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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 286 to 310 of 434. Go back in thread:
Posted by Lorraine on August 29, 2001, at 0:36:06
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 28, 2001, at 22:17:44
Shelli:
> > > 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.
I couldn't take Wellbutrin in the afternoon and sleep that night. You might check on the general board, but I thought Wellbutrin was one of those drugs that heightened anxiety initially (1st two weeks) but then calmed down.
> > >So far I am getting absolutely no antidepressant effects
Are you feeling activated?
> > > 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.
I'll be curious to see what he says.
> > >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.
I'm glad you have it. You have strong survival skills. Without the oxy, you would check yourself into a hospital, right?
> > > > 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.Wow, that's odd. But then my pdoc has been for a long time b/c I have been seeing a therapist and "drugs" have been the big issue for so long.
> > > > 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.So, he's just this odd mixture and you need to extract your allotment of time from him. Ok. I picture him like a gnome without any time to spare.
> > >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)Absent minded? Self-important?
> > >and he’s definitely rather not explain anything to you. But he would rather explain than listen, if that makes any sense.
Type A, can't stand to sit still and listen? Has to interrupt b/c he's gotta keep moving and in control?
>
> > > 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.At least you are willing to do that and hold his feet to the fire for your full 8 or is it 15 minutes?
> > > He has *never * asked "do you have any questions" :- )Most patients don't. My pdoc never asks this either. I just badger him with questions anyway. Mine is more absent professor type actually.
> > > 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.
Listening--he may not have it in him. I'm sure the oxy news is reassuring.
> > > > >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.You tried all this stuff with Nardil? Jeez--
> re splitting oxycontin:
> They are pills. pills. pills. They *do not open *.OK,OK,OK. See I thought the term pills included both tablets and capsules and that tablets--oh, never mind ;-) Bummer. I get it now. Too bad. Your stuck with their doses then.
>
> > I have an amazingly supportive family. It helps a lot.
> I am totally envious.Then, we're even. You with my family and me with your work. But you know, life ain't over for either of us and I may get some rewarding work back and you may well create a good family. If we want them badly enough...
> > > > > > 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?It's a possibility, but the 5HTP will help him fall asleep as well and I felt it's effect immediately (but then I always do, it seems, huh?)
>
> > [re parnate]
> how’s the rash?Rash is going away. Sleeplessness is my issue now. The mood support is not where I want it but I think I have another level of titration to go up. By the way, this sluggishness that I feel mid-afternoon (and other times as well) might be low blood pressure (I took my bp at 3pm when I was crashing down and it was 93 over 56). Salt tablets have been ordered. Today, I really didn't want to crash after eating (blood to the stomach& all), so I ate a teaspoon of salt to ward it off. Seemed to work pretty well. We will see. The sites on low blood pressure say eat salt, drink water, eat 6 meals a day, and elevate the head of the bed to prevent water loss during the night. I don't think I want to try the last two. But I have found myself putting off eat because I don't want the naptime crash that follows.
> > > 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.Never heard of aterex--I'll look it up. I have a tape called "catnapper" that uses brain wave technology to take you down through theta and delta and then back up over a 30 minute period. Ordinarily (without the tape), what I find is if I close my eyes I "plunge" into deep sleep, like falling off a cliff--fairly intense way to go to sleep--wish I could do that naturally at night.
Parnate is still a happening thing, although I am losing my temper a bit more.Let me know what happens with the Wellbutrin. It is such a lovely drug (no weight gain or sexual side effects), that I am still hoping it works for you.
Lorraine
Posted by Elizabeth on August 29, 2001, at 8:19:35
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 28, 2001, at 22:17:44
> 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.
Err...from the Wellbutrin? I'm afraid I've gotten behind in the thread, here.
> 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.
Do you think that when it wears off you become more depressed than you were before you ever took it? That would strike me as something to be concerned about.
About the tolerance thing, I think that at some point you should reach a dose where it plateaus. The question in my mind is, does that mean that you won't have to keep increasing it in order to stay nondepressed, or does it mean that it will stop working and further dose increases won't help anymore? I don't know the answer.
> 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.That is impressive. (Of course, you could show them the prescription bottles, so it's not like they'd just have to take your word for it.) My question would be, what doctor should you go to in such an emergency? (Like, who covers for him when he's away or sick?)
Another thing that might be good for you to do (if you haven't already, that is) would be to develop a relationship with a particular pharmacist -- always fill the OC at the same pharmacy, and let the pharmacist get to know you personally so that s/he will not get weirded out every time you come in with this oxycodone script from a psychiatrist.
> 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.
Oh boy, here comes the transference. < VBG >
> I thought it was important to give you an image because he’s an interesting combination of very cocky and very boyish.
He's also short, I notice. I've seen enough male psychiatrists who look like they're about 17 years old that it's become a stereotype in my mind.
> 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.
I'm not sure what you mean here, no.
My experience is that a lot of good psychiatrists are flakey and disorganised. Maybe they all have ADD. :-) (One pdoc I know admitted that another pdoc had suggested psychostimulants for him! < g > He does come across as being a hyperactive. scatterbrained little fellow.)
> So I have got him up to the explaining part now :-) (But not to the listening part.)
It sounds like you may just be able to train him (that's always a tough hurdle when seeing a new pshrink).
> 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.
That's cool. He sounds like he's really compassionate, and he's obviously confident enough to go out on a limb for you.
> 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).
Hey, how did you find Aricept? Did it do anything? How much were you taking?
(Same questions for naltrexone and Topamax.)
> 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.
That's usually the case with controlled-release formulations.
> 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.
Beware the drug that has few side effects; it may not be doing anything at all. :-)
> what about a low dose of St. john’s wort?
It works for some people, and it might be worth trying since it's easy to get (find out what brands are the most reliable before you buy any). But I wouldn't expect miracles since your depression has been resistant to conventional ADs.
-elizabeth
Posted by Elizabeth on August 29, 2001, at 8:45:42
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 26, 2001, at 14:48:33
> > > > 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.I'm a little puzzled as to what he's talking about, actually. Buprenorphine does have pretty intense side effects -- oxycodone is probably more tolerable -- but it doesn't have any particularly bad drug interactions that I know of. Shelli?
As for tolerance, I think that if oxycodone is causing it, buprenorphine might too, but possibly at a slower rate.
> > 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.
That's interesting. What did the kids in the article say? And when did this trend seem to begin, if the article says? I remember that when I was little, I couldn't wait to grow up, because I felt helpless and ineffective -- I didn't have any real freedom, nobody took me seriously, etc. Now, of course, I'm seeing some of the down side. :-}
> 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.
I can understand the idea of not wanting to put too much pressure on kids. But at the same time, I strongly believe that it's very important for gifted children to get an education that's appropriate to their intelligence. If you try to hold them back, it's likely that they will be very bored and may lose their intellectual curiosity and enthuasiasm. I think there's enough peer pressure on smart kids to be average or "normal" (as opposed to being nerds or whatever) -- the last thing they need is to get pressured to be average by adults, too.
> 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.
I actually think it would be better for him to see a psychiatrist who could make a recommendation as to whether he needs meds than to try to treat him yourself.
> > But you have been on parnate such a short time.
>
> Almost a month (can you believe that?)At what dose, though? I mean, seriously, you shouldn't expect something to work at a subtherapeutic dose just because you've been taking it for a long time.
> 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 don't know how to deal with the afternoon fatigue that seems like a universal side effect of MAOIs. (I think this subject merits a separate thread, actually.)
