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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 55 to 79 of 121. Go back in thread:
Posted by nightlight on November 25, 2001, at 16:52:00
In reply to barbs, opioids, etc. » nightlight, posted by Elizabeth on November 23, 2001, at 19:40:05
>
> > Plain codeine did nothing for my depression, nor did any of the other many painkillers I have used in search of relief from intense cervical pain. Not even the beloved Vicodins from which I have known so many to find tremendous depression relief. ONLY the F#3's for me.
> That's weird. Did you ever take Fiorinal (or Fioricet) without the codiene?Elizabeth~
Yes, did not get the same effect, on my pain or depression.
> > Darvocette 100-2x's a day
>
> Propoxyphene, the main ingredient in Darvocet, is a *really* weak synthetic opioid. ("Darvocet" is how it's spelled, BTW. The "-cet" ending just means it has Tylenol (aCETaminophen) in it, as with Fioricet -- plain propoxyphene is Darvon.) Propoxyphene is pretty comparable to codeine, in terms of how well it relieves pain, I think (the doses are different, of course).Propoxyphene napsylate is the main ingredient in Darvocet. (Thanks for the spelling lesson) and propoxyphene hydrochloride is the main ingredient in Darvon. Altho, there is Darvon-N, which is actually propoxyphene napsylate! Darvon 65mgs. is equal in strength to propoxyphene napsylate 100 mgs. Due to that difference (I would think) propoxyphene is considered to be 2/3 to equal the strength of codeine phosphate 30mgs (what u get in Tyl #3, Fiorinal #3, or Fioricet #3).
> > carisoprodal 350 mgs. prn daily
>
> Soma is a good muscle relaxant (although not "potent"). I tried this one for back pain ("myofascial pain syndrome") as well as Fioricet; the Soma worked much more reliably.My description of Soma as potent is strictly empirically based. I tried I had tried Skelaxin, Robaxin, Flexeril & others I cannot remember w/no relief. One doc prescribed finally prescribed clonazepam. Bingo! It worked well for about 2 yrs. I still take it for anxiety and mood regulation, but my myofascial pain got outta hand again. I had asked about soma in the past, but was denied it due to its *supposed* recreational properties. (It had been recommended by ny hairdresser who also had a herniated cervical disc).An ortho finally asked if I had ever tried it, put me on that & the darvocet, and I eased out of a pain flare that had lasted for weeks. I had been taking the Fiorinal #3 but it really had begun to affect me adversely, made me feel worse, like I had more toxins building up in my muscle tissues and more pain.
By the way, what would you consider to be a *potent* muscle relaxer?> > propanolol 40 mgs. 2 x's a day
>
> What's this one supposed to be for? I don't think I've ever heard of beta-blockers being used for pain (twice-a-day dosing of propranolol is pretty unusual too).Why is twice daily dosing unusual? I starting using Inderal/propanolol abbout 4 yrs. ago to helpw/migraine preventio & hypertension that I experienced in the yr. or 2 after my baby was born. I first took 120mgs.extended release once a day. But, my blood pressure was lowish on that, so I went down to 80mgs a day, but,I took it in 2 40mg tabs9immediate release) that were scored. Eventually, my high blood pressure disappeared, don't know why, so now, I only take the propanolol as needed. I can break the tablets easily into 20 or even 10 mgs, as needed. But, some every day. Sometimes only 20 and sometimes up to 80. It is quite good for the squeezing chest pressure I feel when particularly anxious, and if I feel headachey, have visual auras, etc. I use it to help w/potential migraine.
> > Yes, 'endogenous', simply, I believe, to let me know that he believed that there was something off-balance in my physical chemistry and had been, for a very long time. He knew that my previous pdoc thought I was experiencing 'situational' depression and dysfunction and that, even tho no A-D's were working for me, (or ever had, in the many years of drug trials), I'd get better when my environment became less stressful.
>
> Ah. The expression "endogenous depression" is used more in the UK and some other places than here, but the UK definition is different from what your pdoc meant (they use it to mean what DSM-IV calls "major depression with melancholic features" -- helpful to know if you're ever reading European psychiatric literature).I have not delved much into the DSM-IV, I've had way too little free time in the past few yrs., so my grasp of psychiatric argot is weak. I want to learn a lot more. You must be educated in order to be an activist for and protector of your own body/brain and it's 'idiosyncracies' (to put it benignly).
> I don't think it's very useful to say that a case of depression is "situational" or "non-situational" since "situational" depression often responds to meds and "non-situational" depression can be very hard to treat (with meds or otherwise).And, I have read some articles that say otherwise, that they both respond almost equally well to medication (and time). Weird.
Also the distinction isn't always that clear. (IMO, it usually isn't clear at all.)
I have to agree w/you there! Thanks for your response.
nightlight
Posted by Lorraine on November 25, 2001, at 19:31:49
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 23, 2001, at 20:08:47
Shelli:
I am so glad that the Methadone seems to be helping you. What a long struggle you've had; it would be nice if this piece of the puzzle was solid. The site that I referred to that has a lot of stuff on Methadone is this one:
http://www.addict.f2s.com/sitecontents.html
> > He's retesting me today with a QEEG to see if he can detect why I am having these sublevel panic attacks and to see if he can figure out why my meds aren't working.
