![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 410 to 434 of 434. Go back in thread:
Posted by Elizabeth on October 14, 2001, at 10:31:48
In reply to Re: Hypertensive crises, update » Elizabeth, posted by jojo on October 13, 2001, at 20:43:28
> A few weeks ago, after taking 0.3 mg. of Bup and 10 mg. of Dexedrine, I foolishly decided, four hours later, and being out of town and low on Dexedrine, to substitute 2.6 mg. of Yohimbine for the Dexedrine. My bp went up to 185/107.
Yohimbine is, I believe, a beta-adrenergic agonist. It can do that. I also find that my BP runs a little high on buprenorphine.
> Wishing to avoid the E.R., I smoked ½ of a joint of mj, took 10 mg of Valium, and about 30 mg. of Viagra. Within 15 minutes my bp was down to 135/87. I've got to believe that the reduction was due to the marijuana, as the pills would barely have had time to dissolve.
It might just have been due to the passage of time. Usually BP goes down pretty quickly in situations like that one. (Valium works fairly fast, and it might have played a role.)
> If these results are typical, it would seem that smoked mj may be the fastest way to lower bp without an injected med.
Maybe somebody can test this hypothesis by smoking a joint next time they find their blood pressure elevated. [in jest]
-eliz
Posted by Elizabeth on October 14, 2001, at 10:35:27
In reply to Re: how expensive » Elizabeth, posted by Neal on October 13, 2001, at 23:02:45
> How expensive is it.
Depends where you get it. I get 90 cartridges (of the Abbott generic, not Buprenex(R)) at a retail pharmacy for about $140. That's the lowest price I've gotten it for. I did get some Buprenex recently (pharmacy screwup), I'll dig up the receipt and see how much it was (same quantity, 90 ampuls).
-elizabeth
Posted by Lorraine on October 18, 2001, at 14:29:27
In reply to Re: hanging in there » Lorraine, posted by Elizabeth on October 10, 2001, at 13:28:50
Elizabeth:I thought you'd find this portion of an article of interest:
The FDA is preparing to approve a new medication for opiate addiction that won't be restricted this way. Buprenorphine is an unusual opiate - it has mixed effects on opioid receptors. At lower doses, it produces an opiate receptor-agonist effect like methadone; at high doses, it produces the opiate-blocking effects of naltrexone. Researchers say that at an agonist dose, most patients cannot distinguish it from methadone. (Interestingly, naltrexone is approved as a treatment for opiate addiction, but, because it doesn't provide the anxiety-reducing effects of opiate agonists, it is not as effective as methadone.)Congress has just passed legislation allowing any doctor with training in addictions to prescribe buprenorphine - addicts won't have to venture to ghetto areas or give up freedom to get it. And because it has antagonist effects if addicts try to take extra or use street drugs on top of it, it offers some satisfaction for those who want a drug to punish.
Here is the site:
http://news.bmn.com/hmsbeagle/91/notes/feature1
I just thought that it was interesting that at high doses bupe is an opiate blocker--I guess that is why my pdoc thought it was used with addicts.
Posted by shelliR on October 18, 2001, at 20:40:41
In reply to Re: Hi Judy » shelliR, posted by judy1 on October 11, 2001, at 18:29:08
> Hi Shelli,
> Actually I'm doing a little too well according to my shrink, but I'm not complaining. Went to the pain clinic to be watched like the good girl I am and to be tapered when I have to. I did ask you about DID, didn't know if that was your diagnosis, mine is dissociative disorders NOS. I was curious if that is your diagnosis, how long did it take was it obvious, etc. If not just ignore the last couple of sentences and have a great day- JudyHi Judy. I do have the same diagnosis as you. I have little kids inside but since I'm co-conscious with them, some therapists have put me in the DID category, others in DDNOS. I feel much more like DDNOS because there are so many ways that I don't have the same stresses as with MPD. My "kids" are always cooperative, don't come out unless they're allowed, and I don't find things that I don't know how they got in my house. In other words, the things that make DID so damn hard.
There was a long time that I knew there was one child inside, but all she would say is "I want my mommy". I don't remember exactly when that changed and she was a whole personality. I think the first time I was in the hospital. Then it was a big shock to have others inside--like how would I know who's talking to me, etc. But it all worked out, and the youngest have abreacted a lot of what happened to them. The eight year olds have not talked yet about what happened to them, except to say that it did happen. I don't focus on it a lot because I had a friend that only focused on memories and they never came to her--so I think when they're really they'll come out.
How did you come to diagnosed as DDNOS, instead of DID? Do you have different personalities inside? I guess you must have at least ego states, or you wouldn't be diagnosed.
I'm glad you are doing well. Is that why you went to the pain clinic--to be tapered down? Can they do that outpatient?
