![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 261 to 285 of 434. Go back in thread:
Posted by Elizabeth on August 23, 2001, at 10:19:33
In reply to Re: that other thread » Elizabeth, posted by Cam W. on August 22, 2001, at 13:55:36
> > But how do we provide an incentive for the drug companies to investigate possible bad effects of their products once the products have been approved for marketing?
>
> • That's a good question. I do believe that even if drug companies are forthcoming with information, it will still be missed. For example, that Effexor withdrawal; I knew about the withdrawal in 1997, before an XR version was made.I remember that Effexor XR was first marketed in fall '97 (I started taking it when Nardil pooped out the second time). I had heard about withdrawal symptoms and "ups and downs" (like people often get with short-acting drugs like Xanax or Ritalin) from Effexor long before that. (The reason I stopped taking it without giving it much of a chance was that the immediate-release formulation made me sick to my stomach about 1/2 hour after each dose.)
> The company, since at least 1998 (perhaps before) had the withdrawal information in it's product monograph.
Really. I didn't notice that. That's interesting. They probably wanted to avoid legal consequences, I guess (weren't they the same co. that marketed dexfenfluramine?).
> I guess if you don't scream it out, not everyone listens (or has the time to read the monograph fully).
All that one would have to do if one were really interested in finding that stuff out would be to look on internet discussion boards such as this one!
> It would be silly for a company (who really has to answer to shareholders) to point out the bad issues of their product. That's what competitors are for.
< g > Yeah. I sort of think of capitalism as a lesser evil compared with the alternatives, but the problem of how to get corporations to do the right thing has always been a puzzle to me.
[re Zyprexa and insulin resistance]
> > Even when it's below the therapeutic dose for psychosis? I was taking 2.5-5 mg/day.
> >
> • Pyschosis can be treated with low doses, as well. I don't think that there is an dose/effect gradient, as seen with Effexor.There is with some of the effects, at least (don't know about the diabetes thing). I found there was a huge difference in the amount of sedation and appetite stimulation (the only effects I noticed from it!) with 2.5 mg vs. 10 mg (the most I ever tried taking).
> • I was talking to the Zyprexa rep yesterday (met him in Starbucks interviewing a new rep), and he says that the increased incidence of type II diabetes is only seen in patients with schizophrenia (he later amended that to be, that patients with schizophrenia were the only one's studied, so far).
Umm...duh? :-) I'm skeptical about whether there's a relationship too. Although I have noticed that the placebo groups in controlled trials of antipsychotic drugs always seem to have a nonzero rate of EPS -- I wonder what causes that. Just expectation effect? Or something more?
> The reason he states that there increased numbers of people getting diabetes from taking Clozaril and Zyprexa is that people with schizophrenia are 4 times as likely as the general population to get diabetes. I asked if this number included unmedicated people and he didn't know.
I'm sure that all the medications used for schizophrenia, except maybe Moban, cause appetite stimulation frequently. Sounds like he was trying to play it down.
> He also blamed increased appetite and poorer than normal dietary skills (eg chips & pop diets), as being risk factors. I really can't believe that we have a number of people with schizophrenia have borderline triglyceride levels and coincidentally become diabetic after starting these two atypical antipsychotics.
Me neither. As I implied above, I do think appetite stimulation is at least part of the cause. (That's not to say that we should blame the patients for not having enough "will power" or whatever.)
> > Is Zyprexa really that common compared to Nardil?
>
> • Zyprexa is prescribed much more than Nardil and for numerous indications, at least here in the north.I'm in the north too, thank you very much. :-)
> Nardil is used as a last resort in treatment-resistant depression.
My impression is that MAOIs are making a comeback. I certainly think they should be considered before ECT, if nothing else. Personally, I found MAOIs to be much more tolerable than TCAs, with the exception of desipramine (which I'm taking now). And I think MAOIs probably work for a much broader range of conditions than TCAs do. Desipramine seems to be working about as well as Parnate did for me (nonpsychotic depression with melancholia) -- I still need buprenorphine but my mood, sleep, appetite, etc. are much improved. And I'm sure you've seen my standard rant about how the dietary restrictions have been overplayed.
> Zyprexa seems to be used before Nardil, even though there is little evidence of efficacy for it's long-term use in depression.
I tried Nardil (in Boston) before ever touching any of the antipsychotics. Most nonpsychotic depressives I've known who tried antipsychotic drugs (usually including atypicals) and who didn't have bipolar disorder or comorbid conditions (OCD, borderline personality, etc.) either got no effect from the neuroleptics, or felt worse on them. As I said, I just felt hungry and tired on Zyprexa, Risperdal, Seroquel, and Mellaril (not all at once). I also tried Moban, which had this weird effect on me that's sort of hard to describe -- I felt really heavy and immobilised, sort of. (Droperidol, which I was given as a sedative when I was in the ICU recently, had a similar effect.)
-elizabeth
Posted by Elizabeth on August 23, 2001, at 10:33:02
In reply to Re: I was gone but now I'm back » Elizabeth, posted by Lorraine on August 22, 2001, at 15:16:43
> > How do you accurately measure out 1 mg of Adderall, though???
>
> What do you mean by accurately :-) (1.25 is 1/4 of 5 mg tablet split inaccurately give or take .25 mg). You are a stickler for accuracy aren't you< vbg >Hey, amphetamine is pretty potent stuff -- +/-0.25 mg is a big range.
> > Isn't "massage" just a euphemism? < g > Seriously, can you post the ingredients? (just curious) Is it water-based?
>
> Actually, it turns out it is for "tanning"--it has "tantilizing hot action" and comes in 4 ml tubules to be added to your regular tanning lotion.Tantalizing, huh? (Is it titillating too? Sorry, I'm feeling sophomoric this morning.)
> But, hey, that doesn't stop me....I suppose on of the more customary lubricants like "silk" or such would be good. I just like the tantilizing hot action, what can I say? < g >
< Beavis >Heh heh.< /Beavis >
> > So "hypertension" means the cheese reaction? Then what does "hypertensive episodes" mean???
> is all of this over an "on" rather than an "ve" ending?
I dunno. I'm just confused! (Don't blame me, you're the one who made the distinction in the first place.)
> Elizabeth, are you being accurate (in which event we are doomed b/c like Shelli, I can't even spell) or are you playing?
I'm genuinely confused, I'm not just messing with you or something. :-)
> How about "I will not confuse hypertensive crisis with hypertension" one hundred times on the blackboard, like Bart of the Simpsons.
You can write "I will not confuse hypertensive crisis with hypertension" as many times as you want, that still doesn't mean that I will know what you're talking about!
[re "up-regulated" vs. "down-regulated" -- another one that genuinely confuses me, BTW]
> I shouldn't insist on his language actually because it is confusing. He means over-stimulated vs under-stimulated and he determines this based on your QEEG.Okay, so it has no real-world correlation?
> > I could see that. What does it mean for people like me who tend to be slowed-down and tired
>
> "under-stimulated"...but anxious and easily startled at the same time?
> > Mmm. Too bad anticonvulsants (Depakote, Lamictal, Neurontin) never did much for me (except for the benzodiazepines).
>
> Too bad, but then again maybe your brain wave activity wouldn't show spiking suggestive of temporal lobe epilepsy.I've had a couple of EEGs, they were described as "within normal limits." Never had a qEEG, tho'.
> How is you med trial fairing these days?
I'm on 225 mg of desipramine. It seems to be working about as well as Parnate did -- it's not a substitute for buprenorphine, but it does make a big difference. I'm taking a break from changing anything because my insurance coverage expired (so I need to get new insurance so I can get a primary care doc so I can have an ECG).
> The Parnate is giving me consistent "bad" headaches when I first arise before I take any meds and continues to disrupt my sleep mercilessly.
All the MAOIs I tried (Nardil, Parnate, selegiline, Marplan) caused sleep problems for me. What are the headaches like? (Where does it hurt and can you describe the pain qualitatively at all, that is?)
> I have an appointment tomorrow. I have read that frequent bad headaches can be a prenome (?) of spontaneous hypertensi--drum roll please--ve crises.
(Prodrome?) Headache is a symptom of elevated BP, but it's a very unusual sort of headache, not at all like tension headaches, sinus headaches, etc.
-elizabeth
Posted by Elizabeth on August 23, 2001, at 10:36:18
In reply to Re: Waking Parnate headaches mean? » Cam W., posted by Lorraine on August 22, 2001, at 15:23:46
> I have read that frequent headaches can be a precursor of spontaneous hypertensive reactions and require immediate attention.
Lorraine -- I had spontaneous hypertensive episodes (not related to food or drug interactions) on Parnate, but the only times I had any kind of headache on it were about half an hour after each dose, when my blood pressure peaked. (As a general rule, I don't get headaches except occasionally if I'm congested.)
Waking up in the morning with a headache sounds like a rebound thing, or maybe something related to nonrestful sleep. Have you tried checking your blood pressure when you first wake up, before taking the Parnate?
-e
Posted by Elizabeth on August 23, 2001, at 10:44:55
In reply to Re: Waking Parnate headaches mean? » Cam W., posted by Lorraine on August 22, 2001, at 21:30:57
> > Elizabeth may be a better person to ask this of; she has far more experience with MAOIs than I have.
>
> Yeah, I always ask Elizabeth. She's great.Flattery will get both of you everywhere. :-)
-e
Posted by Lorraine on August 23, 2001, at 11:31:42
In reply to Re: I was gone but now I'm back » Lorraine, posted by Elizabeth on August 23, 2001, at 10:33:02
> > > Hey, amphetamine is pretty potent stuff -- +/-0.25 mg is a big range.
I wish they had 1 mg tabs, don't you?
>
> > > Isn't "massage" just a euphemism? < g > Seriously, can you post the ingredients? (just curious) Is it water-based?It's oil based. No ingredients listed (probably olive oil and hot sauce :-)
> Tantalizing, huh? (Is it titillating too? Sorry, I'm feeling sophomoric this morning.)Sophomoric is good:-)
>
> > > So "hypertension" means the cheese reaction? Then what does "hypertensive episodes" mean???Hypertension is chronic high blood pressure and hypertensive crisis is spiking high blood pressure associated with eating certain foods on MAOs--although it has been known to occur "spontaneously" on Parnate.
> I'm genuinely confused, I'm not just messing with you or something. :-)
OK. You CAN be very funny and your homour is quite dry (and delightful).
> > > [re "up-regulated" vs. "down-regulated" -- another one that genuinely confuses me, BTW]
> > I shouldn't insist on his language actually because it is confusing. He means over-stimulated vs under-stimulated and he determines this based on your QEEG.
>
> Okay, so it has no real-world correlation?No, I think there is--I suspect that people who are up-regulated tend to be aggitated and thin and people who are down-regulated tend to be sluggish and over weight.
> > > How is you med trial fairing these days?
>
> I'm on 225 mg of desipramine. It seems to be working about as well as Parnate did -- it's not a substitute for buprenorphine, but it does make a big difference. I'm taking a break from changing anything because my insurance coverage expired (so I need to get new insurance so I can get a primary care doc so I can have an ECG).When does your new insurance kick in? I'm glad you are at least able to function in the meantime.
> > >What are the headaches like? (Where does it hurt and can you describe the pain qualitatively at all, that is?)
The headaches are very intense. They are on the right and left sides toward the front of my head just above my temples and little to the rear of the temples. They arise spontaneously--no food association. They go away on their own within about an hour. The PDR says "Therapy should be discontinued immediately upon the occurrence of palpitation or frequent headaches during Parnate therapy. These signs may be prodromal of a hypertensive crises". Later it says "Headaches without blood pressure elevation have occurred." I don't know about blood pressure elevation in my case. I wanted to measure it this morning--but, of course, no headache.