My redone QEEG confirms pretty much his earlier assessment--that amphetamine and mood stabilizer are the ticket, but that Adderall is not doing the job. So he switched me to ritalin (I've tried dexidrine before). My initial reaction was increased anxiety, but I cut the dose down to 1/4 of a 10 mg tab 4x a day and that helps. I suspect we are going to try Ritalin SR next. He says the amplitude (or voltage) of alpha waves is low--to him this suggests amphetamines. We did a hyperventilating QEEG also, which showed that when I hyperventilate my voltage goes even lower (it should go higher), which he said indicates that under stress I have no power (voltage) to cope--which certainly is true. It is also true that I feel as though I am always trying to manage my power or energy level.
Meanwhile, my alternative medicine doctor tested my amino acid levels and found low levels of several that are implicated with depression (methionine, phenylalinine, tryptophan, tyrosine, and glutamine) so a custom blend of amino acids reflecting my test results is being made. I will try these for 2 months to see if there is any improvement. I have tried a number of these individually, but she believes it is the combination that is important.
>
> >It seems to be that some of your meds were working, but they have too many side effects. Nardil was workng very well; it was the side effects.You are right. I am making up a chart showing meds tried and whether they were abandoned because I had only a partial response to them or because of side effects.
depression yet. I maintained well on Adderall and Neurontin during my Parnate washout as well.
> > Are there any mood stablizers that you haven't tried yet?Yes, I haven't tried Lithium, Tegretol or Topamax.
>> > > Let me know your next strategy. Either the adderall and neurotin are keeping you afloat, or you are the most patient person I know. Maybe both
I don't know, Shelli, you seem pretty patient to me:-)
> > Well yes, your depression does not sound as painful as many others have been, at least when you are stable on neurotin and adderall. The same person who would never ever to anything to hurt her children can get stuck in suicidal thinking. And sometime the thinking can get so distorted that she begins to believe that her children would be better off without her.
Well, I've certainly thought this before, but I've never acted on it. And, I don't seem to ruminate about it generally. I get the sense some people ruminate about it alot and that some people feel compelled to act on the thought--like maybe these things are different parts of the problem. I think that I think about suicide like someone with MS or some other chronic illness might think about it (this can't be solved, it's no use, i'm just a burden on everyone, they'd be better off without me) and it's worse when I am down. I just know that for some people this is a much tougher problem that can't be thought out of or that feels like it can't be waited out.
>
> Sometimes the hospital can just provide an atmosphere where you can be absolutely you for a while, slumped in that chair. I think at times to really act like you feel, releases some of your energy back to you. I used to feel that with my business. If I was here I had to be totally "on" all the time, to go into the hospital gave me a break from responsibility and excuses.I can really see the appeal to this, Shelli. Family expectations of performance go up when my mood stabilizes and then when my mood falls apart, don't adjust back down, which makes it hard.
>
> Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.It would be pretty funny if all roads did lead to Rome for both of our depressions. I'm glad that you have something that is working for you, that your transition wasn't that bad and that the price is right.
Lorraine
Posted by shelliR on November 28, 2001, at 0:02:48
In reply to Re: Morphine for depression. » shelliR, posted by Lorraine on November 25, 2001, at 19:31:49
Lorraine
>
>
>
> > > He's retesting me today with a QEEG to see if he can detect why I am having these sublevel panic attacks and to see if he can figure out why my meds aren't working.Is this paragraph below about the retest the same day, or is this from your last test?
> My redone QEEG confirms pretty much his earlier assessment--that amphetamine and mood stabilizer are the ticket, but that Adderall is not doing the job. So he switched me to ritalin (I've tried dexidrine before). My initial reaction was increased anxiety, but I cut the dose down to 1/4 of a 10 mg tab 4x a day and that helps. I suspect we are going to try Ritalin SR next. He says the amplitude (or voltage) of alpha waves is low--to him this suggests amphetamines. We did a hyperventilating QEEG also, which showed that when I hyperventilate my voltage goes even lower (it should go higher), which he said indicates that under stress I have no power (voltage) to cope--which certainly is true. It is also true that I feel as though I am always trying to manage my power or energy level.I don't know the difference between concerta and ritalin SR. Both are long-lasting ritalin.
>
> Meanwhile, my alternative medicine doctor tested my amino acid levels and found low levels of several that are implicated with depression (methionine, phenylalinine, tryptophan, tyrosine, and glutamine) so a custom blend of amino acids reflecting my test results is being made. I will try these for 2 months to see if there is any improvement. I have tried a number of these individually, but she believes it is the combination that is important.
>
> >
How does your pdoc feel about changing things from your alternative doctor; he doesn't worry that a change of enzymes might affect his tests and sort of muddy the field?> > >It seems to be that some of your meds were working, but they have too many side effects. Nardil was workng very well; it was the side effects.
>
> You are right. I am making up a chart showing meds tried and whether they were abandoned because I had only a partial response to them or because of side effects.
> depression yet. I maintained well on Adderall and Neurontin during my Parnate washout as well.
>
>
> > > Are there any mood stablizers that you haven't tried yet?
>
> Yes, I haven't tried Lithium, Tegretol or Topamax.I did a long trial of Topomax, because at the time I was working with a pdoc who believed in long trials. I pretty much sleep six weeks of my life away, some of it in the hospital. They kept making me get up to go to these stupid groups and I just couldn't stay up. I had to take a 2 hour nap before gropup therapy to get through it.It reminded me of when I used to work in a psychiatric hospital when I first go out of college. It was a heavy duty unit (called intensive care) and they'd give some of these patients enormous amounts of anti-psychotics, then yell at them because they were not paricipating in the group. i gave them credit for even making it to the groups.