-elizabeth
Posted by Elizabeth on August 29, 2001, at 9:04:39
In reply to Re: Parnate stuff » Elizabeth, posted by Lorraine on August 26, 2001, at 15:10:46
> > > 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.Ahh. I'm not taking MAOIs anymore, so I really don't need to worry about washout periods. What I am wondering is whether stimulants might be helpful to me (also since I'm no longer using MAOIs, I have a chance to find out).
> But, I assume you had no mood support? Anyway--sounds like they may be a good augmenting strategy for you--not necessarily with Desipramine.
I wasn't taking an AD with it. I was doing better -- not well, but better than I was without it. I think it might be a good addition to desipramine.
> It's been about a month, although I increase my dosage about 2 weeks ago.
How much are you taking now?
> Yes, the earthy colors give me comfort.
I can see that. I'd love to see pictures when you're done. :-)
> > 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.Oh, yes. I have many funny stories I could tell about this. The most common thing that happens is when there's a chase scene in my dream, and I jump out of bed in an effort to run away from whatever-it-is. This generally wakes me up, and I find myself on the floor. (A couple times I've jumped out of bed without being woken up by the impact. The result was that when I woke up I was pretty disoriented.)
> 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?
I took my blood pressure at various times. I wasn't able to find any pattern -- it was generally lower than normal, particularly the first thing in the morning. I don't think it got lower in the afternoon when I started feeling tired.
> 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:-(
No, it's not. I've had problems with ireegular, fragmented sleep all my life, and it's a big hassle! Sonata seems like a good thing to try. I actually find Ambien short-acting enough that I can usually use it the way you're supposed to use Sonata. What I would suggest is that you start out trying Ambien at bedtime, and if it's too short-acting and you wake up in the middle of the night, try taking Sonata and see if that gets you through the rest of the night. It's not ideal, but it's better than nothing.
-elizabeth
Posted by Elizabeth on August 29, 2001, at 9:10:33
In reply to Re: (brief hijack) » Elizabeth, posted by Zo on August 26, 2001, at 15:59:17
> Hi Elizabeth,
Hi Zo.
> Whatever happened with you and Buprenex?
I'm still taking it. (It's not Buprenex, however; it's a generic.) It augments the desipramine well, although I still hope to find something with milder side effects that does the same job.
> I had such a positive (post-surgical) response to Vicodin, bupe is the next thing we're going to try. Locally compounded troches.
Compounding, eh? Fancy. (Expensive, too, I'm guessing.) So they pharmacy is basically going to cook up some Subutex for you?
> I *hate* the thought of getting sick, tho.
My suggestion would be that you ask for a small prescription for promethazine or something like that, them. FWIW, I had to start out on a sub-therapeutic dose (1/2 mL q4-6h) in order to avoid the nausea.
-elizabeth
Posted by Elizabeth on August 29, 2001, at 9:42:54
In reply to Re: Update » Elizabeth, posted by shelliR on August 26, 2001, at 20:36:31
> > 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.Well, that could be chalked up to adrafinil being unavailable in the US. Fear of the unknown and all. But the BP elevation is more suggestive. Were you on a MAOI when you took Provigil, and if so what dose and how was your BP? All I have to go on about modafinil-MAOI interactions is my own reaction.
> > 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. :-)That's me! :-) (Nice to know I'm not alone.)
> > 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!)Those pesky critters!
> 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.
AFAIK you should change it as often as you need to. But you're right that it often doesn't last as long as it's supposed to -- that's a problem with many opioid analgesics (including buprenorphine and OxyContin).
> Certainly if your insurance pays there would be problems with early changes, but I thought there was also a medical reason.
I can't think of one. Your doctor should be able to write the prescription such that an insurance co. wouldn't cause trouble (although with expensive products like Duragesic, they might place limits on the amount you can get covered per month anyway).
> So what's your next step with meds? (or life?)
Meds: hoping to try a stimulant with DMI. Life: learning how to drive. (I did, at least, get a learner's permit.)
-elizabeth
Posted by Lorraine on August 29, 2001, at 10:43:17
In reply to more stuff -- Shelli and Lorraine, posted by Elizabeth on August 29, 2001, at 8:45:42
[re kids not wanting to grow up] > > > I hadn't really thought of it [as fear of being an adult] 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.
>
> I can understand the idea of not wanting to put too much pressure on kids. But at the same time, I strongly believe that it's very important for gifted children to get an education that's appropriate to their intelligence. If you try to hold them back, it's likely that they will be very bored and may lose their intellectual curiosity and enthuasiasm. I think there's enough peer pressure on smart kids to be average or "normal" (as opposed to being nerds or whatever) -- the last thing they need is to get pressured to be average by adults, too.elizabeth: I think this has changed so much from when you were a kid (even though it's not that long ago) at least in the major cities. In Los Angeles, there is a tremendous amount of pressure on the kids (in the private schools) to perform. I have a friend whose child is clearly gifted who has him in a regular private school--it's really fine, I think. I know this kids really well (since he was 3); he's in junior high now. Even kids in the public school system go to gifted magnets that are really super. At my son's school, the peer pressure is to be smart. That's why my son (was has a learning disability but is smart) pulled all A's and one B+ and then decided to go for honors Algebra in the fall (which meant that he had to study every day this summer with his father for 1-2 hours). This because he wants to be in the same classes as his friends. These, by the way, are the jocks of the school also. But I am talking private schools so...
> > > I actually think it would be better for him to see a psychiatrist who could make a recommendation as to whether he needs meds than to try to treat him yourself.A little reluctant to do that now. I think I'll give the cognitive therapy a chance. The guy who he is seeing is great. Worked with Beck (the father of cognitive therapy) and co-wrote some books with him. My son is pretty excited because these are real life strategies that they are working on.
>
> > > But you have been on parnate such a short time.
> >
> > Almost a month (can you believe that?)
>
> At what dose, though? I mean, seriously, you shouldn't expect something to work at a subtherapeutic dose just because you've been taking it for a long time.I haven't jumped ship yet. I was on 10 mg for 2 weeks, then upped it to 15 mg for the last 2. I'm playing it by ear; although I probably need to go up another 5 mg at some point. Headaches gone, rash abating--the only issue is sleep.
>
> > 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 don't know how to deal with the afternoon fatigue that seems like a universal side effect of MAOIs. (I think this subject merits a separate thread, actually.)I'll split this off into a separate thread. I did some reading on low blood pressure and it seems like it's a fit--especially because mine dips after eating when the little blood in your system heads to the stomach.
Lorraine
Posted by Lorraine on August 29, 2001, at 10:59:03
In reply to Re: Parnate stuff » Lorraine, posted by Elizabeth on August 29, 2001, at 9:04:39
Hi elizabeth:
> > > > 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.
>
> Ahh. I'm not taking MAOIs anymore, so I really don't need to worry about washout periods. What I am wondering is whether stimulants might be helpful to me (also since I'm no longer using MAOIs, I have a chance to find out).Washouts apply to other drugs as well though...Is there not washout TCA to TCA?
>
> > But, I assume you had no mood support? Anyway--sounds like they may be a good augmenting strategy for you--not necessarily with Desipramine.
>
> I wasn't taking an AD with it. I was doing better -- not well, but better than I was without it. I think it might be a good addition to desipramine.
>Sounds like it.
> > It's been about a month, although I increase my dosage about 2 weeks ago.
>
> How much are you taking now?15 mg.
>
> > Yes, the earthy colors give me comfort.
>
> I can see that. I'd love to see pictures when you're done. :-)I'll see what I can do.