When are you due?Shelli
Posted by shelliR on October 18, 2001, at 21:11:05
In reply to Re: hanging in there » shelliR, posted by Lorraine on October 11, 2001, at 11:36:11
Lorraine
> My husband was such an "eligible bachelor"--you know, on the right track, heading for success, conventional, good provider, good gene pool for kids. All this "picture perfect" stuff scared the putty out of me b/c I was not very conventional and wasn't looking for an eligible bachelor. Plus, my husband wasn't needy. In my previous relationship (with a great guy who has remained a friend)I was a giver and everything was kind of messy--he had no "career" track (he's a janitor now) and he was kind of messed up in a fairly delightful way. When I got together with my husband, it was a big fork in the road for me--to follow my ambitions into law and be involved with someone who wasn't one of the "walking wounded" but was actually capable of giving back in a fairly powerful way. It meant giving up my image of being "f**** up" and becoming a highly functional competent human being. This notion, of sort of giving up my past and walking into the future, was very scarey to me. A life plays out and in retrospect either road may have been good. But taking the road I did required me to push all of my abilities to the limit and seize the day. So I'm not one of those people who has regrets about the things they haven't done, the opportunities that they let pass them by because they were too frightened to risk failure. I risked everything, but then again, to a certain extent I destroyed myself in the process, by pushing too hard, taking on too much stress and ultimately collapsing into a depression.
>
I didn't realize that you thought that you had pushed yourself into depression. I thought you thought it was more hormonal. Were you still working when the depression hit? Is that what you meant by pushing youself into depression?
> > > > > >Have you taken the Myer Briggs? I am a INTJ.
> > > So am I and so is my husband.
> > > > But I have never been attracted to an extraverted man. I do think it might be easier for me to get along with a INTP because I would think that our Js might clash a lot. Have you felt the tug I am talking about at all with your husband?
>
> I don't think my Js are very similar to my husband's Js. He is compulsive about time and things being in their proper place. His "schedule" of activities is a bit amazing. I'm more prone to be late and like having unscheduled time. The only time this conflicts is when he tries to fill up our "social" calendar or when we are on vacation and he want to "accomplish" the city we are visiting (hit all the museums etc). The way we have dealt with this is by recognizing that we are separate and don't have to do the same things even on vacations.So what is the "J" part of you? I always thought of Js as showing good taste and judgment, but also tending to be more critical. Where does your J come out? Does it have anything to do with pushing yourself. I know you are very picky about your house (colors, etc).
>
> > >[re your therapist] > It's very complicated. She has been able to teach me to get myself back on track and that is very satisfying to me; going around in circles of course is very frustrating.
> It almost sounds a little cognitive therapy in approach, although I'm sure she delves into your past as well or maybe she's just organized in her approach.Well, it gets very complicated because I don't remember much at all about the past, especially my family. Zero. No meals together, etc. Some bad memories, but not horrific. We've done some work with the kids, first with my last therapist and then some with this one. And the little ones are in a good place. I'm not so sure about the 8 to 10 year olds. They don't want to talk.
>
> > > > Actually, I think it is very special that you work so hard to have a good marriage, and the working seems to very much pay off.
> It's important to me and, you know, once a gulf begins between two people, it is easy for it to widen. Especially when you have kids that demand a lot of your time.It seems like kids both widen the gulf, but also bring parents together, because there is always that to share.
>>
> Will the Atarax be enough to knock you out? Is your sleep difficulty just staying asleep? I know you are doing the valium--have you thought about Neurontin? I only need to add valium to my nighttime cocktail when I was on Parnate, which was much more activating than Nardil.Well, it's about what Elizabeth talked about. It's not that it's so stimulating; it just disturbs sleep patterns, like my waking up after three hours. Aterex is pretty good; with neurotin I retained fluid in the same way as lamictal.
>> > > >I may print up wallet size samples that I could send out, but it's been nice lately--I e-mail everything to people now (price list, directions)--no more snail mail.
>
> This idea is actually a great way of doing it. "Let me send you out some samples of my recent work since I've switched to digital"I wish there was something else I could say besides digital. Writing it up was fairly easy, and I did use digital. ("are printed digitally using archival ink on heavy weight archival mat surface paper and Piezography™BW software.") Maybe I should leave the digatial out and just talk about archival paper and ink and Piezography BW software when people call?
> > > I rejoined my writing class. I think I shocked them a bit. The theme of my first poem was suicide. The second about being seduced by depressionl. Guy who runs it makes a big point about presentation. I wanted to sort of sink into the chair, but he made me move and talk about my kids and then read--which pretty much had me reduced to tears. Reading is such a vulnerable act, you know.How did you start with the writing class ? How many people are in it?
>
> It's a remarkably personal class and the people are very interesting. Some actors, a comedian, ---mainly though just good writers. A lot of the work brings me to tears, it is very deep. The guy who runs it is from the Second City comedy team. He really requires that you approach this stuff from a deep voice and if you are lucky enough to have written from that place, then he will require that you read it from that place. Sometimes when people read their work the start to cry and he says "it's ok to cry, just breath" and then at most maybe someone will extend a hand to touch the person's arm. I had forgotten how deep this class was. It's what I love about the NDMDA meetings I go to as well. It is life at a deeper level. Anyway, it's a big move for me to get myself back into writing. It requires the discipline of daily writing--let's see if I can do that. Plus, he has me writing from different voices--the child, the mother, the whore, the madonna, the hag, the crone. It's amazing how hard it was to write from the child.