> >
>
> > > > Let me know your next strategy. Either the adderall and neurotin are keeping you afloat, or you are the most patient person I know. Maybe both
>
> I don't know, Shelli, you seem pretty patient to me:-)Well, sort of what choice do we have? Although I was quite ready to try opiates before anyone gave it to me because my depression was so painful, sometimes unbearable. It's always hard for me to explain why it is unbearable . And I don't even know what's exactly happening. Like where the hurt eminated from, except from my chest.
>
> > > Well yes, your depression does not sound as painful as many others have been, at least when you are stable on neurotin and adderall. The same person who would never ever to anything to hurt her children can get stuck in suicidal thinking. And sometime the thinking can get so distorted that she begins to believe that her children would be better off without her.
>
> Well, I've certainly thought this before, but I've never acted on it. And, I don't seem to ruminate about it generally. I get the sense some people ruminate about it alot and that some people feel compelled to act on the thought--like maybe these things are different parts of the problem. I think that I think about suicide like someone with MS or some other chronic illness might think about it (this can't be solved, it's no use, i'm just a burden on everyone, they'd be better off without me) and it's worse when I am down. I just know that for some people this is a much tougher problem that can't be thought out of or that feels like it can't be waited out.Before the codeine, I was in the worst place really stuck. Actually, it was when I was already on the oxy and bit stopped working and I didn't think my pdoc would raise it again. I was in horrible pain and I knew I absolutely couldn't kill myself because it would totally mess up the rest of their lives. I can't believe I actually called them and asked them if I could kill myself. It was probably the stupidest thing I ever did because of course I knew what they would say and I also made them feel so bad. And so I couldn't live and I couldn't die. I felt that at least if I went into the hospital no one could be mad at me for not finishing their work. But I really didn't want to go. Then my pdoc increased my dose and things were okay again.
That's why my pdocs threats are so scary to me; I can't control when I reach the end of the helpfulness of a dose.> >
> > Sometimes the hospital can just provide an atmosphere where you can be absolutely you for a while, slumped in that chair. I think at times to really act like you feel, releases some of your energy back to you. I used to feel that with my business. If I was here I had to be totally "on" all the time, to go into the hospital gave me a break from responsibility and excuses.
>
> I can really see the appeal to this, Shelli. Family expectations of performance go up when my mood stabilizes and then when my mood falls apart, don't adjust back down, which makes it hard.Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?
>
> >
> > Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.Now I am less excited. I want to go back on oxy I think, and I just never know when I'll reach the end of effectiveness. But thers's really no point in not living in the now. I can't control what happens with my body chemistry.
>
> It would be pretty funny if all roads did lead to Rome for both of our depressions. I'm glad that you have something that is working for you, that your transition wasn't that bad and that the price is right.
>
shelli
Posted by Elizabeth on November 28, 2001, at 15:58:17
In reply to Re: barbs, opioids, etc. » Elizabeth, posted by nightlight on November 25, 2001, at 16:52:00
> Propoxyphene napsylate is the main ingredient in Darvocet. (Thanks for the spelling lesson)
And thank *you* for the propoxyphene salts lesson! :-)
> My description of Soma as potent is strictly empirically based.
"Potent" just means that it works in low doses (it's a relevant thing, of course). I usually find that 700 mg of carisoprodol is optimal for my back pain. Compared with, say, 0.3 mg of buprenorphine, that seems like a lot. < g >
> I tried I had tried Skelaxin, Robaxin, Flexeril & others I cannot remember w/no relief.
Those are what I call "fake muscle relaxants" -- the only reason they seem to work at all is because they're sedating (I think they're all antihistamines and/or anticholinergics). Flexeril, for example, is similar to amitriptyline, which works for neuropathic pain but not for musculoskeletal pain.
> One doc prescribed finally prescribed clonazepam. Bingo! It worked well for about 2 yrs. I still take it for anxiety and mood regulation, but my myofascial pain got outta hand again.
Yeah, I've tried using various benzos as muscle relaxants too. Valium worked pretty well the first few times I took it but now it doesn't work at all. (I tried up to 40 mg -- nothing.) I wasn't taking it regularly -- not every day or even every week, just every once in a while. I think that with benzos, as with most of the drugs marketed as muscle relaxants, a lot of the apparent effect is due to sedation.
> I had asked about soma in the past, but was denied it due to its *supposed* recreational properties.
It's related to meprobamate (Miltown, the benzos' predecessor) and I think a small amount is metabolized to meprobamate. Meprobamate was supposed to be a bit of a party drug (compared with the benzos, anyway) and I guess some people get a kick out of Soma too. (It's definitely not something you should take if you're planning on drinking or operating heavy machinery, anyway.) Glad you were able to get it. I always feel like doctors are playing games trying to see if I'm a "drug seeker," so when they recommend something that I know won't work initially, I just go ahead and give it a try. (In this case, I had to take baclofen for a month before I was able to get Soma. Then the doctor in question wrote a script for me to take Soma 3 times a day, which is much more than I use it in real life.)
> I had been taking the Fiorinal #3 but it really had begun to affect me adversely, made me feel worse, like I had more toxins building up in my muscle tissues and more pain.
I know the feeling.
> By the way, what would you consider to be a *potent* muscle relaxer?