> > > I took my blood pressure at various times. I wasn't able to find any pattern -- it was generally lower than normal, particularly the first thing in the morning. I don't think it got lower in the afternoon when I started feeling tired.
>
> > 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:-(
>
> No, it's not. I've had problems with ireegular, fragmented sleep all my life, and it's a big hassle! Sonata seems like a good thing to try. I actually find Ambien short-acting enough that I can usually use it the way you're supposed to use Sonata. What I would suggest is that you start out trying Ambien at bedtime, and if it's too short-acting and you wake up in the middle of the night, try taking Sonata and see if that gets you through the rest of the night. It's not ideal, but it's better than nothing.
Thanks for this input on sleeping meds, elizabeth. I really wanted your take on this. Actually, my hunch is if I keep taking 600-800 Neurontin at bed and use Ambien to sleep, I'll make it through the night. I've read that long term use shouldn't be a problem with these (at least in terms of withdrawal or addiction). But what do you think of the habituation issue--ie that you lose the ability to go to sleep without them.
Lorraine
Posted by Elizabeth on August 31, 2001, at 9:16:05
In reply to Re: Parnate stuff » Elizabeth, posted by Lorraine on August 29, 2001, at 10:59:03
> Washouts apply to other drugs as well though...Is there not washout TCA to TCA?
It's not really a big deal with non-MAOI ADs, no.
> > > It's been about a month, although I increase my dosage about 2 weeks ago.
> >
> > How much are you taking now?
>
> 15 mg.Okay...I wouldn't base your conclusions as to how well it will work on how well it's working at 15 mg. (The minimum effective dose is usually 30, although I think that some effects become noticeable at 20.)
> Thanks for this input on sleeping meds, elizabeth. I really wanted your take on this. Actually, my hunch is if I keep taking 600-800 Neurontin at bed and use Ambien to sleep, I'll make it through the night.
Go with your hunch. (Works for me. < g >)
> I've read that long term use shouldn't be a problem with these (at least in terms of withdrawal or addiction).
Yes, that's true.
> But what do you think of the habituation issue--ie that you lose the ability to go to sleep without them.
I don't know about Neurontin; I never had that problem with Ambien.
-elizabeth
Posted by SLS on August 31, 2001, at 12:17:55
In reply to Re: Parnate stuff » Lorraine, posted by Elizabeth on August 31, 2001, at 9:16:05
> > Washouts apply to other drugs as well though...Is there not washout TCA to TCA?
>
> It's not really a big deal with non-MAOI ADs, no.Dear Elizabeth,
How long of a washout period do you think is sufficient when switching from Effexor to Nardil?
Thanks.
- Scott
Posted by Elizabeth on August 31, 2001, at 14:39:56
In reply to Re: Parnate stuff » Elizabeth, posted by SLS on August 31, 2001, at 12:17:55
> How long of a washout period do you think is sufficient when switching from Effexor to Nardil?
2 weeks is the conservative estimate. I'm not going to make any less-conservative recommendations, if that's okay. :-)
-elizabeth
Posted by SLS on August 31, 2001, at 15:41:01
In reply to Re: Parnate stuff » SLS, posted by Elizabeth on August 31, 2001, at 14:39:56
> > How long of a washout period do you think is sufficient when switching from Effexor to Nardil?
>
> 2 weeks is the conservative estimate. I'm not going to make any less-conservative recommendations, if that's okay. :-)
>
> -elizabeth
Thanks.My NYU guy agrees with you. I just needed a second expert opinion. You do rate in my eyes.
So, desipramine is treating you well? That's great to hear. How has it made things different?
Oldies but goodies.
Smiles...
- Scott
Posted by shelliR on August 31, 2001, at 16:42:29
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on August 29, 2001, at 0:36:06
Lorraine
still getting no antidepressant effects from the wellbutrin and am adjusting to it I think. It's hard to tell, I'll be out of town next week (Southwest) and getting everything in place before I go always makes me crazy. I only see my accountant once a year for business taxes (with extentions due Sept 10 (?)). I'm always crazy (and, always going away) so the fact that I remember this makes me not blame it on the wellbutrin.
>
> Are you feeling activated?
Extremely. When I get very anxious (and my depression is at least somewhat under control), I get very hyper. Yesterday in doing errands (bank, postoffice, accountant, etc), I probably would have been diagnosed as bipolar II . I was extremely verbal and I talked to everyone. I don't think I crossed any lines into totally inappropriate, but only because I was very aware of how hyper I was. Also, when I get tired, I can't sleep, but then generally move beyond that in the day. Sometimes when I am feeling activated but more mellow, I think wow, is this how high energy people feel? This would be nice.re continuing wellbutrin:
I'll be in a very mellow, non-pressured familar place, mostly by myself. So I am going to try to go up to 300mg. If that does nothing for the depression, I'm ready to move on. My pdoc put a limit on how high I can go on the oxy, but I have learned not to totally believe him. (If you recall, he told me no limit Monday!). He told me the first time he can't justify going up, but when I was unbearably depressed, he raised it. He may be saying this is a limit because he does want me to use judgment. In order not to be depressed, I would need to go up 10mg: (again the can't cut the *tablet* thing :-) ) and to sustain that state through the day and evening, it would be 20mg. My depression is tolerable now, but just so, depending on the time of day. Like I took doseII at 3pm and 5mg of valium, and I am very tired, but feeling good.I have an idea but I'm not sure if this is really a bad thing to do. I'd love to hear what you think and please, believe me--I am very strong in making decisions and would not hold you at all accountable. Instead of going up on the oxy, I was thinking of supplementing with a much lower dose of vicodin, since it is so much less potent. Then if it gets to the point where that is no longer working, I'll move up 10mg on oxy. I have vicodin here so there's no issue there. It's the issue of not telling my pdoc. He thinks I should increase the oxy, not add another opiate. But I'm pretty sure that has to do with writing prescriptions for both as a psychiatrist. (he hold me in the hospital it would really raise a red flag). I've never kept anything from my pdocs before, but I feel like it's my body and I'm the one at risk if he's going to set a limit on the oxy. This would allow me to go up much slower. Though in my heart I do not think my pdoc would let me really suffer. If you feel comfortable, feedback please.
> > > >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.
> I'm glad you have it. You have strong survival skills. Without the oxy, you would check yourself into a hospital, right?I guess so. I would at least try that first. (Or maybe buphrenorphine, before the hospital). I have very strong feelings that I can not kill myself because it would totally mess up the rest of my parents' life. They love me very much and would not get over it. There's a few other people who it would affect very deeply, (sister, niece, nephew, close close friends), but it would not mess up their lives.
Also, when I'm not depressed, there is so much about life that I am still learning or find fascinating, etc. My depression is mostly not "I'm a worthless person" depression. It is as close to physical pain as I can imagine. That's another reason it does not feel so strange to take a narcotic to alieviate it.
> So, he's just this odd mixture and you need to extract your allotment of time from him. Ok. I picture him like a gnome without any time to spare.Well maybe he's 5'6" < g >
>
> Absent minded? Self-important?
I wouldn't say self-important or absent minded. I'm actually really not sure yet. It's sort of like a spoiled little boy thing--like knowing he can get away with it. I'll have to find out his birth order. Because he has first child (of same sex) success, but also a lack of responsiblity. I would guess youngest son. I'll have to ask him. (After I tell him he shouldn't wear white shirts, because he looks so much better with his orange and lime shirts. :-))
>
> >and he’s definitely rather not explain anything to you. But he would rather explain than listen, if that makes any sense.