Were those the voices he heard in your writing? Was the child so hard because of your burning? Were you a regular, normal kid before that?Shelli
p.s., my pdoc added concerta to my mixture. I got very spacy today, so he is cutting down both the nardil and wellbutrin. It is unusual for me to hear a pdoc say it sounds like toxcity and want to bring my meds down instead of insisting that I'll get used to them. I almost went into the hosptial to add the concerta; instead I am seeing him almost every day, outpatient.
Posted by Elizabeth on October 19, 2001, at 12:13:37
In reply to Re: hanging in there » Elizabeth, posted by Lorraine on October 18, 2001, at 14:29:27
Lorraine,
That's what a partial agonist is.
(I know about the legislation. It's going to take a while to get passed in the current climate -- Congress is much more concerned about getting anthrax in their mail than about helping addicts get better treatment.)
-elizabeth
Posted by judy1 on October 19, 2001, at 20:18:31
In reply to Re: Hi Judy » judy1, posted by shelliR on October 18, 2001, at 20:40:41
Moving to social side (thanks so much for the response)- Judy
Posted by Lorraine on October 22, 2001, at 9:20:40
In reply to Re: hanging in there » Lorraine, posted by shelliR on October 18, 2001, at 21:11:05
Shelli:
> > >I didn't realize that you thought that you had pushed yourself into depression. I thought you thought it was more hormonal. Were you still working when the depression hit? Is that what you meant by pushing youself into depression?
Yes--not just working, but working for an emotionally abusive man in an incredibly stessful job.
> > > So what is the "J" part of you? I always thought of Js as showing good taste and judgment, but also tending to be more critical. Where does your J come out? Does it have anything to do with pushing yourself. I know you are very picky about your house (colors, etc).Oh, yeah, I'm a perfectionist big time, just in a different way
> > > Well, it gets very complicated because I don't remember much at all about the past, especially my family. Zero. No meals together, etc. Some bad memories, but not horrific. We've done some work with the kids, first with my last therapist and then some with this one. And the little ones are in a good place. I'm not so sure about the 8 to 10 year olds. They don't want to talk.It must be hard to move forward when you don't know what you are up against--the 8-10 year old not talking
[re marraige and kids] > > It seems like kids both widen the gulf, but also bring parents together, because there is always that to share.
This is true. It's just easy to shift the focus to the kids and forget about maintaining the marriage.
> > > I wish there was something else I could say besides digital. Writing it up was fairly easy, and I did use digital. ("are printed digitally using archival ink on heavy weight archival mat surface paper and Piezography™BW software.")This sounds great. Will people--other than experts in your area know what Piezography BW software is?
> > >Maybe I should leave the digatial out and just talk about archival paper and ink and Piezography BW software when people call?
I think you will end up doing more explaining this way. Everyone knows what digital is--maybe "digitally enhanced"?
> > >Plus, he has me writing from different voices--the child, the mother, the whore, the madonna, the hag, the crone. It's amazing how hard it was to write from the child.
>
>
> Were those the voices he heard in your writing? Was the child so hard because of your burning? Were you a regular, normal kid before that?No, he does this with everyone. The child was hard because I didn't have much of a childhood to connect to. That is what was so enriching to me about having kids--that I got a chance through them to experience a good childhood. I have no idea who I was b/4 I was burned. My mom says I was like my daughter--who is actually quite outgoing, but I think it changed my brain chemistry.
> > > p.s., my pdoc added concerta to my mixture. I got very spacy today, so he is cutting down both the nardil and wellbutrin. It is unusual for me to hear a pdoc say it sounds like toxcity and want to bring my meds down instead of insisting that I'll get used to them. I almost went into the hosptial to add the concerta; instead I am seeing him almost every day, outpatient.How are you doing now? The Nardil is working I think, but I am struggling with some side effects--sexual dysfunction, sinus congestion (had this on Effexor also), afternoon sluggishnish, weight gain. I don't know which of these will resolve themselves or which I can handle by lifestyle changes. The anxiety seems to be abating. Afternoon sluggishnish is probably managable. Sinus congestion, I'll have to see. The most problematic are the weight gain and sexual dysfunction. I have authorization to add adderal to my mix--which I may do very carefully. I have moved all of my dosing to am today and am seeing how that goes.
Let me know how your cocktail is going.
Posted by Elizabeth on October 22, 2001, at 10:16:19
In reply to Re: hanging in there » shelliR, posted by Lorraine on October 22, 2001, at 9:20:40
> The Nardil is working I think, but I am struggling with some side effects--sexual dysfunction, sinus congestion (had this on Effexor also), afternoon sluggishnish, weight gain.
