of for several years. So no, "DID in partial remisison" would not work for us. One of the hardest things for me was the awareness of a second child. I was so confused that I didn't even realize that it was a different child; I thought that the other one was just acting really different. So then when I realized, I was scared that I wouldn't know which child was talking to me. And that does happen, and sometimes I have to ask. Now it doesn't seem like a big deal, but then I was in a total panic about it. Also child one was not happy to share me, actually pretty scared that I might forget about her.
And I have a child who looked like the elephant man when I looked at her in my mind for the first time (I never really thought much about how they look--just normal) So when my therapist asked me and that's what I saw I totally flipped, I felt so awful and I dissociated this personality into two distinct personalities--it was very strange and I've been working with this child for a long time to get her to feel okay, since I totally screwed up.
Lorraine, perhaps you can identify in terms of embracing your eight year old.
> Good luck to you. I think that brief-acting drugs (opioids, stimulants) probably are best used with an antidepressant in the background, so to speak. I'm definitely doing much better on buprenorphine and desipramine than I was on buprenorphine alone or desipramine alone (I stopped the buprenorphine for a short time when I first started taking the DMI).
>Thanks. Today was a pretty good day and I didn't supplement the oxy. And the plan was always to have an AD in there also, because the AD I was stopping was prozac, I had a long waiting period. Monday is five weeks.
>
> Early 1960's, I would think. It's just the primary active metabolite of imipramine, the first TCA. I appear to be a "slow hydroxylator" (meaning, in particular, that I don't metabolise TCAs properly), which might explain why I never was able to tolerate other TCAs (amoxapine, nortriptyline) past 75 mg.
>
> Desipramine isn't a perfect success, but it does seem to be a suitable substitute for Parnate (with less hassle involved).
>
and it gives you more options for adjuncts. Have you ever tried buprenorphine in pill form , sub-what-ever?Later, Shelli
Posted by Lorraine on August 4, 2001, at 13:46:56
In reply to Re: jumping in » Lorraine, posted by Elizabeth on August 3, 2001, at 17:10:52
Hi elizabeth:
> > > I think I mentioned that I believe it's possible for ADD (or something similar) to manifest in adulthood, perhaps secondary to depression.I don't think it is important that it be an official diagnosis, only that the symptoms be treated.
> > > My suggestion: cherish your zeal and nurture it. It's precious.You're right.
> > >FWIW, when I tried Neurontin, the feeling reminded me of Xanax.
Well, it is anti-anxiety in its effect, although more gentle and less sudden in its effects. I hated Xanax--it made me feel very druggy, but then I was probably on the wrong dose and didn't know enough at the time to experiment with it.
[re MAOI withdrawal] > > > I've found that benzos work well; not sure about non-benzodiazepine anticonvulsants. Psychostimulants might help also.So that's the parachute then; Adderal, Neurontin and Ativan as needed. Good--it's nice to know the escape route.
> > > I realized, for one thing, that I learn better by reading rather than listening to lectures--so I was always the student buying supplemental text books if I didn't understand a professor.
>
> That's interesting. I learn better from lectures than from reading, I think. I wonder whether this difference has any broader significance.I think this ends up being an important piece of information. You might find yourself, then, taping lectures in difficult classes to relisten to whereas I'd buy another text book that approached the subject from a different angle.
> > > The serum level was over 600 this time, so I'm cutting the dose in half. The doctor who's covering for my pdoc is supposedly going to call me on Monday to discuss what to do next.What is the serum level supposed to be? Cutting it in half--isn't that drastic?
> > > The ECT next step sounds right to me--plus they have that monitor that you strap on that monitors your heart for 24 hours for irregularities.
>
> Okay, I'm confused now. What are you talking about here? (Sorry, I'm probably just being scatterbrained, as usual.)You had said that if your blood levels were high an ECT was the next logical step--I presume this is because TCAs have the heart related side effects. My husband had an abnormal heart beat (skipped a beat occassionally) and they strapped a device to him for 24 hours to see how the heart rate fluctuated over that period. It is a more complete test than an ECT because it spans more time. That was my thought.
> > >My SIL believes that people who are mentally ill are self indulgent and that they take drugs as "cosmetic mood brighteners".
>
> Oh jeez. That's just awful. I suppose she's never had a conversation with a homeless person before.
Who's she to make that kind of judgement?Yeah, but my task is to not allow her opinion on these things to get to me. It's a tough job.
>
> > > I've met a lot of people who have a hard time understanding or believing that I could ever have been very depressed, because when I'm not depressed I'm outgoing, inquisitive, etc.This is the problem with invisible chronic diseases. My SIL sees me and I'm fine. See doesn't see, nor would I allow her to see the down times. It's like energy management in a way. I can store it up for special occassions, like family visits, then I collapse afterward--as though my energy supply was depleted.
>
> About atenolol: my dad takes it (for cardiovascular disease), and he seems to be fine with it. I could ask him if he's noticed any side effects.Don't bother (although it is a nice suggestion). If it becomes necessary, I'll simply try it.
> > > 3d degree burns over 1/3 of my body (thighs and upper abdomine) when I was 8.
>
> My god. At least it's on parts that are usually covered by clothes. Still, I can see how that would cause you problems, especially with intimate relationships.When I was young, I thought I would never marry and so forth. I felt compelled to disclose my scars before I was intimate. Then I came into my own sexually and the boys didn't notice or make a big deal about it. The harder part was when I was a kid, changing for PE and so forth. We moved a lot (7 times in 5 years) so the anticipatory pain of making this "disclosure" was always with me.
>
> > >
> > > Really? What particular interests does [your husband] have?He majored in linguistics and went on to become an attorney. But his private time reading is always math and science. In high school, he thought he was headed for a career in math and science. Then he went to Harvard and found his "excellence" was mediocre in the new pool of peers. It's still part of his passion though. That and history.
>
> [re: mild sexual abuse elaboration}My father used to masturbate in front of me and take pictures of me in sexy nightgowns. Pretty strange--I was paralyzed, unable to move to leave the room (although I'm sure I could)--it was one of those "elephants" in the room that we ignored politely and then, of course, there was the issue of my complicity--but then I think there frequently is in these situations. That's why I refer to it as "mild" and it's also why it probably didn't have much impact on my own sexuality. Years later when my father was dying of lung cancer when I would visit him alone, he would tell me sexually lurid stories. It got to the point where I couldn't visit him alone and it was hard to visit him otherwise. My husband visited him nearly every day for me.
>
> > > My muscle strength (during workouts) varies remarkably depending on my meds.
>
> Huh. Which meds have had which effects in that regard?Well, for instance, the Propanolol made me weak, the Moclobemide gave me muscle cramps in my feet and legs, and the Parnate and Selegiline make me strong.
[re your headaches and Prozac]
Your headaches were not migraines (which are related to seizure activity)?> > > I had the misfortune to be off antidepressants completely for several months after Nardil pooped out the second time.
I had the stupidity to be off ADs for about a year trying SamE and so forth.
> > > Yeah, I know. By the way, do you have Jensen's book--I find it really useful.
>
> Jensen...which one is he? (No, I don't have his book.)Martin Jensen. His book is an informal self-published deal. He gets a lot of criticism for his approach which is basically to "trial" you through many meds very quickly and some people feel his treatment of the science behind mental illness is sloppy. But the book is great for a quick concise run down of the meds, there side effects, the probability of success with certain meds and so forth. You will be happy to note that he does include opiates. I refer to his book a lot as sort of a handbook for where I am because he lists the stimulants and so forth with worksheets as to what has been tried and the effects. His phone number (to order the book) is 949-363-2600.
> > > True. Amen identifies 6 types of ADD, but I think some of these are not ADD truly.
>
> Probably not. I perused his web site; neat stuff. I've been thinking about calling him up and asking if he can refer me to somebody closer to home who could interpret my SPECT scan.Yeah, I have read both of his books and looked at his website. What about his "ring of fire" ADD, don't you think that is something else?
> > >I guess one could say I failed the test. :)
I'm so sorry to hear this. So you are past the therapuetic dose range and still not in remission? If you have to back off, you could try adding an MAO, correct? Tough timing too with your pdoc being out of town. Did you guys formulate a game plan for this contingency before he left for vacation?
Lorraine
Posted by Lorraine on August 4, 2001, at 14:12:50
In reply to Re: jumping in Elizabeth, Lorriane, et.al., posted by shelliR on August 3, 2001, at 18:28:03
Hi Shelli, elizabeth et al:
> > > It's interesting, my sister just told me recently that my SIL thinks that I don't try hard enough to overcome my depression. ....Try harder? I don't even know what she could mean. It is amazing how ignorant people can be, although I find my SIL pretty ignorant and unkind anyway, so I chalk it off to that.
I think that some people know that they are better than you because you are "less than" them and they find things to support this view. Your achilles heel is ripe pickings. I do think the trick is to not internalize and obsess over this stuff. You sound fairly balanced about it. I have really tried to change her opinion by educating her--but nothing changes and there I am with a cup in my hand asking for her approval. Not a good dynamic and one I have to back off from. It's hard though because we used to be close. I used to refer to her as the sister I never had.
> > > [re: we are all so confused]
OK. I thought ECT was ECG that should help clear things up a bit. I knew that the risk side effect profile of TCAs was heart related and so I just misread ECT for ECG. elizabeth is the one considering ECT, not me, I have many roads to walk before I am there. Although, now that I get it, elizabeth don't you have augmentation strategies to consider with a reduced dose of Desipramine?>
> > > Did you go through lots of skin grafts or was there really not enough skin to take from anywhere? How long til your life got back to some type of stability after the fire?