I have also developed a rash on my arms. PDR says "Rare instances of hepatitis and skin rash have been reported" I'm hoping I'm not allergic to MAOs as a class but something in the Parnate. I had an allergic reaction like this to anti-malarial medication. I hope that I am not allergic to sulfate (it's pretty common in drugs isn't it?)
Anyway, odds are I'm off Parnate. One other very odd symptom is pain radiated under my arm pit, like I have pinched a nerve. Isn't that odd?
Thanks for your generous response as usual, elizabeth. I'll let you know what the doctor says today.
Posted by Lorraine on August 23, 2001, at 22:41:08
In reply to Re: Parnate rash/headaches » Elizabeth, posted by Lorraine on August 23, 2001, at 11:31:42
Hi Shelli & elizabeth:
I saw my pdoc today and he thought the headaches were probably rebound (elizabeth, isn't this what you said--take a bow) because I take my doses before noon to try to ameliorate the sleeping problems. The rash, he wasn't so sure about. (I had been painting wearing latex gloves and using turpentine--so maybe this caused the rash.) We decided for me to watch myself over the next few days staying on the Parnate. If I wake up with a headache, I'm to take my blood pressure. And, I will see if the rash goes away or not. If I decide to abandon the Parnate, I will have a 4-5 day washout during which I can use the Adderal and Neurontin. He wrote me a script for Nardil in case I make the switch and asked me to call his office and let them know what I am doing.
elizabeth: The MAO articles that I was talking about are in Psychiatric Annals 31:6/June 2001. Apparently, the entire issue is dedicated to MAOs. The titles include: "The Use of Monoamine Oxidase Inhibitors for Treating Atypical Depression" by Patrick J. McGrath et al; A Neurochemical Perspective on Monoamine Oxidase Inhibitors by Lynn Wecker et al; A Reevaluation of Dietary Restrictions for Irreversible Monoamine Oxidase Inhibitors by Kenneth Shulman et al; Selegiline and other Atypical Monoamine Oxidase Inhibitors in Depression by J. Alexander Bodkin et al; and Monoamine Oxidase Inhibitors Revisited by Jay D. Amsterdam et al.
I have finished the first article regarding MAOs for atypical depression and found it very interesting. They give the DSM definition of atypical depression as well as the Columbia University and discuss studies correlating the criteria specified for atypical depression with efficacy of antidepressants. Very interesting stuff. Let me know if you have difficulty obtaining the studies. I know you would find them of interest--if you haven't already read them :-)
I spoke with my pdoc about upregulation and downregulation and asked him if this was his terminology or used in some area of study. It's his. He finds it descriptive of what is happening on an EEG basis. Downregulated is correlated with low voltage EEG's.
We also talked about Adderal and stopping hair picking and he said that he believes that a lot of symptoms are compensatory. Just as in ADD, kids may pick a fight to provide external stimulation to compensate for the lack of internal stimulation. So that it seems at first glance counterintuitive that ADD kids calm down when they are given stimulants, it makes sense if you view the excess activity as a compensatory mechanism for an understimulated system that is no longer required when stimulants are given. The same he believes may hold true for this woman who was a hair picker and stopped when given Adderal or for my stopping biting my cuticles on Adderal. Interesting thought.
Pleasant dreams to those who are still capable of dreaming (she said bitterly).
Lorraine
Posted by may_b on August 24, 2001, at 10:55:39
In reply to Re: Update Shelli/elizabeth, posted by Lorraine on August 23, 2001, at 22:41:08
Hi Lorraine:
I am keenly interested in these articles. How did you obtain them?
Thanks,
may_b
>The MAO articles that I was talking about are in Psychiatric Annals 31:6/June 2001. Apparently, the entire issue is dedicated to MAOs. The titles include: "The Use of Monoamine Oxidase Inhibitors for Treating Atypical Depression" by Patrick J. McGrath et al; A Neurochemical Perspective on Monoamine Oxidase Inhibitors by Lynn Wecker et al; A Reevaluation of Dietary Restrictions for Irreversible Monoamine Oxidase Inhibitors by Kenneth Shulman et al; Selegiline and other Atypical Monoamine Oxidase Inhibitors in Depression by J. Alexander Bodkin et al; and Monoamine Oxidase Inhibitors Revisited by Jay D. Amsterdam et al.
>
Posted by Elizabeth on August 24, 2001, at 12:05:17
In reply to Re: Parnate rash/headaches » Elizabeth, posted by Lorraine on August 23, 2001, at 11:31:42
> > > > Hey, amphetamine is pretty potent stuff -- +/-0.25 mg is a big range.
>
> I wish they had 1 mg tabs, don't you?Well...I tried taking 1/4 of a 5 mg Adderall, and it didn't have any noticeable effect.
> It's oil based. No ingredients listed (probably olive oil and hot sauce :-)
Yikes. :-)
> Hypertension is chronic high blood pressure and hypertensive crisis is spiking high blood pressure associated with eating certain foods on MAOs--although it has been known to occur "spontaneously" on Parnate.
OK, that's all I wanted to know. "Hypertensive crisis" is usually defined (if it is defined at all) as either diastolic BP > 120 mmHg, or abrupt elevation in blood pressure with end-stage organ damage (no, I don't know what that means). HCs sometimes happen without any connection to MAOIs, BTW; I know a guy who has essential hypertension (generic chronic hypertension) who had one a couple of years ago. (That finally convinced him to go get his hypertension treated.)
> OK. You CAN be very funny and your homour is quite dry (and delightful).
Thanks (I think :) ).
> No, I think there is--I suspect that people who are up-regulated tend to be aggitated and thin and people who are down-regulated tend to be sluggish and over weight.
Oh. (I'm sluggish and thin.)
> When does your new insurance kick in?
What new insurance? New insurance is what I need to find!
> I'm glad you are at least able to function in the meantime.
Me too.
> The headaches are very intense. They are on the right and left sides toward the front of my head just above my temples and little to the rear of the temples.
That doesn't sound like high blood pressure to me -- the headache would be at the base of your skull and/or in the back of your neck.
> The PDR says ...
CYA.
> I don't know about blood pressure elevation in my case. I wanted to measure it this morning--but, of course, no headache.
Try and get a measurement. MAOIs can cause headaches for other, unrelated reasons.
> I have also developed a rash on my arms.
That might be an allergic reaction, or it might be unrelated. In case this is of interest, I had a flare-up of eczema while I was taking Parnate. I don't know if it was caused by the Parnate, but it went away after I stopped taking Parnate.
> I had an allergic reaction like this to anti-malarial medication.
How did you come to be taking that?
> I hope that I am not allergic to sulfate (it's pretty common in drugs isn't it?)
Parnate contains the sulfate salt of tranylcypromine.
Let's see what your next post says....
> I saw my pdoc today and he thought the headaches were probably rebound (elizabeth, isn't this what you said--take a bow) because I take my doses before noon to try to ameliorate the sleeping problems.
FWIW, I tried all sorts of dose schedules and the insomnia was about the same regardless. I think that once you reach steady-state levels, it doesn't make much difference when you take it.
> The rash, he wasn't so sure about. (I had been painting wearing latex gloves and using turpentine--so maybe this caused the rash.)
What on earth posesses you to come into contact with all these weird chemicals?!
> We decided for me to watch myself over the next few days staying on the Parnate. If I wake up with a headache, I'm to take my blood pressure.
Good. I want to know what it is. :-)
> If I decide to abandon the Parnate, I will have a 4-5 day washout during which I can use the Adderal and Neurontin.
That's good. Do you have Klonopin or Xanax? Those have helped me a lot when going off MAOIs.
> He wrote me a script for Nardil in case I make the switch and asked me to call his office and let them know what I am doing.
Yeah, they usually like it if you tell them when you change something. :-}
I don't know if I've mentioned this before, but I have a book on MAOIs that might interest you. (I recognise most of the articles you listed, BTW.)
> Pleasant dreams to those who are still capable of dreaming (she said bitterly).
It's a small price to pay.... (BTW, my intense dreams are back. No abnormal movements, though. < cross fingers >)
-elizabeth
Posted by Lorraine on August 24, 2001, at 12:45:34
In reply to Re: Parnate stuff » Lorraine, posted by Elizabeth on August 24, 2001, at 12:05:17
Elizabeth:
> > No, I think there is--I suspect that people who are up-regulated tend to be aggitated and thin and people who are down-regulated tend to be sluggish and over weight.
>
> Oh. (I'm sluggish and thin.)So much for my suspicions--but do you do well on stimulants?
>
> > When does your new insurance kick in?
>
> What new insurance? New insurance is what I need to find!That does not sound easy given preexisiting condition unless it is part of a group plan. What are your options?
> > The headaches are very intense. They are on the right and left sides toward the front of my head just above my temples and little to the rear of the temples.
>
> That doesn't sound like high blood pressure to me -- the headache would be at the base of your skull and/or in the back of your neck.Thank-you--this is very helpful to me. I didn't know what occipital meant.
>
> > The PDR says ...
>
> CYA.That's what my pdoc said as well.
>
> > I don't know about blood pressure elevation in my case. I wanted to measure it this morning--but, of course, no headache.
>
> Try and get a measurement. MAOIs can cause headaches for other, unrelated reasons.Today, slight headache, blood pressure was low (93/66) with a pulse of 62. I'm feeling more confident that these are rebound headaches. I had them on Effexor, which I also had to take all in the morning. The time of day that I take the medication does have an effect on my sleeping. If I take it later than 12:30 pm I cannot go to sleep at night until very late (2am or 3am).
>
> > I have also developed a rash on my arms.
>
> That might be an allergic reaction, or it might be unrelated. In case this is of interest, I had a flare-up of eczema while I was taking Parnate. I don't know if it was caused by the Parnate, but it went away after I stopped taking Parnate.Wait what is eczema?
>
> > I had an allergic reaction like this to anti-malarial medication.
>
> How did you come to be taking that?went to Belize where malaria is still pretty common. But we actually saw very few mosquitos. You have to imagine me with the rash that pretty much covered me calling into my husband's office and asking them to go to Dr. Koop's site to make sure it wasn't a drug interaction and then to see which med was causing it. I'm sure his secretary's eye-brow was raised at the number of meds I was taking:-)
>
> > I hope that I am not allergic to sulfate (it's pretty common in drugs isn't it?)
>
> Parnate contains the sulfate salt of tranylcypromine.I know. That's why I'm concerned.
> > > FWIW, I tried all sorts of dose schedules and the insomnia was about the same regardless. I think that once you reach steady-state levels, it doesn't make much difference when you take it.I think we may respond to this differently. Could you "feel" the Parnate kick in with your doses? I can. If I take more than 5 mg at a time, I hyperventilate again.
>
> > The rash, he wasn't so sure about. (I had been painting wearing latex gloves and using turpentine--so maybe this caused the rash.)
>
> What on earth posesses you to come into contact with all these weird chemicals?!Painting a house.
> > If I decide to abandon the Parnate, I will have a 4-5 day washout during which I can use the Adderal and Neurontin.
>
> That's good. Do you have Klonopin or Xanax? Those have helped me a lot when going off MAOIs.I have Atavan. Do you think I'll need it even with the stimulant and neurontin?
> I don't know if I've mentioned this before, but I have a book on MAOIs that might interest you. (I recognise most of the articles you listed, BTW.)I would be interested in it if it interests you:-)
> It's a small price to paySee to say this you must not love to sleep. I love to sleep and I love to dream and I love to wake up in the morning feeling "refreshed" by my sleeping and dreaming.