Type A, can't stand to sit still and listen? Has to interrupt b/c he's gotta keep moving and in control?I'm exactly sure about that either yet. I think it's about having a map in his head and feeling it's not necessary to share, because he knows where he is going, or when to create a new map. So it's a control thing in that sense, but I'm not sure it's a competitive control thing. And also he thinks it wastes time, because he knows where we're going.
> > > > 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.
> At least you are willing to do that and hold his feet to the fire for your full 8 or is it 15 minutes?more like 8.
> > > > He has *never * asked "do you have any questions" :- )
> Most patients don't. My pdoc never asks this either. I just badger him with questions anyway. Mine is more absent professor type actually.Details, please. dress, body type, age, etc.
>>
> > > > > >I've tried nardil with just about every conceivable adjunct possiblity because it's the only AP that's ever helped
> You tried all this stuff with Nardil? Jeez--
well all stimulents except for concerta, and all APs were one day trials.
> OK,OK,OK. See I thought the term pills included both tablets:
good point.
[re parnate]
> Parnate is still a happening thing, although I am losing my temper a bit more.
Do you normally have a temper and ADs control that, or is the temper coming from the activating effect of parnate?
Update on parnate, please.Shelli
p.s., leaving Sunday. I'll still be on the net next week to some extent because not much happens after 10pm there.
Posted by Zo on August 31, 2001, at 16:47:57
In reply to Re: (brief hijack) » Zo, posted by Elizabeth on August 29, 2001, at 9:10:33
Posted by shelliR on August 31, 2001, at 17:32:39
In reply to Re: Update » shelliR, posted by Elizabeth on August 29, 2001, at 9:42:54
> Well, that could be chalked up to adrafinil being unavailable in the US. Fear of the unknown and all. But the BP elevation is more suggestive. Were you on a MAOI when you took Provigil, and if so what dose and how was your BP? All I have to go on about modafinil-MAOI interactions is my own reaction.You going to be frustrated with all questions about how much, because it's all a blur to me. My pdoc had her nurse-practitioner go through all my records and do the whole drug history thing, but I can't find it. So many of my failed drugs were at low doses, except I went pretty high up on topomax and serzone. I think I forgot the serzone/nardil combination in my list. Mostly my pdoc was the type that kept saying you didn't try it long enough, or you didn't go high enough. I was pretty stupid in the long trial thing. But those were the drugs that made me tired, or had no effect--not drugs I couldn't tolerate well. Topomax was my last straw. I feel no way every again am I going to completely waste three weeks of my life sleeping unless I have a signed written guarantee.
>
> > > 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. :-)
> That's me! :-) (Nice to know I'm not alone.)That's what makes it so hard to turn away from. Takes away depression, adds energy. Except for tolerance (*big* except), it's the perfect drug for me and it sounds like for you also.
>
> > 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.
> AFAIK you should change it as often as you need to. But you're right that it often doesn't last as long as it's supposed to -- that's a problem with many opioid analgesics (including buprenorphine and OxyContin).I mean, does oxycontin last twelve hours for anyone? I can see someone landing in a hospital being treated for horrific pain by an inflexible doctor and they'd be in horrible pain for four hours!
>>
> > So what's your next step with meds? (or life?)
>
> Meds: hoping to try a stimulant with DMI.
Concerta was my favorite: (actually the only one I could tolerate), if your insurance pays for it.Life: learning how to drive. (I did, at least, get a learner's permit.)
Congratulations. That is way cool (as my fourteen year old niece would say) :-)
Really, that's going to be a big upgrade for your other-than-city life.Shelli
Posted by Lorraine on September 3, 2001, at 20:48:59
In reply to Re: Parnate stuff » Lorraine, posted by Elizabeth on August 31, 2001, at 9:16:05
Elizabeth:
I was gone for the long weekend up near the Russion River in Northern California and so my delay in responding.
[re Parnate]
> > > > It's been about a month, although I increase my dosage about 2 weeks ago to 15 mg.> Okay...I wouldn't base your conclusions as to how well it will work on how well it's working at 15 mg. (The minimum effective dose is usually 30, although I think that some effects become noticeable at 20.)
I won't make it to 20, I don't think. When I went to 15, I started becoming irritable and cranky. I had hoped this would abate with time, but it didn't, so I stepped back down to 12.5, which left me with insufficient mood support and irritable to boot. So, I think, I'm off the Parnate and on to Nardil after a 5 day washout period on amphetamines and neurontin.
[re Ambien] Is this a strange medication or what????!! I'm not sure I get it yet. I take the pill 10 mg and take 800 neurontin (actually chewing them slightly so that the caps will process quicker), then wait 30 minutes, then lay down and feel like there is no way I can sleep. Maybe 30 minutes pass, then I start counting my breaths (which is what I do to still my mind) and tell myself I only have to count 20 breaths (breath in 1, 2; breath out 1,2,3,4). By breath 10 or so I'm asleep, but I don't know what to attribute it to. I never feel like I am coming on to the Ambien. Does this sound right?
> I don't know about Neurontin; I never had that problem with Ambien.I'm glad to hear that the Ambien is neither addictive nor habituating. I went out and bought ear plugs to help with the sleeping also.
So you are going to try augmenting your Desipramine with stimulants, I read. Adderal worked well with me. I read in the archives of Psychobabble that Desipramine and Nardil are a good combination--that the Desipramine avoided the weight gain issues with Nardil.
How are your driving lessons going? I tried to buy the book you recommended, but it's out of print so I've requested notification from Amazon of used copy sales (here's your chance!< g >)
Posted by Lorraine on September 3, 2001, at 21:45:26
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on August 31, 2001, at 16:42:29
Shelli:
What, both of us gone the same time. Well, I'm home now (big sigh).
> still getting no antidepressant effects from the wellbutrin and am adjusting to it I think.This is unfortunate.
> > > Are you feeling activated?
> Extremely. When I get very anxious (and my depression is at least somewhat under control), I get very hyper.I never got beyond the activation = anxiety phase with Wellbutrin.
> re continuing wellbutrin:
> I'll be in a very mellow, non-pressured familar place, mostly by myself. So I am going to try to go up to 300mg. If that does nothing for the depression, I'm ready to move on.It's nice to try this is a non-pressured environment where you can watch your reactions, although I find that sometimes I can miss seeing my depression if I am not around people. My depression is so apparent in my avoidance behavior and in the fact that my voice lowers an octive. Sometimes I can hear this voice thing in other people as well (like my best friend who also has depression on and off).
> > > My pdoc put a limit on how high I can go on the oxy, but I have learned not to totally believe him.
I agree that he sounds like he is just trying to keep you honest and accountable.
> > > [re oxy]Like I took doseII at 3pm and 5mg of valium, and I am very tired, but feeling good.
You don't mind feeling very tired? that would drive me nuts. I hate sedation.
> > > I have an idea but I'm not sure if this is really a bad thing to do. I'd love to hear what you think and please, believe me--I am very strong in making decisions and would not hold you at all accountable.Shelli, you are very strong period. I don't worry about whether you would feel pressure to conform to my opinion or even elizabeth's.
> > >Instead of going up on the oxy, I was thinking of supplementing with a much lower dose of vicodin, since it is so much less potent. Then if it gets to the point where that is no longer working, I'll move up 10mg on oxy. I have vicodin here so there's no issue there. It's the issue of not telling my pdoc. He thinks I should increase the oxy, not add another opiate.
Have you explained to him that you want to move up on your doses more gradually?
> > > But I'm pretty sure that has to do with writing prescriptions for both as a psychiatrist. (he hold me in the hospital it would really raise a red flag).