Hey, good to hear that it's doing something positive for you. I've been having some problems with congestion too. I think it's safe to use oxymetazoline nasal sprays (e.g., Afrin) with Nardil, though you might want to monitor your BP the first time to reassure yourself. (I've done it many times myself with Nardil, Marplan, and Parnate, and have never seen any evidence that it's a problem. I would not expect it to be a problem because it's a locally-acting drug, and even though there's a possibility that some could be absorbed into the bloodstream, the concentration would be too tiny to make any difference. Taking a pill like Sudafed with MAOIs, OTOH, is not safe.)
Watch out for the weight gain -- be mindful of what you're eating, and so on, that's pretty much all you can do. (FWIW, it's supposed to plateau at some point.)
The afternoon nod might be helped by good old-fashioned caffeine, and the anxiety should continue to dwindle.
> I have authorization to add adderal to my mix--which I may do very carefully.
That would be another thing that could help you to stay awake during the day (I found that Cylert helped me regularize my sleep-wake cycle and didn't interfere with sleep if I took it first thing in the AM). I would start off with no more than 2.5 mg, however.
HTH
-elizabeth
Posted by Lorraine on October 22, 2001, at 18:31:04
In reply to Re: hanging in there » Lorraine, posted by Elizabeth on October 19, 2001, at 12:13:37
Elizabeth:
The Nardil has kicked in. However, I am battling side effects including sexual dysfunciton, weight gain, insomnia (which Neurontin and Ambien handle), nasal congestion, afternoon drowsiness and some visual impairment. Given this I suspect I will be making adjustments. The anxiety seems to be lessening.
I'm wondering if you have read the immunology section of the book Treatment Resistent Mood Disorders by Jay D. Amsterdam, Mady Hornig (Editor), Andrew A. Nierenberg (Editor). It is pretty interesting in terms of the immune system connection with depression.
Lorraine
Posted by judy1 on October 24, 2001, at 10:09:03
In reply to Re: hanging in there » Elizabeth, posted by Lorraine on October 22, 2001, at 18:31:04
I was happy to read about your success with Nardil (although the side effects sound pretty awful). I'm not familiar with the book you posted and since Immunology is my field I was wondering if you could give a brief summary of the immune system- mood disorder relationship. I was under the impression that depression weakens the immune systen so that you're more susceptible to infections. Is this pretty much what the author(s) are saying? Curiously, when I am manic I am never physically ill and don't feel pain from injuries that I have incurred from car accidents. Thanks- Judy
Posted by judy1 on October 24, 2001, at 19:40:18
In reply to Elizabeth?, posted by judy1 on October 24, 2001, at 10:09:03
Posted by Lorraine on October 25, 2001, at 11:51:03
In reply to Whoops, sorry to Lorraine (nm), posted by judy1 on October 24, 2001, at 19:40:18
There is a correlation between depression and immune system inflammatory response. Part of the question is the chicken and egg that you always have with correlational analysis--namely is the depression causing the immune system impairment or is immune system impairment causing the depression or is some other factor causing both? Here is the summary of the chapter:
"There is considerable evidence that MDE in general and TRD in particular, may be accompanied by an immune-inflammatory response, as demonstrated by (i) an acute phase response (APR); (ii) an increased production of cytokines such as IL-6; and, (iii) activation of lymphocytes (T cells). The role of such immune activation in the pathophysiology of MDE and TRD remains to be determined. Clinical strategies that modulate immune function might be explored in TRD, including treatment with steroid antagonists, protein blockers and antibodies to IL-6 or sIL-1R. In this context, patients receiving anti-IL-6 antibody as a therapeutic adjuvant for TRD should show striking reductions in serum APP levels. Recent qantidepressant drug trials in MDE with several CNS peptide blockers that alter immunoendocrine function have been undertaken, and these studies suggest that the immunoendocrine laboratory findings since the 1980s will be the clinical treatment of the near future".
Posted by judy1 on October 25, 2001, at 18:50:11
In reply to Re: Immune system and depression » judy1, posted by Lorraine on October 25, 2001, at 11:51:03
That was absolutely fascinating- thank you so much for taking the time to summarize the chapter for me (although now I want to purchase the text :-)
Take care, Judy
Posted by shelliR on October 26, 2001, at 0:16:32
In reply to Re: hanging in there » shelliR, posted by Lorraine on October 22, 2001, at 9:20:40
> Have either been too depressed to write, oversleeping from too much medication, or feeling good and needing to work.
Will write soon --hopefully tomorrow--about my new med combo.
I miss you.Shelli
Posted by judy1 on October 26, 2001, at 22:38:53
In reply to Re: hanging in there Eliz, Judy, » Lorraine, posted by shelliR on October 26, 2001, at 0:16:32
I've missed you too- please let me know how you are doing- Judy
Posted by shelliR on October 28, 2001, at 23:03:08
In reply to Re: hanging in there » shelliR, posted by Lorraine on October 22, 2001, at 9:20:40
>Hi Lorraine
>
> > > >I didn't realize that you thought that you had pushed yourself into depression. I thought you thought it was more hormonal. Were you still working when the depression hit? Is that what you meant by pushing youself into depression?