.... (BTW, my intense dreams are back. No abnormal movements, though. < cross fingers >)
Crossed. (Do you associate dreams with abnormal movements? Do you mean restless leg syndrome?)
Lorraine
Posted by Lorraine on August 24, 2001, at 13:17:31
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 22, 2001, at 19:59:15
Hi shelli:
I am sorry that I didn't respond to this. I think I did but messed up when I posted. I've been wondering how you are and why you haven't posted recently. (ok 2 days< g >)
> > >[re parnate] But I did feel really tired and sick; I do remember that.
I felt pretty sluggish in the afternoons, which then expanded to the mornings. I gave up Neurontin during the day to help alleviate this. Shelli, mood diaries help with the "memory" problems. I'd be lost without one.
> > > Well, not everyone has alters. So you already know you're different from most people. And then it does really get into what the definition of DID is.All a bunch of group think. I think all the symptom clusters are an example of the human capacity to spot patterns where none exist.:-)
[re talk therapist]You could just view her as you "work" therapist and see her when you are capable of "work".
Wellbutrin is a great drug if it works for you. It is a puppy upper and I felt it right away. (we seem to respond differently though to drugs).
I was very suicidal
I am so sorry to hear this. And concerned. How are you now? Does it help to remember to just crawl under the desk until the storm passes?
What happened with your pdoc on Thursday?
> > > I can't even discribe how low I had gotten. And tt scares me to think it is not over yet.I know that must be really scarey. I hope you are doing ok. I feel like a heel for not responding to this sooner (you don't need to take care of me on this :-)
> > >I'm glad that Jahl reminded me of the lability aspect of the wellbutrin, because it's enabling me to keep a minisule perspective right now.
I thought I was going to crawl out of my skin on Wellbutrin. My anxiety shot through the roof. But I know a lot of people don't have that reaction and I hope you are one of them.
> > >I made an appointment with someone for next week which was a crazy thing to do
You might have thought it would make you feel more in control or that you were accomplishing something. Your work provides you with a lot of rewards usually. It must be hard to be unable to function.
> > >so I am feeling off-center and very unprofessional. But at least she is off the schedule for next week.It's like they say in an airplane, first you put the oxygen mask on yourself, then you do for others. You know this, but I will say it anyway, it is not unprofessional to take care of yourself when you are sick. It is irresponsible to not take care of yourself when you are sick. You are doing everything you can Shelli. You just can't control this disease or your response to meds. All you can do is batten down the hatches during the tough times and survive so that you will be here when times are better--moods pass. I also want to remind you that you have a serious disease. If you were having a bad spot with MS, you would go easier on yourself I think. Somehow, I think, we buy into the notion that we "ought" to be able to do better than we can even though we know it's not something we can snap out of.
> > > Did you used to like vacations. I mean, is this part of the depression? Do you ever just go away with your husband?
Hard to say if I used to like vacations. I think I thought I was supposed to enjoy vacations. I go away with my husband once a year. This is terrible to admit, but I still find I have to "manage my energy" level to make it good for him.
> > >I'm hoping that her teenage years won't be too rough on us.
>
> I hope they won't be rough on her :-)They say that the years of greatest risk for mental illness are the years of hormonal change. I share your hope for her.
> I 've only just heard about spontaneous hypertensive crises in the last week. (Of course, I've never had one). It's good to see what your doctor thinks. Have you taken your BP at home during these headaches?Just today and it was fine. Well the rash may end the Parnate trial for me. I have to see if it subsides.
Do take care of yourselfLorraine
Posted by Lorraine on August 24, 2001, at 13:18:50
In reply to Re: Update Shelli/elizabeth, posted by may_b on August 24, 2001, at 10:55:39
May_b:
My pdoc copied them for me.
> I am keenly interested in these articles. How did you obtain them?
>
> Thanks,
> may_b
>
>
> >The MAO articles that I was talking about are in Psychiatric Annals 31:6/June 2001. Apparently, the entire issue is dedicated to MAOs. The titles include: "The Use of Monoamine Oxidase Inhibitors for Treating Atypical Depression" by Patrick J. McGrath et al; A Neurochemical Perspective on Monoamine Oxidase Inhibitors by Lynn Wecker et al; A Reevaluation of Dietary Restrictions for Irreversible Monoamine Oxidase Inhibitors by Kenneth Shulman et al; Selegiline and other Atypical Monoamine Oxidase Inhibitors in Depression by J. Alexander Bodkin et al; and Monoamine Oxidase Inhibitors Revisited by Jay D. Amsterdam et al.
> >
Posted by shelliR on August 24, 2001, at 22:17:45
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 24, 2001, at 13:17:31
Hi Lorraine, Elizabeth, friendly lurkers if any
> I am sorry that I didn't respond to this. I think I did but messed up when I posted. I've been wondering how you are and why you haven't posted recently. (ok 2 days< g >)
Chapter I:What I'm doing and why I didn't write
Well, right now I am really really tired. Overstimulated, then so tired in the afternoon, unable to take a nap, so I'm in that zombie place, if you know where I mean. Especially because it's 9:30(dst--Elizabeth :-) here, so what do you do when you feel this dragged out? If ESPN was a bit more in tune with my preferences, it would be showing the second semi-final (Jennifer Capriati against Venus Williams) of the Pilot Pen Tennis Tournament (warmup for the US open, in case you're not tennis fans), and I would be watching that and doing the treadmill. (I actually don't mind doing the treadmill when I'm really tired if I am watching something that I'm really into). Instead, ESPN2 has been reserved for car racing and the semi-final will be shown recorded at midnight. Bummer. See those are the really important things in life. (I'm *not* kidding).Which moves me right into why I haven't written for 2 whole days < g >. Actually, I'm a tennis nut, especially women's tennis. So there's been some great tennis going on (deep women's field), and I am also trying to get work out in between the matches and do the treadmill 45 minutes each day. (And there weren't any questions that I hadn't answered, I don't think :-) )
Chapter II: About Therapy
> You could just view her as you "work" therapist and see her when you are capable of "work".
Well, in theory that's a good idea, but not really practical. If I want my "times" reserved then I have to go because my insurance does not pay for missed appointments. To not go would be a big change and I'm not up to making any major decisions or changes right now. But we're working with EMDR and "managing affect". Sometimes it's very helpful for your therapist to set up the agenda. Like Thursday I walked in and she said, okay, we're going to continue working on "managing affect". When my life was more active than my depression, I would then sometimes say, "but.....came up this week....", and then we'd do an agenda change. But this is fine for now.We totally stay away from the topic of medication, which feels totally bizarre, since that is the focus of what's going on now. But the opiate thing is so disturbing to her that it is best to not even mention it. And probably talking about what feelings are coming up and how to stop them from overwhelming me is more useful anyway.
>
Chapter III: Wellbutrin, Other Assorted drugs, and Addiction
> Wellbutrin is a great drug if it works for you. It is a puppy upper and I felt it right away. (we seem to respond differently though to drugs).What is a puppy upper? (Will something wag or poop in the wrong place :-) ) No really, I never heard that term.
I know that I am not feeling any good effects yet because I wake up so depressed. The extra oxycontin is helping enormously. The only problem with the wellbutrin is that it's making me verbally inarticulate (which my pdoc says comes up quite often with wellbutrin and hopefully will go away). Being verbally inarticulate is not okay for me. I will give it some time, but here's my main concern, which I will ask him about when I see him on Monday. He says, "don't worry, it's a trial", but meanwhile during these trials the oxy gets me through and I need his absolute commitment that he is willing to raise the oxy as high as it needs to be raised until I find a med that works. Because with each failed trial, I have become habituated to 10 more mg of the oxy. (It's really too bad it's not offered in 5mg--because I am actually going up 10mg more than I need to each time. Like now I take 20 bid, instead of 15bid.I asked him again about buph and he feels that it is a "dirty" drug, that it has too many side effects and causes too many complications in combinations with other drugs. He's also not convinced there is no tolerance with buprenorphine.
Elizabeth, this is just his opinion, and I didn't really get into a discussion about it because I have very little time with him and was focusing on the wellbutrin (which is also not his favorite AD because of complicated side effects). I still wouldn't mind trying buph, especially after reading posts from Neil and jojo. But I am fine with the oxy as long as the rug is not pulled from under me. I am not scared of my tolerance to it, in terms of never being able to get off or going through horrible withdrawal or anything. I can't imagine that it would be worse than effexor, for example.> I was very suicidal
> I am so sorry to hear this. And concerned. How are you now? Does it help to remember to just crawl under the desk until the storm passes?To be honest, what helped was the fact that my doctor upped the oxycontin and I started a new trial with wellbutrin. And I went back on estrogen--I'm going to try it for a new months and then rethink it. I am getting what are hot flushes, (not flashes) which is a sign of lowered estrogen (in spite of my 2 glasses of soy milk daily).
> What happened with your pdoc on Thursday?
didn't raise wellbutrin because of my experience of inarticulation.
> I thought I was going to crawl out of my skin on Wellbutrin. My anxiety shot through the roof. But I know a lot of people don't have that reaction and I hope you are one of them.Well the mental/verbal aspect is more troublesome, but I did take 5mg of valium today. I'm also not at all worried about valium addiction. (Am I sounding more and more like an addictive personality with all my denial in this posts? < g >) I've taken valium off and on through my entire adult life (that or klonopin) and I just feel it normalizes a shakey life that could be even shakier. I mean, I have PTSD, and I will have to take drugs for depression and anxiety, and do therapy. It isn't my fault and these drugs allow me to have a richer life. It feels very simple to me.
>
> > > >so I am feeling off-center and very unprofessional. But at least she is off the schedule for next week.
>
> It's like they say in an airplane, first you put the oxygen mask on yourself, then you do for others. You know this, but I will say it anyway, it is not unprofessional to take care of yourself when you are sick. It is irresponsible to not take care of yourself when you are sick. You are doing everything you can Shelli. You just can't control this disease or your response to meds. All you can do is batten down the hatches during the tough times and survive so that you will be here when times are better--moods pass. I also want to remind you that you have a serious disease. If you were having a bad spot with MS, you would go easier on yourself I think. Somehow, I think, we buy into the notion that we "ought" to be able to do better than we can even though we know it's not something we can snap out of.
>
Thanks for the lecture. Really.Chapter IV: Work, Vacations and Family Issues
I am always struggling with work issues because even when my depression is under control, I distract easily. Having a DD is part of it. It obviously does take a lot of discipline to work at home by yourself and that is always a struggle for me. Plus I am really slow at doing things; that is by temperment and it's the way I like to work. But I need to work on using work time more efficiently, so I don't feel guilty when I'm not working. Today was good because I had deadlines (post office closes, frame store closes) so I pushed myself to finish what needed to get framed and mailed before I got on the computer, for example. :-) And that is important because it makes me feel much better about myself and less out of control.
>
> > > > Did you used to like vacations. I mean, is this part of the depression? Do you ever just go away with your husband?
>
> Hard to say if I used to like vacations. I think I thought I was supposed to enjoy vacations. I go away with my husband once a year. This is terrible to admit, but I still find I have to "manage my energy" level to make it good for him.I think I understand that. Is it like his energy level is higher or different, so you feel like you are keeping the pace at his level so *he* can feel, "I had a great vacation." I can see if you do have different energy levels that it would be easier working out living together than planning time on a vacation. Is this what you mean? I guess also different types of vacations would be more suited to one energy level over another. How are your energy levels different?