I would worry about the drug interactions and beyond that I might try it. (Dr. Koop has a good interaction checker).
I've never kept anything from my pdocs before, but I feel like it's my body and I'm the one at risk if he's going to set a limit on the oxy.
I don't think he is going to set a limit really. so perhaps honesty should rule the day. I haven't kept anything from my pdoc. I sort of figure that he is willing to take fairly substantial risks with me and I owe him honesty. I am also pretty confident that once you breach the "trust", all that risk taking gets withdrawn. More important for me to maintain the relationship than mess we my meds in a way he would be uncomfortable with. My goal is to enhance his comfort level. Whew! Having said all that, I don't think you should add the vicoden without his knowledge and consent:-(
[re: When things fall apart] I would at least try that first. (Or maybe buphrenorphine, before the hospital). I have very strong feelings that I can not kill myself because it would totally mess up the rest of my parents' life.
Well, that's the kids for me and my husband and mother and a few close friends.
> > > Also, when I'm not depressed, there is so much about life that I am still learning or find fascinating, etc.
This is good to recognize and remember when you need to.
> > >My depression is mostly not "I'm a worthless person" depression. It is as close to physical pain as I can imagine.
That's an odd way of putting it. But I think it is accurate for me as well.
> > >And also he thinks it wastes time, because he knows where we're going.
This would definately bother me, but then I like to have a lot more control and understanding about my medical stuff than most doctors are willing to indulge.
> > > > > He has *never * asked "do you have any questions" :- )
> > Most patients don't. My pdoc never asks this either. I just badger him with questions anyway. Mine is more absent professor type actually.
>
> Details, please. dress, body type, age, etc.Tall, sixty-something, lean, stooped, wirey hair. Passionate about his craft, tendency to think aloud, always willing to think and give full weight to what you say unless it is in accordance with orthodox medicine:-)
> > > OK,OK,OK. See I thought the term pills included both tablets:
> good point.Yeah, but I was still able to drive you nuts with it< vbg >
> > > Update on parnate, please.Temper and irritation became a fairly major issue so I scales back from 15mg to 12.5 with the end result being that I lacked mood support and was irritable to boot. So I think I'm on to Nardil. By the way, did you say you tried Nardil augmented with Desipramine? In the archives, someone raved about this combo.
Let us know how the Wellbutrin fairs in your continued trials.
Lorraine
>
> Shelli
> p.s., leaving Sunday. I'll still be on the net next week to some extent because not much happens after 10pm there.
Posted by Lorraine on September 4, 2001, at 21:25:50
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 3, 2001, at 21:45:26
Doing my washout from Parnate to Nardil with adderal and neurontin. Took 10 mg adderal this morning, fine. Took second 10 mg adderal this afternoon, started feeling funny. Tingling moving up my neck to my head and headache coming on, waited a little (not long) felt worse. Took blood pressure 165/97, i think. Took antidote crushed it under tongue, blood pressure came down, right away and within an hour or so was clearly normal, although high for me on MAO. I feel very hungover. Not an experience I want to repeat necessarily.
Posted by shelliR on September 5, 2001, at 11:15:08
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 3, 2001, at 21:45:26
Hi Lorraine.
> What, both of us gone the same time. Well, I'm home now (big sigh).big sigh of relief? I don't know if long weekends fit under the heading of vacations.
re continuing wellbutrin:
> > I'll be in a very mellow, non-pressured familar place, mostly by myself. So I am going to try to go up to 300mg. If that does nothing for the depression, I'm ready to move on.
> It's nice to try this is a non-pressured environment where you can watch your reactions, although I find that sometimes I can miss seeing my depression if I am not around people.My primary depression is there, whether people are around or not. That's why I call it so physical. I have had two days of 300mg of wellbutrin with very little improvement. It is so much easier to tolerate being depressed when I don't have to work--at least this type of depression.
But then I have also another type of depression/anxiety/angst that has to do with people and fitting in in life and that is much more apparent when I am around people, especially new people or people I don't know well. I'm not sure whether that could be medicated and if so, I'm not sure what I would have to give up in exchange.
In the last few days small things have made me realize that I have both very strong right and left brain hemispheres. But I can only be in one side or the other; my transitions are incredibly slow. Anyway I am really excited about realizing that. Maybe a small corpus colluseum (sp?). So maybe if my neurotic existential depression/anxiety was medicated, I would also lose my excitement at these useless discoveries.An example: For months I've been using :-) because I know it is the sign for smile. But I was thinking okay, first colon, then dash then parenthesis. For the first time last month I SAW that OF COURSE it is a smile sideways. I felt so stupid, because I am so visual. Then some other similar things came to mind and I realized when I am in left brain mode (i.e., writing posts, I am totally out of visual mode), so that was really fun to realize and I felt less stupid.
Anyway, I can only write things like that on the board because the post is directed to you. If it was directed to the whole board, I'd feel that I was totally boring everyone.
I'll take my chances on boring you < g >.
> > > > [re oxy]Like I took doseII at 3pm and 5mg of valium, and I am very tired, but feeling good.
> You don't mind feeling very tired? that would drive me nuts. I hate sedation.Well I have always been a spurt person--put total energy out then become really tired later. And I do felt strange about being so tired in the afternoon (sort of ashamed), and sometimes when I'm not home, it felt really bad. But that was a side effect that I *was* willing to accept. And if I can sleep for even 20 minutes to half-hour in the afternoon, I am totally energized the whole evening. I think not having children made it easier for me and working for myself. Still, it's amazing to have all this energy on wellbutrin, and if it doesn't work as my main AD, I can see it as an adjunct (rather than stimulants, for example)
BTW, I have asked my pdoc to do a nardil/wellbutrin combo, but he was less than enthusiastic. He said he has another idea first (which of course he didn't share with me). I think with him if I really insist on trying something, he will prescribe it for me. But since the oxycontin is making life even more than bearable (when I am up to the right amount), I will try to be patient with his ideas.
> Shelli, you are very strong period. I don't worry about whether you would feel pressure to conform to my opinionThat's good. I do have certain vulnerabilies that make me feel not very strong. And don't say (please) that everyone does--because not everyone wants to die because of their vulnerabilities.
> or even elizabeth's.
*even* Elizabeth's < g >. I get different things from both of you.
> Have you explained to him that you want to move up on your doses more gradually?He is not ideal in the area of accepting explanations. He says, "take as much oxy as you need, don't worry". That's his most often response to me: "don't worry" It's definitely a dismissal as well as reassurance. But let's not go there. :-)
> I would worry about the drug interactions and beyond that I might try it. (Dr. Koop has a good interaction checker).
I've already combined oxy and vicodin a couple of times for bad migraines.
> I've never kept anything from my pdocs before, but I feel like it's my body and I'm the one at risk if he's going to set a limit on the oxy.
> I don't think he is going to set a limit really. so perhaps honesty should rule the day. I haven't kept anything from my pdoc. I sort of figure that he is willing to take fairly substantial risks with me and I owe him honesty. I am also pretty confident that once you breach the "trust", all that risk taking gets withdrawn. More important for me to maintain the relationship than mess we my meds in a way he would be uncomfortable with.My goal is to enhance his comfort level.
??????? *his*? I think maybe I read that out of context.Whew! Having said all that, I don't think you should add the vicoden without his knowledge and consent:-(
>
I think I just caught your thought process in real time. < g >. I think you're right. I didn't feel at all guilty not telling him about the mixing for migraines because it might have become too complicated and I've only done it twice. But in general trust is incredibly important
> > > >And also he thinks it wastes time, because he knows where we're going.