My mom told me I could have skin grafts, I refused. I was 8 and in a lot of pain, I just wanted the pain to end. The alternative to skin grafts, by the way, is not pleasant--it involves wet soaking bandages and stripping them off along with dead (and, the painful part, not so dead) skin until the wound heals. I was back in school probably 8-10 weeks after the fire, but with bandages on. I was placed in a class for people who were handicapped, which didn't help me self-esteem. Then my family for unrelated reasons (and, no we were not in the military) started moving a lot (7 times in 5 years) so no stability, no community, no or few friends. It was a pretty rough 5 years and I did suffer a break down during that period.
> > > > BTW, in regard to back pain and meds, selegiline gave me back pain, really shoulder pain almost from the start, although I didn't think to associate it with it until I started to get bad pains in my legs. When I went off of it, both the shoulder pain and leg pain went away.
I think it's common. Day 5 Parnate. Still ok, not full mood support yet. Mild hyperventilation.
Lorraine
Posted by Lorraine on August 4, 2001, at 14:47:25
In reply to Re: stuff, posted by shelliR on August 3, 2001, at 22:41:01
> >
> > >One of the hardest things for me was the awareness of a second child. ...And I have a child who looked like the elephant man when I looked at her in my mind for the first time (I never really thought much about how they look--just normal) So when my therapist asked me and that's what I saw I totally flipped, I felt so awful and I dissociated this personality into two distinct personalities--it was very strange and I've been working with this child for a long time to get her to feel okay, since I totally screwed up.
>
> Lorraine, perhaps you can identify in terms of embracing your eight year old.Oh, yes, (Lorraine, here) this inner child of mine was so needy and clingy and weepy and weak and sad, I just couldn't stand it. It took me a long time before I realized that my job as the adult was to protect her and that I could do that and then just to open the pipeline and acknowledge that part of myself.
> > >the ADI was stopping was prozac, I had a long waiting period. Monday is five weeks.(L, here) Don't you just hate that? I could have killed my pdoc when I realized the wash out period for Prozac. They ought to tell you up front.
Posted by Elizabeth on August 4, 2001, at 15:33:57
In reply to Re: jumping in Elizabeth, Lorriane, et.al., posted by shelliR on August 3, 2001, at 18:28:03
> It's interesting, my sister just told me recently that my SIL thinks that I don't try hard enough to overcome my depression. This is actually fascinating to me.
"Fascinating" is not the word I'd use to describe it!
It sounds like your sister-in-law is a judgmental person in general. A lot of people are like that: they have strong opinions on subjects that they know nothing about.
> Elizabeth, what is would be affected by having too high a blood level. Could it affect your organs? Like liver damage, etc.?
The main risk is cardiotoxicity, actually. The heart has to be working like clockwork, and if it gets out of sync even a little bit, you can get major problems. An ECG would find any such problems, though.
I sort of feel sorry for the poor guy who's covering for my pdoc, having to deal with all this stuff!
I agree with you about ECT: I think that any medication is preferable to it. Even if you developed tolerance and had to keep increasing the dose, I would say that opioids are safer than ECT, except perhaps for people who have addictive tendencies. And even then, with proper monitoring I believe it can be done safely. (The first thing you become tolerant to is the respiratory depression, so increasing the dose to compensate for tolerance is safe -- you can't do this safely with some other types of drugs, such as barbiturates.)
> BTW, in regard to back pain and meds, selegiline gave me back pain, really shoulder pain almost from the start, although I didn't think to associate it with it until I started to get bad pains in my legs. When I went off of it, both the shoulder pain and leg pain went away.
I wonder about this sort of thing; do you think it might be related to the amphetamine metabolites of selegiline? (They're the l- enantiomers, and they have more peripheral and less central effect compared with d-amphetamine and d-methamphetamine (Dexedrine and Desoxyn).)
Buprenorphine does away with my back pain completely, and unlike other things I've tried (Valium, Soma, Ultram), it works reliably. It's also much less expensive than having a facet block every week would be. :-)
> Once I knew I had kids inside, as each one let her presence be known, I was always co-conscious.
Did you have periods of lost time before that?
> So no, "DID in partial remisison" would not work for us.
Damn. :-)
> Today was a pretty good day and I didn't supplement the oxy. And the plan was always to have an AD in there also, because the AD I was stopping was prozac, I had a long waiting period. Monday is five weeks.
Ahh. That's the main down side of Prozac, IMO: the long washout period. I definitely think that opioids are usually best used in combination with antidepressants rather than by themselves; short-acting drugs (such as opioids and stimulants) can be destabilising, and an AD can smooth things out.
> > Desipramine isn't a perfect success, but it does seem to be a suitable substitute for Parnate (with less hassle involved).
>
> and it gives you more options for adjuncts.Yes. I'm particularly interested in seeing whether psychostimulants would help me, since Cylert worked in the past and since I have ongoing attention problems.
> Have you ever tried buprenorphine in pill form , sub-what-ever?
Subutex and Temgesic are the brand names that I'm aware of. No, I've never tried getting medication from outside the U.S.
-elizabeth
Posted by Elizabeth on August 4, 2001, at 23:06:40
In reply to Re: jumping in » Elizabeth, posted by Lorraine on August 4, 2001, at 13:46:56
[re ADHD]
> I don't think it is important that it be an official diagnosis, only that the symptoms be treated.Yes; but in order for them to get treated, they generally must first be recognised! I don't think most pdocs would be willing to diagnose "adult-onset ADD," but they should be willing to consider the possibility that ADD-like symptoms associated with depression and/or anxiety might be treatable with the same medications that work for ADD (i.e., stimulants).
> > > >FWIW, when I tried Neurontin, the feeling reminded me of Xanax.
>
> Well, it is anti-anxiety in its effect, although more gentle and less sudden in its effects. I hated Xanax--it made me feel very druggy, but then I was probably on the wrong dose and didn't know enough at the time to experiment with it.That's too bad. I've found Xanax to be one of the more convenient benzos for my purposes: it works fast enough that I can use it to fend off a panic attack, and it's not too sedating or impairing for me, so I can take the high-end dose that I usually need (2 mg) without getting totally zonked.
> [re MAOI withdrawal]
> So that's the parachute then; Adderal, Neurontin and Ativan as needed. Good--it's nice to know the escape route.Heh. Yeah, I can see why stimulants would be effective, although I've never tried using them for that purpose myself.
> I think this ends up being an important piece of information. You might find yourself, then, taping lectures in difficult classes to relisten to whereas I'd buy another text book that approached the subject from a different angle.
I've tried taping lectures. It doesn't work for me. I just take copious notes and use the text as a reference rather than as my primary source of information.
> What is the serum level supposed to be? Cutting it in half--isn't that drastic?
Generally accepted therapeutic serum leves for desipramine range from about 125-300 ng/mL. Yes, cutting the dose in half is drastic, but the doctor covering for my pdoc wanted me to stop taking it altogether (to which I said "no way!").
> You had said that if your blood levels were high an ECT was the next logical step
No, I said *ECG*, not ECT! An electrocardiogram, to determine if the high desipramine levels are causing cardiotoxicity.
> This is the problem with invisible chronic diseases. My SIL sees me and I'm fine. See doesn't see, nor would I allow her to see the down times.
Heh. I'm like that: if I'm depressed, I just disappear. I don't find attention or "support" to be useful when I'm depressed (unless it's something concrete like making sure that I don't get dehydrated), so what's the point of seeking people out?
> It's like energy management in a way. I can store it up for special occassions, like family visits, then I collapse afterward--as though my energy supply was depleted.
I do a very poor job of faking it when I try to.
> When I was young, I thought I would never marry and so forth.
I had similarly fatalistic ideas when I was a child; like, I was convinced I wouldn't live past 30.
> He majored in linguistics and went on to become an attorney. But his private time reading is always math and science. In high school, he thought he was headed for a career in math and science. Then he went to Harvard and found his "excellence" was mediocre in the new pool of peers. It's still part of his passion though. That and history.
Harvard, huh? That's kind of funny to me because I've found most Harvard undergrads to be of pretty mediocre intelligence. (Although my dad and my brother went there, so I guess they aren't all bad. :-) ) I took a few science courses there when I decided to go pre-med after I'd already graduated (in case it's not obvious by now, I went to MIT < g >), and I found them really trivial compared to the science and engineering classes I'd taken as an undergrad (even the introductory-level ones).
So, what kind of law does your husband practise? I think it's always useful to have a lawyer as a relative or friend. Plus, I've always found the lawyers I've met to be interesting people to talk to.
> My father used to masturbate in front of me and take pictures of me in sexy nightgowns. Pretty strange--I was paralyzed, unable to move to leave the room (although I'm sure I could)--it was one of those "elephants" in the room that we ignored politely and then, of course, there was the issue of my complicity--but then I think there frequently is in these situations. That's why I refer to it as "mild" and it's also why it probably didn't have much impact on my own sexuality. Years later when my father was dying of lung cancer when I would visit him alone, he would tell me sexually lurid stories. It got to the point where I couldn't visit him alone and it was hard to visit him otherwise. My husband visited him nearly every day for me.
That sounds pretty bad to me; I mean, it could have been worse, but being exposed to that kind of stuff as a child -- it can't be good for you. Did you experience any sort of closure when he died? That must have been hard; I would think that you'd have really mixed emotions about it.
> Well, for instance, the Propanolol made me weak, the Moclobemide gave me muscle cramps in my feet and legs, and the Parnate and Selegiline make me strong.
Propranolol doesn't exert its effects directly on the skeletal muscles: it decreases cardiac output, so your tissues don't get as much oxygen. It's understandable why you'd feel "stronger" on stimulant-like drugs (Parnate and selegiline). The muscle cramps from moclobemide puzzle me, though.