>
> > > >I'm hoping that her teenage years won't be too rough on us.
> > I hope they won't be rough on her :-)
> They say that the years of greatest risk for mental illness are the years of hormonal change. I share your hope for her.Since she has the personality that you have described, I would think that she'll be fine. I can imagine that your depression makes you watch her closely, but you were also a neglected child and she is not. I mean that even if genetically she has a predisposition to depression, the circumstances usually have to be there for depression to be manifested. Not always of course, like with you, Elizabeth, but more often than not.
Schizophrenia is a strange thing, because it is often manifested in the late teen years and if I remember correctly, more often for boys. That is a strange thing that I don't know a lot about but I should. Both an old boyfriend and my friend's brother both had normal childhoods and began to show signs of schizophrenia at about age 18 or 19.
>I'm of course, wondering, about you and parnate. If the rash turns out to not be an issue, you didn't get a headache today, so I don't get why you are feeling so pessimistic? Or is the talk about nardil a just in case scenario so you'll be ready if...?
BTW, I'm getting nightmares, not awful ones, more like bad long dreams since I started wellbutrin that I really do not like.
Wishing that you wake up rested without a headache tomorrow and a rash has nothing to do with parnate.
Oh wow, I can believe it is now 11 pm and I have written this much. This was like my evening activity. I think I should go back and put in chapters, or present it as a serial. See what happens when I don't write for two days. What is the face for embarrassed?Take care,
Shelli
Posted by Lorraine on August 25, 2001, at 11:47:30
In reply to Re: Update Lorainne, Elizabeth, et. al., posted by shelliR on August 24, 2001, at 22:17:45
> > > Which moves me right into why I haven't written for 2 whole days < g >. Actually, I'm a tennis nut, especially women's tennis. So there's been some great tennis going on (deep women's field), and I am also trying to get work out in between the matches and do the treadmill 45 minutes each day. (And there weren't any questions that I hadn't answered, I don't think :-) )
I am happy you have a hobby that distracts you. My husband and son are tennis buffs--both very good players and, yes, we watch a lot of tennis. It is one of the few sports I can tolerate watching. I used to play but my lack of talant was depressing.
>
> Chapter II: About Therapy
> > >To not go would be a big change and I'm not up to making any major decisions or changes right now. But we're working with EMDR and "managing affect". Sometimes it's very helpful for your therapist to set up the agenda. Like Thursday I walked in and she said, okay, we're going to continue working on "managing affect". When my life was more active than my depression, I would then sometimes say, "but.....came up this week....", and then we'd do an agenda change. But this is fine for now.You will find a way to make it work with her; it sounds like you have the motivation. It's nice that she is so proactive.
>
> > > We totally stay away from the topic of medication, which feels totally bizarre, since that is the focus of what's going on now. But the opiate thing is so disturbing to her that it is best to not even mention it. And probably talking about what feelings are coming up and how to stop them from overwhelming me is more useful anyway.I used to walk into therapy each time and say "the meds aren't working"--it got old as a discussion topic. The more important one for me became how do I resume "life" and stop putting it on hold until the meds kick in.
> > > Chapter III: Wellbutrin, Other Assorted drugs, and Addiction
> What is a puppy upper?An activating drug. On Saturday Night Live (back when it was good), Gilda Radner (who was still alive) had a routine with a bassett hound and a cha-hau-hau. The bassett hound would come dropping in and she would say "oh, you look like you need a puppy upper" and she would give him a bisquit. The basset would turn into a cha-hau-hau and start jumping up repeatedly and nipping at her. She would then say "oh you need a doggy downer" and so forth. Pretty funny routine at the time.
> > > I know that I am not feeling any good effects yet because I wake up so depressed.
Shelli: how do stimulants work with you? Are they effective at all? It doesn't sound like they are gauging your reaction to Wellbutrin.
> > > The extra oxycontin is helping enormously. The only problem with the wellbutrin is that it's making me verbally inarticulate (which my pdoc says comes up quite often with wellbutrin and hopefully will go away). Being verbally inarticulate is not okay for me.
This didn't happen to me on Wellbutrin.
> > >during these trials the oxy gets me through and I need his absolute commitment that he is willing to raise the oxy as high as it needs to be raised until I find a med that works.
I've asked this question before. This is not in capsules you can split? Get some empty capsules at the health food store and eyeball the splitting of the capsules by holding the capsules up to the light. It will allow you to increment up more slowly on your oxy and buy you time on your habituation. I have had to do this a lot because I am so dose sensitive. It's a pain in the butt, but doesn't take that long. I'd split enough caps for a week at a time. Hey, 1/2 hour out of your life. It's worth it.
> > > I asked him again about buph and he feels that it is a "dirty" drug, that it has too many side effects and causes too many complications in combinations with other drugs. He's also not convinced there is no tolerance with buprenorphine.He likes to make his job easier, doesn't he?
> > >But I am fine with the oxy as long as the rug is not pulled from under me. I am not scared of my tolerance to it, in terms of never being able to get off or going through horrible withdrawal or anything. I can't imagine that it would be worse than effexor, for example.You are probably right. Effexor was very hard for me to come off of.
> > > To be honest, what helped was the fact that my doctor upped the oxycontin and I started a new trial with wellbutrin. And I went back on estrogen--I'm going to try it for a new months and then rethink it. I am getting what are hot flushes, (not flashes) which is a sign of lowered estrogen (in spite of my 2 glasses of soy milk daily).I met with my wholistic practitioner last week and talked about hormones. She is premenopausal (barely) and takes progesterone to help control her moods. She said too little progesterone and too much progesterone causes depression. She also said that when you first become perimenopausal, it is your progesterone level that dips first. Anyway, she will be putting me back on estrogen but adding progesterone to that. She says she can tell day to day whether she needs more progesterone and tweeks her dose accordingly. She also confirmed that for PMS, the issue is progesterone rather than estrogen. Thought I'd pass this along given that you are considering all of this stuff.
> > > What happened with your pdoc on Thursday?
> didn't raise wellbutrin because of my experience of inarticulation.You might try adding Serzone at night. I was on this combo for a while. The Serzone helped me sleep and the Wellbutrin woke me up.
> > > Well the mental/verbal aspect is more troublesome, but I did take 5mg of valium today.I used to take two extra strength Buffrin before tests when I got my MBA--it really helped with thought clarity.
> > > I'm also not at all worried about valium addiction. (Am I sounding more and more like an addictive personality with all my denial in this posts? < g >)
You sound like someone who has come to grips with the fact that you will need to take meds for life and that the meds you need to take may be meds with the potential for addiction. You are not trying to get high, which is what addiciton is about. You are trying to medicate a serious condition and you know what withdrawal is about. So, I suspect that you are pretty grounded about all of this but a bit desperate right now in your quest.
> > > Thanks for the lecture. Really.Your welcome:-)
> > > Chapter IV: Work, Vacations and Family Issues
> I am always struggling with work issues because even when my depression is under control, I distract easily. Having a DD is part of it. It obviously does take a lot of discipline to work at home by yourself and that is always a struggle for me. Plus I am really slow at doing things; that is by temperment and it's the way I like to work. But I need to work on using work time more efficiently, so I don't feel guilty when I'm not working. Today was good because I had deadlines (post office closes, frame store closes) so I pushed myself to finish what needed to get framed and mailed before I got on the computer, for example. :-)You are right on track here, I think. You need to find out what you can do when you are feeling bad. Doing the mindless errands (frame shop; post office) works. For me, at least, the trick is to get my foot out the door, then the rest follows. What about doing the artistic stuff (not the shoots) when you are down? If you actually start working on your painting the photos when you are down, are you capable of pulling in the creative energy?
> >
[re me and vacations > > > >I think I understand that. Is it like his energy level is higher or different, so you feel like you are keeping the pace at his level so *he* can feel, "I had a great vacation." I can see if you do have different energy levels that it would be easier working out living together than planning time on a vacation. Is this what you mean? I guess also different types of vacations would be more suited to one energy level over another. How are your energy levels different?Bingo! Yes, he is very very very high energy and I am not, especially when I am depressed. His idea of a great vacation would be to go someplace educational, get up crack of dawn and conquer the place step by step; roll into bed at 10pm. I can't do this. We have found ways to accommodate our different energy levels--like when we were in DC the last time, I didn't go on every excurtion with them (neither did my son). Last vacation, I planned so I could have some chill time. But even being fully aware of this--there is a constant pressure with him to "do" something. It is his own internal anxiety that drives this and, thankfully, he is aware of this. I still feel the pressure though.
[re my daughter]
> Since she has the personality that you have described, I would think that she'll be fine. I can imagine that your depression makes you watch her closely, but you were also a neglected child and she is not.My daughter tells me that she doesn't want to grow up and leave her childhood because it has been so great. Can you imagine? That is so foreign from my childhood and yours.... Plus she has no traumas--no burns; no sexual abuse, no physical abuse; no deaths; no constant moving with the stress and loss of community that goes with that.
> > >I mean that even if genetically she has a predisposition to depression, the circumstances usually have to be there for depression to be manifested.
I think this is true for her. I worry much more about my son, who is emotionally intense and more predisposed I think to mood problems.
> > > Schizophrenia is a strange thing, because it is often manifested in the late teen years and if I remember correctly, more often for boysThis doesn't run in the family so I don't worry about it.
> > >I'm of course, wondering, about you and parnate.
Well, I have response but not remission. I can't increase right now because of the side effects--which include more hyperventilation as I increase the dosage. I still have the rash and it looks worse, but my husband says "it always gets redder when it's healing" and my daughter says "mommy, this is worse". So I'm giving it a few more days. I didn't get the headache this morning either. My pessimism has to do with the tears behind my eyes I think. Break-through depression.
> > >Or is the talk about nardil a just in case scenario so you'll be ready if...?
Yeah, I want the visa for my next trip so to speak in my pocket. It makes me feel better to know the next step is at hand.
> > > BTW, I'm getting nightmares, not awful ones, more like bad long dreams since I started wellbutrin that I really do not like.
I think I had that with Wellbutrin for a while.
> > >Wishing that you wake up rested without a headache tomorrow and a rash has nothing to do with parnate.Thanx. I dreamed of kittens last night. Wouldn't have known it if I hadn't woke up. Soft kitten curled around each other in a box.
Keep in touch, shelli
Posted by Elizabeth on August 25, 2001, at 11:48:56
In reply to Re: Parnate stuff » Elizabeth, posted by Lorraine on August 24, 2001, at 12:45:34
> So much for my suspicions--but do you do well on stimulants?
I haven't had much of a chance to find out. I did take a very low dose of Cylert for about 6 months in college, and that seemed to be helpful.
> > What new insurance? New insurance is what I need to find!
>
> That does not sound easy given preexisiting condition unless it is part of a group plan. What are your options?It's a bit complicated. I should have the info in the mail sometime in the next few days.
> > That doesn't sound like high blood pressure to me -- the headache would be at the base of your skull and/or in the back of your neck.
>
> Thank-you--this is very helpful to me. I didn't know what occipital meant.< g > The occipital lobe is in the back, yeah.
> > > The PDR says ...
> >
> > CYA.
>
> That's what my pdoc said as well.I'm really worried that I seem to be thinking like your pdoc. :-)
> > Try and get a measurement. MAOIs can cause headaches for other, unrelated reasons.
>
> Today, slight headache, blood pressure was low (93/66) with a pulse of 62.That's about how my BP was running when I was taking Parnate. FWIW, I did get headaches occasionally from low blood pressure, especially upon getting up out of bed in the morning.