> Yes--not just working, but working for an emotionally abusive man in an incredibly stessful job.I had misunderstood that. I thought you quit your job to spend more time with your children. But maybe they both are true?
>
> It must be hard to move forward when you don't know what you are up against--the 8-10 year old not talkingI sort of think two things are happening in therapy, either simultaneously or sequentially. One is dealing with old stuff to get past them, process, grieve, or whatever it takes. The other is more cognitive; sort of given who I am, what are my goals, what gets in the way, and how to I work with the things that get in the way. Right now what happened when I was eight is not feeling all that important. My internal focus is still mostly on the little ones. because they talk a lot. But I could see a situation, like if I get involved in a intimate relationship where their goals and mine may differ, and I would have to deal with simultaneous old pain and as well as new life issues. Right now all my focus in on to find meds that work and finish all my work that is promised, which now feels impossible.
I’m not sure what I am doing in therapy now; I think I basically need a center of support that I can’t give myself.
> [re marraige and kids] > > It seems like kids both widen the gulf, but also bring parents
> This is true. It's just easy to shift the focus to the kids and forget about maintaining the marriage.That's interesting for me, because I never think much about maintaining a marriage as being a different subject than maintaining a family. People I know with small children seem to spent about 100% of their energy outside of work (especially if both parents work) with their children. But I am, I suppose, not seeing the "couple part". Like sex is definitely about couples and not children.
All my relationships have been so short (all under two years) that sex was an overwhelming part of our time. (Like almost every time we saw each other). I have always wondered first what it would be like to be in a relationship which includes sex but not as the main focus and also why so many people have so little sex (statistically). Not you Lorraine!--no seriously, I know it is a big important part of your marriage. With my good friends who are married, it seems to be an important part of their marriages, and I can get it about being tired with babies, but otherwise, why do you think intimacy in marriage drops so much lower after time? I wonder if a lot of people don’t really like each other any more, but it’s too hard to make such major changes (like leaving). Of course our divorce rate is high anyway.
>
And Judy, if you are reading this, I know some of sexual acting out is a major part of your mania.
>> No, he does this with everyone. The child was hard because I didn't have much of a childhood to connect to. That is what was so enriching to me about having kids--that I got a chance through them to experience a good childhood. I have no idea who I was b/4 I was burned. My mom says I was like my daughter--who is actually quite outgoing, but I think it changed my brain chemistry.
Do you mean in the sense that all trauma changes brain chemistry, or something different?
You don’t remember before eight at all?
I sort of have the same sense of gratitude toward my inside kids because they are able to live things I was not or could not feel. They’d would really like to have their own bodies, and I feel bad about that. They want real hugs.Now it’s Sunday, and my ankles are still so swollen. I’ve been working every day and I feel tired and scared. Like I can’t deal with things going wrong aside from depression. My car lights are not working right (only the brights and dims work), but I can’t give up my car. Last time it took several days for them to get it back to me. Times like this I would like someone to just take care of me.
How is your nardil is working and that some of the side stuff you are working through. Have you tried the adderal yet? My pdoc added some ritalin in the morning (along with concerta)to try to help the oxycontin kick in faster, but it didn’t do anything. I am still feeling somewhat depressed and extremely oversensitive, but at least there is a bottom on the depression. I don’t know what drug the ankle swelling is related to. Nardil can do that; but I’ve never experienced it before. It’s really bad.
Shelli
Posted by shelliR on October 28, 2001, at 23:14:38
In reply to Re: hanging in there Eliz, Judy, » shelliR, posted by judy1 on October 26, 2001, at 22:38:53
> I've missed you too- please let me know how you are doing- Judy
I'm overwhelmed but not at rock bottom recently.
What do you mean you lost two whole days? Do you know where you were? Something inside of you is really trying to take over. Does anything in particular set off the lost of time?I remember that you didn't want to talk about the past because it was so painful. But you really are going to have to figure out who inside of you is taking you away. Do you have any clues? I'm really worried, especially with a new baby on the way. How old is your other child? I wonder if things are coming up now because of the pregnancy, that didn't come up before.
Maybe if you trying writing, personalities may write back.
Shelli
Posted by judy1 on October 29, 2001, at 0:09:07
In reply to Re: hanging in there » Lorraine, posted by shelliR on October 28, 2001, at 23:03:08
> And Judy, if you are reading this, I know some of sexual acting out is a major part of your mania.:-) Boy you have me pegged but I don't think that's a marriage problem, it's definitely a manic one I've had most of my life.
I'm so sorry you are feeling so down, do you think you've become tolerant to the oxycontin? I'm tapering my fentanyl and can I ever feel it. I never had luck with stimulants and depression (re: cocaine) they just make me anxious and depressed. Is it possible to go a little higher on the oxy and see what happens?
I lost 2 days in San Francisco (maybe there is a song there)- sent my shrink enough sourdough bread for his entire block and my therapist ghiradelli chocolate, but I don't remember any of it and I guess I'll have to wait and see my credit card. You made a couple of good points- possibly the pregnancy and my son is 9 (like you I have memory problems at 8) so there may be a connection. I saw my shrink and therp this week and I'm working hard although you just scared me with the idea of writing something down; you are a lot more confident than I am with even the possibility of alters.