> [re your headaches and Prozac]
> Your headaches were not migraines (which are related to seizure activity)?No, they weren't migraines. That was the only time in my life that I've ever had headaches frequently.
> I had the stupidity to be off ADs for about a year trying SamE and so forth.
Some of that stuff is actually worth trying. Don't kick yourself for doing it. What else did you try besides SamE?
> Martin Jensen. His book is an informal self-published deal. He gets a lot of criticism for his approach which is basically to "trial" you through many meds very quickly and some people feel his treatment of the science behind mental illness is sloppy. But the book is great for a quick concise run down of the meds, there side effects, the probability of success with certain meds and so forth. You will be happy to note that he does include opiates. I refer to his book a lot as sort of a handbook for where I am because he lists the stimulants and so forth with worksheets as to what has been tried and the effects. His phone number (to order the book) is 949-363-2600.
You're right, it does sound pretty unscientific: some meds work quickly (like within 3 hours after taking them), some take a few days to work, and some can take weeks. You can't generalise about how
On the other hand, with all the antidepressants that have worked for me, I've at least noticed something within two weeks, although it may have taken longer to realise the full therapeutic effect. So I think there is something to the idea of brief trials.
> I'm so sorry to hear this. So you are past the therapuetic dose range and still not in remission?
Oh no, it's definitely working -- didn't I mention that? I just hope that it will still work at the lower dose that I'm taking now!
> Tough timing too with your pdoc being out of town. Did you guys formulate a game plan for this contingency before he left for vacation?
Nope. Neither of us really thought it was likely that there'd be a problem like this; we just thought that it would be a good idea to check the serum level because of some past experiences I've had with medications that suggested I might be deficient in the relevant enzyme.
-elizabeth
Posted by Lorraine on August 5, 2001, at 10:51:57
In reply to Re: jumping in - Shelli, Lorriane, et.al., posted by Elizabeth on August 4, 2001, at 15:33:57
> > > The main risk is cardiotoxicity, actually. The heart has to be working like clockwork, and if it gets out of sync even a little bit, you can get major problems. An ECG would find any such problems, though.
L: I would think this would be the next step--an ECG:-). Is it deja vu or temporal lobe epilepsy< g >?
> > > I agree with you about ECT: I think that any medication is preferable to it.L: ECT is on my list--it's just down quite a ways. I have a hard time separating truth from fluff with it. You know, the posters who go on and on about the evils of Effexor, for instance. Well, I was on Effexor and I know about its "evils" (and it's therapeutic benefits) and so I can put what they are saying into perspective and know what's true and not true about what they are saying. With ECT you have the medical profession saying one thing and some patients saying another. I suspect this is a group of "outliers" (not people who lie, but people who fall outside the normal statistical range of response), but I don't know. One person wrote about how her memory loss resulted in her forgetting the years following her children's birth until the procedure. That scared me senseless.
> > BTW, in regard to back pain and meds, selegiline gave me back pain, really shoulder pain almost from the start, although I didn't think to associate it with it until I started to get bad pains in my legs. When I went off of it, both the shoulder pain and leg pain went away.
L: That's my experience with it--especially as I tried to increase my dose of selegiline above 2.5 mg 2x day.
> > >I wonder about this sort of thing; do you think it might be related to the amphetamine metabolites of selegiline?
L: Perhaps but Adderal doesn't do this to me.
>
> Buprenorphine does away with my back pain completely, and unlike other things I've tried (Valium, Soma, Ultram), it works reliably. It's also much less expensive than having a facet block every week would be. :-)L: elizabeth, what is your "mechanical" situation with your back. My chiro did an Xray and all of that and said T5? (lower lumber) was injured.
things out.
> > > Desipramine isn't a perfect success, but it does seem to be a suitable substitute for Parnate (with less hassle involved).L: elizabeth, what do you mean "less hassle"--the dietary restrictions? I ate cheese last night and the night before (feta and mozallera) and was fine. I also drank an import beer (Heineken) throwing caution to the wind. I was fine, although I realize that I am not up to a therapeutic dose and this "fine" may change as I up my dose. I also slept well yesterday--although I am really being particular about sleep hygiene. (Same time to bed each night, when I wake up in the middle of the night not brushing my teeth (as i like to do), practicing techniques to throw my brain waves out of "beta", lying there).
> > > Yes. I'm particularly interested in seeing whether psychostimulants would help me, since Cylert worked in the past and since I have ongoing attention problems.L: elizabeth, have you tried Provigal? Just curious.
> > > No, I've never tried getting medication from outside the U.S.
L: I don't know about your "class" of drugs and customs, but importing Moclobemide with an RX was really not a hassel and the way that you are having to take your opiates sounds like a big deal to me.
Lorraine
Posted by Lorraine on August 5, 2001, at 11:57:54
In reply to Re: jumping in » Lorraine, posted by Elizabeth on August 4, 2001, at 23:06:40
> > >[re treatment of ADD like symptoms in depression]
L: language can actually get in the way here. The concept of cognitive impairment is pretty widely recognized in depression, whereas ADD becomes like a hurdle you have to jump over to get the meds.
> > > [re MAOI withdrawal]
> > So that's the parachute then; Adderal, Neurontin and Ativan as needed.
> I can see why stimulants would be effective, although I've never tried using them for that purpose myself.L: I guess it's why my pdoc considers MAOs to be stimulants when he says my QEEG profile calls for stimulants and anti-convulsants.
> I've tried taping lectures. It doesn't work for me. I just take copious notes and use the text as a reference rather than as my primary source of information.L: See, now, you are tapping into a third method of learning which is by writing. That always worked for me--consolidating my notes into an outline and then consolidating that outline down further. By the way, have you heard of the Cornell system of taking notes? (When your child has a learning disability you end up teaching these skills explicitely).
> > >Yes, cutting the dose in half is drastic, but the doctor covering for my pdoc wanted me to stop taking it altogether (to which I said "no way!").L: elizabeth, you might want to read Preskorn's columns on therapeutic dose monitoring, toxicity and individual patient variation. I thought they were great. Perhaps you can glean something about your particular response history that is useful.
http://www.preskorn.com/columns/9605.html
http://www.preskorn.com/columns/9603.html
http://www.preskorn.com/columns/9611.html> > >You had said that if your blood levels were high an ECT was the next logical step
>
> No, I said *ECG*, not ECT!
L: I had a real laugh when I recognized what was behind this misunderstanding.
> > >if I'm depressed, I just disappear.L: I just disappear from others and from myself--I feel myself slip away. When a new drug works for a day or so I say to my husband, "I'm back!"
> > > Harvard, huh?L: He hated his experience at Harvard, yet wants my daughter to go there. At the 25 union, (which is a lot of fun there) he made it a pilgrimage of healing--so everyone that he talked with for any length of time, he would say how awful his experience at Harvard was, how alone he felt, how outclassed he felt. (Don't get me wrong, my husband is not a whiner or a guy with low self-esteem.) Anyway, it was wonderful because people started opening up on a different level. Most people said "that's exactly how I felt!" All in all a very healing experience for him.
>
> So, what kind of law does your husband practise?L: Same law I used to practice--corporate law for entertainment clients. The problem is that everyone finds it "useful" to have a friend that knows law. I find myself spending a fair amount of time "fending" people off because the balance in the relationship becomes lopsided--unless the other person is a doctor or accountant, they usually cannot give back on a comparable basis. And then people start asking you not just about their legal problems, but their friends legal problems. So (since I'm a bit co-dependent and an "over-giver generally) what I do is "help" people but not do the work for them. Like I will sit side-by-side with my friend and help her write the letter to her landlord or employer.
> > > Did you experience any sort of closure when he died? That must have been hard; I would think that you'd have really mixed emotions about it.L: Mixed emotions is right and no real closure. I did grieve his death though. Maybe you grieve for the lost opportunity or for the father you never had. I came to view him as a "sick pup". I did have closure though with my mom, which was great. This happened when I told her about the abuse and she started to explore her own abuse in childhood for the first time. She also came to recognize the emotional abuse that my father had given her. She had this dream that my father was perfect (this was our family fallacy really) and that her love for him was perfect and that if he didn't love her back as much as she wanted, then there was something lacking in her. So her own growth has been astounding to watch. It has brought us very close together.
> > > Well, for instance, the Propanolol made me weak, the Moclobemide gave me muscle cramps in my feet and legs, and the Parnate and Selegiline make me strong.
>
> Propranolol doesn't exert its effects directly on the skeletal muscles: it decreases cardiac output, so your tissues don't get as much oxygen. It's understandable why you'd feel "stronger" on stimulant-like drugs (Parnate and selegiline). The muscle cramps from moclobemide puzzle me, though.L: elizabeth, noone talks about all of the effects of these drugs, but I've found that if I suspend my disbelief and simply chart how the drugs effect me, there are real differences in these areas that aren't "supposed" to be there. My trainer notes these as well. Muscle cramps with Moclobemide are similar to back aches with selegiline. It's just an increase in muscle tone.
> > > I had the stupidity to be off ADs for about a year trying SamE and so forth.
>
> Some of that stuff is actually worth trying. Don't kick yourself for doing it. What else did you try besides SamE?L: All of the neurotransmitter precursors. And although brain blood barrier is supposed to preclude many of these from having an effect--well again I found that if I was willing to suspend my disbelief, there were real effects caused by these neurotransmitters. For instance, tyrosine was a real activating drug for me--and I couldn't take it because it increased my hyperventilation and my edginess. HTP 5 was sedating to me. Phenylalamine created a sense of pressure or urgency that was intolerable to me. GABA is in fact sedating--I use it with my son when he cannot sleep and in a pinch I use it myself.