> The time of day that I take the medication does have an effect on my sleeping. If I take it later than 12:30 pm I cannot go to sleep at night until very late (2am or 3am).
I think that after you've been taking it for a while, it won't matter (for better or for worse).
> Wait what is eczema?
Dermatitis -- skin inflammation. Causes include autoimmune reactions, repeated contact with irritants, fungal infection, etc.
> > Parnate contains the sulfate salt of tranylcypromine.
>
> I know. That's why I'm concerned.Well...what other drugs have caused rashes for you, if any?
> I think we may respond to this differently. Could you "feel" the Parnate kick in with your doses? I can. If I take more than 5 mg at a time, I hyperventilate again.
I couldn't "feel" it, but I sure had a hard time if I missed it. (No headaches, just low mood and lethargy.) The sympathomimetic effect (hyperventilation) is something you should adjust to after taking it for a while.
> > What on earth posesses you to come into contact with all these weird chemicals?!
>
> Painting a house.Well, good luck. What colour?
> I have Atavan. Do you think I'll need it even with the stimulant and neurontin?
I've never used Neurontin for that purpose, so I don't know how it compares to the benzos.
> I would be interested in it if it interests you:-)
:-) It's _Clinical Advances in MAOI Therapies_, Kennedy ed.
> > It's a small price to pay
>
> See to say this you must not love to sleep. I love to sleep and I love to dream and I love to wake up in the morning feeling "refreshed" by my sleeping and dreaming.I sleep better on ADs than off them. I love to dream too, despite some of the problems it has caused me (!), but I still think it's a small price.
> .... (BTW, my intense dreams are back. No abnormal movements, though. < cross fingers >)
>
> Crossed. (Do you associate dreams with abnormal movements? Do you mean restless leg syndrome?)No, not RLS. I think I must have mentioned this before: I have a sleep disorder which causes me to retain skeletal muscle tone during REM sleep. As a result, I move around in my sleep trying to act out my dreams.
-elizabeth
Posted by Lorraine on August 25, 2001, at 17:26:31
In reply to Re: Parnate stuff » Lorraine, posted by Elizabeth on August 25, 2001, at 11:48:56
[re stimulants] > I haven't had much of a chance to find out. I did take a very low dose of Cylert for about 6 months in college, and that seemed to be helpful.
That sounds promising. You might try them during a washout if your pdoc is willing. Was it helpful as in activating or as in cognitively?
Let's hope the insurance sorts itself out soon.> > > > The PDR says ...
> > >
> > > CYA.
> >
> > That's what my pdoc said as well.
>
> I'm really worried that I seem to be thinking like your pdoc. :-)Me too. :-) (although you both are pretty untraditional is some respects--he having dumped DSM categories entirely--and you recognizing your need to medicate with opiates).
> > > That's about how my BP was running when I was taking Parnate. FWIW, I did get headaches occasionally from low blood pressure, especially upon getting up out of bed in the morning.See now that's what I thought when I took that reading. And my orthostatic hypotension is pretty pronounced now (definately have to be careful standing up from a squatting position). Plus my "sluggishness" could be this, couldn't it? Maybe I should get some of those salt tablets. I wonder where you get them--seem unlikely for a health food store, don't they? Well, the internet will guide me.
>
> > The time of day that I take the medication does have an effect on my sleeping. If I take it later than 12:30 pm I cannot go to sleep at night until very late (2am or 3am).
>
> I think that after you've been taking it for a while, it won't matter (for better or for worse).for better, let's hope:-)
>
> > Wait what is eczema?
>
> Dermatitis -- skin inflammation. Causes include autoimmune reactions, repeated contact with irritants, fungal infection, etc.sounds a lot like my rash, doesn't it? So your's stayed until you quite Parnate?
>
> > > Parnate contains the sulfate salt of tranylcypromine.
> >
> > I know. That's why I'm concerned.
>
> Well...what other drugs have caused rashes for you, if any?Penicillan, anti-malarial med (not a sulfate); the stuff they scrub you down for surgery; and maybe, although, my memory is faint here sulfer antibiotics--
> > >The sympathomimetic effect (hyperventilation) is something you should adjust to after taking it for a while.You think? I'm concerned because I had hyperventialtion, then it went away, then it came back (maybe when I increased my dose to 15 mg?)
> > > Painting a house.
>
> Well, good luck. What colour?I am somewhat of a colour freak. Each room is a different colour with a different colour trim. I mix some of my own paints from raw pigment (bet you didn't know that could be done, huh?) and do special paint techniques. I like for rooms to have a certain effect on mood (wouldn't you know?)
Anyway, the living room is maybe tobacco color, the dining alcove terracota with gold mixed in--gives you some idea. Pretty stuff actually.> :-) It's _Clinical Advances in MAOI Therapies_, Kennedy ed.
Thank you--another book for the collection.
> > > I sleep better on ADs than off them.OK, that's right because you are not atypical depression and I am.
> > > No, not RLS. I think I must have mentioned this before: I have a sleep disorder which causes me to retain skeletal muscle tone during REM sleep. As a result, I move around in my sleep trying to act out my dreams.
Do you wake up tired? Do your muscle get a chance to rebuild themselves?
Still holding even with Desipramine? I'm still waiting with the rash and then if that turns out ok, then I'll wait to see if I can increase my dosage very slowly over time and deal with the sleep problems. No headache today again.
Lorraine
Posted by shelliR on August 25, 2001, at 19:58:09
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 25, 2001, at 11:47:30
> Shelli: how do stimulants work with you? Are they effective at all? It doesn't sound like they are gauging your reaction to Wellbutrin.
I don't know what you mean by "....they are gauging your reaction to Wellbutrin"
Re stimulents: I have hated the feeling that all stimulents have given me. Hated ritalin, dexadrine, adderall. Adrafinil was okay (but caused a hypertensive reaction with nardil). Since being off the nardil I tried concerta (I think I told you about that), and it was hard to get a reading with both concerta and the oxy. They were way too stimulating together. If I go back on nardil, that is a possiblity (without the oxy), but I'm not really sure since the other stimulents made me feel so awful.
> I've asked this question before. This is not in capsules you can split? Get some empty capsules at the health food store and eyeball the splitting of the capsules by holding the capsules up to the light. It will allow you to increment up more slowly on your oxy and buy you time on your habituation. I have had to do this a lot because I am so dose sensitive. It's a pain in the butt, but doesn't take that long. I'd split enough caps for a week at a time. Hey, 1/2 hour out of your life. It's worth it.No, its a time release tablet and you can't split it. When I first found that out, I realized that it was not the best of all worlds because my 10mg start made me a little spacy and high. But it is better than vicodin in that it has no APAP pain med with it that can cause problems (I can't remember what problems--maybe liver problems)
>
> > > > I asked him again about buph and he feels that it is a "dirty" drug, that it has too many side effects and causes too many complications in combinations with other drugs. He's also not convinced there is no tolerance with buprenorphine.
>
> He likes to make his job easier, doesn't he?
Well, the side effects would be mine, so I don't understand what you mean.
>
> I met with my wholistic practitioner last week and talked about hormones. She is premenopausal (barely) and takes progesterone to help control her moods. She said too little progesterone and too much progesterone causes depression. She also said that when you first become perimenopausal, it is your progesterone level that dips first. Anyway, she will be putting me back on estrogen but adding progesterone to that. She says she can tell day to day whether she needs more progesterone and tweeks her dose accordingly. She also confirmed that for PMS, the issue is progesterone rather than estrogen. Thought I'd pass this along given that you are considering all of this stuff.Well, for pms, I use a natural progesterone suppository and it helps a lot with the physical symptoms. For me it doesn't touch my premenstrual depression, which I have had even when my depression was mostly under control. A deficit of estrogen is what causes hot flashes (and my flushes, I guess) (at least that's why I have been reading). Because of the study that came out in the Archives of General Psychiatry in June of this year (which indicated that estradiol is an effective antidepressant treatment for perimenopausal women), I started estradiol But I was really confused because my sister and cousin had the same type of invasive breast cancer so I stopped taking it. (Also I became more depressed and didn't know what it had to do with.) But now I think I want to try it for several months, and I want to stick with the same type and dose that was used in the study. I'm sorry now that I went off of it, because I might have known by now if it is helpful. If it proves to be helpful, I might try natural estrogen or black cohosh and see if the good result can be duplicated. In any case, now I have to ask my gyn to put me on natural progesterone. I remember you said before that it was better to take it during the whole cycle than just 1 week of the cycle.
>> You might try adding Serzone at night. I was on this combo for a while. The Serzone helped me sleep and the Wellbutrin woke me up.
So far I am not having any problems sleeping at night, but I'm still only taking 200mg a day. I did take serzone for a while (no positive affect on depression), but I don't remember it making me sleepy. I'll have to see if I have trouble with sleep--that comes after being able to talk. :-) I know I didn't have size effects with serzone, so it is something I can add.
>
>
>
>
> You are right on track here, I think. You need to find out what you can do when you are feeling bad. Doing the mindless errands (frame shop; post office) works. For me, at least, the trick is to get my foot out the door, then the rest follows. What about doing the artistic stuff (not the shoots) when you are down?Well, actually I wasn't doing mindless stuff. I both had to do some creative stuff and some detail work (writing receipts, designing frame sizes, etc.) Then I had to take my finished products to the post office and to the framer I work with. I was not feeling very depressed, I just had to push to make myself focus (more DD stuff). Since the oxy was raised, the depression has been very tolerable. It really depends on how severe my depression is what I am able to do. But transitions are really difficult for me, even when I am not depressed. Doing artistic work requires a transition , which takes effort, even when I am not depressed. Once the bridge is crossed, it is fine. That is unless my depression is the extremely horrible, painful depression that I have had this year when I am not taking a narcotic. I had that last week because I had become habituated to the dose of oxy that I was on and my pdoc was away. I really didn't think he would let me raise it when he got back, so that had much to do with why I felt so hopeless and suicidal. Without the oxy working, my depression is too painful for me to through these trials. Both the waiting periods and the failures.
>
>
> My daughter tells me that she doesn't want to grow up and leave her childhood because it has been so great. Can you imagine? That is so foreign from my childhood and yours.... Plus she has no traumas--no burns; no sexual abuse, no physical abuse; no deaths; no constant moving with the stress and loss of community that goes with that.I can only imagine because of my niece.
She said the same thing about not wanting to get older than I think, fifteen, when she was about your daughters age (I'm not sure how she feels about it now --age 14). Part of it was that she loved her life, but also part of it was that she didn't perceive of adults having fun and enjoying life like kids do (at least the kids she knows). And then I was amazed to read a piece in the Wash Post talking about how that lack of eagerness to grow up was becoming a common feeling that differed a lot from the previous generations. I don't remember what I thought about becoming an adult in the future, but I didn't perceive it as a bad thing, like my niece and the kids in the article did. My guess about it is that parents share more about their stresses with their children, so children don't have illusions about happily ever after. What do you think? I mean why do you think this is a more common feeling in kids today?
>
Speaking of which: how to your kids relate to your depression. Do you talk about it, and especially, do they ask about it?> I worry much more about my son, who is emotionally intense and more predisposed I think to mood problems.
How is he doing now? He's been in therapy, right? But not on medications?
>
>
> > > >I'm of course, wondering, about you and parnate.
So I'm giving it a few more days. I didn't get the headache this morning either. My pessimism has to do with the tears behind my eyes I think. Break-through depression.But you have been on parnate such a short time. I would expect that the AD effect will definitely increase with time and dose.
I think that first good reaction is often not continuous, and it might take a full four or five weeks for you to get the whole effect.BTW, I am just curious if you ever tried lamictal. (Because a MAOI and lamictal was my best combination ever).