Hmm. Well, barbiturates are usually effective at around 100 mg, but I wouldn't count that as much more potent than the typical 350 mg dose of Soma (same order of magnitude). Valium, with doses starting at 5 mg, would be considered more potent. Even Valium is considered "low potency" for a benzo, though. Potency isn't generally the most relevant characteristic to consider when you're picking out a med, IMO.
> Why is twice daily dosing unusual?
I was wrong about that, sorry. I was thinking of something else. Propranolol is usually given 2-3 times daily.
I seem to recall that it's not all that unusual for women to develop hypertension when they're pregnant. I don't know why, though -- you might ask your doctor about it if you're planning on having any more kids.
> It is quite good for the squeezing chest pressure I feel when particularly anxious, and if I feel headachey, have visual auras, etc. I use it to help w/potential migraine.
It's effective for preventing migraines and also, often, for the peripheral manifestations of anxiety, like chest pain, shakes, tachycardia, etc. (I use it for essential tremor. Good stuff.)
> I have not delved much into the DSM-IV, I've had way too little free time in the past few yrs., so my grasp of psychiatric argot is weak.
"Endogenous depression" isn't used in DSM-IV anyway.
> And, I have read some articles that say otherwise, that they both respond almost equally well to medication (and time). Weird.
Yes, that's true. You can try to label someone "situationally" or "nonsituationally" depressed, but it isn't much of a predictor of how they will respond to treatment.
-elizabeth
Posted by Elizabeth on November 28, 2001, at 16:06:52
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 28, 2001, at 0:02:48
> I don't know the difference between concerta and ritalin SR. Both are long-lasting ritalin.
They use different controlled-release technologies. Concerta is supposed to be better (i.e., lasts longer).
> Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?
You make it sound like you can usually "fake it." Can you? I can up to a point, but when the depression gets really bad, I can't really hide it (and often I don't even care about hiding it by the time it's that bad).
-elizabeth
Posted by Lorraine on November 28, 2001, at 18:47:52
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 28, 2001, at 0:02:48
Shelli:
> >
> Is this paragraph below about the retest the same day, or is this from your last test?My most recent QEEG (done last week).
> > My redone QEEG confirms pretty much his earlier assessment--that amphetamine and mood stabilizer are the ticket, but that Adderall is not doing the job. So he switched me to ritalin (I've tried dexidrine before). My initial reaction was increased anxiety, but I cut the dose down to 1/4 of a 10 mg tab 4x a day and that helps. I suspect we are going to try Ritalin SR next. He says the amplitude (or voltage) of alpha waves is low--to him this suggests amphetamines. We did a hyperventilating QEEG also, which showed that when I hyperventilate my voltage goes even lower (it should go higher), which he said indicates that under stress I have no power (voltage) to cope--which certainly is true. It is also true that I feel as though I am always trying to manage my power or energy level.
>
> I don't know the difference between concerta and ritalin SR. Both are long-lasting ritalin.They're the same--my mistake.
>
> >
> > Meanwhile, my alternative medicine doctor tested my amino acid levels and found low levels of several that are implicated with depression (methionine, phenylalinine, tryptophan, tyrosine, and glutamine) so a custom blend of amino acids reflecting my test results is being made. I will try these for 2 months to see if there is any improvement. I have tried a number of these individually, but she believes it is the combination that is important.
> >
> > >
> How does your pdoc feel about changing things from your alternative doctor; he doesn't worry that a change of enzymes might affect his tests and sort of muddy the field?I have to talk to him about it. It's hard to keep static though, you know. I'd like to get someplace stable for the holidays even if it is not permanent. The good thing is I don't have to wait weeks to find out if a stimulent is working.
> I did a long trial of Topomax, because at the time I was working with a pdoc who believed in long trials.Did you also lose weight on it like some people report? (That would be pretty odd to lose weight while sleeping.)
> >
> > I don't know, Shelli, you seem pretty patient to me:-)
>
> Well, sort of what choice do we have? Although I was quite ready to try opiates before anyone gave it to me because my depression was so painful, sometimes unbearable. It's always hard for me to explain why it is unbearable . And I don't even know what's exactly happening. Like where the hurt eminated from, except from my chest.
> > I can't believe I actually called them and asked them if I could kill myself. It was probably the stupidest thing I ever did because of course I knew what they would say and I also made them feel so bad.Maybe you needed to have them say it to you. On my birthday (just passed) I asked my husband and each of the kids to write me a note about why they loved me. It was great to read them, great (particularly for the kids) to think about why they loved me and I learned a lot about the entire family. But, part of the reason I had them write the notes was so that I could store them in my suicide file (where I keep letters that would stop me if I got to that point).
> That's why my pdocs threats are so scary to me; I can't control when I reach the end of the helpfulness of a dose.
This would really scare me also.
> >
> > I can really see the appeal to this, Shelli. Family expectations of performance go up when my mood stabilizes and then when my mood falls apart, don't adjust back down, which makes it hard.
>
> Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?Oh, yeah. They all know when I dip. I'm either weepy, lethargic or brittle. Plus I try to tell them so they won't think my behavior is because of something they did or didn't do. Sometimes I just ask to be left alone (when I want to sit and cry--I can comfort myself well enough with stacks of books and I don't want to be bringing everyone else down, though they feel the void anyway).
> > I want to go back on oxy I think, and I just never know when I'll reach the end of effectiveness. But thers's really no point in not living in the now. I can't control what happens with my body chemistry.