>
> > > Martin Jensen. >
> You're right, it does sound pretty unscientific: some meds work quickly (like within 3 hours after taking them), some take a few days to work, and some can take weeks.L: I don't use Jensen for his theories. His book has great checklists and has a lot of useful charts and so forth that don't reflect his theories. I will say though that testing stimulants, benzos and anti-convulsants in rapid succession to determine which one is right for you makes sense.
> > >we just thought that it would be a good idea to check the serum level because of some past experiences I've had with medications that suggested I might be deficient in the relevant enzyme.L: You might read the articles noted above on this issue.
Lorraine
Posted by Lorraine on August 6, 2001, at 10:02:37
In reply to Re: jumping in, posted by Lorraine on August 5, 2001, at 11:57:54
Shelli: I'm concerned about you. How are you doing? Where are you with your meds?
Posted by shelliR on August 6, 2001, at 10:58:35
In reply to Re: jumping in Shelli, posted by Lorraine on August 6, 2001, at 10:02:37
> Shelli: I'm concerned about you. How are you doing? Where are you with your meds?
Hi Lorraine.
The last few days have been really hard. I have an appointment to see my pdoc today and unless he has a better idea, I'll start parnate. I increased the oxycontin to get through the last few days. My therapist, who is totally against opiate use (and valium for that matter), has told me that she would only work with me if I did not self-medicate and I had agreed to that. Of course my pdoc did not return my call to see if it was okay to increase it until the parnate set in, so I was left with a choice of signing myself into the hospital (again) or taking more oxy. I choose to increase the dose, so I could continue to work. I have vacation plans for the first week in September and have much to do before I leave. Also, I've had my fill of hospitals; they used to feel helpful for me to go in for 5 days to stablilize, but the last two times have been overstimulating for me *and* I felt trapped.
The last time, the only positive was that I was hooked up to this doctor who prescribed the oxy for me instead of me taking vicodin on my own. I remain convinced that a possible *addiction* (habituation) to codone/contin is better than the other options.
Anyway, after talking to my therapist re phone over the weekend, I told her I cannot maintain my commitment until parnate or whatever kicks in. And so,unless my pdoc says today that I can increase-- prn, my therapist will terminate with me. She wants me to come in, but she is so clear about this that I don't see the point of getting myself all crazy so she can feel that we've terminated properly.
Anyway, I see my pdoc at 2 est, then therapy is scheduled at 3, and I will go or not depending on what he says.
I feel this morning that I have gotten a lot out of our work together, and that I don't lose what I've gotten if we terminate. I have been feeling this year anyway, that we are not getting much therapy work done, because it is hard to work on issues when I am this depressed. But I wouldn't choose to terminate at this time, so I am feeling very anxious. Also, I'm sure I can go back to her if I decide at some point that I can keep the agreement, it's just that she will have given away my times ( 2x), and one of the times is a double session.So that's been what's going on; thanks for asking, but really, try not to be concerned. I am feeling fairly optimistic about parnate. I am also trying to get my next option in line; I will also be asking my pdoc if there is anything else I could try for sleep with the nardil. I think if I could raise my dose of nardil and continue the oxycontin, that might possibly work well enough for me, or dropping the oxycontin and adding concerta. (concerta and oxy were too much for me; both act as stimulents for me).
Meanwhile I am filling my work commitments which is extremely important to me. The summer is pretty loose on deadlines, but vacations will be ending at the end of August, so I need to get ready my deliverables.
I am nervous how I will get everything in with my pdoc in his allowable eight minutes. :-)
I have written everything down that we need to discuss.I'll let you know what happens either tonight or tomorrow.
Are you feelings any anti-depressants effects from the parnate, or *just* no side effects?
Shelli
Posted by Elizabeth on August 6, 2001, at 11:49:02
In reply to Re: jumping in - Shelli, Lorriane, et.al., posted by Lorraine on August 5, 2001, at 10:51:57
> You know, the posters who go on and on about the evils of Effexor, for instance. Well, I was on Effexor and I know about its "evils" (and it's therapeutic benefits) and so I can put what they are saying into perspective and know what's true and not true about what they are saying.
Heh. I had a very extreme reaction to Effexor, but I don't go around preaching about what an evil drug it is because I know that my reaction was unusual and that Effexor helps a lot of people (and besides, I don't generally apply moral judgments to inanimate objects anyway :-) ).
> With ECT you have the medical profession saying one thing and some patients saying another.
Yes. Of course, the people who feel that it caused problems for them are going to be the most vocal ones -- not the people who were helped. I've seen people respond to ECT, and it can be miraculous; also, I've never met anyone other than on the internet who claimed to have had any serious memory loss, personality change, etc. due to ECT. I don't place too much stock in internet rumors. There are a lot of people out there (not just on the net, of course, but they tend to be especially vocal on the net) who are hypochondriacal about side effects and who tend to attribute symptoms to ECT or medication regardless of the likelihood of a cause-effect relationship.
At the same time, it would take some real convincing (not just appeals to authority) to make me feel comfortable with the idea of having ECT. Anyway, there doesn't seem to be much reason why I should be considering it: it's not like I don't respond to medications or something.
> > > >I wonder about this sort of thing; do you think it might be related to the amphetamine metabolites of selegiline?
>
> L: Perhaps but Adderal doesn't do this to me.Adderall isn't just d,l-amphetamine; it's a mixture of various amphetamine salt isomers. The logic behind this mix is a mystery to me, but Adderall does seem to have some significant advantages over other stimulants.
The amphetamine metabolites of selegiline are levo- isomers, which tend to have more pronounced peripheral effects than d-amphetamine and d-methamphetamine relative to central effects (that is, they have more side effects relative to desired effects).
> elizabeth, what is your "mechanical" situation with your back. My chiro did an Xray and all of that and said T5? (lower lumber) was injured.
"Thoracic facet syndrome." (I don't fully understand the anatomy behind it.) I don't think it's an injury, but a congenital anomaly. The facet joints are located in between the vertabrae; in my case, the inflamed joints are the ones in between the vertabrae designated T8-T9 and T9-T10 (i.e., the lower thoracic vertabrae). A facet block is used as a diagnostic tool; they inject a local anaesthetic, followed by a corticosteroid, into the suspected problem joint(s). When I had one, the back pain disappeared for a full week (this was when it had been at its worst, which was what prompted me to go see a doctor about it).
A lot of my back pain is referred; it affects large areas of my back. Of interest, it is almost always limited to only one side ef my back (left or right). This reminds me of migraine headaches, and I wonder if there is a relationship (several blood relatives of mine have migraines).
> elizabeth, what do you mean "less hassle"--the dietary restrictions?
That's not as much of a problem for me as the limitations on medications that can be added to the MAOI. In particular, I'd like to give psychostimulants another try.
> I ate cheese last night and the night before (feta and mozallera) and was fine.
Mozzarella isn't a problem usually; feta is something you should probably avoid.
> I also drank an import beer (Heineken) throwing caution to the wind.
The imported beers that have been associated with problems are much more obscure ones. I think Heineken is probably fine; what you really want to be careful about is tap beer (of any kind).
> elizabeth, have you tried Provigal? Just curious.
I tried Provigil while I was on Parnate. 150 mg/day didn't seem to do a thing, but 200 made me jittery (shaking, exaggerated startle response, racing thoughts, etc.). Like I said: I want to give stimulants another try.
> LI don't know about your "class" of drugs and customs, but importing Moclobemide with an RX was really not a hassel and the way that you are having to take your opiates sounds like a big deal to me.
It's not that big a deal. If I really wanted to, my pdoc would probably be willing to try switching to something that comes in a pill (MS Contin, OxyContin) or patch (Duragesic). Buprenorphine is kind of expensive, and my insurance wouldn't cover drugs ordered from outside the U.S.
On to your other post....
> I guess it's why my pdoc considers MAOs to be stimulants when he says my QEEG profile calls for stimulants and anti-convulsants.
MAOIs behave a lot like stimulants, yes.
> See, now, you are tapping into a third method of learning which is by writing.
I know; taking notes reinforces the learning from looking and listening.
> elizabeth, you might want to read Preskorn's columns on therapeutic dose monitoring, toxicity and individual patient variation.
I'm familiar with this stuff, but it doesn't provide the information I'm really interested in (specifically, what the relationship between dose and serum level is in normal vs. slow metabolisers).
> He hated his experience at Harvard, yet wants my daughter to go there.
Uhh...that's a little weird.
> Same law I used to practice--corporate law for entertainment clients. The problem is that everyone finds it "useful" to have a friend that knows law.
Sure. But people shouldn't expect their lawyer friends to provide free services (well, except maybe if they're a really close relative -- parent, child, spouse). It's just helpful to be able to talk to someone and get an idea of what you need to do in a situation where the law is involved. Similarly, if you have a friend who's a doctor, that can be helpful in terms of getting referrals or advice as to what you should be doing.
> I did have closure though with my mom, which was great. This happened when I told her about the abuse and she started to explore her own abuse in childhood for the first time.
This seems to be common -- women who were abused as children marrying abusive men. Somewhere, the cycle has to stop. You seem to be be the one who's stopped it.
> elizabeth, no one talks about all of the effects of these drugs, but I've found that if I suspend my disbelief and simply chart how the drugs effect me, there are real differences in these areas that aren't "supposed" to be there.
It's not a question of what they're "supposed" to do and what they aren't; rather, we don't really know about all the actions of these drugs, and a lot of them probably have actions that we don't know about at all.
> All of the neurotransmitter precursors. And although brain blood barrier is supposed to preclude many of these from having an effect--well again I found that if I was willing to suspend my disbelief, there were real effects caused by these neurotransmitters.