Talk to you soon, Shelli
Posted by Elizabeth on August 26, 2001, at 11:24:24
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 25, 2001, at 19:58:09
> Adrafinil was okay (but caused a hypertensive reaction with nardil).
How high was your blood pressure? I'm curious because I tried adding modafinil to Parnate and my blood pressure was elevated, but only modestly.
> Since being off the nardil I tried concerta (I think I told you about that), and it was hard to get a reading with both concerta and the oxy. They were way too stimulating together.
So you find opioids activating too?
> No, its a time release tablet and you can't split it. When I first found that out, I realized that it was not the best of all worlds because my 10mg start made me a little spacy and high. But it is better than vicodin in that it has no APAP pain med with it that can cause problems (I can't remember what problems--maybe liver problems)
APAP is acetaminophen -- Tylenol. If you take very large amounts, it can cause liver damage, yes. You can get immediate-release oxycodone without any extra stuff added.
BTW I think your pdoc may be right that buprenorphine causes more side effects than oxycodone or some of the other opioids. If you wanted the one with the least side effects, my choice would be the fentanyl patch (Duragesic).
> But you have been on parnate such a short time. I would expect that the AD effect will definitely increase with time and dose.
> I think that first good reaction is often not continuous, and it might take a full four or five weeks for you to get the whole effect.Me too. Sometimes Parnate works rapidly, but not for everyone.
> BTW, I am just curious if you ever tried lamictal. (Because a MAOI and lamictal was my best combination ever).
I tried adding Lamictal to Nardil...didn't do a thing!
-elizabeth
Posted by Elizabeth on August 26, 2001, at 11:25:32
In reply to Re: Parnate stuff » Elizabeth, posted by Lorraine on August 25, 2001, at 17:26:31
> That sounds promising. You might try them during a washout if your pdoc is willing.
Washout?
> Was it helpful as in activating or as in cognitively?
Increased alertness and improved attention. I think I mentioned that it also helped my to maintain a normal circadian rhythm, something I've had trouble with since infancy. I would take it first thing in the morning, feel awake and clear-headed by the time I needed to go to class, and start getting tired close to when I should be going to bed rather than in the late afternoon or early evening. (Most effective antidepressants have made this worse, not better.)
I think that salt for orthostatic hypotension is a fine idea (it doesn't have to be in tablets). Be sure you're getting enough fluids, too. French fries (the salt-supersaturated ones from McDonald's) and Gatorade was my favourite cure.
> > Dermatitis -- skin inflammation. Causes include autoimmune reactions, repeated contact with irritants, fungal infection, etc.
>
> sounds a lot like my rash, doesn't it? So your's stayed until you quite Parnate?Yes, but it only appeared after I'd been on Parnate for a while, so it's not clear that there was a relationship. Plus I've had atopic eczema before. It was probably just a flareup.
> > Well...what other drugs have caused rashes for you, if any?
>
> Penicillan, anti-malarial med (not a sulfate); the stuff they scrub you down for surgery; and maybe, although, my memory is faint here sulfer antibiotics--Do you mean sulfa drugs? (Bactrim, Septra, etc.)
> >The sympathomimetic effect (hyperventilation) is something you should adjust to after taking it for a while.
>
> You think?I'm pretty sure. I had it on Parnate too when I first started taking it.
> I am somewhat of a colour freak. Each room is a different colour with a different colour trim.
Oh, you're painting the inside! That sounds fun. I imagine you (for whatever reason) as being an artistic, creative person, and your description of how you're playing with the paints seems to confirm that. The colours you're using sound very earthy.
> > I sleep better on ADs than off them.
>
> OK, that's right because you are not atypical depression and I am.I'm not convinced that people who have atypical depression are sleeping *well*. They sleep a lot, but it seems like they never feel rested. Does that sound right?
> > No, not RLS. I think I must have mentioned this before: I have a sleep disorder which causes me to retain skeletal muscle tone during REM sleep. As a result, I move around in my sleep trying to act out my dreams.
>
> Do you wake up tired? Do your muscle get a chance to rebuild themselves?Neither. The problem is that sometimes I awaken myself (usually by jumping out of bed) and other times I have attacked the person next to me in my sleep (!). (Nothing serious, but it does freak them out sometimes.)
> Still holding even with Desipramine?
Yup. I'm pleased.
> I'm still waiting with the rash and then if that turns out ok, then I'll wait to see if I can increase my dosage very slowly over time and deal with the sleep problems. No headache today again.
Good -- maybe you're adjusting to it. I hope it works out for you.
-elizabeth
Posted by Lorraine on August 26, 2001, at 14:48:33
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 25, 2001, at 19:58:09
>
>
> > > Shelli: how do stimulants work with you? Are they effective at all? It doesn't sound like they are gauging your reaction to Wellbutrin.
> I don't know what you mean by "....they are gauging your reaction to Wellbutrin"For me, Wellbutrin was very much like a stimulant. Just didn't sound like you were reacting positively--word loss and so forth--didn't sound energized.
> >
> > > > > I asked him again about buph and he feels that it is a "dirty" drug, that it has too many side effects and causes too many complications in combinations with other drugs. He's also not convinced there is no tolerance with buprenorphine.
> >
> > He likes to make his job easier, doesn't he?
> Well, the side effects would be mine, so I don't understand what you mean.I meant that the complications in combinations with other drugs could probably be worked out if he cared to do it. And, the side effects were yours so you could determine whether they were bothersome or not. When I read what you wrote it just sounded like he was in essence saying "let's do this; it's easier". Shelli, I don't know your doctor so if a comment I make isn't useful just dismiss it and move on.
> > > Well, for pms, I use a natural progesterone suppository and it helps a lot with the physical symptoms.So, you are ahead of the game on this one--you already know what it does.
> > > For me it doesn't touch my premenstrual depression, which I have had even when my depression was mostly under control.
That's too bad and increasing the dose has no effect either, I take it?
> > >A deficit of estrogen is what causes hot flashes (and my flushes, I guess) (at least that's why I have been reading).
This is my understanding as well.
> > >Because of the study that came out in the Archives of General Psychiatry in June of this year (which indicated that estradiol is an effective antidepressant treatment for perimenopausal women), I started estradiol. But I was really confused because my sister and cousin had the same type of invasive breast cancer so I stopped taking it.
All of these factors make it difficult to decide what to do--for me as well. My mom had breast cancer as well. Two articles were useful to me in trying to figure this all out: "The Good News about Natural Estrogen http://www.naturalhormones.com/goodnews.html and "Menopause: Hormones and Other Therapies Sorting Out the Options http://www.woodmed.com/MenopauseHormonesOther.htm I think I ended up thinking that perhaps I should be on bi-extrogen, which is composed of estriol (80%) and estradial (20%). The estriol is not supposed to be associated with breast cancer and may actually aid in preventing it. The osteoporosis benefits still apply, although I'm not sure about the cardiovascular. All of this information is still in a state of flux and more studies need to be done. But I suspect that this is where I end up. My doctor will determine the dosage of progresterone and estrogen and have a compounding pharmacy make it up. We will then tweek it until it is right, although I am not so optimistic about the tweeking process given the number of other variables (drug trials) going on simultaneously. I'll let you know what happens with me ultimately on this. The test results should be in soon.
[re Wellbutrin]
> > > I know I didn't have size effects with serzone, so it is something I can add.You are speaking of weight gain < vbg >?
> > > It really depends on how severe my depression is what I am able to do. But transitions are really difficult for me, even when I am not depressed. Doing artistic work requires a transition , which takes effort, even when I am not depressed. Once the bridge is crossed, it is fine.
This is an interesting way of looking at it. I have found this too--that there is a transition to cross which is difficult. I used to use a hynosis type tape made specifically for this transition (I taped it myself) and it did help at the time I used it.
> > > I can only imagine because of my niece.
> Part of it was that she loved her life, but also part of it was that she didn't perceive of adults having fun and enjoying life like kids do (at least the kids she knows). And then I was amazed to read a piece in the Wash Post talking about how that lack of eagerness to grow up was becoming a common feeling that differed a lot from the previous generations. I don't remember what I thought about becoming an adult in the future, but I didn't perceive it as a bad thing, like my niece and the kids in the article did. My guess about it is that parents share more about their stresses with their children, so children don't have illusions about happily ever after. What do you think? I mean why do you think this is a more common feeling in kids today?I think there is some truth to all of this and want to talk to her about it. I don't know why kids would feel this way, perhaps they are getting a taste of being an adult earlier because of the pressure we put on kids these days or perhaps they see the world as too fast and hard. I hadn't really thought of it before--except in the context of choosing schools for them and deciding not to put them in an AP mill school because childhood is important to protect from adult pressures until necessary.
> >
> > > Speaking of which: how to your kids relate to your depression. Do you talk about it, and especially, do they ask about it?They know about it. We have discussed it specifically. They know when a med isn't working frequently. If my behavior is going to affect them, I tell them what is going on. They frequently comfort me if things are tough. We told them a couple of years ago when I got off Effexor and my behaviour (reclusive, hybernating) was clearly maladaptive and not something that I wanted role modeled for them.
> > I worry much more about my son, who is emotionally intense and more predisposed I think to mood problems.
> How is he doing now? He's been in therapy, right? But not on medications?Right. The therapy has just been one appointment and I'm trying to set up a regular schedule for him. But his aggression and anger is so near the surface now, I'm wondering about meds. His therapist said that in boys aggressive behaviour frequently is the result of a lack of serontonin. I could try 5HTP with him. I'm wrestling with it.
[re Parnate:]My pessimism has to do with the tears behind my eyes I think. Break-through depression.
>
> But you have been on parnate such a short time.Almost a month (can you believe that?)
> > >I would expect that the AD effect will definitely increase with time and dose.
Yes, and I increased my dose about two weeks ago.
> I think that first good reaction is often not continuous, and it might take a full four or five weeks for you to get the whole effect.
The headaches seem to have abated and if the rash goes away, then I'll continue with it for longer. The other side effect is just a lithargy in the afternoon--when my blood pressure seems to dip (93/56) so maybe salt tablet and water?
>
> BTW, I am just curious if you ever tried lamictal. (Because a MAOI and lamictal was my best combination ever).I tried lamictal and found it made me very edgy and anxious. Still with a different drug, its impact my be different.
Hope the Wellbutrin kicks in positively and you are able to articulate it.Lorraine
Posted by Lorraine on August 26, 2001, at 15:10:46
In reply to Re: Parnate stuff, posted by Elizabeth on August 26, 2001, at 11:25:32
> > That sounds promising. You might try them during a washout if your pdoc is willing.
>
> Washout?Periods between drugs when switching. Like if I switch from Parnate to Nardil, I will have a 4 day washout from the time I stop taking Parnate to the time I can start on Nardil.
>
> > Was it helpful as in activating or as in cognitively?
>
> Increased alertness and improved attention. I think I mentioned that it also helped my to maintain a normal circadian rhythm, something I've had trouble with since infancy. I would take it first thing in the morning, feel awake and clear-headed by the time I needed to go to class, and start getting tired close to when I should be going to bed rather than in the late afternoon or early evening. (Most effective antidepressants have made this worse, not better.)But, I assume you had no mood support? Anyway--sounds like they may be a good augmenting strategy for you--not necessarily with Desipramine.
>
> > > Well...what other drugs have caused rashes for you, if any?