And you can bear the cost? If the methadone doesn't quite do it, can you combine the two (oxy and methadone)? or augment the methadone?
I hope things pick up again for you.
Lorraine
Posted by shelliR on November 28, 2001, at 19:36:13
In reply to Re: Morphine for depression. » shelliR, posted by Elizabeth on November 28, 2001, at 16:06:52
>
> > Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?
>
> You make it sound like you can usually "fake it."That seems like a strange thing to say to me.. I've never used the term fake it and I don't even think in those terms.
*Can you?
I can up to a point, but when the depression gets really bad, I can't really hide it (and often I don't even care about hiding it by the time it's that bad).
There are times that I am so severely depressed that I stay in bed all day, mostly sleeping. My cat loves it, I am like a big cat mom. But the stimulents make that a lot more difficult now (for better and worse). I find it amazing how I am able to come out of my depression (like when I am shooting, or even clients are over). I don't feel like I'm faking it; something happens, perhaps it's a good dissociation, where I don't feel anything about myself, including the depression. There were a few photo sessions before I went into the hospital in July, that that I could feel my depression (actually more of an irritation) for the first time, I thought that could never happen. That was shortly before I went on oxyconton.
Mostly I am able to come out of my depression enough to be civil, like if I had to run out to the store and see someone. But I live alone, so that makes things very different. When I asked the question to Lorraine, I meant do her children always notice the depression, or do they go right on chatting about themselves like teenagers generelly do.(Actually, I get the idea that her son is not a chatterer. And I waw also imaging that her husband knows but maybe you just go on many times as if you were not depressed.
>
What about your SO, Elizabeth? Do you consciously make an attempt to separate sometimes from the depression with him, not to fake your mood, but just to avoid, sort of let your relatiohship distract from the depression. Does he *want* to knew all your moods.Are you still doing well on your meds? And is your SO's depression still pretty much in remission since he started, was it remeron?
Shelli
Posted by SLS on November 29, 2001, at 17:51:19
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 28, 2001, at 0:02:48
> But I really didn't want to go. Then my pdoc increased my dose and things were okay again.
Hi Shelli.I'm not good for more than a few sentences, but a thought occurred to me as I read your post. Have you ever tried amantadine (Symmetrel)? It's a long shot, but if Lamictal helped a little, perhaps amantadine could help augment or reduce the induction of tolerance to opioids via NMDA receptor antagonism. Get one of the real brainiacs to look into it for you.
See 'ya.
- Scott
Posted by Elizabeth on November 30, 2001, at 1:17:51
In reply to Re: Morphine for depression. » Elizabeth, posted by shelliR on November 28, 2001, at 19:36:13
> > > Can your family always tell when you're depressed? Is there that big a difference in your behavior toawrd everyone?
> >
> > You make it sound like you can usually "fake it."
>
> That seems like a strange thing to say to me.. I've never used the term fake it and I don't even think in those terms.I just meant pretending not to be depressed.
> There are times that I am so severely depressed that I stay in bed all day, mostly sleeping.
Me too except for the sleeping part. (You know things are bad when you start thinking about abusing Zyprexa just so you can escape. :-} )
> But the stimulents make that a lot more difficult now (for better and worse).
Well...is it just more difficult to sleep, or is it also more difficult to lie around not caring about anything?
> I find it amazing how I am able to come out of my depression (like when I am shooting, or even clients are over). I don't feel like I'm faking it; something happens, perhaps it's a good dissociation, where I don't feel anything about myself, including the depression.
That sounds like more than what I mean by "faking it." It sounds like your depression is amenable to distraction -- a useful thing to know.
> What about your SO, Elizabeth? Do you consciously make an attempt to separate sometimes from the depression with him, not to fake your mood, but just to avoid, sort of let your relatiohship distract from the depression. Does he *want* to knew all your moods.
He's been depressed himself, and I don't feel I have to hide it from him, which is good because I'm a pretty crappy liar. < g > I'm not sure how trying to "separate" from the depression would be different from trying to feel better or pretend to feel better, but I've certainly attempted the latter two approaches without success.
Now, whether I *talk* to him about it or not is another story. Actually when I think about it, that depends more on him than on me, because I don't like to talk about it and that's not something I would do spontaneously. I don't try to hide it from him (like I said, bad liar), but when he's troubled about something, even if I'm depressed I will do my best to be supportive. I do make an active effort not to bring other people down, especially him.
> Are you still doing well on your meds? And is your SO's depression still pretty much in remission since he started, was it remeron?
He was taking CA Rocket Fuel+++ (he's the one who got me psyched about that), Remeron + Celexa + Provigil + Wellbutrin SR, but he was able to drop the Remeron (worried about weight gain, it was making him hungry) and is still doing well.
As for me -- comme ci, comme ca. My health insurance lapsed a couple months ago and I've been sort of in limbo trying to work something out in that regard.
-elizabeth
Posted by Elizabeth on November 30, 2001, at 1:18:38
In reply to Re: Morphine for depression. » shelliR, posted by SLS on November 29, 2001, at 17:51:19
> Have you ever tried amantadine (Symmetrel)? It's a long shot, but if Lamictal helped a little, perhaps amantadine could help augment or reduce the induction of tolerance to opioids via NMDA receptor antagonism.
I didn't know that about Lamictal or amantadine. I believe that the current thinking is that NMDA blockers don't really prevent tolerance, they just augment the opioid, alas. I've known a few people who used DXM to that end, although I'm not sure about the effective dose range.