It's not just the blood-brain barrier (which can be subject to individual variation); there are also things like first-pass metabolism.
> HTP 5 was sedating to me.
Err...you mean 5-HTP, right? < g >
-elizabeth
Posted by Lorraine on August 6, 2001, at 12:10:22
In reply to Re: jumping in » Lorraine, posted by Elizabeth on August 3, 2001, at 17:10:52
Elizabeth:
Here's a study on the effectiveness of SSRIs on headaches. Thought you'd be interested given your Prozac experience:
SSRIs Nearly as Effective as Tricyclics for Chronic Headache
--------------------------------------------------------------------------------WESTPORT, CT (Reuters Health) Aug 01 - Although more studies show the effectiveness of tricyclic antidepressants in treating chronic headache, selective serotonin reuptake inhibitors (SSRIs) may be as effective while offering a safer side-effect profile, according to results of a meta-analysis.
In a search of literature going back to 1966, Dr. Jeffrey L. Jackson from the Uniformed Services University of the Health Sciences in Bethesda, Maryland and his associates identified 38 randomized, placebo-controlled trials of antidepressants used as prophylaxis for chronic headache. Nineteen study arms investigated tricyclic antidepressants, 18 studied serotonin-blocking agents, and seven studied SSRIs.
Treated patients were twice as likely to improve compared with those given placebo, the investigators report in the July issue of the American Journal of Medicine. Those treated with antidepressants also used less analgesic medication. Results were unaffected by class of antidepressant or whether headaches were migraine or tension type.
"What was interesting [was] that SSRIs seemed about as effective as tricyclics, although they are not effective for other neuropathies," Dr. Jackson told Reuters Health.
Because there are fewer studies involving SSRIs, the data are not as robust as those for tricyclics, he said. His inclination remains to prescribe tricyclics for patients with chronic headaches, he said, "because I know how effective they are."
However, for patients where the anticholinergic effects of tricyclics would be a concern, Dr. Jackson would definitely recommend an SSRI.
Posted by Lorraine on August 6, 2001, at 18:54:02
In reply to Re: jumping in Shelli » Lorraine, posted by shelliR on August 6, 2001, at 10:58:35
Shelli: It's good to hear from you.
> > >The last few days have been really hard. I have an appointment to see my pdoc today and unless he has a better idea, I'll start parnate.
Parnate is definately providing a floor for me and some stability and I feel I can rely upon my mood. That is a very big deal for me. The downside is I am still doing some hyperventilating--though better than before. And I am having trouble sleeping at night. So I need to figure out what to do here. I also think I need to increase my Parnate a tad, but am reluctant to do so until the hyperventilating thing is under control. I get mid afternoon slumps--where I feel very sleepy.
> > > I increased the oxycontin to get through the last few days. My therapist, who is totally against opiate use (and valium for that matter), has told me that she would only work with me if I did not self-medicate and I had agreed to that. Of course my pdoc did not return my call to see if it was okay to increase it until the parnate set in, so I was left with a choice of signing myself into the hospital (again) or taking more oxy. I choose to increase the dose, so I could continue to work.
Why is she so distrusting of you? This on again off again thing would drive me nuts. And she just seems inflexible about it....
> > >but the last two times have been overstimulating for me *and* I felt trapped.
That's generally how I feel about hospitals.
> > >I remain convinced that a possible *addiction* (habituation) to codone/contin is better than the other options.
Yikes. That's a tough spot to stand in. What are your other options--MAO and sleep medication of some sort?
> Anyway, I see my pdoc at 2 est, then therapy is scheduled at 3, and I will go or not depending on what he says.Well, of course, I dieing to know what he said.
> I feel this morning that I have gotten a lot out of our work together, and that I don't lose what I've gotten if we terminate.This is a positive way of looking at it.
> > > I have been feeling this year anyway, that we are not getting much therapy work done, because it is hard to work on issues when I am this depressed.
I know, it's not very fruitful when you are sitting there saying "my meds aren't working".
> > >But I wouldn't choose to terminate at this time, so I am feeling very anxious. Also, I'm sure I can go back to her if I decide at some point that I can keep the agreement, it's just that she will have given away my times ( 2x), and one of the times is a double session.
Maybe you should move on to a therapist who doesn't put you through this stuff. I really don't like the feel of it.
>
> I am feeling fairly optimistic about parnate. As you should be. For me, the biggest issue seems to be sleep.> > > Meanwhile I am filling my work commitments which is extremely important to me. The summer is pretty loose on deadlines, but vacations will be ending at the end of August, so I need to get ready my deliverables.
It's great that you can pull yourself together to accomplish this much when your mood is not where you would like it.
>
> I am nervous how I will get everything in with my pdoc in his allowable eight minutes. :-)
> I have written everything down that we need to discuss.This too would drive me nuts. These guys are making you feel like you are lucky to get an inch of them. Plus, I'd probably go blank when I entered the door. Good luck.
>
> I'll let you know what happens either tonight or tomorrow.
>
> Are you feelings any anti-depressants effects from the parnate, or *just* no side effects?The AD effects are strong. There are side effects--mainly sleep related.
Lorraine
Posted by shelliR on August 6, 2001, at 20:35:14
In reply to Re: jumping in » Elizabeth, posted by Lorraine on August 6, 2001, at 12:10:22
Hi Guys,
Tomorrow will be my first day on Parnate. I think I'll take 5mg in the morning and hope for the best.
In the meantime, my pdoc gave me the okay to up my oxycontin (10mg bid to 10mg bid + 10mg prn).
And he changed my klonopin to valium.
How can you give up a doctor like this who doesn't freak out about either valium or oxycontin, just doesn't
return phone calls? I can't. And it's not like he has a rep as a crazy man or anything. Brillant but not dependable--
that's his rap sheet.
I really haven't seen any brillance, just more openness to options. And he won't give me valium for panic attacks
and klonopin for sleep. (Just wants to stick to one--"choose", he says), so he does have some limits on what he willl
prescribe.
My therapist said on the phone over the weekend that I was exhibiting addictive behavior; I replied that
I was exhibiting the behavior of someone horribly depressed who is trying to stay alive and *really* doesn't
want to go into the hospital *again*.
I asked my pdoc about a switch to buprenorphine instead of oxycontin because of the less addictive possibility, but
he didn't think it was worth it. (See I was trying to show my non-addictive behavior. :-) )So I am still with my therapist (she didn't really believe he'd add more oxy as a prn), and we've agreed not to talk
about medication. (although she dutifully records what I am taking in her notes). It's sort of not the best situation, but I really wanted to work out attachment issues with her--not
just switch therapists again and move the attachment to someone else like I always do. Then after attachment, work
on intimate relationship issues. Anyway, until my meds are stabilized I won't switch, but if I could find an MSW who was also a body worker (so she would be covered by my insurance), I might consider switching
therapists at some point. It's hard; she so good for me in some areas of my life and I've already exposed
all my shame with her, so I don't want to start over. (but if I've really worked out my shame issues with her why does it seem so scary to bring them up with someone else?)But I do feel a lack of respect for me eminating
because of the codone/contin and have felt it before regarding several things I've done that she strongly disagrees with. (and
they are not things that any of my friends disagreed with, or even my doc of ten years asked me why do I care what she thinks about .....) So I have to go around finding a lot of outside support over things she is judges me about. Actually it's hard for
me to remember at this moment that I generally really like her.So all in all, I'm pleased that I'm starting parnate tomorrow, and I'm pleased that I have flexiblity around the oxycontin.
Hope you both (all --if there are any lurkers) are doing okay.
And I wondering, Elizabeth if you've gotten any information that is helpful to you re serum levels.
Have you felt anything different yet, since halving your dose? (i.e., not as well?)Thanks for letting me write a book here; btw, haven't you guys ever heard of a library. Lorriane, you could get The Magic Daugher from the library, *then* if you like it, buy it.
Tomorrow: Parnate
The First Chapter
by Shelli Anon
Posted by shelliR on August 6, 2001, at 21:24:50
In reply to Re: jumping in Shelli » shelliR, posted by Lorraine on August 6, 2001, at 18:54:02
Lorraine, I hadn't read your post before I sent mine off.
>
>
> Parnate is definately providing a floor for me and some stability and I feel I can rely upon my mood. That is a very big deal for me. The downside is I am still doing some hyperventilating--though better than before. And I am having trouble sleeping at night. So I need to figure out what to do here. I also think I need to increase my Parnate a tad, but am reluctant to do so until the hyperventilating thing is under control. I get mid afternoon slumps--where I feel very sleepy.I had that problem with nardil and sleep also. Afternoon sleepiness and horrible difficulty staying asleep at night. That never got any better for me so I had to stay on a relatively low dose of nardil. I am taking both atarax and klonopin hs, but that wasn't enough if I went above 45mg which is just a normal dose. So probably I will have to face that with parnate also.
What is your pdoc suggesting, as far as the sleep problem?
>
> > > > I increased the oxycontin to get through the last few days. My therapist, who is totally against opiate use (and valium for that matter), has told me that she would only work with me if I did not self-medicate and I had agreed to that. Of course my pdoc did not return my call to see if it was okay to increase it until the parnate set in, so I was left with a choice of signing myself into the hospital (again) or taking more oxy. I choose to increase the dose, so I could continue to work.
>
> Why is she so distrusting of you? This on again off again thing would drive me nuts. And she just seems inflexible about it....
because she thinks I'm going to end up a drug addict. She's been saying this for the past three years.> > > >but the last two times have been overstimulating for me *and* I felt trapped.