We can share our balloon ankles together- make sure you put your legs up whenever you can. I hope tomorrow looks brighter to you, all my best- Judy
Posted by shelliR on October 30, 2001, at 17:31:43
In reply to Re: hanging in there » shelliR, posted by judy1 on October 29, 2001, at 0:09:07
Hi Judy.
>
> I'm so sorry you are feeling so down, do you think you've become tolerant to the oxycontin? I'm tapering my fentanyl and can I ever feel it. I never had luck with stimulants and depression (re: cocaine) they just make me anxious and depressed. Is it possible to go a little higher on the oxy and see what happens?
I am doing okay. But I probably am getting more habituated to this dose of the oxy. I used to get a little buzz after it took effect but no longer feel that. Still it takes about an hour to kick in and I go from feeling bad to okay. But the bad is not as bad, and the okay is not as good as when I go up in dose. If it were up to me, here's the place where I would raise it a bit. :-) We are still working on combinations using stimulents and wellbutrin to help out. I don't think they hurt, I just don't know if they're much help.>
> I lost 2 days in San Francisco (maybe there is a song there)- sent my shrink enough sourdough bread for his entire block and my therapist ghiradelli chocolate, but I don't remember any of it and I guess I'll have to wait and see my credit card. You made a couple of good points- possibly the pregnancy and my son is 9 (like you I have memory problems at 8) so there may be a connection. I saw my shrink and therp this week and I'm working hard although you just scared me with the idea of writing something down; you are a lot more confident than I am with even the possibility of alters.
>
Well it easier for me to be confident. First of all I've been in the hospital many times with lots of people with DID, and also a support group with other people with dissociative disorders, so I am very used to the diagnosis. It doesn't even seem strange to me anymore, just painful. I don't know how you can get through it without looking at the abuse at all, but I know that EMDR has helped a lot of people go through the
abuse much more quickly and easily.Second, because I don't lose time, my life has been much more stable than people with the DID diagnosis. I get scared and sad and depressed but so far nobody inside acts out. I think there are still secrets in me, but they're not even close to the surface, and other things have been worked through, hopefully fully.
I'm guessing that my abuse was much less awful than the people I know with DID. Also I wonder if the tapering of the fentanyl (you said you were starting to feel it) may be affecting parts that the opiates helped keep inside before. When you say you can feel the tapering, do you mean physically, or depression-wise or both.
Were your family scared out of their minds last weekend, or have they sort of gotten used to this?
> We can share our balloon ankles together- make sure you put your legs up whenever you can. I hope tomorrow looks brighter to you, all my best- Judy
You also,
Shelli
Posted by judy1 on October 30, 2001, at 20:32:13
In reply to Re: hanging in there » judy1, posted by shelliR on October 30, 2001, at 17:31:43
Hi Shelli,
I guess I feel the depression kicking in and another bout with SI (probably both connected to opiate receptors). I feel incredibly guilty about what I do to my family- my husband was furious, my son anxious. I haven't done anything like this (travel) in a while and I'm willing to bet that it won't happen again. I've known people with DID and found them fascinating and fun to be with- but for some reason I'm in complete denial and fear when it comes to myself. Take care of yourself- Judy
Posted by Lorraine on October 31, 2001, at 13:13:21
In reply to Re: hanging in there » Lorraine, posted by shelliR on October 28, 2001, at 23:03:08
Hi Shelli:
I've been painting again so just returned.
> >
> > > > >I didn't realize that you thought that you had pushed yourself into depression. I thought you thought it was more hormonal.By the way, Shelli, I do think it was part hormonal. They say that the times that a woman is more likely to become depressed are during times of hormone change and I was perimenopausal. My new regular doctor told me to take phosphorylated serine to reduce my cortisol output at night.
>
> I had misunderstood that. I thought you quit your job to spend more time with your children. But maybe they both are true?I didn't quit to be with my children, but being with them is a benefit of having quit. Plus, in therapy after I quit, I realized that I had been repeating a cycle of abandonment in my family by simply "not being there" because my work required that I work incredible hours and bring home work besides.
> >I sort of think two things are happening in therapy, either simultaneously or sequentially. One is dealing with old stuff to get past them, process, grieve, or whatever it takes. The other is more cognitive; sort of given who I am, what are my goals, what gets in the way, and how to I work with the things that get in the way. Right now what happened when I was eight is not feeling all that important. My internal focus is still mostly on the little ones. because they talk a lot. But I could see a situation, like if I get involved in a intimate relationship where their goals and mine may differ, and I would have to deal with simultaneous old pain and as well as new life issues. Right now all my focus in on to find meds that work and finish all my work that is promised, which now feels impossible.