-elizabeth
Posted by SLS on November 30, 2001, at 7:43:58
In reply to Re: Morphine for depression. » SLS, posted by Elizabeth on November 30, 2001, at 1:18:38
> > Have you ever tried amantadine (Symmetrel)? It's a long shot, but if Lamictal helped a little, perhaps amantadine could help augment or reduce the induction of tolerance to opioids via NMDA receptor antagonism.
>
> I didn't know that about Lamictal or amantadine.Lamotrigine inhibits the release of glutamate, thereby reducing NMDA stimulation. Amantadine (a relative of memantine) blocks NMDA receptors. It was probably a dumb idea.
> I believe that the current thinking is that NMDA blockers don't really prevent tolerance, they just augment the opioid, alas.
I see.
> I've known a few people who used DXM to that end,
For opioid enhancement or for the prevention of desensitization? Did it work?
- Scott
Posted by Elizabeth on November 30, 2001, at 14:50:18
In reply to Re: Morphine for depression. » Elizabeth, posted by SLS on November 30, 2001, at 7:43:58
> For opioid enhancement or for the prevention of desensitization? Did it work?
Sure it works, and like I said, they don't prevent tolerance; they just augment.
Thanks for the info about Lamictal and Symmetrel.
-e
Posted by shelliR on December 3, 2001, at 12:48:07
In reply to Re: Morphine for depression. » shelliR, posted by Lorraine on November 28, 2001, at 18:47:52
Lorraine,
> My most recent QEEG (done last week).
Are there changes in the QEEG since last time you had the test?
>I did a long trial of Topomax, because at the time I was working with a pdoc who believed in long trials.
> Did you also lose weight on it like some people report? (That would be pretty odd to lose weight while sleeping.)Right,no weight loss.
>
>
> weepy, lethargic or brittle. Plus I try to tell them so they won't think my behavior is because of something they did or didn't do. Sometimes I just ask to be left alone (when I want to sit and cry--I can comfort myself well enough with stacks of books and I don't want to be bringing everyone else down, though they feel the void anyway).That makes a lot of sense. Sort of like you were feeling sick in any other way. How is your son doing, and your daughter with her "new" sense of herself in the family after seeing his therapist?
And your next trial is to change the stimulent or try another mood stablizer, I can't remember. what's going on with your meds?Shelli
Posted by Lorraine on December 4, 2001, at 10:01:21
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on December 3, 2001, at 12:48:07
Shelli:
I'm on a trial of concerta and neurontin. I was on ridalin and neurontin--but that was too much up and down. I've only been on the concerta a short time (2 days) so too early to tell. I've been a bit down but then I am withdrawing from a shorter term amphetamine (ritalin) so my body may be adjusting. Anyway I haven't been posting much b/c it just seems like this is "process" work, try one drug and then another and then another. I don't see magic bullets, just one foot in front of the other until things work.
Lorraine
Posted by shelliR on December 4, 2001, at 21:30:34
In reply to Re: Morphine for depression. » shelliR, posted by Lorraine on December 4, 2001, at 10:01:21
> Shelli:
>
> I'm on a trial of concerta and neurontin. I was on ridalin and neurontin--but that was too much up and down. I've only been on the concerta a short time (2 days) so too early to tell. I've been a bit down but then I am withdrawing from a shorter term amphetamine (ritalin) so my body may be adjusting. Anyway I haven't been posting much b/c it just seems like this is "process" work, try one drug and then another and then another. I don't see magic bullets, just one foot in front of the other until things work.
>
> LorraineHi Lorraine,
Well, I like to know where you're walking, so let me/us know, okay? Is the plan to find the right stimulent with the right mood stabilizer, and leave ADs out of the picture? I am on cercerta. I couldn't adjust to any of the stimulents until I was on with a narcotic. And now I really don't know whether it makes a difference whether or not I take it, even though I'm up to 54mg a day.
Actually, you could probably take away most of my other drugs and it wouldn't make a difference. I am also up to 400 mg of wellbutrin, but I'm still very very tired late afternoon. I have this theory that life is just too much to last a full day, and if I take a 30minute nap, everything feels better. I'm going to try spliting the concerta to twice a day, try to get around that theory. The only reason I care is when I am not home, or when people want to pick up stuff in the late afternoon, I can't take a nap, and then I almost fall asleep sitting up at about 8pm. (and wake up at 9 or 10, because my body thinks it's a nap, not time to sleep)Take care,
Shelli
Posted by manowar on December 5, 2001, at 13:05:26
In reply to Re: Methadone for depression. » Lorraine, posted by shelliR on December 4, 2001, at 21:30:34
> I'm going to try spliting the concerta to twice a day, try to get around that theory.
Hi Shelly,
From what my pdoc told me, Concerta is just Ritalin XR that works a lot better than the drug Ritalin XR. He told me that 1/3 of it is released immediately, 1/3 is released 3 hours later and the last 1/3 is released 3 hours later. I found that it works great and it is effective for me for 8-10 hours.Since the Concerta is a timed-release preparation, I don't think it would be a good idea to split it in half. You may need a higher dose for it to be effective.
This is what I'm doing:
Since the Concerta (72 mg) wears off for me around 4-6 in the afternoon, my pdoc gave me a script for regular Ritalin (20 mg) so that I could take one when the Concerta starts to wear off. The Ritalin last for 3-4 hours.