> >
> > Penicillan, anti-malarial med (not a sulfate); the stuff they scrub you down for surgery; and maybe, although, my memory is faint here sulfer antibiotics--
>
> Do you mean sulfa drugs? (Bactrim, Septra, etc.)I wouldn't know their names--the sulfa antibiotics. but I think this rash will either confirm that there is a problem or go away.
>
> > >The sympathomimetic effect (hyperventilation) is something you should adjust to after taking it for a while.
> >
> > You think?
>
> I'm pretty sure. I had it on Parnate too when I first started taking it.It's been about a month, although I increase my dosage about 2 weeks ago.
>
> > I am somewhat of a colour freak. Each room is a different colour with a different colour trim.
>
> > > Oh, you're painting the inside! That sounds fun. I imagine you (for whatever reason) as being an artistic, creative person, and your description of how you're playing with the paints seems to confirm that. The colours you're using sound very earthy.Yes, the earthy colors give me comfort.
> > > I'm not convinced that people who have atypical depression are sleeping *well*. They sleep a lot, but it seems like they never feel rested. Does that sound right?I felt rested, although it was always hard to get up in the morning.
> > > The problem is that sometimes I awaken myself (usually by jumping out of bed) and other times I have attacked the person next to me in my sleep (!). (Nothing serious, but it does freak them out sometimes.)That can create some real excitement, I'll bet.
> > > Still holding even with Desipramine?
>
> Yup. I'm pleased.That's fabulous!
>
> > I'm still waiting with the rash and then if that turns out ok, then I'll wait to see if I can increase my dosage very slowly over time and deal with the sleep problems. No headache today again.
>
> Good -- maybe you're adjusting to it. I hope it works out for you.No headache again today and rash seems slightly better. Now I need to eat some salt for the low blood pressure--yesterday during my afternoon "dip" at 4pm it was 93 over 56 so I think that explains the dip. You complained of a dip also didn't you? Did you ever take your blood pressure during a dip?
Sleep meds are definately on the agenda? Is Sonata the place to start. I read it is short acting and you can take it again if you wake up in the middle of the night. Last night I fell asleep at 12:30 am and woke at 2, stayed awake until 5:00, then back to sleep until 8. This is not a good sleep schedule for me:-(
Lorraine
Posted by Zo on August 26, 2001, at 15:59:17
In reply to Re: Parnate stuff, posted by Elizabeth on August 26, 2001, at 11:25:32
Hi Elizabeth,
Whatever happened with you and Buprenex? I had such a positive (post-surgical) response to Vicodin, bupe is the next thing we're going to try. Locally compounded troches. I *hate* the thought of getting sick, tho.
Thanks,
Zo
Posted by shelliR on August 26, 2001, at 20:36:31
In reply to Re: Update » shelliR, posted by Elizabeth on August 26, 2001, at 11:24:24
Hi Elizabeth.
> > Adrafinil was okay (but caused a hypertensive reaction with nardil).
> How high was your blood pressure? I'm curious because I tried adding modafinil to Parnate and my blood pressure was elevated, but only modestly.Systolic went from my usual 100 (+/-) to 168. There must be something more risky about adrafinil vs modafinil because my pdoc (last one) was really encouraging the use of provigal with nardil, but told me pointblank that she did not want me to try adrafinil. (I guess I had terminated with her by the time I tried it.) BTW, provigal made me sleep all the time for two weeks straight.
> > Since being off the nardil I tried concerta (I think I told you about that), and it was hard to get a reading with both concerta and the oxy. They were way too stimulating together.
> So you find opioids activating too?Yes, feeling PMS, tired and sick in my stomach. Take vicodin, wait 45 minutes, then go out and mow the lawn. :-)
> > No, its a time release tablet and you can't split it. When I first found that out, I realized that it was not the best of all worlds because my 10mg start made me a little spacy and high. But it is better than vicodin in that it has no APAP pain med with it that can cause problems (I can't remember what problems--maybe liver problems)
> APAP is acetaminophen -- Tylenol.
I know that, I just can't spell acetaminophen. < g >
Or even tylenol (you know, tylanol, tylenal--it's the vowels that throw me off!)
> BTW I think your pdoc may be right that buprenorphine causes more side effects than oxycodone or some of the other opioids. If you wanted the one with the least side effects, my choice would be the fentanyl patch (Duragesic).I don't know. From what I've read the fentanyl patch often doesn't last as long as it's supposed to, and it's not good to change it more often. I'm not sure why you can't change it more often, but it it's anything like the oxy, I'd be spending one third of my time depressed. Certainly if your insurance pays there would be problems with early changes, but I thought there was also a medical reason.
>So what's your next step with meds? (or life?)
Shelli
Posted by shelliR on August 26, 2001, at 22:45:28
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 26, 2001, at 14:48:33
> > > > Shelli: how do stimulants work with you? Are they effective at all? It doesn't sound like they are gauging your reaction to Wellbutrin.
> > I don't know what you mean by "....they are gauging your reaction to Wellbutrin"
> For me, Wellbutrin was very much like a stimulant. Just didn't sound like you were reacting positively--word loss and so forth--didn't sound energized.I'm still confused. Who is "they"? Stimulents made me feel awful. Like try for one day and never try again, awful.
I'm not hating Wellbutrin; it doesn't make me tired, or sick, or fat. It is making more anxious, I think, and that made be what dooms the trial. Being anxious makes me more dissociative. The articulation thing seems to be clearing up; I wasn't very aware of it this weekend, although my tongue still feels a little thick. I'm not getting any positive effects, but I also am not up to a therapeutic dose. Hey, I've only been on wellbutrin for five days! (Not that I am very hopeful, but I'm not particularly hopeful about medication at this point). My only idea after wellbutrin is to go back to nardil and try augmentation strategies again and continue the estradiol. And I'm still definitely open to augmentation with buph, but even if my pdoc says okay, I have no idea if I'll be able to tolerate it.
> > > > > > I asked him again about buph and he feels that it is a "dirty" drug, that it has too many side effects and causes too many complications in combinations with other drugs. He's also not convinced there is no tolerance with buprenorphine.
> > > He likes to make his job easier, doesn't he?
> > Well, the side effects would be mine, so I don't understand what you mean.
> I meant that the complications in combinations with other drugs could probably be worked out if he cared to do it. And, the side effects were yours so you could determine whether they were bothersome or not. When I read what you wrote it just sounded like he was in essence saying "let's do this; it's easier". Shelli, I don't know your doctor so if a comment I make isn't useful just dismiss it and move on.
>Okay, now it's sounding like you don't like my pdoc. < g >
No, seriously, I do totally understand what you are saying.
I tried working with this pdoc last year and could not deal with the way he doesn't explain things, writes things off without a discussion, sees you for five minutes, etc. etc. etc.
So why am I back?Mostly because I could not find a pdoc that I work well with, my one pdoc who I worked with for ten years and I were totally stuck. I went to a few other ones, several a few times, and just couldn't find someone, say like my gyn, who I felt was smart and knowledgable and understood that I was deperately depressed and taking vicodin to survive.
So I ended up in the hospital for the second time this year, and he happens to attend on a different unit in this hospital *and* he is known for being brillant, creative, and for being not particularly easy to work with.
And I know the only thing that has been helping me is vicodin. I've tried nardil with just about every conceivable adjunct possiblity because it's the only AP that's ever helped me. So I have this guy saying he will give me an opiate and we will work on finding the right AD for me.It was an offer I was and am still not in any position to refuse.
The oxy is keeping me functional so I can continue to work *and* do drug trials again.
I am nervous that I will become habituated to this dose and he won't raise me again. I have to clear that up tomorrow because I have been the most scared about that all weekend. If I don't get a guarantee, I will get all the hydro I can order for security, because I don't think this internet access thing is going to last much longer because it's not a very safe thing or a unethical thing. There is a pain doctor I called that I will go to if it ever comes to that.>
> All of these factors make it difficult to decide what to do--for me as well. My mom had breast cancer as well. Two articles were useful to me in trying to figure this all out: "The Good News about Natural Estrogen http://www.naturalhormones.com/goodnews.html and "Menopause: Hormones and Other Therapies Sorting Out the Options http://www.woodmed.com/MenopauseHormonesOther.htm I think I ended up thinking that perhaps I should be on bi-extrogen, which is composed of estriol (80%) and estradial (20%). The estriol is not supposed to be associated with breast cancer and may actually aid in preventing it. The osteoporosis benefits still apply, although I'm not sure about the cardiovascular. All of this information is still in a state of flux and more studies need to be done. But I suspect that this is where I end up. My doctor will determine the dosage of progresterone and estrogen and have a compounding pharmacy make it up. We will then tweek it until it is right, although I am not so optimistic about the tweeking process given the number of other variables (drug trials) going on simultaneously. I'll let you know what happens with me ultimately on this. The test results should be in soon.Thanks for the urls. That's the kind of thing I'll start looking into after I've been on the estradiol for a few months. If my depression is under control I may not do any HRT. My sister isn't and she's doing fine. For me right now it is totally for the depression. My friend just told me Friday that estriol is associated with breast cancer, so I'll have to read that info. Also, talk to my gyn when it's time.
> You are speaking of weight gain < vbg >?
Well, weight gain is the only one I get a hard time about. Mostly it's sleeping 16 hours, or shaking or becoming disoriented.
>
>
> > > > It really depends on how severe my depression is what I am able to do. But transitions are really difficult for me, even when I am not depressed. Doing artistic work requires a transition , which takes effort, even when I am not depressed. Once the bridge is crossed, it is fine.
> This is an interesting way of looking at it. I have found this too--that there is a transition to cross which is difficult. I used to use a hynosis type tape made specifically for this transition (I taped it myself) and it did help at the time I used it.You are a highly motivated person. I love colors also btw (what is it with colours? :-) ), but I hate the act of painting walls (I'm really bad at it, so I hire someone). But if I told you what colors my walls are, that would add to my paranoia that one of my clients will recognize me on this board. With the city that I live in (near) and my profession, the colors of my walls are probably the next most revealing thing to identify me. Now I've probably made you really curious! < g >
> Speaking of which: how to your kids relate to your depression. Do you talk about it, and especially, do they ask about it?
> They know about it. We have discussed it specifically. They know when a med isn't working frequently. If my behavior is >going to affect them, I tell them what is going on. They frequently comfort me if things are tough. We told them a couple of >years ago when I got off Effexor and my behaviour (reclusive, hybernating) was clearly maladaptive and not something that I >wanted role modeled for them.That's really really good. They sound like great kids.
> > > I worry much more about my son, who is emotionally intense and more predisposed I think to mood problems.
> > How is he doing now? He's been in therapy, right? But not on medications?
> Right. The therapy has just been one appointment and I'm trying to set up a regular schedule for him. But his aggression and anger is so near the surface now, I'm wondering about meds. His therapist said that in boys aggressive behaviour frequently is the result of a lack of serontonin. I could try 5HTP with him. I'm wrestling with it.Why 5HTP? I don't know anything about that. Is that what his therapist is recommending?
> [re Parnate:]My pessimism has to do with the tears behind my eyes I think. Break-through depression.
> But you have been on parnate such a short time.
> Almost a month (can you believe that?)Wow, I am surprised it's been that long.
> The headaches seem to have abated and if the rash goes away, then I'll continue with it for longer. The other side effect is > > > just a lithargy in the afternoon--when my blood pressure seems to dip (93/56) so maybe salt tablet and water?I never could work out the lethargy in the afternoon with nardil, but I never tried salt; Actually I never related it to my blood pressure. (I never had a blood pressure cuff until I had my one reaction with adrafinil, this past year.)
> Hope the Wellbutrin kicks in positively and you are able to articulate it.