Shelli, my son is having an amazing experience with his cognitive therapist. The whole family went in for a two hour session and I have to say it was incredible. There was very little interest in how we were feeling except to the extent that those feelings could be used to trace maladaptive thought patterns. Within the 2 hours, this man "nailed" each of us pretty accurately. I was amazed because the realizations that I walked out with would have taken a year or so in regular therapy. Plus, he nailed my daughter--who is so sweet and lovely that most therapists just nod and grin because she is not a "problem". Anyway, if you switch therapists you might want to try cognitive therapy for a stretch. I found my therapist by researching Beck's (the founder of cognitive therapy) site--he's in Pennsylvania, I believe. My guy co-wrote a number of books with him. I do think that it is a matter of how gifted the therapist is.
>
> I’m not sure what I am doing in therapy now; I think I basically need a center of support that I can’t give myself.That is a useful way for you right now.
> > > That's interesting for me, because I never think much about maintaining a marriage as being a different subject than maintaining a family. People I know with small children seem to spent about 100% of their energy outside of work (especially if both parents work) with their children. But I am, I suppose, not seeing the "couple part". Like sex is definitely about couples and not children.
Right and there are only so many hours in the day. People need time to work, be with their kids, be with each other and be alone. It's hard to fit it all in. The being with each other tends to fall to the wayside unless a concerted effort is made to stay connected.
>
> >All my relationships have been so short (all under two years) that sex was an overwhelming part of our time. (Like almost every time we saw each other). I have always wondered first what it would be like to be in a relationship which includes sex but not as the main focus and also why so many people have so little sex (statistically). Not you Lorraine!--no seriously, I know it is a big important part of your marriage. With my good friends who are married, it seems to be an important part of their marriages, and I can get it about being tired with babies, but otherwise, why do you think intimacy in marriage drops so much lower after time? I wonder if a lot of people don’t really like each other any more, but it’s too hard to make such major changes (like leaving). Of course our divorce rate is high anyway.I think there are a number of factors. One is that once you have been with someone a number of years, the sex falls off because the "excitement" factor of having a new lover is not there. Another is that people simply do not "work" on their relationships and my experience is that unless you actively work on your relationships, miscommunications occur which over time tend to make people drift apart. The glow of he can "do no wrong" which is so chemically driven gets replaced by annoyances at all the petty habits that people have that drive you crazy. You have to be willing to find those habits "endearing". I also think that keen driving sexual interest that people have before the relationship has "baked" or settled into a long term commitment is part of nature driving us to reproduce. We have lost the art of commiting to people and valuing connection above instant gratification--which is why a lot of people switch partners or have lovers--to embrace the "spark" rather than tend the fire over time.
>
> > Do you mean in the sense that all trauma changes brain chemistry, or something different?All serious physical trauma before a certain age affects brain development by damaging the cortisol system (they say)and your ability to deal with stress. I have also read of a connection between burns and depression.
> You don’t remember before eight at all?Very, very little. I created a timeline for a therapist once and had to go to my mother and my brother to fill it in.
> > I sort of have the same sense of gratitude toward my inside kids because they are able to live things I was not or could not feel.So they represent an important part of you.
> > Now it’s Sunday, and my ankles are still so swollen.
Shelli, edema is a side-effect of Nardil. I am struggling right now with swollen joints in my fingers and real difficulty with my night vision and driving. I am lowering my Nardil dose from 45 to 30 to see if it helps. Read this article: "Monoamine Oxidase Inhibitors: Adverse Effects" by Paul Perry
www.vh.org/Providers/Conferences/CPS/19.html
Among the side effects noted for Nardil are the following: Syncope (fainting), Disorientation, Edema, Rash (I had this, remember?), Weight Gain, Urinary Retention, Paresthesias (which I think is the numbness in my hands now), Drowsy, and Anorgasmia. Some of these, like rash are not common, but you know me, if there is a possible side effect, I will find a way to have it:-)
I’ve been working every day and I feel tired and scared. Like I can’t deal with things going wrong aside from depression. My car lights are not working right (only the brights and dims work), but I can’t give up my car. Last time it took several days for them to get it back to me. Times like this I would like someone to just take care of me.
>
>
>
> How is your nardil is working and that some of the side stuff you are working through. Have you tried the adderal yet?I am taking adderal with it now. It works pretty well in terms of energy and appetite supression. The pain is taking it 3 times a day because of the ups and downs that creates. But adderal is coming out with a time release once a day thing which I am looking forward to.
> > >My pdoc added some ritalin in the morning (along with concerta)to try to help the oxycontin kick in faster, but it didn’t do anything.
I'm sorry to here that. I think amphetamines either work right away or not--is your dose high enough?
> > >I am still feeling somewhat depressed and extremely oversensitive, but at least there is a bottom on the depression.
So you have response but not remission? The Nardil is really bringing me out of my depression so I'm hoping I can deal with the side effects. One of the options for the sexual side effects is to take an antihitamine (cyproheptadine). I'm wondering if that is why you do not experience the sexual dysfunction.