--Tim
Posted by shelliR on December 5, 2001, at 13:59:03
In reply to Re: Methadone for depression. » shelliR, posted by manowar on December 5, 2001, at 13:05:26
Hi Tim,
> From what my pdoc told me, Concerta is just Ritalin XR that works a lot better than the drug Ritalin XR. He told me that 1/3 of it is released immediately, 1/3 is released 3 hours later and the last 1/3 is released 3 hours later. I found that it works great and it is effective for me for 8-10 hours.
>Is Ritalin XR still available? If it is, it might be related to a paten release. Or a way to get around a name that seems to be so associated with ADD?
> Since the Concerta is a timed-release preparation, I don't think it would be a good idea to split it in half. You may need a higher dose for it to be effective.Sorry, you're right. I did come across as if I meant splitting the pill. I actually meant splitting the dose-2 morning, 1 early afternoon.
>
> This is what I'm doing:
> Since the Concerta (72 mg) wears off for me around 4-6 in the afternoon, my pdoc gave me a script for regular Ritalin (20 mg) so that I could take one when the Concerta starts to wear off. The Ritalin last for 3-4 hours.I think that's a good plan. I didn't want to have to keep track of one more pill (to get a prescription of, renewal, etc, of ritalin.) It's already scary (to me) how many different drugs I'm taking for depression.
Shelli
Posted by JahL on December 6, 2001, at 11:34:15
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 28, 2001, at 0:02:48
> > > Anyway, I am excited that the methodone seems positive (although not perfect) and I find myself looking forward to things that may be around the corner. It would be interesting after all of this searching we both ended up with methodone as the pain mood stabilizer after all these other trials.
> Now I am less excited. I want to go back on oxy I think, and I just never know when I'll reach the end of effectiveness. But thers's really no point in not living in the now. I can't control what happens with my body chemistry.Hi Shelli.
Don't presently have the motivation to trawl thru long threads. Was wondering why you wanted to return 2 Oxy. Methadone not doing the trick? Can you tell me why you prefer the 'real' opiates (or is that a silly Q??)? What dose are you taking?
That specialist guy I was telling you about as good as told me to try anything I can get my hands on. He told me they're currently 'burying bodies' which might otherwise be saved were it not for restrictive, draconian govt. legislation concerning opioids and the like. It would seem his hands are tied...
I think Methadone low-dose is helping a little. Now I've got the green (in both senses of the word) light.......
Hope you're doing OK,
J.
Posted by jazzdog on December 6, 2001, at 12:20:58
In reply to Re: Methadone for depression. » shelliR, posted by JahL on December 6, 2001, at 11:34:15
Hi Jahl-
So what did your pharmacologist have to say about depersonalization? And new ideas?
- Jane
Posted by JahL on December 6, 2001, at 18:44:03
In reply to Re: pharmacologist report? » JahL, posted by jazzdog on December 6, 2001, at 12:20:58
> Hi Jahl-
>
> So what did your pharmacologist have to say about depersonalization? And new ideas?Hi Jane.
You know what, I did the full 90 minutes w/o mentioning depersonalisation. Might have something to do with having only 3 hours sleep over 2 days & a sodding 6 hr round trip.Also I'm not especially depersonalised at present and because I've been this way all my life, I only tend to notice when the DP is particularly bad. Actually, I found it pretty easy to connect today & I know I gave a good a/c of myself. I suspect it may have had something to do with the low-dose Methadone I'm taking, though I wouldn't like to comment further until I've upped the dose. I've actually spied a couple of articles implicating the endogenous opioid system in DD disorders. I think there are at least 2 board members here who suffer from dissociative disorder and benefit from opioids...
We concentrated on BPII as a single entity and mainly focussed on the depression. When this remits, so do all my other symptoms.
He said that as far as British psychiatry was concerned I had already pushed the envelope far beyond what was considered 'reasonable' and that I would probably have a better chance treating myself, "given you seem to know more than the average psychiatrist." < g > (I know sh*t-all)
His main suggestion was to retain all present meds and add Tryptophan to augment the SSRI (currently Celexa). Of course this is not popular practice in the US right now because of the past EMS scares but he assures me he has had some success with this method (tho he doesn't deny that there still exists a theoretical risk).
I have a modicum of faith if only because this was the first pdoc I've ever met who truly knows his stuff. No pretence. No picking apart of my childhood. No condemnation for my drug *use*. You get the picture. Easily the most valuable 90 mins I've ever spent with a doc ('cept the one who operated on my hand...) It's just a shame I finally find this person when my journey seems to be nearing its end...
Rgds,
J.PS I'm still technically at the DP unit so I'll keep you abreast of any developments. However they've recently started mumbling about 'disability management' & the like which doesn't sound too promising...
Posted by Lorraine on December 6, 2001, at 20:20:43
In reply to Re: Methadone for depression. » Lorraine, posted by shelliR on December 4, 2001, at 21:30:34
Shelli:
I'll keep you posted. I think the plan is to try the stimulants first. Concerta is supposed to last 12 hours I think--which is a short day so staggering your doses might make sense. I'm on the lowest dosage 16 mg so that's not an option. I'm still not sure where I am with it anyway. Pretty sure the transition from short action to sustained release is done, but then there's figuring out the Neurontin piece, which has come down (from 1500mg a day to about 800-900 mg a day) and my system is probably still adjusting to that decrease. Anyway, cutting a long ramble short, I'll keep you posted. Thanks for the concern.