> This would definately bother me, but then I like to have a lot more control and understanding about my medical stuff than most doctors are willing to indulge.Well, of course this is not a perfect match. But we've been there before. :-)
>> > Details, please. dress, body type, age, etc.
> Tall, sixty-something, lean, stooped, wirey hair. Passionate about his craft, tendency to think aloud, always willing to think and give full weight to what you say unless it is in accordance with orthodox medicine:-)Passionate is good. And he listens and thinks too. Sounds good; can't remember what that feels like. I wonder why he (and some people in general) are stooped.
>
>
>
> > > > OK,OK,OK. See I thought the term pills included both tablets:
> > good point.
> Yeah, but I was still able to drive you nuts with it< vbg >Oh, my, did it show? < vbg >
> Update on parnate, please.
> Temper and irritation became a fairly major issue so I scales back from 15mg to 12.5 with the end result being that I lacked mood support and was irritable to boot. So I think I'm on to Nardil. By the way, did you say you tried Nardil augmented with Desipramine? In the archives, someone raved about this combo.Does Desipramine have a brand name? I can't recall what that is off the top of my head.
I have a feeling that you will not be as sensitive to nardil as you were to parnate. Aside from sleep disturbance and afternoon fatigue (which I think is partially just my own blood sugar patterns), I was not at all conscious of taking a drug.
I wouldn't be disappointed if the nardil didn't kick in as quickly as parnate. I've never read about immediate anti-depressant with nardil. (Hopefully YMMV) If you get the afternoon fatigue or have difficulty sleeping, I'm sure you can work on that after. As for sleeping at night, I do need something to stay asleep. That has been a small price to pay considering that I feel that nardil really saved my life.
Be patient if my responses are not immediate. It turns out that by the time it's 10pm, I'm totally exhausted (no naps, so far). It takes more energy for me to write because I'm not used to using a laptop.
shelli
Posted by Lorraine on September 6, 2001, at 10:29:25
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 5, 2001, at 11:15:08
Shelli:
>
> > What, both of us gone the same time. Well, I'm home now (big sigh).
>
> big sigh of relief?Yes, still happy to be home, although I do love the place I was visiting-- a friends house that was homesteaded during the California land rush. No running water, 1300 acres in the middle of nowhere. It was beautiful and he is a good friend.
> re continuing wellbutrin:
> > > My primary depression is there, whether people are around or not. That's why I call it so physical. I have had two days of 300mg of wellbutrin with very little improvement. It is so much easier to tolerate being depressed when I don't have to work--at least this type of depression.Sorry the Wellbutrin isn't kicking in grand force for you. For me being enervated is a large part of my depression so if I am on an activating drug and "get busy" things seem ok. Then if I slow down and talk with people, it is very obvious that I am still in my depression. I guess I try to distract myself a lot.
> > > But then I have also another type of depression/anxiety/angst that has to do with people and fitting in in life and that is much more apparent when I am around people, especially new people or people I don't know well. I'm not sure whether that could be medicated and if so, I'm not sure what I would have to give up in exchange.Sounds like a bit of Social Anxiety? I know I have some.
> In the last few days small things have made me realize that I have both very strong right and left brain hemispheres.What an interesting thing to notice. Then your transition into the artist mode is a transition from one hemisphere to another.
>> > >Still, it's amazing to have all this energy on wellbutrin, and if it doesn't work as my main AD, I can see it as an adjunct (rather than stimulants, for example).
I found Moclobemide very activating as well. I only had to leave it because of the anxiety it caused me--which was not as bad as Wellbutrin, but too much for me.
> > > BTW, I have asked my pdoc to do a nardil/wellbutrin combo, but he was less than enthusiastic. He said he has another idea first (which of course he didn't share with me).Sounds like he has some plan mapped out in his head for your course of treatment. Maybe he derives cues from your reactions to the various drugs he tries you on.
> > >I do have certain vulnerabilies that make me feel not very strong. And don't say (please) that everyone does--because not everyone wants to die because of their vulnerabilities.
Your vulnerabilities sound very tender, more like wounds? Is there shame attached?
> > >He says, "take as much oxy as you need, don't worry". That's his most often response to me: "don't worry" It's definitely a dismissal as well as reassurance. But let's not go there. :-)
He's in the driver's seat as long as he knows where he is going and you are enjoying the view so to speak....
> > >[re trust and pdoc] My goal is to enhance his comfort level.
> ??????? *his*? I think maybe I read that out of context.You said you got this further on in your post. But just to make clear, I see the relationship with pdocs as a two way street. They have a certain amount of liability exposure for making more aggressive drug choices and need some assurance that we can be trusted to handle those drugs or they will become more conservative--which, when you are treatment resistant is not helpful. So I work on his comfort level. I'm a good girl; I report back; I don't throw him any loops and in turn, he is willing to try what he thinks will really work for me and not worry about liability issue. Now my therapist, on the other hand, works on my comfort level;-)---see the wink?
> > > > >And also he thinks it wastes time, because he knows where we're going.
> > This would definately bother me, but then I like to have a lot more control and understanding about my medical stuff than most doctors are willing to indulge.
>
> Well, of course this is not a perfect match. But we've been there before. :-)Shelli, I just have an incredible distrust of doctors and their abilities. I know it's unfair, but there it is. I'm sure my heavy handed participation in the drug selection for me is no better than your pdocs informed plan. At worst, we are both random and if that's the case, then it doesn't matter whose plan you follow so long as you don't unnecessarily retrace your steps.
>
> > >Passionate is good. And he listens and thinks too. Sounds good; can't remember what that feels like. I wonder why he (and some people in general) are stooped.He is stooped because of mild scholiosis (sp?)--curvature of the spine.
I'm off Parnate now. First day I tried using adderal during my washout period and had a mild hypertensive crises. I say mild to appease the medical gods because my blood pressure (165/96?) didn't approach a medical emergency. To me though the crises was extreme--very bad headache and terrible stiff neck. I took the antidote, relatively early (within 15 or 20 minutes of onset--hey, it was my first time, I wasn't sure what was going on). That really wiped me out. I'd say I was down for the count for 2 days. Yesterday, was filled with severe hot flash types
of symptoms and I don't know if this was from withdrawal from Parnate, the hypertensive crises, or the fact that I went of estrogen about 4 weeks ago. Plus, now that I am off the Parnate, I think it was causing some sexual dysfunction.I start the Nardil on Saturday. The sleep disruption thing is very upsetting to me and I'm not sure how I will fair with that side effect. Last night I took a valium in addition to the ambien and neurontin and slept well. But I'm not sure I want a benzo habit.
> > > I have a feeling that you will not be as sensitive to nardil as you were to parnate. Aside from sleep disturbance and afternoon fatigue (which I think is partially just my own blood sugar patterns), I was not at all conscious of taking a drug.I hope you are right. The afternoon fatigue though seems common and I don't think it's your blood sugar pattern. I started another thread on it and from the responses I got (n=3) it seems that blood pressure reaches a natural low between 3 and 4 pm daily; one person was medicated for low blood pressure while on MAOs; another adjusted over time (but didn't take his blood pressure.) My hunch is it's blood pressure related and because I took mine during on of these slumps and it was so clearly low my plan is to use salt tablets (there is a buffered type that is recommended--Thermosomething) and drink plenty of water and see if that helps. It will be my little experiment, I'll let you know.