:-)Shelli
Posted by Lorraine on August 27, 2001, at 10:13:06
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 26, 2001, at 22:45:28
Shelli:
> > > >how do stimulants work with you? Are they effective at all? It doesn't sound like they are gauging your reaction to Wellbutrin.
> > > I don't know what you mean by "....they are gauging your reaction to Wellbutrin"
> > For me, Wellbutrin was very much like a stimulant. Just didn't sound like you were reacting positively--word loss and so forth--didn't sound energized.
>
> I'm still confused. Who is "they"?"They" Indefinite pronoun referring to stimulents :-)
> > > I'm not hating Wellbutrin; it doesn't make me tired, or sick, or fat. It is making more anxious, I think, and that made be what dooms the trial. Being anxious makes me more dissociative. The articulation thing seems to be clearing up; I wasn't very aware of it this weekend, although my tongue still feels a little thick. I'm not getting any positive effects, but I also am not up to a therapeutic dose. Hey, I've only been on wellbutrin for five days! (Not that I am very hopeful, but I'm not particularly hopeful about medication at this point). My only idea after wellbutrin is to go back to nardil and try augmentation strategies again and continue the estradiol. And I'm still definitely open to augmentation with buph, but even if my pdoc says okay, I have no idea if I'll be able to tolerate it.
Actually, this doesn't sound so bad. I believe that Wellbutrin is known to increase anxiety the first couple of weeks or so. Yeah, it won't make you fat (isn't that nice?) Unless the anxiety is off the roof, I'd give it more than 5 days. Maybe some Klonopin for the anxiety, meanwhile?
>
>
> > > > Okay, now it's sounding like you don't like my pdoc. < g >I know it sounds like that, but I think I was actually just feeling protective of you. And, I generally am pretty willing to dump on doctors, especially when they sound arrogant and dismissive:-)
> > > I tried working with this pdoc last year and could not deal with the way he doesn't explain things, writes things off without a discussion, sees you for five minutes, etc. etc. etc.Sounds painful, but he is giving you something that you need right now so grin and bear seems to be the best you can do.
> So why am I back?
>
> Mostly because I could not find a pdoc that I work well with, my one pdoc who I worked with for ten years and I were totally stuck. I went to a few other ones, several a few times, and just couldn't find someone, say like my gyn, who I felt was smart and knowledgable and understood that I was deperately depressed and taking vicodin to survive.It's really, really hard to find a good pdoc, shelli and I don't think you should switch in the middle of a crises, especially when you are on a drug that is highly controversial (oxy) and which would make it hard for you to find a pdoc that is open to prescribing it. This is not a time to change. You are clear about this and I agree.
You could take some steps toward change if you feel he is not for you for the long run. You might post on the board asking for referrals to someone in your area. When I was feeling gloomy about my pdoc I did that and asked everyone I knew personally who was on multiple meds for a referral. I ended up with a list of say 3 pdocs that I could switch to if I ever want to. I'm happy with my pdoc now, but it's nice to have the list in my back pocket so to speak.
>
> > >I've tried nardil with just about every conceivable adjunct possiblity because it's the only AP that's ever helped me.Which adjuncts did you try? Just curious in case I need adjunts.
> > >I am nervous that I will become habituated to this dose and he won't raise me again. I have to clear that up tomorrow because I have been the most scared about that all weekend.I just wish you could increase your dosage in smaller steps. I swear if it were me, I would have those capsules open on the table and inspect the grains to see have to divide the dose--notwithstanding the time release nature of it. 1/2 the grains wouldn't work? Well, I would try it--that's just me. Heck, I counted grains of Effexor to get off it--I think it was time release XR, but I'm not sure. Dividing grains sounds different to me than cutting a time release tablet because you can count the grains in the capsules but not the tablets. Then you could "save" the other half like a squirrel preparing for winter.
[re menopause urls]
> Thanks for the urls. That's the kind of thing I'll start looking into after I've been on the estradiol for a few months. If my depression is under control I may not do any HRT. My sister isn't and she's doing fine. For me right now it is totally for the depression. My friend just told me Friday that estriol is associated with breast cancer, so I'll have to read that info. Also, talk to my gyn when it's time.Here's an even better link--it's to Medscape's Menopause center: http://www.medscape.com/medscape/features/ResourceCenter/Menopause/public/RC-index-menopause.html
> > > > > It really depends on how severe my depression is what I am able to do. But transitions are really difficult for me, even when I am not depressed. Doing artistic work requires a transition , which takes effort, even when I am not depressed. Once the bridge is crossed, it is fine.
> > This is an interesting way of looking at it. I have found this too--that there is a transition to cross which is difficult. I used to use a hynosis type tape made specifically for this transition (I taped it myself) and it did help at the time I used it.
>
> You are a highly motivated person. I love colors also btw (what is it with colours? :-) ), but I hate the act of painting walls (I'm really bad at it, so I hire someone). But if I told you what colors my walls are, that would add to my paranoia that one of my clients will recognize me on this board. With the city that I live in (near) and my profession, the colors of my walls are probably the next most revealing thing to identify me. Now I've probably made you really curious! < g >Yes, you have, but you have my email to send the colors to. My garage is a deep intense royal purple. I need to add gold stars to it--haven't yet.
> > > That's really really good. They sound like great kids.
I have an amazingly supportive family. It helps a lot.
[re my son]
>
> > > > I could try 5HTP with him. I'm wrestling with it.
>
> Why 5HTP? I don't know anything about that. Is that what his therapist is recommending?Well, he didn't say 5HTP, he said SSRI's, but 5HTP is a good place to start because it of it's low side effects. I took it a while at bed time, it just make me sleepy and I was sleepy the next day. He is having a really hard time with his anger though. His cousin--my OCD niece--is on Luvox. She was in seriously trouble, flunked freshman year (all F's except 2 D's in drill team and PE), major acting out; screaming at mom and generally out of control. She is now doing so much better (she was visiting here this weekend) and has me really rethinking this stuff. In part, she is doing so much better because her self-confidence is improved. Interesting for me, the OCD apparently interferred with her ability to learn (she was always counting) so that they are not sure if she has a learning disability or not. Watching her, it is clear to me that she does and that it is the same disability my son has (auditory processing). For instance, she is 16 and doesn't know what a "plum" is. She knows it's a fruit. Those types of holes and gaps are so indicative of learning disabilities. So if the OCD was interfering with her ability to learn language, it must have been pretty severe. I'm happy she is moving forward now. I'm glad her mother (my SIL who believes that I should snap out of it) was willing to let her daughter use medication, which she so clearly needed.
[re parnate]
> > The headaches seem to have abated and if the rash goes away, then I'll continue with it for longer. The other side effect is > > > just a lithargy in the afternoon--when my blood pressure seems to dip (93/56) so maybe salt tablet and water?
>
> I never could work out the lethargy in the afternoon with nardil, but I never tried salt; Actually I never related it to my blood pressure. (I never had a blood pressure cuff until I had my one reaction with adrafinil, this past year.)
>
I'll let you know how it works. I could also just cave in and take the nap--but I really hate any more disruption to the sleep process. What did you do about insomnia, by the way?Lorraine
Posted by shelliR on August 28, 2001, at 22:17:44
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 27, 2001, at 10:13:06
Hi Lorainne,
>Yeah, it won't make you fat (isn't that nice?) Unless the anxiety is off the roof, I'd give it more than 5 days. Maybe some Klonopin for the anxiety, meanwhile?
Today I took the wellbutrin for the first time all together first thing in the morning, and I did get extremely anxious in the early afternoon so I took a second valium. But tonight I haven’t taken any. So far I am getting absolutely no antidepressant effects so I’ll talk to my pdoc Thursday about whether to continue. I am still on the same 200 because he wants to go really slowly. It’s so scary to me how depressed I am when the oxy wears off--like when I wake up, or if I don't overlap doses; I truly don’t think I could stay alive without it.
> > > > > Okay, now it's sounding like you don't like my pdoc. < g >>You could take some steps toward change if you feel he is not for you for the long run. You might post on the board asking > >for referrals to someone in your area. When I was feeling gloomy about my pdoc I did that and asked everyone I knew > > > > >personally who was on multiple meds for a referral. I ended up with a list of say 3 pdocs that I could switch to if I ever want >to. I'm happy with my pdoc now, but it's nice to have the list in my back pocket so to speak.
That’s not a bad idea. I really don’t have a sense of who on the board is in my area. There is one person, but interestingly we’ve made no connection on the board even though we both have been posting for a long time now. Oh and Marie--but she lives pretty far in VA.
I felt pretty good about my session Monday with my pdoc; I started feeling more of a connection. He is my safety net now, not my therapist.
I asked him Monday what I should do if something happens to him. Like he gets hit by a car and I am unable to get my file. Like how do I go to the next pdoc and say , okay, my pdoc died, I was taking oxycontin, wellbutrin, and valium for depression and a dissociative disorder. And they would look at me, like sure, right. He told me I should just tell them I was working with
_____ ______ (fill in his name) and they would accept my meds. So this guy is not lacking in confidence. He's actually sort of cute when asked questions like that. Visually, he's about 5'5" with big brown eyes and hair that sticks straight up. He either wears a white shirt with his suit, or orange or lime green linen. He can actually handle both those colors. Also, he has an accent; he’s Armenian. Monday when he took someone out of order, and left the other person waiting, he apologized on his knees.I thought it was important to give you an image because he’s an interesting combination of very cocky and very boyish. And I think I’m made him out as very stiff, but he’s not at all. More he’s completely unreliable in timing (he never came when he said he would when I was in the hospital, so I just learned never to believe him about time) and he’s definitely rather not explain anything to you. But he would rather explain than listen, if that makes any sense.
And I also have to say, "I can’t leave until you explain to me…., or else he’d get me out in literally five minutes with my drug schedule and scripts but no questions answered. He has *never * asked "do you have any questions" :- ) I think some of this is because he is so hospital oriented, and in the hospital you do only see your prescribing doctor for about 5 to 10 minutes a day, but you see them everyday. His office is on the ground floor of the psychiatric hospital I was in. So I have got him up to the explaining part now :-) (But not to the listening part.) But Monday he reassured me about taking the oxycontin, that he doesn't have a ceiling for me and we are trying to find a AD combination for me.
> > > >I've tried nardil with just about every conceivable adjunct possiblity because it's the only AP that's ever helped me.
> >Which adjuncts did you try? Just curious in case I need adjuncts.Since 1/00: sam-e, lamictal, aricept, naltrezone, provigal (modafinil) topomax; ritalin, dexadrine, adderall, resperadone, seroquel (the last five just one day trials because they made me feel so awful). Before that lithium and the older mood stabilizers. There have been probably been others over the years that I forgot to write down in my notes.
re splitting oxycontin:
They are pills. pills. pills. They *do not open *.
And they cannot be cut in half because the time release is in layers, and if you cut them you break the coating, and the inside (long release) becomes exposed.> I have an amazingly supportive family. It helps a lot.
I am totally envious.
> > > > > I could try 5HTP with him. I'm wrestling with it.
> > Why 5HTP? I don't know anything about that. Is that what his therapist is recommending?
Well, he didn't say 5HTP, he said SSRI's, but 5HTP is a good place to start because it of it's low side effects.what about a low dose of St. john’s wort?
> [re parnate]
how’s the rash?
>. I could also just cave in and take the nap--but I really hate any more disruption to the sleep process. What did you do about insomnia, by the way?aterex and klonpin (or valium). But I love to take naps, and they feel really good if I can keep them to about 1/2 hour.
let me know how the parnate and everything else is coming along.
Shelli
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