> That's generally how I feel about hospitals.Sometimes they've really helped me get through wash out periods and also times when the stress in my life was to great for me to handle and I had to I guess be "taken care of" in the sense that I didn't have to work, or explain why I wasn't working, or remember to eat, etc. Of course, a cruise might have also done the trick and I might have considered that if my insurance paid for cruises :-)
>
> > > >I remain convinced that a possible *addiction* (habituation) to codone/contin is better than the other options.
>
> Yikes. (see that's how my therapist feels :-)) That's a tough spot to stand in. What are your other options--MAO and sleep medication of some sort?
well the parnate is being added to the oxycontin; so parnate doesn't have to carry the whole weight, nor will oxycontin.
> > Anyway, I see my pdoc at 2 est, then therapy is scheduled at 3, and I will go or not depending on what he says.
> Well, of course, I dieing to know what he said.
now you know :-)
>
>
> Maybe you should move on to a therapist who doesn't put you through this stuff. I really don't like the feel of it.
I have ambivelent feelings. She is the smartest therapist I've ever had which is really important to me. She is able to teach me things about relating which make my life easier. She keeps me very focused, which is also important to me. She has a lot of experience with dissociative disorders, although my inside kids are not close to her, like my last therapist: that's a long story. She is very into EMDR, which hasn't helped me very much in my work with her, but sometimes I guess it's been good. She is wonderful on the phone with me when I am in crisis; never gets upset that I called and has a pager so she calls right back if she is in town. So those are her positives. With many of my past therapists it was frustrating for me to be quicker than they were, and just smarter in a certain type of way. I don't have that problem with her. My past therapists were also much more nuturing, but I don't think that is a priority for me now.Her negatives are that she is always believes she is right, and once she takes a stand, she won't back down. I believe that sometimes she goes as far as to distort reality to "be right" and that is upsetting. But then I think every therapist has blind spots and I am always easily able to find them. I was quite amazed that the medical director of the unit I go on in the hospital, was able to convince her that it is not necessarily a bad thing to try opiates for depression with me, and that my pdoc is brillant if not orthodox. So then she accepted the oxycontin, but only if I strictly followed what was prescribed for me. So when I added some this past week, that's when the controvery resurfaced. I did break my commitment, but I would do it again. I really have to say that she has helped me in ways that other therapists have not been able to.
> >
> > I am feeling fairly optimistic about parnate. As you should be. For me, the biggest issue seems to be sleep.
We can work on that one together!
>>
> >
> > I am nervous how I will get everything in with my pdoc in his allowable eight minutes. :-)
> > I have written everything down that we need to discuss. >
> This too would drive me nuts. These guys are making you feel like you are lucky to get an inch of them. Plus, I'd probably go blank when I entered the door. Good luck.I walked in and said: " I have a lot of stuff. Can I have my full fifteen minutes?" So we did quickly go over everything: valium instead of klonpin: yes. Increase oxycontin: yes Try buprenorphine instead of oxy? No. See you Thursday.
> >
> > I
> The AD effects are strong.
That's amazing --you've been taking it less than a week now? I'm not anticipating that for me, although I have heard that parnate takes effect faster than nardil. But a week vs five weeks?There are side effects--mainly sleep related.
We'll work on those.
>
>
Shelli
Posted by shelliR on August 6, 2001, at 22:45:47
In reply to Re: jumping in - Shelli, Lorriane, et.al., posted by Elizabeth on August 4, 2001, at 15:33:57
> > It's interesting, my sister just told me recently that my SIL thinks that I don't try hard enough to overcome my depression. This is actually fascinating to me.
> "Fascinating" is not the word I'd use to describe it!
Well, I see it that way because I am so detached from it. When I stopped talking to my SIL it really drove her crazy; it still does. She'll call my mother and tell her that I didn't say hello, etc. But she has never said to me, "hey what's going on?" or "what don't you acknowlege me?" so it gives me a lot of power in the relationship. Although when I stopped talking to her it didn't have to do with power, more with self-preservation. But with such a judmental person, power is not a bad thing to have.> > Once I knew I had kids inside, as each one let her presence be known, I was always co-conscious.
> Did you have periods of lost time before that?
No I only lost time once for a few minutes and it was funny that I did the typical thing all people with DID do; I tried to catch on about what my friend was talking about and figure out how long I "left", in other words tried to figure it all out and not miss a step so that she wouldn't know. The funny thing is that she would not have cared; it was just impulse on my part to "be normal." Nothing precipitated it that I could figure out, but it was different from anything else that I had ever experienced, or have ever experienced since.Much different from when I am very floating, or sort of space in and out of things without missing anything. (well, anything important:-) )
I was raped at gun point in September of my senior year of college and I still have a lot of things I can't remember about it. I was very much in shock as you can imagine and didn't call the police for three hours. But strangely enough, I got a call many months later that the assailant pleaded guilty to the rape, but I was out of the country for the lineup. I have always felt grateful that he didn't physically hurt me and that this was a pre-aids period. But within several months I could not feel my body when I was around people. It did not affect sex at all at the time, but my therapist thinks that I have never really dealt with it and that it is still affecting me. I was twenty and didn't tell my parents because I thought their knowledge would be more of a burden to me than a help. I finally told them about five years ago.There was a daytime tv show called "Queen for a day", when I was very very young, where three women would come on and tell how horrible their lifes were and the audience would vote for the one who had the worst life and she would win a refrigerator or a dishwasher or something like that. I just had the feeling when I was writing about my rape that I was on that show: I was physically abused at age____, sexually abused at age_____, raped at 20. Do I get a refrigerator? :-)
Lorraine may remember that show; and maybe your parents would, Elizabeth!
>
> > So no, "DID in partial remisison" would not work for us.
> Damn. :-)
:-)> > Today was a pretty good day and I didn't supplement the oxy. And the plan was always to have an AD in there also, because the AD I was stopping was prozac, I had a long waiting period. Monday is five weeks.
> Ahh. That's the main down side of Prozac, IMO: the long washout period. I definitely think that opioids are usually best used in combination with antidepressants rather than by themselves; short-acting drugs (such as opioids and stimulants) can be destabilising, and an AD can smooth things out.I hope so because I have been falling fast.
>> Yes. I'm particularly interested in seeing whether psychostimulants would help me, since Cylert worked in the past and since I have ongoing attention problems.
What's the difference between cylert and concerta. I could look it up, but then I think I'd lose this post. I could look it up later!
>
> > Have you ever tried buprenorphine in pill form , sub-what-ever?
> Subutex and Temgesic are the brand names that I'm aware of. No, I've never tried getting medication from outside the U.S.Is that because you'd have to pay out of pocket? It seems like it might be worth a try if the other is such a bother. Have you discussed with your pdoc getting meds from outside the U.S.?
Shelli
Posted by Elizabeth on August 7, 2001, at 8:03:45
In reply to Re: jumping in Shelli » Lorraine, posted by shelliR on August 6, 2001, at 10:58:35
> My therapist, who is totally against opiate use (and valium for that matter), has told me that she would only work with me if I did not self-medicate and I had agreed to that.
I wonder if she thinks that patients with cancer, AIDS, etc. should be given opioids for their pain? :-P
I hope things work out for you, Shelli.
> (concerta and oxy were too much for me; both act as stimulents for me).
Hey, I'm not alone! (re: opioids acting like stimulants)
-elizabeth
Posted by Elizabeth on August 7, 2001, at 8:31:56
In reply to Re: Update Lorainne, Elizabeth, et. al., posted by shelliR on August 6, 2001, at 20:35:14
> Tomorrow will be my first day on Parnate. I think I'll take 5mg in the morning and hope for the best.
I hope that works out for you. The sleep problems -- difficulty maintaining sleep at night and drowsiness in the afternoon -- seem to be pretty much universal with MAOIs, unfortunately.
> In the meantime, my pdoc gave me the okay to up my oxycontin (10mg bid to 10mg bid + 10mg prn).
Good! So you don't have to worry about what happens with your therapist.
> And he changed my klonopin to valium.
So Valium works for you for panic attacks? That's weird. How much do you take?
> I really haven't seen any brillance, just more openness to options.
That's better than brilliance, IMO.
> My therapist said on the phone over the weekend that I was exhibiting addictive behavior; I replied that
> I was exhibiting the behavior of someone horribly depressed who is trying to stay alive and *really* doesn't
> want to go into the hospital *again*.I really don't think your therapist is in a position to make value judgments like that.
> I asked my pdoc about a switch to buprenorphine instead of oxycontin because of the less addictive possibility, but
> he didn't think it was worth it. (See I was trying to show my non-addictive behavior. :-) )Jeez. I think he's probably right, although you might try switching to buprenorphine if the OxyContin loses its effect: I think you're less likely to become tolerant to buprenorphine. (I could be wrong about that, of course. I've never even taken oxycodone.)
> So I am still with my therapist (she didn't really believe he'd add more oxy as a prn), and we've agreed not to talk
> about medication.That's probably for the best. Your therapist isn't an MD, is she? (For a while I was in the odd position of seeing an MD therapist and another MD for meds.)
> ... I really wanted to work out attachment issues with her--not
> just switch therapists again and move the attachment to someone else like I always do. Then after attachment, work
> on intimate relationship issues.This stuff is very foreign to me. How does one "work on attachment issues?" (And what are attachment issues, anyway?)
What's your therapist's approach/school of thought, if you know?
> But I do feel a lack of respect for me eminating
> because of the codone/contin and have felt it before regarding several things I've done that she strongly disagrees with.Therapists aren't superhuman. They make judgments and have subjective opinions just like everybody else does.
> And I wondering, Elizabeth if you've gotten any information that is helpful to you re serum levels.
Uh. No, not really. I talked to the doctor who's covering for my pdoc; he said that he would expect a dose of 300 mg/day to result in a serum level of about 200-250 in a normal metaboliser.