> > >I wouldn't be disappointed if the nardil didn't kick in as quickly as parnate. I've never read about immediate anti-depressant with nardil.Unfortunately, I think you are right
[re desipramine and nardil]: Desipramine is the TCA that elizabeth is one right now and I believe that desipramine is it's brand name. If you do go back to Nardil, this combo might be worth a shot. Desipramine has a reputation for being activating, but, according to elizabeth, is better for sleep cycles than MAOs.
How is your vacation treating you otherwise?
Lorraine
Posted by shelliR on September 6, 2001, at 13:34:24
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 6, 2001, at 10:29:25
Hi Lorraine.
re continuing wellbutrin:
>Sorry the Wellbutrin isn't kicking in grand force for you. For me being ener is a large part of my depression so if I am on an activating drug and "get busy" things seem ok. Then if I slow down and talk with people, it is very obvious that I am still in my depression. I guess I try to distract myself a lot.In some ways being energized is helpful when I'm depressed. At other times, when I hurt so badly I can't stand it, sleep has always been my only escape from the pain. And that is not an option on wellbutrin (for better and worse).
> > > > But then I have also another type of depression/anxiety/angst that has to do with people and fitting in in life and that is much more apparent when I am around people, especially new people or people I don't know well. I'm not sure whether that could be medicated and if so, I'm not sure what I would have to give up in exchange.
> Sounds like a bit of Social Anxiety? I know I have some.I don't know if it's social anxiety, per say. I've never thought of it that way, but maybe it is a specific type. I talk very easily with people and generally have the feeling that I am interesting and entertaining. I am very light in the company of others, which is probably something that would surprise you--considering the intensity of my posts.
Most of my anxiety re people is how to navigate through life solo. My closest friend (male) remarried two years ago and so my immediate world has changed.
On this vacation I am fine by myself--have this really cute little house and cable to watch the US open, plus short rides bring me into incredible natural beauty and awesome art. But when I am around couples vacationing together, I get very anxious about myself and go back to my little house.
> > > > BTW, I have asked my pdoc to do a nardil/wellbutrin combo, but he was less than enthusiastic. He said he has another idea first (which of course he didn't share with me).
> Sounds like he has some plan mapped out in his head for your course of treatment. Maybe he derives cues from your reactions to the various drugs he tries you on.I think he only pretends he has a plan. And depending on what he wants to do next, I may really push the nardil/wellbutrin combo, although the nardil was totally not working any more for me.
>> He's in the driver's seat as long as he knows where he is going and you are enjoying the view so to speak....
No, I don't see it that way. I see us sharing the driver's seat. (He probably sees me as a backseat driver. < g >) I wanted to try Parnate; he wasn't enthusiastic but wrote the prescription. I had wanted to try wellbutrin before, he thought it was too complicated as a base drug, but when I wanted to go back on nardil, he brought up trying wellbutrin as *his* idea. It's much more of a personality thing--like he has to feel like he's in control, than it is really a control thing. At least so far. I would not take a drug I'm not comfortable with and it remains to be seen if he is willing to be a little bit risky with nardil and wellbutrin. (He doesn't like to work with MAOIs). But I am curious about his next idea. It was his idea to go to oxy, which I think was the right thing to do in terms of less ups and downs than vicidin. I actually don't believe he even had his next idea yet when he said that.
> I'm off Parnate now. First day I tried using adderal during my washout period and had a mild hypertensive crises. I say mild to appease the medical gods because my blood pressure (165/96?) didn't approach a medical emergency. To me though the crises was extreme--very bad headache and terrible stiff neck. I took the antidote, relatively early (within 15 or 20 minutes of onset--hey, it was my first time, I wasn't sure what was going on). That really wiped me out.
Yes, I had the same thing happen with adrafinil and nardil, and didn't have a antidote. I drove quickly to the pharmacy to take my BP, which also was up to 165 or so. I can't believe in retrospect I didn't drive to the hospital. But I had been taking nardil for so long without any hypertensive reactions that I didn't even own a cuff. But it didn't affect me at all after the incident. I did buy a cuff, though.
I'd say I was down for the count for 2 days. Yesterday, was filled with severe hot flash types
> of symptoms and I don't know if this was from withdrawal from Parnate, the hypertensive crises, or the fact that I went of estrogen about 4 weeks ago.probably not worth it to even try to figure that one out
Plus, now that I am off the Parnate, I think it was causing some sexual dysfunction.
I don't think I had any sexual dysfunction on nardil, but it's really hard to tell if it had a small effect because I was on it almost my entire adult life. Opiates make me feel very sensual, but they definitely interfere with full orgasmic release.
> I start the Nardil on Saturday. The sleep disruption thing is very upsetting to me and I'm not sure how I will fair with that side effect. Last night I took a valium in addition to the ambien and neurontin and slept well. But I'm not sure I want a benzo habit.
>
See, I don't get that kind of thinking. I see it as you go around once and then it's over. (as far as I know, yet) So life should be as positive as possible. If a benzo at night keeps you on an antidepressant that works, it sort of strikes me as puritanical to worry about a "habit".
> > > >I wouldn't be disappointed if the nardil didn't kick in as quickly as parnate. I've never read about immediate anti-depressant with nardil.
>
> Unfortunately, I think you are right
>
> [re desipramine and nardil]: Desipramine is the TCA that elizabeth is one right now and I believe that desipramine is it's brand name.Oh yea, it looked familiar. I tried TCAs in my early twenties and they totally spaced me out. I'd be afraid to try again I think. I never got past one day on them, but I'm not sure which TCAs I tried; it was so long ago.
>
re nardil: I don't think I got the sleeping side effect until it kicked it for me.BTW, still no wellbutrin AD effect--today my fourth day on 300mg. No side effects, either now. But I did get some encouragement on the board, and it did take forever for nardil, so the trial goes on, at least until I see my pdoc on Monday.
>
Shelli
Posted by Lorraine on September 7, 2001, at 9:23:57
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 6, 2001, at 13:34:24
Hi Shelli:
> In some ways being energized is helpful when I'm depressed. At other times, when I hurt so badly I can't stand it, sleep has always been my only escape from the pain. And that is not an option on wellbutrin (for better and worse).Sounds like hypersomnia (my personal favorite when meds don't prevent it), which also falls in the category of atypical depression.
> > >I am very light in the company of others, which is probably something that would surprise you--considering the intensity of my posts.Wouldn't really surprise me. I think you're funny.
> > > Most of my anxiety re people is how to navigate through life solo. My closest friend (male) remarried two years ago and so my immediate world has changed.This would be very hard for me. As hard as it is to go on vacation with my family which wants to "do" something all the time. This would be harder. It would be good for you to find another single close friend to do things with---support groups? Not for abuse survivors (I think you said you were tired of those), but maybe just a NDMDA group?
>
> On this vacation I am fine by myself--have this really cute little house and cable to watch the US openWe've been watching it too.
> > >, plus short rides bring me into incredible natural beauty and awesome art. But when I am around couples vacationing together, I get very anxious about myself and go back to my little house.
We give up so much for this illness, it seems. Day to day we don't have to notice, but then we do something and the loss is so stark.
> > > I think he only pretends he has a plan. And depending on what he wants to do next,That may be as good as "having" a plan. It maintains forward momentum.
> > >(He probably sees me as a backseat driver. < g >) I wanted to try Parnate; he wasn't enthusiastic but wrote the prescription.
Back seat drivers are good for control freaks--they drive them nuts:-)
> > > Yes, I had the same thing happen with adrafinil and nardil, and didn't have a antidote. I drove quickly to the pharmacy to take my BP, which also was up to 165 or so. I can't believe in retrospect I didn't drive to the hospital.