Lorraine
> Well, I like to know where you're walking, so let me/us know, okay? Is the plan to find the right stimulent with the right mood stabilizer, and leave ADs out of the picture? I am on cercerta. I couldn't adjust to any of the stimulents until I was on with a narcotic. And now I really don't know whether it makes a difference whether or not I take it, even though I'm up to 54mg a day.
> Actually, you could probably take away most of my other drugs and it wouldn't make a difference. I am also up to 400 mg of wellbutrin, but I'm still very very tired late afternoon. I have this theory that life is just too much to last a full day, and if I take a 30minute nap, everything feels better. I'm going to try spliting the concerta to twice a day, try to get around that theory. The only reason I care is when I am not home, or when people want to pick up stuff in the late afternoon, I can't take a nap, and then I almost fall asleep sitting up at about 8pm. (and wake up at 9 or 10, because my body thinks it's a nap, not time to sleep)
>
> Take care,
> Shelli
Posted by jscottb on December 6, 2001, at 21:19:59
In reply to Re: Morphine for depression. » Lorraine, posted by shelliR on November 16, 2001, at 12:30:36
> Wow. I'm really curious about the use of an opiate for depression. I suffer from depression and I still battle my demons with opiates. Although I have been opiate free for almost 4 months, I still fight the battle every day. I got in trouble for prescription fraud, and I must never entertain those thoughts again. I take Paxil for depression, but opiates have always done wonders for that. I admit it. I love opiates. How could I proceed in finding the right doctor? Thanks.
> >
> > Shelli: It's Lorraine jumping in. I just wanted to see how you are doing on the Oxy. Have you stablized? Is your depression under control? I had an allergic reaction to Nardil (inflamed swollen hands, lose of feeling in fingertips--actually listed as a known side effect) and had to go off. I'm deciding my next step and opiates are on the agenda but probably not my next step.
> >
> > Lorraine
>
>
> Hi Lorraine,
>
> Good to hear from you, wish it were under better circumstances. When did the nardil reaction occur?
>
> It's been about five or six weeks since I've been on this dose of oxy and my depression is under control. I don't think that's long enough to tell although I am very hopeful. I just went up another 20mg, but only because I have thought the last time I went up that it was slightly lower than it could be--I mean I'm already habituated, why not feel as good as possible, without feeling at all drugged.
>
> Unfortunately, it looks like I *will* be switching to methodone in a few weeks because they haven't even received the paperwork in my pdoc's office. I am only allowed to get it from them and they are putting zero energy into it. It is horrible timing for a med change in terms of work, but hopefully the transition will not be a huge deal.
>
> If I become unstabilized on either oxy or methodone, it will be a hugh jolt. I am willing to go as high as my pdoc will let me, if it means not being depressed. I am still unstable premenstrually, but that's more fear, and anxiety, specifically around finishing all commitments with work and around the fear that my doctor can stop working with me any time he chooses and I would have to detox. And then I would be at square one with the depression. I also have no guarantee that methodone will have the same effect as oxy, but he
> seems to think so. Monday, I'll ask him why methodone rather than morphine, but I won't hold my breath expecting an answer.
>
> If I feel like this during the next year, that is good enough. My feelings are more good than bad, and the bad involves insecurity rather than depression.
>
> How bad is your depression now? What do you see as possibilities for your next trial. Also, have you
> discussed opiates with your doctor, or are you
> assuming from knowing him,that he will be supportive around this?
>
> BTW, opiates make me anorgasmic, but I figure if I'm ever "involved" I can skip the evening dose. I have never heard Elizabeth say that she has had any sexual problems with buprenorphine.
>
> Good luck on your next decision. Keep us informed.
>
> Shelli
Posted by jazzdog on December 7, 2001, at 12:22:20
In reply to Re: pharmacologist report? » jazzdog, posted by JahL on December 6, 2001, at 18:44:03
Thanks for the update. Good to know somebody is out there who makes some sense to you. Good luck with the tryptophan and methadone.
- Jane
Posted by judy1 on December 8, 2001, at 4:03:01
In reply to Re: Morphine for depression. (how to find doc?), posted by jscottb on December 6, 2001, at 21:19:59
If you are truly treatment resistant, you might try a mood disorder program at a University- many of them use opiates with their patients who don't respond to every other AD and combo. I suspect that people on this board have tried EVERYTHING with their docs and it was kind of a last resort. If you fall in that category, it's worth a shot in asking. As far as the prescription fraud goes, I see that as an effort to self- medicate, but a lot of docs won't. Take care, judy
Posted by Elizabeth on December 8, 2001, at 7:32:24
In reply to Re: Morphine for depression. (how to find doc?) » jscottb, posted by judy1 on December 8, 2001, at 4:03:01
> If you are truly treatment resistant, you might try a mood disorder program at a University- many of them use opiates with their patients who don't respond to every other AD and combo.
I wouldn't say "many." It's unfortunate, but there are a lot of doctors out there who have the rigid, inflexible attitude that opioids are not "appropriate" for treatment of depression. I know there are many of us who only respond to opioids, but I'm afraid we aren't going to see opioid antidepressant treatment become standard in our lifetimes.
> I suspect that people on this board have tried EVERYTHING with their docs and it was kind of a last resort. If you fall in that category, it's worth a shot in asking.
And do your best to make it clear to the doctor that you're not just looking to get high or whatever. Seriously: it seems like doctors almost automatically mistrust anyone who asks for opioids.
-elizabeth
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