> Have you felt anything different yet, since halving your dose? (i.e., not as well?)
Yes; it doesn't seem to be helping as much. I hope that I can find a level that isn't toxic but still works.
> Thanks for letting me write a book here; btw, haven't you guys ever heard of a library.
Your stories are more interesting than most books. :-)
Looking at later posts:
> What's the difference between cylert and concerta?
Cylert is pemoline -- a different drug altogether, not amphetamine-like. Concerta is just a new slow-release formulation of methylphenidate (i.e., Ritalin).
> > I've never tried getting medication from outside the U.S.
Is that because you'd have to pay out of pocket?
That, and the hassle. A lot of things. If it were something truly distinctive then I might consider it, but just for a different (and possibly less effective) formulation of a drug I can get here? Nah. I have thought about asking my pdoc if he'll show me how to give it to myself IM so that I don't have to do the whole lying down thing in the middle of the day.
-elizabeth
Posted by Elizabeth on August 7, 2001, at 8:35:08
In reply to Re: jumping in » Elizabeth, posted by Lorraine on August 6, 2001, at 12:10:22
I'm pretty sure that the headaches I was having when I was 14 were directly related to my depression. (I probably give the Prozac more credit than it deserves because although if it did anything for my depression it was very subtle, it did seem to do away with the headaches.)
-elizabeth
Posted by Lorraine on August 7, 2001, at 11:04:05
In reply to Re: Update Lorainne, Elizabeth, et. al., posted by shelliR on August 6, 2001, at 20:35:14
Hi Shelli, elizabeth, others:
I just wanted to say that when I address something in the heading to Shelli or elizabeth it is never meant to be exclusive--any and all readers, writers, thinker are welcome to join in.
> Tomorrow will be my first day on Parnate. I think I'll take 5mg in the morning and hope for the best.
That's how I started out too. Then day 2 5mg am and 5mg pm.
> In the meantime, my pdoc gave me the okay to up my oxycontin (10mg bid to 10mg bid + 10mg prn).
You may not need it, but I guess it's good for keeping your therapist at bay.
> And he changed my klonopin to valium.
> How can you give up a doctor like this who doesn't freak out about either valium or oxycontin, just doesn't
> return phone calls
Flexibility really counts, I think.> My therapist said on the phone over the weekend that I was exhibiting addictive behavior;
Shelli, do you have an addictive past?
> > >and we've agreed not to talk about medication.I wonder if you could do this generally with her. I mean what is she doing second guessing your meds anyway. We all "self-medicate" to the extent that we make do with what we have reducing doses, increasing doses--this is not considered a big deal normally
> > > but I really wanted to work out attachment issues with her--not just switch therapists again and move the attachment to someone else like I always do. Then after attachment, work on intimate relationship issues.
Shelli--do you have attachment issues with your therapist? Is she a surrogate parent in some way?
> > >I've already exposed all my shame with her, so I don't want to start over. (but if I've really worked out my shame issues with her why does it seem so scary to bring them up with someone else?)
Shame is a big, big, big, big ,big deal. I think. It takes a lot of faith in someone to work through shame issues with them. I'm not sure I could do that with someone who threatens to withdraw their approval of me. Also I'm wondering if working out attachment issues with someone who threatens to abandon you is best. Shelli, if you can't leave her now (and I understand how hard it is to do that and how hard it is to start with someone new) then maybe you should write her a letter about this stuff. Because it sounds like you guys have some things to work out here and it could be good for you to do this more immediate work on your relationship with her. (Shelli, I know I'm being pushy--so just take what you find useful and toss the rest. Judgmentalism is a huge issue with me. I'm allergic to it. :-)
> > >[re shame worked out] shelli--i had lot of shame issues that I worked out with my therapist and have disclosed to people who are very close to me (husband, friends). I don't think it would bother me to talk to a new therapist about them, but I haven't disclosed some to my mother (and I should just for healing) or my brother (might never be able to). Part of it is choosing people that it is safe to disclose things to. I don't think the "vulnerability" goes away--I think that it quits running you life though. Or, better way to look at it, loses its power slowly over time.
> > >[re why do I care what she thinks]
Huge issue for me Shelli--isn't this what "shame" is all about? I attended a Recovery Inc meeting last week where someone was talking about an encounter he had with his landlord and said "i realize i didn't have to let the bridge down". These guys have their own lingo--but the point was that there was the external world and the internal world and that we choose how much of the external world to allow in. Somehow this "bridge" concept clicked for me as an image. This make me think that Recovery inc might have something of value for you. You might check them out (they are everywhere).
> > > Hope you both (all --if there are any lurkers) are doing okay.
I'm doing well, actually. Yesterday, I took my second dose at 12:45 (instead of 1:30) and I exercised. I was able to sleep pretty well so that's encouraging.
> > > Thanks for letting me write a book here;
I'm glad you did. We share some issues.
btw, haven't you guys ever heard of a library. Lorriane, you could get The Magic Daugher from the library, *then* if you like it, buy it.
Yeah, I used to do that (it's actually great here, i can request books online and then pick them at my local library). The problem is that when I hibernate, I stop going out. So now that I am in an up-swing, I could start this again.
Lorraine
Posted by Lorraine on August 7, 2001, at 12:06:47
In reply to Re: jumping in Shelli » Lorraine, posted by shelliR on August 6, 2001, at 21:24:50
Shelli:
> > > I had that problem with nardil and sleep also. Afternoon sleepiness and horrible difficulty staying asleep at night. That never got any better for me so I had to stay on a relatively low dose of nardil. I am taking both atarax and klonopin hs, but that wasn't enough if I went above 45mg which is just a normal dose. So probably I will have to face that with parnate also.
> > > What is your pdoc suggesting, as far as the sleep problem?I haven't yet talked with my pdoc re sleeping issues. I would rather find a way of dealing with them without adding a sleeping pill to my packet of pills. Maybe a combination of good sleep hygiene, meditation (brain wave tapes that track the sleeping state), exercise, pill taking adjustment etc. What is atarax?
> > > because she thinks I'm going to end up a drug addict. She's been saying this for the past three years.Why does she believe this?
[re hospitals]
> > > Sometimes they've really helped me get through wash out periods and also times when the stress in my life was to great for me to handle and I had to I guess be "taken care of" in the sense that I didn't have to work, or explain why I wasn't working, or remember to eat, etc. Of course, a cruise might have also done the trick and I might have considered that if my insurance paid for cruises :-)Yes, I think hospitals are a tool to have in our case of tricks.
> > > > >I remain convinced that a possible *addiction* (habituation) to codone/contin is better than the other options.
> >
> > Yikes. (see that's how my therapist feels :-Yes, but I don't see your position as "bad" just lower on the list of alternatives than perhaps you have placed it. Jensen says the following: "since the opiates are a brain transmitte, they can fail like anyh other chemical systeim in the grain. Potentially abusable "reward center" chemicals are an integral part of the brain's circuitry". He also notes the opiates works partically by locking the release of substance P and that substance P antagonists are being developed which help depression. He says other stuff (I like his book, by the way, which you cannot get at the library:-)) The question isn't whether there are valid medical reasons for trying opiates, there are, the question is whether you will become addicted to them. To me this centers on whether you use them in an abusive fashion--ie to get high--and whether you are prone to addiction. See my pdoc wouldn't hesitate to prescribe opiates if that was what I needed. He does not believe that people become addicted when you medicate them with the "right" substance. He also doesn't believe addiction is an issue for me. It sounds like your pdoc agrees with this philosophy but your therapist wants to second guess this. Does she have good reason to think this will be a problem for you?
> > > well the parnate is being added to the oxycontin; so parnate doesn't have to carry the whole weight, nor will oxycontin.Parnate's pretty robust. You may not need more--although I am still on Neurontin, which surprising does offer some mood support and helps with the anxiety.
> > > I have ambivelent feelings. She is the smartest therapist I've ever had which is really important to me. She is able to teach me things about relating which make my life easier. She keeps me very focused, which is also important to me. She has a lot of experience with dissociative disorders, although my inside kids are not close to her, like my last therapist: that's a long story. She is very into EMDR, which hasn't helped me very much in my work with her, but sometimes I guess it's been good. She is wonderful on the phone with me when I am in crisis; never gets upset that I called and has a pager so she calls right back if she is in town. So those are her positives.This is a tremendous list of positives.
> > >With many of my past therapists it was frustrating for me to be quicker than they were, and just smarter in a certain type of way. I don't have that problem with her.
I really understand this point, although my best therapist was not smarter than me (she just really knew what she was doing and it's not brain surgery as they say but a real art). And my smartest therapist was not the best on for me. I think finding a good therapist is very difficult. It took me 20 years to find the one that unlocked the door to my personal bunker from he** and helped me clean house. These people are few and far between.
>
> Her negatives are that she is always believes she is right, and once she takes a stand, she won't back down.Shelli, you might think about writing her a letter and reading it to her in therapy. She can take the letter and think about it later. I find letters are helpful when people close their minds, especially if you keep it in the tone of "I feel". She sounds like a keeper, but ironing out your relationship issues with her would be a great thing, not just for you and her, not just for her (she could probably use some loving feedback in this area), but also for you and your future relationships.
> > The AD effects are strong.
> That's amazing --you've been taking it less than a week now? I'm not anticipating that for me, although I have heard that parnate takes effect faster than nardil. But a week vs five weeks?Well, I felt the Parnate on day 1. I felt Moclobemide on day 1. These are activating drugs. You feel them right away or at least I do. But my pdoc said I'd feel it right away also.
> There are side effects--mainly sleep related.
> We'll work on those.Yes, we will :-) Welcome to the club.