Didn't go to the hospital or take an antidote???? What happened? did you pressure come down on its own?
> > > I start the Nardil on Saturday. The sleep disruption thing is very upsetting to me and I'm not sure how I will fair with that side effect. Last night I took a valium in addition to the ambien and neurontin and slept well. But I'm not sure I want a benzo habit.
> >
> See, I don't get that kind of thinking. I see it as you go around once and then it's over. (as far as I know, yet) So life should be as positive as possible. If a benzo at night keeps you on an antidepressant that works, it sort of strikes me as puritanical to worry about a "habit".You are making me think:-) I think you are probably right, it is some puritanical nonsense loop that I run through my head. I probably need to get over it now. I've been taking valium and ambien to sleep the last couple of nights. Partly because I still have a bad neck aches from the hypertensive crises. I have slept well.
> >BTW, still no wellbutrin AD effect--today my fourth day on 300mg. No side effects, either now. But I did get some encouragement on the board, and it did take forever for nardil, so the trial goes on, at least until I see my pdoc on Monday.
I'll be anxious to see what he says and what his plan is :-)
Lorraine
Posted by Lorraine on September 7, 2001, at 10:14:23
In reply to Re: Parnate stuff » Elizabeth, posted by Lorraine on September 3, 2001, at 20:48:59
elizabeth: You didn't respond to my 9/3 message and i miss you.:-)
> Elizabeth:
>
> I was gone for the long weekend up near the Russion River in Northern California and so my delay in responding.
>
> [re Parnate]
> > > > > It's been about a month, although I increase my dosage about 2 weeks ago to 15 mg.
>
> > Okay...I wouldn't base your conclusions as to how well it will work on how well it's working at 15 mg. (The minimum effective dose is usually 30, although I think that some effects become noticeable at 20.)
>
> I won't make it to 20, I don't think. When I went to 15, I started becoming irritable and cranky. I had hoped this would abate with time, but it didn't, so I stepped back down to 12.5, which left me with insufficient mood support and irritable to boot. So, I think, I'm off the Parnate and on to Nardil after a 5 day washout period on amphetamines and neurontin.
>
> [re Ambien] Is this a strange medication or what????!! I'm not sure I get it yet. I take the pill 10 mg and take 800 neurontin (actually chewing them slightly so that the caps will process quicker), then wait 30 minutes, then lay down and feel like there is no way I can sleep. Maybe 30 minutes pass, then I start counting my breaths (which is what I do to still my mind) and tell myself I only have to count 20 breaths (breath in 1, 2; breath out 1,2,3,4). By breath 10 or so I'm asleep, but I don't know what to attribute it to. I never feel like I am coming on to the Ambien. Does this sound right?
>
>
> > I don't know about Neurontin; I never had that problem with Ambien.
>
> I'm glad to hear that the Ambien is neither addictive nor habituating. I went out and bought ear plugs to help with the sleeping also.
>
> So you are going to try augmenting your Desipramine with stimulants, I read. Adderal worked well with me. I read in the archives of Psychobabble that Desipramine and Nardil are a good combination--that the Desipramine avoided the weight gain issues with Nardil.
>
> How are your driving lessons going? I tried to buy the book you recommended, but it's out of print so I've requested notification from Amazon of used copy sales (here's your chance!< g >)
Posted by Lorraine on September 7, 2001, at 15:30:10
In reply to Re: Update Lorainne, Elizabeth, et. al. » Lorraine, posted by shelliR on September 6, 2001, at 13:34:24
Shelli:
I was thinking about the post by Zo on August 21 re "Buprenorphine--just started trial-Elizabeth" and thought of you and your quandry about oxy and dosing. Isn't one way to get around your dosing problem to have your oxy ground and compounded by a compounding pharmacy into smaller doses? This could be in pill or lotion form. My pdoc had mentioned to me that one of his patients was having a lot of side effects and was allergic to certain meds and that they started compounding them into lotions that she applies on her skin, which seemed to help. Anyway just a thought.
Posted by shelliR on September 7, 2001, at 22:08:05
In reply to Re: Update Lorainne, Elizabeth, et. al. » shelliR, posted by Lorraine on September 7, 2001, at 9:23:57
Hi Lorraine
re: oversleeping
> Sounds like hypersomnia (my personal favorite when meds don't prevent it), which also falls in the category of atypical depression.well, don't most people who are depressed (and not simultaneously hyper) want to get in bed and pull the covers over their head when they are depressed?
Is this only part of atypical depression? I suppose that type A depressives might decide that a good long walk might help? Or immersing themselves in their work. Most workaholics though, are not depressives; they are people who are at their best in that arena.
> > > >I am very light in the company of others, which is probably something that would surprise you--considering the intensity of my posts.
> Wouldn't really surprise me. I think you're funny.I'm much more entertaining in person. :-)
> > > > Most of my anxiety re people is how to navigate through life solo. My closest friend (male) remarried two years ago and so my immediate world has changed.> This would be very hard for me. As hard as it is to go on vacation with my family which wants to "do" something all the time. This would be harder. It would be good for you to find another single close friend to do things with---support groups? Not for abuse survivors (I think you said you were tired of those), but maybe just a NDMDA group?
maybe. there's lots of things to do to meet people; I'm probably support grouped out. I can't imagine going on a vacation with a friend--too intense, although it would make me feel less vulnerable. All my friends at the moment are married. I keep planning on going to a function of the vegetarian association where I live, but I always find some excuse not to go. Not out of fear, more out of laziness. Food is not a stimulating subject for me, but there might be interesting people. I entertain myself very well, so I don't have a lot of incentive. I did try going to a movie club--movie, then discussion, but I got really bored listening to people analyze the movie. The people I listen to on NPR are a lot smarter and more interesting, and I don't have to get out of my car. (Bad attitude.)
One of my married friends has nothing in common with her husband; it's a very strange relationship (with no children, nor any planned). She is usually up to coming along, if I want to do something that I don't feel comfortable doing alone, like going to a concert. And I do that for her, also.
>
> > > > Yes, I had the same thing happen with adrafinil and nardil, and didn't have a antidote. I drove quickly to the pharmacy to take my BP, which also was up to 165 or so. I can't believe in retrospect I didn't drive to the hospital.
> Didn't go to the hospital or take an antidote???? What happened? did you pressure come down on its own?Yes, I keep taking my BP and it never got to 170. Within about fifteen minutes it was back down to normal. This happened twice; the first time I was pretty scared but figured they'd call an ambulance for me if necessary. When I was on parnate I was better prepared (with cuff). None of my pdocs have recommended keeping an antidote with me. If I go back on nardil (especially with wellbutrin), I'll be better prepared.
>>
> You are making me think:-)
Well thinking is good, right? :-)> I'll be anxious to see what he says and what his plan is :-)
As long as the oxy is working , I am really not feeling depressed. I would like to increase the wellbutrin again. I'd do it tommrrow, but I don't want take any chance in messing up my last day here. I've put in a lot of time with the wellbutrin with no anti-depressant effects (I can tell because I wake still up still in a very bad depression until the morning oxy kicks in), but as long as I've hung in this long--I'd like to see what happens in another ten days or so, working up to 450mg.
It is really nice to take such a complete break from work. I could extend this vacation if I didn't have work obligations and if the U.S. open continued. It's sort of centering me, and my friend and I are e-mailing back and forth about it. (We are both tennis obsessed; that's how we got to be such good friends. He still plays; and I watch the matches on tv)
Good luck tomorrow with nardil.
Shelli
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