I don’t know what drug the ankle swelling is related to.I vote for Nardil. Here's an interesting article on Edema entitled EDEMA - PATHOPHYSIOLOGY AND TREATMENT by Donald E. Kohan, M.D., Ph.D.
http://umed.med.utah.edu/ms2/renal/Word%20files/c)%20Disorders%20of%20Volume_Ed.htm.He suggests that, although edema is not a medical emergency, it is important to find out the underlying cause of the edema rather than simply treating it with diuretics.
I hope things improve for you. It was nice to hear from you.
Lorraine
Posted by Lorraine on October 31, 2001, at 13:42:03
In reply to Re: hanging in there Eliz, Judy,, posted by shelliR on October 28, 2001, at 23:14:38
Shelli:
In light of our discussion re sex and committed relationships-- I found this interesting:
"In addition, women who were currently involved in a committed relationship experienced greater oxytocin increases in response to positive emotions than single women. The researchers speculate that a close, regular relationship may influence the responsiveness of the hormone, said Turner.
These preliminary findings bring up some intriguing questions, said Teresa McGuinness, MD, PhD, UCSF clinical psychiatry faculty member and co-author of the paper. Because oxytocin is released in men and women during sexual orgasm, it may be involved in adult bonding, said Turner. There is also speculation that in addition to facilitating lactation and the birthing process, the hormone facilitates the emotional bond between mother and child. "
Here's the link, which also speculated that oxytocin may be involved in anti-depressant action as well as the ability to bond or socially connect with others. It is invovled with breast feeding as well, which for me was pretty obvious--I was positively euphoric and knew it was chemical, but didn't know which chemical. So suppose the part of the drive for sex is for the oxytocin that it produces and then you have children and start releasing this hormone just in terms of this relationship, I'd imagine that the need for sex would go down. Kind of interesting, huh?
Posted by shelliR on November 12, 2001, at 22:35:02
In reply to Re: Get a load of this!, » shelliR, posted by Lorraine on October 31, 2001, at 13:42:03
Hi Lorraine,
Assume you're still doing well on the nardil? I have been very mixed up with meds, too long to explain. Have written in other posts if you're still checking in.Mostly I've been working.
Shelli
Posted by katie tkm on September 23, 2002, at 7:13:19
In reply to Re: Update Shelli/elizabeth, posted by Lorraine on August 23, 2001, at 22:41:08
hi lorraine
this is a pretty old thread so i realise i may not be able to contact you.
i'm really interested it the "psyichiatric annals" you mention but have not been able to find the journal.
i'm in australia.
could you please let me know how to find these articles?
regards and goodluck
katieHi Shelli & elizabeth:
>
> I saw my pdoc today and he thought the headaches were probably rebound (elizabeth, isn't this what you said--take a bow) because I take my doses before noon to try to ameliorate the sleeping problems. The rash, he wasn't so sure about. (I had been painting wearing latex gloves and using turpentine--so maybe this caused the rash.) We decided for me to watch myself over the next few days staying on the Parnate. If I wake up with a headache, I'm to take my blood pressure. And, I will see if the rash goes away or not. If I decide to abandon the Parnate, I will have a 4-5 day washout during which I can use the Adderal and Neurontin. He wrote me a script for Nardil in case I make the switch and asked me to call his office and let them know what I am doing.
>
> elizabeth: The MAO articles that I was talking about are in Psychiatric Annals 31:6/June 2001. Apparently, the entire issue is dedicated to MAOs. The titles include: "The Use of Monoamine Oxidase Inhibitors for Treating Atypical Depression" by Patrick J. McGrath et al; A Neurochemical Perspective on Monoamine Oxidase Inhibitors by Lynn Wecker et al; A Reevaluation of Dietary Restrictions for Irreversible Monoamine Oxidase Inhibitors by Kenneth Shulman et al; Selegiline and other Atypical Monoamine Oxidase Inhibitors in Depression by J. Alexander Bodkin et al; and Monoamine Oxidase Inhibitors Revisited by Jay D. Amsterdam et al.
>
> I have finished the first article regarding MAOs for atypical depression and found it very interesting. They give the DSM definition of atypical depression as well as the Columbia University and discuss studies correlating the criteria specified for atypical depression with efficacy of antidepressants. Very interesting stuff. Let me know if you have difficulty obtaining the studies. I know you would find them of interest--if you haven't already read them :-)
>
> I spoke with my pdoc about upregulation and downregulation and asked him if this was his terminology or used in some area of study. It's his. He finds it descriptive of what is happening on an EEG basis. Downregulated is correlated with low voltage EEG's.
>
> We also talked about Adderal and stopping hair picking and he said that he believes that a lot of symptoms are compensatory. Just as in ADD, kids may pick a fight to provide external stimulation to compensate for the lack of internal stimulation. So that it seems at first glance counterintuitive that ADD kids calm down when they are given stimulants, it makes sense if you view the excess activity as a compensatory mechanism for an understimulated system that is no longer required when stimulants are given. The same he believes may hold true for this woman who was a hair picker and stopped when given Adderal or for my stopping biting my cuticles on Adderal. Interesting thought.
>
>
> Pleasant dreams to those who are still capable of dreaming (she said bitterly).
>
>
> Lorraine
This is the end of the thread.
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