Lorraine
Posted by shelliR on August 7, 2001, at 12:33:18
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 7, 2001, at 11:04:05
Hi Lorraine, Elizabeth et.al.:
>
> I just wanted to say that when I address something in the heading to Shelli or elizabeth it is never meant to be exclusive--any and all readers, writers, thinker are welcome to join in.
I support that fully.
>> > In the meantime, my pdoc gave me the okay to up my oxycontin (10mg bid to 10mg bid + 10mg prn).
> You may not need it, but I guess it's good for keeping your therapist at bay.No, I do think I need it, at least until parnate hopefully kicks in.
>> > My therapist said on the phone over the weekend that I was exhibiting addictive behavior;
>
> Shelli, do you have an addictive past?
No. At one point I got pretty high up on valium (30mg a day) but that was only for one week. And then I got completely off of it. So, really no other addictions, except I am a true sugar/starch addict. If I bought a cake I would eat the whole thing. I have learned out to deal with that by not buying "whole " things. That is easy now, because I live alone, but at other times it has been a struggle. It is an absolute addiction though. Once I start, I can't stop, unless I am at someone's house or at a restaurant (and embarrassment saves me) and I even throw things out so I won't eat them. This is not a serious problem in my life, but I do have the feeling of what an addiction is, rather than wanting to take a drug that is potentially addicting because I don't want to feel depressed. The difference between sugar and say alcohol is that if I don't have sugar, I don't crave it.
> I wonder if you could do this generally with her. I mean what is she doing second guessing your meds anyway. We all "self-medicate" to the extent that we make do with what we have reducing doses, increasing doses--this is not considered a big deal normallyshe is a very opinionated person. I don't hold things back from her; we just "fight" at times. I made a commitment to her about only taking drugs that my pdoc prescribes (because I was taking vicodin on my own). So then I broke that commitment so I had to deal with how to proceed from there. Because my pdoc stepped in and said it was okay, I am back sticking to the commitment. This is really the only issue she has ever threatened me with, so I'm not all the time thinking is she going to terminate with me or anything. She is totally unflexable on this one because she thinks I'm in danger of becoming an addict. I don't agree, and I don't really care all that much when I am feeling very depressed. If my pdoc had said no, I would have supplemented with drugs off the internet and terminated with her. I couldn't tolerate that level of depression. And I knew that I was starting parnate, so it was a lifetime decision.
>
> > > > but I really wanted to work out attachment issues with her--not just switch therapists again and move the attachment to someone else like I always do. Then after attachment, work on intimate relationship issues.
>
> Shelli--do you have attachment issues with your therapist? Is she a surrogate parent in some way?
Attachment is a very complicated issue. There was a thread relating to that a month or so back and if you read the posts between marie, judy and I, you will get a sense, I think, about what it means to me. http://www.dr-bob.org/babble/social/20010717/msgs/7666.html>
> > > >I've already exposed all my shame with her, so I don't want to start over. (but if I've really worked out my shame issues with her why does it seem so scary to bring them up with someone else?)
>
> Shame is a big, big, big, big ,big deal. I think. It takes a lot of faith in someone to work through shame issues with them. I'm not sure I could do that with someone who threatens to withdraw their approval of me. Also I'm wondering if working out attachment issues with someone who threatens to abandon you is best. Shelli, if you can't leave her now (and I understand how hard it is to do that and how hard it is to start with someone new) then maybe you should write her a letter about this stuff. Because it sounds like you guys have some things to work out here and it could be good for you to do this more immediate work on your relationship with her. (Shelli, I know I'm being pushy--so just take what you find useful and toss the rest. Judgmentalism is a huge issue with me. I'm allergic to it. :-)Yes, you are being pushy :-). And that's okay--you care. But I'm pretty clear on this because I've worked with her for four years now and know what we can work out and what is just a waste of time and energy to keep pushing. The only issue about working together has been the meds. She has this strange thing about MDs. (Maybe because she's married to one, and at one point she was in medical school). She thinks if you're with a doctor you do exactly what he/she tells you to do, or you leave and find another doctor. Anyway, it's her belief system, I don't buy it completely. I think you also do what you have to to survive in life and if it means self-medicating, I don't have a problem with that. But I always tell my pdocs what I have done, always tell them if I am supplementing and if they can't handle working with me, it's their choice. Her complaint is that I tell after, not before.
>
> > > >[re shame worked out] shelli--i had lot of shame issues that I worked out with my therapist and have disclosed to people who are very close to me (husband, friends). I don't think it would bother me to talk to a new therapist about them, but I haven't disclosed some to my mother (and I should just for healing) or my brother (might never be able to). Part of it is choosing people that it is safe to disclose things to. I don't think the "vulnerability" goes away--I think that it quits running you life though. Or, better way to look at it, loses its power slowly over time.I really want to get the medication thing straight before I make any changes in my life. I have not disclosed some of my shame issues to anyone but her, and several other past therapists. But I have gotten the furthest on shame issues with her. I don't feel a need to share them with anyone else at this point. I am still working, I guess, on sharing them with her.
>
> > > >[re why do I care what she thinks]
> Huge issue for me Shelli--isn't this what "shame" is all about? I attended a Recovery Inc meeting last week where someone was talking about an encounter he had with his landlord and said "i realize i didn't have to let the bridge down". These guys have their own lingo--but the point was that there was the external world and the internal world and that we choose how much of the external world to allow in. Somehow this "bridge" concept clicked for me as an image. This make me think that Recovery inc might have something of value for you. You might check them out (they are everywhere).I'm not generally interested in support groups, but that does sound interesting. I was in a support group for several years with other women who had been sexually or emotionally abused and it was good but then I got to a point where I wanted to spend my time outside of therapy living, doing stuff, not focusing on pain, or how to do good things for yourself. I do a lot of nice things for myself and am pretty forgiving of myself. I have to work really hard on not letting people hurt me--really minor things hook right into my depression , and so far I can only deal with that cognitively, since that is my strongest function. And that is a very big thing that I recognize that I have to continue to work on.
>
>
> I'm doing well, actually. Yesterday, I took my second dose at 12:45 (instead of 1:30) and I exercised. I was able to sleep pretty well so that's encouraging.Very encouraging. Are you up to 20mg a day or 10?
>
> > > > Thanks for letting me write a book here;
>
> I'm glad you did. We share some issues.
Thanks.> Yeah, I used to do that (it's actually great here, i can request books online and then pick them at my local library). The problem is that when I hibernate, I stop going out. So now that I am in an up-swing, I could start this again.
I'm so glad that you are in an upswing; I don't think MAOIs poop out quickly in the same way SSRIs do.Shelli
>
Posted by Lorraine on August 7, 2001, at 12:37:29
In reply to Re: jumping in - Shelli, Lorriane, et.al. » Elizabeth, posted by shelliR on August 6, 2001, at 22:45:47
Hi: Shelli, Elizabeth, others:
> Well, I see it that way because I am so detached from it. When I stopped talking to my SIL it really drove her crazy; it still does. She'll call my mother and tell her that I didn't say hello, etc. But she has never said to me, "hey what's going on?" or "what don't you acknowlege me?" so it gives me a lot of power in the relationship. Although when I stopped talking to her it didn't have to do with power, more with self-preservation. But with such a judmental person, power is not a bad thing to have.
My MIL is vary judgmental. After years of trying to please her (10), I took her for a walk and told her that I was done trying to please her, that I thought she had always disliked me and that there was nothing that I could do that would change that, that it was painful for me to be around her and that I would no longer stay in her house, although she was free to visit us. What a load off my mind that was. I was respectful and loving during the talk. I'm not sure now 5 years later--with SIL hating me because of it--that it was the "right" thing. It was the only thing to do at the time to protect myself. But now I'm wondering about that concept of simply not extending the bridge to people who are hurtful to me as opposed to banishing them from the kingdom. It's an area I need to work on.
> > >in other words tried to figure it all out and not miss a step so that she wouldn't know. The funny thing is that she would not have cared; it was just impulse on my part to "be normal." Nothing precipitated it that I could figure out,
The drive to be normal, when you have a shame based core is pretty compelling in my case at least.
> > > I was raped at gun point in September of my senior year of college and I still have a lot of things I can't remember about it. It did not affect sex at all at the time, but my therapist thinks that I have never really dealt with it and that it is still affecting me. I was twenty and didn't tell my parents because I thought their knowledge would be more of a burden to me than a help. I finally told them about five years ago.Shelli--this is terrible. Don't you have some PTSD from this?
>
> There was a daytime tv show called "Queen for a day", when I was very very young, where three women would come on and tell how horrible their lifes were and the audience would vote for the one who had the worst life and she would win a refrigerator or a dishwasher or something like that.I didn't know that's what that show was about. I thought it was about people who embodied the highest notion of motherhood.
> > >I just had the feeling when I was writing about my rape that I was on that show: I was physically abused at age____, sexually abused at age_____, raped at 20. Do I get a refrigerator? :-)
Not exactly a refrigerator. Some how I think we could both be contestants, but I'm hoping you would win :-) It gives me some comfort though to see someone else who struggles with some of the same stuff I struggle with. I read a very moving article called "Depression and Spiritual Growth" http://chandra.astro.indianaedu/bipoloar/spirit.htm Anyway, he says we emotional depth, authenticity, compassion and strength. The article is great. I keep it in my emergency kit. He talks compellingly about suicide and why it is important that we resist it.
>
> What's the difference between cylert and concerta. I could look it up, but then I think I'd lose this post. I could look it up later!Concerta is a stimulant-like Ritalin, but 10-12 hr steady release; Cylert is pemoline, a stimuland that has some liver risk associated with it.
Lorraine
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